14: Normal Pregnancy: Antepartum Care Flashcards
Gravidity (G)
Number of times a woman has been pregnant
Parity (P)
Refers to the number of pregnancies led to a BIRTH at or beyond 20 weeks or an infant weighing more than 500 gms
Parity - FPAL
F = Full term (37-42 weeks) P = Preterm (20-36+6) A = Abortions-include all pregnancy losses <20 wks L = Living
A woman who has given birth to 1 set of twins at term and both are living - Gs and Ps?
G1P1002
A woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriage and 1 ectopic pregnancy. She has 3 living children. Gs and Ps?
G4P1123
Normal physical exam findings associated with pregnancy
Systolic murmurs, exaggerated splitting and S3, palmar erythema, spider angiomas, linea nigra, striae gravidarum, Chadwicks sign
Prenatal labs at first visit
CBC, type and screen (Rh), rubella titer, STIs, cervical cytology, diabetes, urine culture
Effect of pregnancy on hematocrit and hemoglobin
Decreased by 30-34 weeks - increase in plasma volume causes a physiologic anemia
Gestational age
Number of weeks that have elapsed between the first day of LMP and date of delivery
hCG levels for positive pregnancy test
25 IU/L
Rate of hCG increase in first 30 days during a normal pregnancy?
hCG level doubles every 2.2 days
When can pregnancy be verified with gestational sac? hCG level at this point?
Gestational sac seen around 5 weeks
Mean hCG 1500-2000 IU/L
Naegels rule
LMP minus 3 months + 7 days in patients with regular 28 day cycles
Crown Rump Length (CRL)
Visualized on ultrasound between 6-11 weeks and can determine due date within 7 days
Most common chromosomal disorders
Aneuploidy; Turner’s and Klinefelter’s
Most common risk factor for autosomal trisomies?
Advanced maternal age (35+ yrs)
Most common class of spontaneous abortions
Autosomal trisomies
Most common single chromosomal abnormality found in spontaneous abortions
Turner’s syndrome (45XO)
Most common gene carried in North American whites?
CFTR gene; cystic fibrosis
What is the most important way to lower risk of neural tube defects?
Folic acid supplementation
First trimester screening
Maternal age, fetal NT thickness, b-hCG, PAPP-A
Second trimester screening
Triple screen: b-hCG, estriol, maternal serum AFP
Quad screen: b-hCG, estriol, AFP and inhibin A
Amniocentesis
Diagnostic procedure at 16-20 weeks
Chorionic villi sampling
Diagnostic procedure at 11 weeks
Teratogen
Any agent or factor that can cause abnormalities of form/function in exposed fetus (often pharmaceutical)
Most vulnerable stage to teratogens
Organogenesis - day 17-56 post-conception
Most common teratogen to which a fetus is exposed
ALCOHOL (FAS)
Symptoms of Fetal Alcohol Syndrome
- Growth restriction
- Facial abnormalities
- CNS dysfunction
Effect of tobacco smoking on fetus
IUGR, low birth weight, increased risk of spontaneous abortion, fetal death, neonatal death and prematurity
Effect of radiation on fetus
Dose dependent effects during critical period (2-6 wks)
Exposure before 2 weeks - all or none effect
Less than 5 rads exposure = no risk
Frequency of office visits during pregnancy
4 weeks until 28 weeks
2 weeks from 28-36 weeks
weekly 36 weeks until delivery
When does screening via fetal survey US occur
20 weeks
When does screening for GDM, hemoglobin and hematocrit occur?
28 weeks
When do you give Rhogam to Rh- patients, as well as Tdap vaccine?
28 weeks
When do you screen for Group B strep carrier with vaginal culture?
35 weeks
Normal fetal movement
10 movements in 2 hours
Reactive NST
2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes monitoring
Positive CST
If late decels noted with contractions, delivery is warranted
