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Women's Health Unit 2 > 3 Prenatal Care > Flashcards

3 Prenatal Care Flashcards

1
Q

What Hx questions do you need to ask during preconception evaluation?

A

Current health status:
• Regular menses?
• Chronic medical conditions? (high BMI, PCOS, DM, HTN, Thyroid, CKD, etc)
• Current meds? (Are they safe in pregnancy?)
• Age
• Substance use/abuse

Reproductive history

Family History

Nutrition and physical activity

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2
Q

What is considered advanced maternal age (AMA)?

A

> 35 🙄

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3
Q

What physical exams should you perform during preconception consultations?

A

BMI measurement
Check for dental caries
CV/Pulm
Pelvic exam

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4
Q

What labs must you run during a preconception consultation?

A

HIV TEST*****

If indicated - TSH/T4, HA1C

Ask if UpToDate on immunizations (MMR, Varicella, Hep B, Flu, Tdap)

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5
Q

Recommendations for women who for some unknown reason want to get pregnant

A

Obtain/maintain good control of medical illnesses**

Prenatal vitamin with folic acid and DHA beginning at least 1 month prior to trying to conceive

Abstain from substance use (alcohol, tobacco, illicit drugs)

Menstrual diary

OTC OPKs

Timed intercourse around ovulation day

Education - takes the average couple 1 year to conceive w/o intervention

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6
Q

What is the daily recommended dose of folic acid for those trying to conceive?

A

0.4 - 0.8 mg

4mg if history of NTD

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7
Q

When is the idea time for the first prenatal care visit?

A

Between 8-10 weeks

Most accurate U/S dating occurs in the first trimester

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8
Q

Pertinent hx items to include in first prenatal visit

A

GYN hx (last pap, hx of abnormal pap, hx of STI, hx of PID, pregnancy/delivery hx)

Intended vs unintended pregnancy

Domestic violence

Substance use

Inherited diseases

Barriers to routine visits

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9
Q

What is the G/P system for recording obstetrical hx?

A

G = Gravida = Total Number of Pregnancies (multiple gestation count as 1 pregnancy)

P = Para = TPAL
T= # full term births
P = # preterm births
A = # abortions (spontaneous, induced, ectopic)
L = # living children
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10
Q

Early term = _____ weeks

A

37.0 - 38.6 weeks

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11
Q

Full term = ______ weeks

A

39.0-40.6 weeks

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12
Q

Late term = _____ weeks

A

41.0 - 41.6 weeks

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13
Q

Post term = _____ weeks

A

42.0 weeks and beyond

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14
Q

What is LMP?

A

1st day of last menstrual period

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15
Q

What is EDC

A

Estimated date of confinement

= EDD (estimated date of delivery)

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16
Q

What is GA?

A

Gestational age

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17
Q

What is Naegele’s Rule?

A

Estimating EDD based on LMP

Add 7 days to LMP and subtract 3 months

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18
Q

What pelvic exam findings should you expect at the first prenatal visit?

A

Pay attention to uterus size, shape, and adnexa - is uterus larger/smaller than expected for GA?

CHADWICK’S SIGN - blue to purple tint of vaginal walls/cervix

HEGAR’S SIGN - palpable softening of the isthmus

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19
Q

Blue to purple tint of vaginal walls/cervix

A

Chadwick’s sign

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20
Q

Palpable softening of the isthmus

A

HEGAR’S sign

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21
Q

What breast changes occur in the early prenatal period?

A

Montgomery tubercles

Dilated veins

Enlarged breasts, expanding Arellano

Tenderness to palpation

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22
Q

What is the old timey way of determining if they baby will be able to be born vaginally?

