by Cynthia M. Schmidt, M.D., M.L.S.
Published December 2015
Updated July 2019
You should complete the first and second episode of this tutorial miniseries before beginning this third episode.
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http://list.unmc.edu/gots/tutorial/sb3n
-- and continue working on the tutorial in the new browser.
Remember:
If the screen jitters, right-click on the header of the instruction panel and click the "reload" or "refresh" option or icon.
If you don't need a recap, skip forward to the next page.
Sarah Pilger is an obese, pregnant, 16 year-old with fundal height of 27 cm. Her LMP suggests a current gestational age of 24.5 weeks. Fetal ultrasound performed yesterday is also consistent with a 24.5 week gestation but shows asymmetric (brain-sparing) growth retardation. The fetal biparietal diameter is at the 50th percentile but the abdominal circumference and femur length are lagging behind near the 10th and 3rd percentile, respectively.
Other abnormal fetal ultrasound findings -- placental thickening, ascites, and in the brain - mild ventriculmegaly and multiple small intraparenchymal calcifications -- are consistent with a fetal infection.
Sarah was referred to you for nutritional counseling because of her obesity. Sarah's obesity is certainly a concern but is not the only nutrition-related concern. You have learned that it is likely that Sarah has actually lost weight during her pregnancy. She began a strict 900 - 1000 calorie/day diet and increased her physical activity level about a week after she must have become pregnant.
The fundal height measured at 24.5 weeks after Sarah's last menstrual period (LMP) was 27 cm. What gestational age would be expected to correlate with a 27 cm uterine fundus?
Methods for measuring and interpreting fundal height seem like basic information that all medical students would learn during the course of their studies. Standard medical textbooks are often the best source for such basic information.
The library has both printed and electronic books that contain this type of information. The electronic books are available during our renovation. Print books can be requested through interlibrary loan.
There are three 'points of entry' for a search of the McGoogan Library's entire e-book collection.
The first two portals are just different ways of accessing the library's e-Book Finder. The e-Book Finder only allows:
The third portal provides entry to the library's online catalog. When searching the catalog you can search for both print and e-books simultaneously, but you can also easily limit your search to e-books. The catalog has a more robust search engine than the e-Book Finder. The catalog search allows:
using a search that may include:
There are two portals for the e-Book Finder search:
1) Find the "Ebooks" area in the middle of the homepage.
2) Alternately, you can find the "Online Journals/Ebooks" link on the homepage. Unfortunately, the link is not always obvious.
*If your browser window is wide enough, you will see buttons above the picture and can click on the "Online Journals/Ebooks" link.
*If your browser, isn't wide enough to display links above the picture, find and click on the "Menu" icon.
Click on the "Online Journals/Ebooks" option that appears.
When you reach the "Online Journals/Ebooks" page:
obstetrics
-- in the search box. (Searches for -- obstetric -- or -- pregnancy -- or -- prenatal -- might produce other, potentially useful, results).
The third book search portal leads to a library catalog search. As mentioned earlier, the catalog search is more powerful than the "e-books only" search option.
Of course, you could perform the same -- obstetrics -- search you performed in the e-Book finder, but, since the catalog search will handle complicated searches, it's worth thinking about the terms that might be helpful.
obstetrics, obstetric, pregnancy, pregnant, prenatal, gravid, gravida
obstetric*, pregnan*, prenatal, gravid*
obstetric* OR pregnan* OR prenatal OR gravid*
-- and paste it in the catalog search box, and hit the "Enter" key on your keyboard.
You should a number of potentially useful books.
When you search this single collection, AccessMedicine, you can perform a full-text search and retrieve a list of the chapters that include the word/s of interest.
AccessMedicine's extensive e-book collection includes basic science, basic clinical medicine, and and more advanced clinical medicine texts.
To get to AccessMedicine:
In the future, you can reach the library's homepage by going to any unmc.edu page and clicking the "Library" link at the bottom of the "Quick Links" list in the lower right-hand corner of the page.
IMPORTANT: It's possible that the side-panel will make the AccessMedicine page too narrow to display the results or to later display the text of the chapter you want to read. If you can't see the AccessMedicine search results easily, click the "floating guide" icon at the top of this instruction panel.
(When you wish to return the instruction panel to the side position, just click on the "floating guide" icon again.)
The initial search results are not always the most relevant.
"Prenatal care > Fundal Height"
section of William's Obstetrics. (William's is THE standard obstetrics text. )
Sarah's fundal height was 27 cm at a time when the date of her last menstrual period suggested a gestational age of 24 weeks. Based on the information about fundal height in William's and your knowledge about Sarah, would you expect her fundal height measurement to produce an accurate estimate of gestational age?
You've seen that fundal height measurements in obese, pregnant women may produce falsely high estimates of gestational age. Of course, obesity can also affect other aspects of pregnancy care.
For example, how much weight should Sarah gain during her pregnancy?
What are the implications of a possible weight loss during the first half of her pregnancy in an obese patient like Sarah?
Standard medical texts might include this information. However, these are issues that don't arise in every pregnancy. Sometimes questions like these, issues that might be the province of sub-specialists, are covered better by UpToDate.
To reach UpToDate:
If UpToDate contains an article that includes information about weight loss in obese, pregnant women it might also give you information about the recommended weight gain.
obese AND "weight loss" AND pregnancy
The quotes (" ... ") tell the search engine that you want the quote-enclosed words to be adjacent to each other and in the order specified.
The AND tells the search engine that you want both of the AND-adjacent search terms to be present in each UpToDate article retrieved. The AND is optional in UpToDate. The search engine will handle a space between search terms as though an AND was present.
Obesity in Pregnancy: Complications and Clinical Management
Which of the following neonatal outcomes is associated with weight loss by obese pregnant women?
If your browser window is small, the outline panel may be hidden. Click the "View Outline" link above the article's title to see the outline above the article.
The Google BMI calculator says that Sarah's BMI is 33.9. (You may recall that Sarah has a weight of 210 lb and a height of 5 foot and 6 inches.)
How much weight does the IOM recommend that Sarah gain during her pregnancy?
Before leaving the article:
The following optional questions cover the major points of this tutorial episode:
Which of the following is true of both UpToDate and AccessMedicine' advanced search (a,b, or both (c))?
Which of the following resources is more likely to contain information of interest to sub-specialists?
Click here to begin the next episode.