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Clinical 1 (Part B) > 20 - Perinatal Care > Flashcards

20 - Perinatal Care Flashcards

1
Q

Nutritional recommendations in pregnancy:

Calcium

A

1000 mg daily for those 19-50 yrs old (plus vitamin D 600 IU)

1300 mg daily for those < 19 years old (plus vitamin D 600 IU)

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2
Q

Nutritional recommendations in pregnancy:

Folic Acid

A

0.4 mg daily

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3
Q

Nutritional recommendations in pregnancy:

Iodine

A

220-250 micrograms daily

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4
Q

Nutritional recommendations in pregnancy:

Iron

A

27 mg daily

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5
Q

Why is folic acid supplementation important in pregnancy?

A

To prevent neural tube defects

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6
Q

What is the recommended caffeine intake during pregnancy?

A

< 300 mg/day

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7
Q

Does pregnancy increase or decrease the immune system?

A

decreases it

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8
Q

What is listeria present in?

A

unpasteurized milk, soft-ripened cheeses, deli meat

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9
Q

How do we prevent getting listeria?

A

Avoid unpasteurized milk, soft-ripened cheeses, deli meat, reheat until steaming hot, wash raw fruit/veggies well

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10
Q

What is salmonella present in?

A

raw seafood, raw eggs, sushi that hasn’t been properly handled/prepared

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11
Q

How do we prevent getting salmonella?

A

avoid raw or soft-cooked eggs, raw cookie dough, avoid sushi that hasn’t been prepared properly

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12
Q

What is methylmercury present in?

A

Fish (shark, swordfish, mackerel, albacore tuna)

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13
Q

How much fish is safe in pregnancy?

A

2 servings/week

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14
Q

How do we prevent methylmercury poisoning in pregnancy?

A
  • Only 2 servings of fish/week

- Choose fish lower in mercury (shrimp, salmon, canned light tuna)

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15
Q

What is toxoplasma?

A

A parasite in raw meat, soil & dirty cat litter

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16
Q

How do we prevent toxoplasma in pregnancy?

A

Wear gloves if gardening, have someone else change the litter box, cook meat thoroughly

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17
Q

When is travel safe in pregnancy?

A

Generally safe up to 4 weeks before expected due date

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18
Q

What are the risks of air travel when pregnant?

A

Immobilization and pregnancy both increase the risk of venous thromboembolism:
-Maintain hydration, frequent walking, stretching & isometric leg exercises, compression stockings

Cabin hypoxemia:
-Concern in those with CV disease & compromised uterine blood flow (preeclampsia, growth restricted)

Cosmic radiation:
-ICRP recommends max exposure of 1 mSv over 40 week pregnancy (longest internal flight is <15% of this)

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19
Q

What things need to be considered before air travel?

A
  • Increased risk of VT
  • Comorbid conditions: respiratory & cardiac disease, pregnancy complications
  • Air line policies
  • Medical resources & insurance at destination
  • Exposure to infectious diseases at destination (vaccination, malarial prophylaxis)
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20
Q

Are hot tubs/saunas safe in pregnancy?

A
  • Avoid in 1st trimester

- Heat exposure in early pregnancy is associated with neural tube defects & miscarriage

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21
Q

Are hair treatments safe in pregnancy?

A
  • Human studies showed very limited systemic absorption, quantities unlikely to reach fetus
  • Personal use by pregnant women 3-4 times throughout pregnancy is not considered to be of concern
  • Should be avoided if there are burns or open wounds on the area to be treated
  • Occupational use (hairdresser): wear gloves, ensure adequate ventilation in workplace
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22
Q

What are some prenatal discomforts?

A
  • Nausea & vomiting, heartburn, constipation, hemorrhoids
  • Leukorrhea (increased vaginal discharge)
  • Gingivitis
  • Edema
  • Varicose Veins
  • Cutaneous changes: spider angioma’s, melasma, striae gravidarum
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23
Q

What is physiologic edema caused by?

