2/20 Prenatal Care - Merjanian Flashcards
prenatal care
comprehensive program including:
- preconceptional care
- prompt dx of preg
- initial prenatal care eval
- followup prenatal visits
preconceptional care
concept
goals
health during preg depends on health before preg
preconceptional care assists with:
- reducing risks
- promoting healthy lifestyles
- improving readiness for preg
- vaccinations
- genetic screening
- weight loss/gain analysis
- folic acid daily → prevents neural tube defects
preconceptional genetic screenings
- carrier testing
- sickle hemoglobinopathies
- thalessemias (SE asian, Mediterranean, AfAm)
- cystic fibrosis (Caucasians of European descent, Ashkenazi Jews)
- Ashkenazi Jewish panel
- Tay-Sachs, Niemann-Pick, Gaucher, Canavan disease, Fanconi anemia, Bloom syndrome, CF
pregnancy test
detect hCG in maternal blood and urine → provide basis for endocrine tests of preg
typically get pos urine preg test 4 wk after last menstrual period
hCG
- glycoprotein with high carbohydrate content
- produced by syncytiotrophoblasts
- prevents involution of corpus luteum (principle site of progesterone formation in first 6wk)
hCG
glycoprotein with high carbohydrate content
- produced by syncytiotrophoblasts
- prevents involution of corpus luteum (principle site of progesterone formation in first 6wk)
composed of 2 subunits: alpha, beta
- alpha is identical in LH, FSH, TSH, hCG → immunoassays are developed specifically for beta subunit
definitions
- nulligravida
- gravida
- primagravida
- multigravida
- nullipara
- primapara
- multipara
- nulligravida : not pregnant, never has been
-
gravida : currently preg OR has been preg, irrespective of outcome
- primagravida : in first preg
- multigravida : has been preg more than once
- nullipara : never given birth before (to fetus beyond 20wk)
- primapara : delivered once (fetus beyond 20wk) → fetus alive/dead
- multipara : delievered two or more pregnancies (fetus beyond 20wk)
obstetrical history
G_P_ _ _ _
G _ : total number of pregnancies
P _ _ _ _ :
- term deliveries
- preterm deliveries
- abortuses
- living children
normal preg duration
Naegele’s Rule
trimesters
280 days or 40wk from first day of last menstrual period
Naegele’s Rule: +7d to first day of LMP, then -3mo
- first trimester: thru 14wk
- second trimester: thru 28wk
- third trimester: thru 42wk
delivery by 41wk3d
cigarette smoking
incr risk of: placental previa, placental abruption, premature ruptures of membranes, preterm delivery/low-birthweight infants, spontaneous abortion, fetal death
mechanism:
- fetal hypoxia from increased carboxyHb
- reduced uteroplacental blood flow
- direct toxic effects of nicotine
alcohol use in pregnancy
ethanol is most common teratogen
fetal alcohol syndrome
- growth restriction
- facial abnormalities
- CNS dysfx
- fetal tox is dose-related
- greatest risk: first trimester
- abstain if pregnant or planning pregnancy
illicit drug use in preg
agents including: heroin, opiates, cocaine, amphetamines, barbituates, marijuana
chronic use, large quantities is harmful to fetus
- fetal distress
- low birthweight
- drug withdrawal after birth
frequency of prenatal care
every 4 weeks until 28wk
every 2 weeks until 36wk
weekly until delivery
teratogens
- 2-3% of gen pop have major defects apparent at birth → 5% may be result of maternal exposure to drugs/chemicals
- timing is critical:
- before 3wk → all or none
- 3-8wk → MOST CRITICAL WINDOW!!! (bc time of organogenesis)
- after 8wk → growth and fx
teratogens/effects to know
medications
- ACE inhibitors
- aminoglycosides
- carbamezapine
- DES
- folate antagonists
- lithium
- methimazole
teratogens/effects to know
- iodine (lack or excess)
- maternal diabetes
- vitamin A (excess)
teratogens/effects to know
- phenytoin
- tetracyclines
- thalidomide
- valproate
- warfarin
- SSRI
- thiazide diuretics
