04. Prenatal Care Flashcards
Preconception general preparation
Start PNV & folic acid > 6wks before conception.
Achieve healthy state and comorbidities should be controlled
Time required to detect Beta hCG in blood
11 days after conception
Time required to detect Beta hCG in urine
12-14 days after conception
What should happen to beta hCG levels during pregnancy?
Should double every 48-72 hr & peak between wks 8-11
When does beta HCG have limited clinical significance in a healthy pregnancy?
After ~6 weeks when fetal heartbeat can be monitored
Naegle’s Rule
Due date estimation. (LMP + 7 days) - 3 months = Estimated due date
When is Naegle’s Rule useless?
Unknown LMP; Irregular menses; No menses
How many visits does ACOG recommend for a 40 week pregnancy?
14
S/Sx of Presumptive Pregnancy
Amenorrhea; Breast tenderness; Fatigue; N/V; Urinary frequency
S/Sx of Probably Pregnancy
Uterine enlargement; (+) Preg test; Signs (Hegar’s; Chadwick’s; Goodell’s)
Signs of Confirmatory Pregnancy
(+)FHT; Movement by examiner; (+) U/S
1st Pregnancy Visit
5-6 weeks to check for FHR; Quantitative beta HCG should be ~ 5000; Obtain PMH; Psychosocial hx; FH; Prev Preg; GYN
Prenatal Labs that should be drawn
UA & culture; Type& screen; HIV/HepB/RPR; Rubella titer; CBC; Pap/GC/CHL; Hemoglobin profile;
Common Symptoms in 1st Trimester
Vaginal bleeding d/t Intercourse, Implantation bleeding; Cramping (everyone); Back pain d/t stretching broad lig.; Urinatary frequency d/t hormones
What should determine weight gain during pregnancy?
BMI
How much weight should a woman with an average BMI gain during pregnancy?
25-35 lb
How much weight should an obese woman gain during pregnancy?
11-20 lb
How much weight should morbidly obese woman gain during pregnancy?
0 lb
What are pregnancy complications associated with overweight mothers?
Higher C-section rates; Macrosomic fetus; Shoulder dystocia
What are pregnancy complications associated with underweight mothers?
Malnutrition; Malabsorption; Eating disorder?
What is the recommended amount of folic acid for most pregnancies?
0.4 mg QD = 400 mcg QD
What is the recommended amount of folic acid when there is higher risk of neural tube defects?
4.0 mg QD = 4000 mcg QD
What factors predispose a fetus to higher risk of neural tube defects?
Mother with history of a fetus with NTD; Mother with NTD; Mother on Dilantin
What foods should be avoided by pregnant women?
Raw/undercooked meats; Deli meats/salads
At what point in fetal development should the fundus be palpable at the umbilicus?
22 weeks gestation
What activities are restricted during pregnancy?
No heavy lifting (> 30 lb)
How long is travel acceptable in pregnancy?
Up to 32 weeks gestation; after 32 weeks, travel may be approved to areas with hospitals. If traveling by car, must stop every 2 hours to reduce DVT risk
How many caffeinated drinks can be safely enjoyed daily during pregnancy?
1
Preterm contractions
Contractions before 37 wks without cervical dilation
Preterm labor
Contractions before 37 wks with cervical dilation
How are preterm contractions treated?
With patient education
How is preterm labor treated?
With Magnesium Sulfate
What is leukorrhea? What is it’s relationship to pregnancy?
Increased watery, odorless vaginal d/c; Normal during pregnancy. Advise patients it’s normal before it happens.
What are three drug classes notorious for teratogenic effects during the first trimester?
ACE inhibitors; Anti-epileptics; Illicit drugs
When is Rhogam indicated?
Indicated for patients with KNOWN negative Rh factor
When should Rhogam be given?
After any bleeding episode during gestation for 12 wks;
Regular dosing @ 28 wks
Repeat after delivery if baby is Rh(+)
What does Rhogam do?
Protects Future pregnancies
If antenatal testing shows thickened nuchal translucency and absence of the nasal bone, what genetic disorder should be suspected?
Trisomy 21- Down Syndrome
What are the components of a Quad Screen?
AFP; hCG; Estriol; Inhibin-A
Why is a Quad Screen ordered?
Screen for genetic disorders; abnormal results warrant more extensive investigation
When is a Quad Screen performed?
16-18 weeks of gestation