A
  • Hormone-induced Na retention (Increased plasma volume)

- Uterine compression of the interior vena cava

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24
Q

What are some differential diagnosis for edema in pregnancy?

A
  • Preeclampsia
  • DVT
  • cellulitis
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25
Q

_____ ______ = symmetric, bilateral leg edema that lessens with recumbency (laying down)

A

physiologic edema

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26
Q

_____ = tender unilateral swelling of a leg or calf, erythema & warmth

A

DVT

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27
Q

_____ = hypertension and proteinuria

A

preeclampsia

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28
Q

_____ = tender unilateral swelling in a leg or calf, erythema (asymmetric), warmth and sometimes fever

A

Cellulitis

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29
Q

What are some symptoms that suggest preeclampsia?

A
  • bilateral
  • accompanied by HTN
  • edema involves the hands, face & sacram
  • blurry vision
  • dyspnea
  • nausea, vomiting, jaundice
  • decreased urine output
  • confusion, headache
  • weight gain that is sudden and dramatic
  • rash
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30
Q

What are some key questions that need to be asked when a pregnant patients comes to the pharmacy wondering about getting rid of swelling?

A
  • Does the swelling get relieved when laying down/elevating them
  • When did it start?
  • Is it in both ankles?
  • Any redness or warm to touch?
  • Any fever?
  • Maybe ask her to take BP reading
  • Any swelling anywhere else in the body?
  • Pitting edema? (leaves an impression in the leg which goes back to normal with time)
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31
Q

Are varicose veins itchy?

A

Yes - can be

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32
Q

Edema and varicose veins can cause such symptoms as ?

A
  • numbness
  • mild pain
  • aching
  • heavy feeling
  • itching, throbbing, irritation around vein
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33
Q

Describe the etiology of varicose veins (same to edema)

A
  • In addition hormones (progesterone) relax muscular walls of blood vessels
  • Blood vessel valve weakens & blood stagnates in vein causing distension and ballooning
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34
Q

What are some self-management strategies for deem & varicose veins?

A
  • Compression stockings
  • Sleep in left side-laying position (allows IVC to open and more draining to happen over night)
  • Maintain adequate fluid intake
  • Avoid prolonged standing
  • Rest with legs elevated often
  • Do not sit with legs crossed
  • Maintain physical activity
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35
Q

What is melasma/chloasma?

A

“Mask of Pregnancy”

  • Dark skin discolouration occurs on sun exposed areas
  • Generally affects the face, often symmetrical
  • Caused by excess melanin in the skin
36
Q

Why does melasma/chloasma happen in pregnancy?

A

Elevations in E and P levels in epidermal & dermal cells and melanocyte-stimulating hormone upon sun exposure may potentiate tyrosinase activity and thus stimulate melanogenesis

**Requires exposure to UV rays - SPF sunscreen is very important

37
Q

Melasma/chloasma:

Risk factors

A
  • genetic predisposition

- darker skin tones

38
Q

Melasma/chloasma:

Does it stay after pregnancy is over?

A

Usually fades after delivery (within 1 year)

10-30% of cases persist

39
Q

Describe spider angioma’s

A
  • Central red pundit with radiating branches
  • Usually appears in 2nd to 5th month of pregnancy
  • Most common around eyes & areas drained by SVC (neck, face, upper chest, arms & hands)
  • Vascular distention & proliferation of blood vessels during pregnancy increase risk
40
Q

Who does spider angioma’s affect more?

A

Caucasians

41
Q

Are spider angioma’s present after pregnancy?

