Initial patient education

A. Frequency of prenatal visits, recommendations for nutrition, weight gain, exercise, rest, and sexual activity, routine pregnancy monitoring (eg, weight, urine dipstick, blood pressure, uterine growth, fetal activity and heart rate), listeria precautions, toxoplasmosis precautions (eg, hand washing, eating habits, cat care) should be discussed.

B. Abstinence from alcohol, cigarettes, illicit drugs should be assessed. Information on the safety of commonly used nonprescription drugs, signs and symptoms to be reported should be discussed, as appropriate for gestational age (eg, vaginal bleeding, ruptured membranes, contractions, decreased fetal activity).

C. Headache and backache. Acetaminophen (Tylenol) 325-650 mg every 3-4 hours is effective. Aspirin is contraindicated.

D. Nausea and vomiting. First-trimester morning sickness may be relieved by eating frequent, small meals, getting out of bed slowly after eating a few crackers, and by avoiding spicy or greasy foods. Promethazine (Phenergan) 12.5-50 mg PO q4-6h prn or diphenhydramine (Benadryl) 25-50 mg tid-qid is useful.

E. Constipation. A high-fiber diet with psyllium (Metamucil), increased fluid intake, and regular exercise should be advised. Docusate (Colace) 100 mg bid may provide relief.

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