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Tomo I. Diccionario Maya. Maldonado Editores. Bricker, Victoria R. Papers in Mayan Linguistics, pp. University of Missouri. Salt Lake City. The University of Utah Press.

Bruce S. Hofling, Charles Andrew. Itzaj Maya Grammar. University of Utah Press. Diccionario maya de bolsillo. Editorial Dante.

Curso de lengua maya para investigadores. Nivel I. Manual de vocabulario. Smailiu, Ortwin. Tozzer, Alfred M.

A Maya Grammar. New York. Dover Publications, Inc. Kin janal. Kin jantik. No es la meta principal de este diccionario hacerlo, ni es un espacio apropiado.

O sea, para ellos no se necesita el sufijo -t. Popular y su forma transitiva es bojolajt. Un nen. Algunos usan esta forma para dar una diferencia de significado de la otra.

Related Papers. By Shigeto Yoshida. Tesis doctoral, CIESAS-CDMX. Women typically start to feel fetal movements between 16 to 24 weeks gestation primigravida women will often not feel fetal movements until after 20 weeks gestation.

Reduced fetal movements are associated with adverse pregnancy outcomes, including stillbirth , fetal growth restriction , placental insufficiency , and congenital malformations.

You should always ask about fetal movements once the patient is of the appropriate gestation to be able to feel them:. Vaginal bleeding is an important symptom that can be relevant to a wide range of obstetric and gynaecological diseases.

You should also ask about fatigue if anaemia is suspected and symptoms of hypovolaemic shock e. All healthy women will have some degree of regular vaginal discharge, so it is important to distinguish between normal and abnormal vaginal discharge when taking an obstetric history.

You should ask the patient if they have noticed any changes to the following characteristics of their vaginal discharge :. Urinary tract infections are common in pregnancy and need to be treated promptly.

Untreated urinary tract infections in pregnancy have been associated with increased risk of fetal death, developmental delay and cerebral palsy.

Pre-eclampsia is a relatively common condition in pregnancy which is characterised by maternal hypertension, proteinuria, oedema, fetal intrauterine growth restriction and premature birth.

The condition can be life-threatening for the mother and the fetus. As a result, it is essential to ask about symptoms of pre-eclampsia as part of every patient review during pregnancy.

Fever is important to ask about when considering infectious pathology e. Weight loss is a symptom of hyperemesis gravidarum and other significant conditions e.

Pruritis in the context of pregnancy is suggestive of obstetric cholestasis it typically affects the palms and soles of the feet.

The exploration of ideas, concerns and expectations should be fluid throughout the consultation in response to patient cues. This will help ensure your consultation is more natural , patient-centred and not overly formulaic.

It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided several examples for each of the three areas below.

A systemic enquiry involves performing a brief screen for symptoms in other body systems which may or may not be relevant to the primary presenting complaint.

A systemic enquiry may also identify symptoms that the patient has forgotten to mention in the presenting complaint.

Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience. Some examples of symptoms you could screen for in each system include:.

Clarify the current gestational age of the pregnancy e. You should ask about the results of the scan or check the medical records if the patient is unsure.

The key findings to note include:. Check the patient is currently up to date with their vaccinations including:.

Pregnancy can have a significant impact on maternal mental health , therefore it is essential that patients are screened for symptoms suggestive of psychiatric illness e.

Sensitivity clarify the gestation of the stillbirth if this is not already documented. Questions about miscarriage, terminations and ectopic pregnancies need to be asked in a sensitive manner in a private setting.

It can be very difficult for women to discuss these topics. These questions should only be asked when relevant and by a person who is competent to do so.

Clarify the gestation at which the termination of pregnancy was performed and the method of management e. Clarify the site of the ectopic pregnancy and how it was managed e.

Diabetes type 1 or 2 : blood glucose control can deteriorate significantly during pregnancy resulting in poor maternal health and fetal complications e.

Hypothyroidism : untreated or undertreated hypothyroidism can result in congenital hypothyroidism with significant neurodevelopmental impact. Epilepsy : seizures during pregnancy pose a risk to both the mother and fetus e.

Previous venous thromboembolism VTE : pregnancy is a pro-thrombotic state, therefore, women who have previously developed a venous thromboembolism are at significantly increased risk of developing further VTEs without prophylactic treatment e.

Genetic disease : it is important to identify any genetic diseases e. It is essential to gain an accurate overview of the medications the patient is currently and has previously taken during the pregnancy.

The first trimester is when the fetus is most at risk of teratogenicity from drugs, as this is when organogenesis occurs.

Clarify the prescribed medications the patient has been taking since falling pregnant, noting which they are still taking and which they have now stopped including drug name, dose and route.

Ask if the patient was using contraception prior to becoming pregnant and if so, clarify what method of contraception was being used.

Check the patient has stopped their contraception or had their contraceptive device removed e. If the patient is taking prescribed or over the counter medications, document the medication name , dose , frequency , form and route.

Some medications are commonly used in pregnancy to both reduce the risk of fetal malformations and treat the symptoms of pregnancy.

Taking a brief family history can help to further assess the risk of adverse outcomes to the mother and fetus during pregnancy. This can also help inform discussions with parents about the risk of their child having a specific genetic disease e.

Understanding the social context of a patient is absolutely key to building a complete picture of their health.

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