A

90% regress by 3 months post partum

42
Q

Striae gravidarum = ____ _____

A

stretch marks

43
Q

Describe Striae gravidarum (stretch marks)

A
  • Red or purple lines or streaks, fade to pale lines. Can be itchy.
  • Commonly affect breasts, abdomen and thighs
44
Q 
Striae gravidarum (stretch marks):
Risk factors
A
  • degree of abdominal distension
  • maternal weight gain
  • genetic predisposition
  • younger maternal age
45
Q 
Striae gravidarum (stretch marks):
Mechanism ?
A

not well understood
-E, adrenocorticol hormone & relaxin: influence connective tissue formation (promotes separation of the collagen fibrils) leading to formation of striae when skin stretched

46
Q 
Striae gravidarum (stretch marks):
Present after birth?
A

Usually persist postpartum, may fade over months to 1-2 years

47
Q

Melasma:

_______ = key

A

prevention (broad-spectrum sunscreen)

48
Q

Melasma:

Describe the pharmacological treatment options

A
  • hydroquinone
  • azelaic acid
  • trentinoin (this is toxic during pregnancy so i’m assuming treatment is after birth)
49
Q

Melasma:

Camouflage techniques?

A

mineral makeup containing titanium dioxide/zinc oxide

50
Q

Do we treat angioma’s?

A

Treatment not required (resolve in 3 months)

Could treat with IPLS (intense pulsed light source)

51
Q

List some common agents to treat striae gravidarum

A
  • cocoa butter
  • hyaluronic acid
  • vitamin E
  • cantella asiatica extract
  • bitter almond oil
52
Q

MOA of the agents to treat striae gravidarum?

A
  • stimulation of fibroblastic activity leading to increased production of collagen
  • increased blood perfusion through massaging of the area and potential anti-inflammatory
  • increased skin hydration
53
Q

_____ = only used post arum (toxic to babe)

A

tretinoin

54
Q

What would you do if a person wants a skin lightening cream that is safe in pregnancy?

A
  • Recommend broad-spectrum sunscreen
  • Tell them that it will most likely go away after pregnancy
  • Could recommend make up with titanium dioxide/zinc oxide
55
Q

Prenatal Signs of Potential complications (prob signs for referral)

A
  • Severe vomiting (risk of dehydration)
  • Signs of infection (fever, diarrhea, pain on urination)
  • Abdominal cramping
  • Vaginal bleeding
  • Sudden loss of fluid from vagina or continued leakage of fluid from the vagina (LOL THIS IS YOUR WATER BREAKING LMAO)
  • decreased fetal activity
  • signs of preterm labor (ex. low, dull backache, increased uterine activity compared to previous patterns; menstrual-like cramps; diarrhea, etc)
56
Q

Describe normal nipple pain

A
  • pain subsides within 30-60 seconds of initiation of feeding
  • often peaks around 3-6 days postpartum
  • usually resolves in about a week
57
Q

Describe trauma nipple pain

A
  • pain persists or increases throughout feeding
  • lasts > 1 week
  • cracks, fissures, bleeding
58
Q

Describe bleb nipple pain

A
  • shiny white bump at tip of nipple (blocked nipple pore)

- pinpoint pain on feeding

59
Q

Describe eczema nipple pain

A
  • bilateral
  • Hx of eczema, assess for exposure to new irritant
  • Red scaly rash usually not entered around nipple
60
Q

Describe raynaud’s or vasospasm nipple pain

A
  • Triphasic color change (red, white and blue)
  • Intense pain, burning, numbness, prickling, stinging
  • Pain on exposure to cold (may be during, following or b/w feedings)
61
Q

Possible infections that can cause nipple pain?

A

mastitis

candidiasis

62
Q

How can we manage nipple trauma?

A

Nipple care:

  • Wash with warm water and mild soap when bathing
  • Avoid excessive moisture

Cool or warm compresses

Acetaminophen or ibuprofen

Could use lanolin or hydro-gel dressings (avoid vitamin E oils or creams)

63
Q

How do you manage a nipple bleb?

A

warm soaks

frequent feedings

64
Q

How do you manage engorgement and plugged ducts?

A
  • Optimize feeding technique & encourage frequent feeding
  • Avoid tight or restrictive clothes (impede milk flow)
  • Warm compress or shower may enhance letdown and facilitate milk removal (by expression or by baby)
  • Cool compresses between feeding to decrease swelling/discomfort (ice 15 min on & 45 min off)
  • Plugged ducts - massage breast from affected area toward nipple
65
Q

List some risk factors for breast pain caused by mastitis (infection of breast tissue)

A
  • previous mastitis
  • engorgement
  • poor milk drainage
  • nipple damage
66
Q

Mastitis:

Most common pathogen?