A

Pelvimetry

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23
Q

Routine labs drawn at first prenatal visit

A

URINE HCG (make sure their preggo - duh)

Pap, GC/Chlamydia cultures

CBC

Blood type and Rh

Antibody screen

Rubella and varicella titers (even if vaccinated)

Syphilis, Hep B, HIV testing

UA and culture

+/- TSH, CF screening, TB testing, Ha1C

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24
Q

During the first prenatal visit, fetus size can vary +/- _____ days from EDD

A

5-7 days

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25
Q

Common food items to avoid during pregnancy

A

Tuna, shark, swordfish, etc - high mercury

Raw meats/eggs

Hot dogs, deli meats, raw milk - listeriosis

More than 200 mg caffeine daily (~1 12-oz cup of coffee)

No ceviche

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26
Q

Exercise recommendations for prenatal visits

A

150 min of exercise weekly for pregnant/postpartum women

Start slow and encourage daily exercise

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27
Q

BMI of ________ is considered underweight

Expected range of total weight gain during pregnancy = _______

A

<18.5

28-40lbs

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28
Q

BMI of ________ is considered normal weight

Expected range of total weight gain during pregnancy = _______

A

18.5-24.9

25-35lbs

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29
Q

BMI of ________ is considered overweight

Expected range of total weight gain during pregnancy = _______

A

25-29.9

15-25lbs

30
Q

BMI of ________ is considered obese

Expected range of total weight gain during pregnancy = _______

A

≥30

11-20lbs

31
Q

GA for the 1st trimester

A

Week 1 - 12w6d

32
Q

GA for the 2nd trimester

A

Week 13 - 26w6d

33
Q

GA for 3rd trimester

A

Week 27 - end of pregnancy

34
Q

What should be the frequency of prenatal visits?

A

First 28 weeks - q4 weeks

Weeks 28-36 - q2 weeks

Week 36 and beyond - weekly

35
Q

What is quickening?

A

First fetal movements

36
Q

In a woman’s first pregnancy, quickening occurs…

A

At 18-20 weeks

37
Q

In subsequent pregnancies after the first, quickening occurs…

A

At week 16-18

38
Q

When should a pregnant woman do fetal kick counts?

A

Beginning in 3rd trimester

If <10 kicks/rolls/flutters within 2 hours, go to ER

39
Q

When can fetal heart tones be detected?

A

Doppler might pick them up by 10-12 weeks but be careful doing it too early - it sucks if you can’t hear them b/c you’re trying too soon

40
Q

_____bpm is WNL for fetal heart rate

A

110-160bpm

41
Q

Fundal height is measured from ______ to ______

A

Pubic bone to uterine fundus

42
Q

Fundal height at 12 weeks should be ….

A

At the pubic symphysis

43
Q

Fundal height at 20 weeks should be…

A

At the umbilicus

44
Q

Why does fundal height typically drop after 36-38 weeks?

A

Due to fetus dropping into pelvis (Lightening) and decreasing amniotic fluid index (AFI)

45
Q

What PE findings should you always look out for during prenatal visits, other than FHT and Fundal height?

A

BP

Edema

Urine sample at every visit!

46
Q

Why do we do urine samples at every prenatal visit?

A

Checking for protein levels and glucose

47
Q

When can fetal sex be determined?

A

With NIPT (non-invasive perinatal Testing) as early as 9 weeks but $$$$

By U/S as early as 16 weeks GA

48
Q

Which U/S is the most important one?

A

2nd trimester, between 18-22 weeks

This is the anatomy U/S that evaluates for anatomical abnormalities, fetal position, location/status of placenta
AFI, cervical length

Fetus can vary +/- 10-14 days from EDD at this point (but doesn’t change the due date)

49
Q

What important counseling occurs during the 2nd trimester?

A

Address abnormal lab values

Pick a pediatrician

FLU VACCINE

Preterm labor precautions

Gestational DM testing

TDAP VACCINE

Cord blood banking

50
Q

Which blood draw is the most important

A

During the 3rd trimester, at 24-28 weeks

ABO and Rh
CBC
RPR for Syphilis

1hr glucose challenge —> 3 hr if failed

+/- Rhogam if Rh (-)

51
Q

What is a passing result for the 1 hour glucose challenge?

