2- Prenatal Care Flashcards
What age is concerned advanced maternal age (AMA)?
> 35 yo
Which vaccines is it most important to make sure a woman has prior to conceiving?
MMR, varicella
(live vaccines)
Female pt should be taking prenatal vitamins with what 2 specific ingredients starting 1 month prior to trying to conceive?
Folic acid: 0.4- 0.8 mg, 4 mg if hx of NTD or AMA
DHA
When should a pregnant pt present for their 1st visit?
8-10 weeks
How do you determine obstetrical hx using Gravida (v), Para (w, x, y, z) (TPAL)?
v = # of pregnancies (multiple gestation counts as 1 pregnancy)
w = # of full term births (after 37 wks)
x = # of preterm births
y = # of abortions (spontaneous, induced, ectopic)
z = # of living children
What is considered early, full, late, and post term pregnancies?
Early: 37-38 wks
Full: 39-40 wks
Late: 41 wks
Post: 42+ wks
What rule is used to determine EDC (estimated date of confinement)/ EDD (estimated date of delivery)?
Add 7 days to LMP and subtract 3 months
What sign of early pregnancy may be noted at the first prenatal care visit and is distinguished by a blue to purple tint of the vaginal walls/ cervix?
Chadwick’s sign
What sign of early pregnancy may be noted at the first prenatal care visit and is distinguished by palpable softening of the isthmus?
Hegar’s sign
What breast exam finding may be noted at first prenatal visit and can be initially concerning to pt?
(also: dilated veins, enlarged breasts with expanding/ darkening areola, TTP)
Montgomery tubercles
(sebaceous glands that appear as small bumps on areola)
What is the most important lab ordered at the first prenatal visit?
Urine HCG
Why do you perform an US at the first prenatal previsit?
Confirmation of EDD
R/o ectopic (empty uterus but (+) pregnancy test)
What are common foods to avoid during pregnancy?
High mercury fish, raw meats/ eggs/ fish, processed meats (listeriosis), <200 mg caffeine daily
How much exercise is recommended for pregnant and postpartum women?
150 minutes/ week
What is considered an acceptable amount of weight to gain during pregnancy?
~30 lbs
Once pregnant, pt should avoid travel due to risk of what?
ZIKA
What weeks of pregnancy are considered 1st, 2nd, and 3rd trimester?
1st: week 1-12
2nd: week 13-26
3rd: week 27+
How often should a pregnant pt be seen in:
- the first 28 weeks?
- weeks 28-36?
- weeks 36+?
First 28 weeks: q 4 wks
Weeks 28-36: q 2 wks
Weeks 36+: weekly
When/ what is the first fetal movement felt by the mother?
18-20 wks, quickening
(sooner if not 1st pregnancy, 16-18 wks)
How many fetal kick counts should be felt beginning at the 3rd trimester?
10 within 2 hours
(kicks/ rolls/ flutters)
What is used to detect fetal heart tone (FHT) between 10-12 weeks and what rate is considered to be WNL?
Dopper, 110-160 bpm
What is the location of the fundal height measurement at 12 and 20 weeks?
12 weeks = pubic symphysis
20 weeks = umbilicus
What is defined as the point in time when the fundal height drops after 36-38 weeks due to the fetus dropping into the pelvis and deceasing AFI (amniotic fluid index)?
Lightening
What labs should be checked at every visit for pregnant pt?
Urine sample- protein (pre-eclampsia), glucose (GDM)
When/ with what is fetal gender determined?
US @ 16 weeks GA
NIPT (non-invasive prenatal test) @ 9 weeks GA (serum draw)
What is evaluted during the 2nd trimester US (performed between 18-22 weeks GA)?
Fetal anatomy
What is included in the lab draw during the 3rd trimester visit (aside from CBC, RPR, ABO/ Rh, antibody screen)?
1 hr/ 3 hr glucose challenge
+/- Rhogam
1 hour glucose challenge test (performed during 3rd trimester visit) involves giving pt 50g oral glucose load. What results are considered normal/ abnormal and how would you proceed?
< 140 mg/ dL = pass
> 140 mg/ dL = abnormal = proceed w/ 3 hr glucose tolerance test
> 200 mg/ dL = automatic fail = GDM
3 hour glucose challenge test (performed during 3rd trimester visit) involves giving pt 100g oral glucose load with 4 total blood draws. What results are considered abnormal?
2 abnormal values = fail
1 value > 200 mg/ dL = automatic fail = GDM
What is determined by the 3rd trimester US (performed during 32-34 weeks of GA)?
Fetal growth/ position, state of placenta and AFI
What can be used to determines the baby’s position in utero with hands on gravid abdomen?
Leopold Maneuvers
What is determined by the 3rd trimester cervical exam (performed at 35-40 weeks GA)?
Dilation, effacement, station, position, presenting part
When should you perform group B strep culture with swab of lower vagina and rectum and what is done if culture is (+)?
35-37 weeks GA
If (+) intrapartum abx prophylaxis
What Bishop scores are indicative of the highest chance of successful induction (vaginal delivery) and highest change of failed induction (therefore indicating c-section)?
Successful: 8-13 points
Failed: 0-4 points
What are the expected results of an NST (nonstress test) performed during the 3rd trimester of pregnancy?
Minimum of 2 accelerations
Accelerations must increase in FHR by 15 bpm and last for 15 seconds
What tests might be performed for high risk pregnancy in the 3rd trimester?
NST (nonstress test)
BPP (biophysical profile)
What is used for high risk pregnancy during the 3rd trimester to measure fetal movement, muscle tone, breathing movements, as well as AFI?
BPP (biophysical profile)
Perfect score = 8/8 (or 10/10 if FHR included)
What optional testing for prenatal care is a sonographic determination of nuchal translucency performed between 11-13.6 weeks GA and what might it indicate a higher risk for?
NT scan, Down Syndrome
What optional testing for prenatal care is a serum draw that coincides with NT scan, measures PAPP-A/ Beta HCG and what might it indicate a higher risk for?
FTS (first trimester screening), Down Syndrome and Edwards Syndrome
What optional testing for prenatal care is a serum draw performed as early as 9 weeks GA, have fetal fraction of 8%, and drawn in place of FTS if performed with NT scan?
NIPT (non-invasive perinatal screening)
(expensive)
What optional testing for prenatal care is a maternal serum marker for AFP, performed between 15-21.6 weeks GA and what might it indicate a higher risk for?
AFP only
Higher risk of NTD
What optional testing for prenatal care can be drawn in NT/FTS was no performed, is most accurate between 16-18 weeks, and shows serum markers for AFP, uE3, hCG, and inhibin A in maternal serum?
What might it indicate a higher risk for?
Maternal serum screen
NTD, Down Syndrome, Edward Syndrome
What additional supplements are recommended for a woman of AMA?
4 mg folic acid/ day, daily ASA
Earlier aneuploidy screening, involving maternal fetal medicine (MFM), level 2 ultrasounds, antenatal testing, and delivery @ 39 weeks is indicated when?
AMA (> 35 yo)