A

S. aureus

67
Q

Mastitis:

Management?

A
  • Supportive measures as for engorgement
  • Antibiotics indicated if fever is present or if symptoms do not improve within 12-24 hours with supportive measures
  • Cloxacillin or cephalexin 500 mg PO QID
  • Clindamycin 300 mg QID if MRSA suspected or beta lactic allergy
  • Treatment duration 10-14 days

*Symptoms should resolve within 48-72 hours of initiating antibiotics

68
Q

Nipple Candidiasis:

Diagnosis?

A
  • Pain out of proportion to physical finding (often sharp, shooting pain)
  • Affected nipple appears pink/red & shiny or the skin may be flaky
  • Exclusion of other causes of breast pain
69
Q

Nipple Candidiasis:

Predisposing factors?

A
  • history of infant oral or diaper candid infection
  • history of maternal VVC
  • previous antibiotic use
  • nipple damage
70
Q

Nipple Candidiasis:

Management?

A
  • Non-pharms to prevent reinfection and cross contamination of candida
  • Mother and child should be treated simultaneously
71
Q

Nipple Candidiasis:

Treatment duration?

A

As with other fungal infections, continue 1 week AFTER patient is symptom free

72
Q

Nipple Candidiasis:

What are the pharmacological treatment options?

A
  • Topcial antifungals - miconazole or clotrimazole preferred over nystatin
  • Applied after each feeding

-If fissures present, topical antibiotic often added
APNO = all purpose nipple ointment: 2% miconazole in mupirocin 2% ointment; betamethasone ointment 0.1% aa

  • Possible add on therapy: Gentian violet 1% once daily for 3-4 days (used for a max of 1 week, should never be used alone)
  • THIS STUFF IS SHIT - WHY IS IT IN OUR NOTES

-If treatment failure: consider Fluconazole 400 mg STAT then 200 mg daily for at least 2 weeks

73
Q

What are common reasons to use a breast pump?

A
  • To stimulate milk production
  • To maintain milk supply
  • To provide infant with breast milk
74
Q

Tips for breast pumping

A
  • Wash hands with soap and water before pumping
  • Ensure that the pump pieces and milk collection containers are clean (wash with hot soapy water & rinse)
  • Ensure flanges are the approbate size
  • WTF is the flange man
75
Q

How can you manage the difficulty with let-down (milk coming out?)
OMG USE NORMAL WORDS

A
  • Gently massage the breasts before pumping
  • Apply a warm wet cloth to breasts before pumping
  • Pump in a quiet, darkened room to avoid distractions
  • Look at a picture of the baby or smell of the baby’s blanket
76
Q

List 3 ways to care for the vaginal area (perineum) after child birth

CTMA pg 1114

A
  • Prevent constipation by drinking water and eating fibre
  • Kegel exercises to strengthen the area
  • Use a pillow when sitting
77
Q

Signs for referral?

A

If you have severe pain, a foul-smelling discharge or a high fever

78
Q

Lochia

A

uterine discharge after birth

79
Q

Days 2-3 PP:

What type of Lochia?

A

Lochia = bright red, small clots

80
Q

Days 3-10 PP:

What type of Lochia?

A

Lochia serosa = brown or pink

81
Q

Days 10-up to 6 weeks PP:

What type of Lochia?

A

Lochia alba = white or pale yellow

82
Q

Bleeding beyond 6 weeks, increasing bleeding or clots larger than a ____- size should be reffered

A

quarter/loonie

83
Q

When does the period usually return?

A

within 1-6 months

84
Q

List 3 post partum mood disorders

A

1) Postpartum “Blues” (max 2 weeks)
2) Postpartum Depression
3) Postpartum Psychosis

85
Q

What are some postnatal red flags? (list 4)

A
  • Abnormal vaginal bleeding
  • Fever/chills
  • Painful, difficult or frequent urination
  • Breasts have signs of infection

Clinical 1 (Part B) (11 decks)

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