A

<140 mg/dL

52
Q

What if you get a result of >140mg/dL on 1 hour glucose challenge?

A

Abnormal —> proceed with 3 hour challenge

Unless >200mg/dL = automatic fail, congrats, you now have gestational diabetes!

53
Q

How is the 3 hr glucose tolerance test different from the 1 hr challenge?

A

100g vs 50g

4 total blood draws:
• Fasting <95
• 1 hour <180
• 2 hours <155
• 3 hours <140

Two abnormal values = fail

One value exceeding 200 = fail

54
Q

What needs to happen if an expectant mother is Rh negative?

A

Rh immune globulin 300µg given between 28-30 weeks

55
Q

What are you evaluating for on U/S during the 3rd trimester?

A

Fetal growth, fetal position, state of placenta, and AFI

Should be done between 32-34 weeks

56
Q

What manual thing can you do to determine the baby’s position?

A

Leopoldo maneuvers

57
Q

What should occur during prenatal visits at 35-40 weeks?

A 
Cervical exams to determine:
• Dilation
• Effacement
• Station
• Position
• Presenting part
58
Q

What is Effacement?

A

Thinning of the cervix

59
Q

What is dilation?

A

It’s exactly like it sounds

60
Q

What is station?

A

How far down the baby’s head is in the pelvis

61
Q

When is Group B strep culture performed?

A

Swab of both lower vagina and rectum between 35-37 weeks GA

If (+), intrapartum abx prophylaxis is indicated to prevent neonatal GBS (normally penicillin)

62
Q

Early onset neonatal GBS

A

Symptom onset <24 hours from birth

Most common Sx: Sepsis, PNA, meningitis

63
Q

Late onset neonatal GBS

A

Sx onset within 4-5 weeks of birth

Most common Sx: Bacteremia, meningitis, focal infections

64
Q

What scoring system is used to determine if a pregnant woman can safely be induced?

A

Modified Bishop

Scores based on:
• Dilation (0-3)
• Effacement (0-3)
• Station (0-3)
• Cervical consistency (0-2)
• Position of cervix (0-2)

8-13 points = highest chance of successful induction

0-4 points = highest chance of failed induction

65
Q

What testing is done for high risk pregnancies in the 3rd trimester?

A

NST - tracing of fetal HR and uterine activity x 20 min
• Must have min of 2 accelerations by 15 bpm lasting at least 15 sec

Biophysical profile
• Fetal U/S measuring (movement, muscle tone, breathing, AFI) - perfect score is 8/8
• Fetal HR also measured and scored —> perfect score 10/10

66
Q

What things should you discuss with the patient during the 3rd trimester?

A 
Anesthesia plans
Fetal kick counts
Preterm labor/labor precautions
Breastfeeding
Postpartum contraception
FMLA or disability forms
GBS
Post-erm/induction counseling
67
Q

What is an NT scan and when is it performed

A

Nuchal Translucency

Performed between 11-13.6 weeks

Thickened NT is soft marker for Down Syndrome

68
Q

What is FTS and when is it performed

A

First Trimester Screening

Serum draw that coincides with NT scan

Measures PAPP-A and ßHCG

If elevated, soft markers for Down Syndrome and Edwards Syndrome

69
Q

What is NIPT and when is it performed?

A

Non-invasive Perinatal Screening

Serum draw as early as 9 weeks

Fetal fraction of 8% needed

It’s expensive though - so offer but not many will do it

70
Q

How is AFP testing used in prenatal screening?

A

Maternal serum measured between 15-21.6 weeks GA

If elevated, can indicated possible NTD (screening only, not diagnostic)

71
Q

What is the Maternal Serum Screen and when is it performed?

A

Aka Quad screen

Drawn if NT/FTS was not performed. If NT/FTS already done, do AFP only

Performed at 15-21.6 weeks but most accurate at 16-18 weeks

Screens for NTDs, Downs, and Edwards Syndrome

Women's Health Unit 2 (4 decks)

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