iSilo The Johns Hopkins Manual of Gynecology and Obstetrics

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Extra info for iSilo The Johns Hopkins Manual of Gynecology and Obstetrics

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A. Underweight women may gain 40 lb or more, whereas overweight women should limit weight gain to less than 25 lb. b. 0 lb per week is gained in the last two trimesters of pregnancy. c. If a patient has not gained 10 lb by midpregnancy, her nutritional status should be carefully evaluated. d. Inadequate weight gain is associated with an increased risk of low birth weight in infants. Inadequate weight gain seems to have the greatest effect in women whose weight is low or normal before pregnancy.

Patients should be instructed that pregnancy may cause changes in physical comfort and sexual desire. 3. Increased uterine activity after intercourse is common. 4. For women at risk of preterm labor placenta or vasa previa or women with histories of previous pregnancy loss, avoidance of sexual activity may be recommended. I. Employment 1. Most patients are able to work throughout the entire pregnancy. 2. Heavy lifting and excessive physical activity should be avoided. 3. Modification of occupational activities is rarely needed, unless the job involves physical danger.

B. The phase of maximum slope is defined as the period of active labor when the rate of cervical dilation is maximal. Once established, this rate tends to be constant for each individual until the deceleration phase is reached. Primary dysfunctional labor is defined as an active-phase dilation at a rate less than the fifth percentile. 5 cm/hour for multiparas ( Table 5-1). TABLE 5-1. STAGES AND PHASES OF LABOR c. Deceleration phase. During the terminal portion of the active phase, rate of dilation sometimes slows, with termination at full cervical dilation.

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