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Endo/Repro II Test 1 > 6. NL Pregnancy: Antepartum Care > Flashcards

6. NL Pregnancy: Antepartum Care Flashcards

1
Q

What is the goal of pre-conception care?

A

Make sure pts health is BEST before conception to reduce adverse effects for W, fetus and neonate.

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2
Q

______% of pregnancies are NOT planned.

A

49%

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3
Q

ACOG recommends a visit by pt who is considering to get pregnany to ID risks and promote pre-conception healthy via what measures?

A
    1. ID risks
    1. Promote health
    1. Medical intervention (DB management)
    1. Psychosocial intervention (reduce stress)
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4
Q

As part of preconception care, when should a women start folic acid and why?

Does in someone with no hx of NTD vs hx of previous child w/ NTD.

A
  • At least 1 month before conception to ↓ risk of neural tube defects (spina bifida and anecephaly)
    • NO Hx of NTD = 0.4 mg
    • Hx = ↑ to 4.0 mg
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5
Q

Explain the terms gravidity and parity and know how to classify them properly

A
  • Gravidity = number of times pregnant
  • Parity = broken down into FPAL
    1. ​# of PG that led to birth at or beyond 20 weeks
    2. Infant weighs more than 500g
      1. F (full-term) = 37- 42 weeks
      2. Preterm = 20-36 weeks and 6 days
      3. Abortions = pregnancy loss before 20 weeks (< 500 grams) including ectopic pregnancy and spontaneous and elective abortions.
      4. Living
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6
Q

What is G/P?

W gave birth to 1 set of twins at full term and both living

A

G1P1002

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7
Q

What is G/P?

W gave birth to 1 term infant, 1 set of preterm twins and has had 1 miscarriages and 1 ecotopic PG; 3 living children

A

G4P1123

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8
Q

What should be done at the 1st prenatal visit?

A
  1. Get THOROUGH HISTORY
    1. Medical (dm, htn?)
    2. Reproductive (PTD, preclampsia)
    3. Family
    4. Nutritional
    5. Social
    6. Psychosocial
  2. Complete PE
  3. Labs
  4. Confirm pregnancy and viability
  5. Estimate gestational age and due date
  6. Provide genetic counseling
  7. Discuss tetraology (meds)
  8. Advice on how to decrease early PG sx
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9
Q

List some of the NL PE findings in pregnancy (5)

A
  1. Systolic murmurs w/ exaggerated splitting and S3
  2. Palmar erythema + Spider angiomas
  3. Linea nigra = dark nips
  4. Striae gravidarum
  5. Chadwicks sign = blue hue of vagina
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10
Q

What prenatal labs are usually done at 1st visit?

A
  1. CBC
  2. Blood type and screen for Rh
  3. Rubella vaccine
  4. Syphillis/HBsAg/HIV/cervical cytology of gon and chlam
  5. Screen for DB is risk factors
  6. UC
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11
Q

Is pregnancy is hyper/hypo-coagulable state?

How does that effect fibrinogen, urine protein, platelets and hematocrit/hemoglobin?

A

Hypercoagulable; ↑ serum fibrinogen, urine protein, platelets; ↓ hematocrit/hemoglobin

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12
Q

What is the gestational age?

A

of weeks between [first day of LMP & delivery date].

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13
Q

How do we confirm a pregnancy and the viability? What hCG value is considered a (+) pregnancy test?

A
  1. + pregnancy test: hCG is +25 IU/L
  2. Transvaginal US detects gestational sac around 5 weeks with a hCG of 1500-2000 IU/L
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14
Q

How do we evaluate whether a patient has a early IUP or ectopic PG?

A

In a NL PG: hCG should double every 2.2 days.

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15
Q

How can we determine the due date of a pregnancy

A
    1. LMP using Naegels rule
    1. PE by measuring size of the uterus
    1. US
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16
Q

What is Naegels rule for estimating the expcted day of delivery for a lady who is normally cycling every 28 day?

A

(LMP - 3 months) + 7 days = expected date of delivery

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17
Q

To calculate the expected date or delivery, Naegels rule can only be used in who?

A

Patients with REGULAR 28 day cycles; cannot be used in ppl with irregular cycles or does not know LMP.

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18
Q

How can we determine the due date via US in 1st, 2nd, 3rd trimester?

How accurate will they be?

A
  • 1st trimester: Crown Rump Length (CRL) can be seen at 6-11 weeks and determine due date within 7 days
  • 2nd trimester: measure length of femus, circumference of abdomen and biparietal diamter between 12-20 weeks; determines due date w/i 10 days
  • 3rd timester: due date can be off +/- 3 weeks h
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19
Q

CRL = ____ _______ = fetal demise

A

CRL > 5mm without fetal cardiac activity

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20
Q

What is considered advanced maternal age when genetic counseling should be offered?

A

35 y/o +

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21
Q

After how many spontaneous abortions should chromosomal studies (karyotyping) be done on a mother and father?

A

After 3 or more

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22
Q

Women that are ____ years or older at an in increased risk of autosomal trisomies (13, 18 and 21) or sex chromosomes abnormalities?

A

35 years or older

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23
Q

A couple who previously had a child with Down Syndrome has a ____% risk of giving birth to another affected child with a chromosomal abnormality.

A

1%

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24
Q

If a couple comes in with a balanced translocation, what should be done?

A
  • Receive counseling about having a bb with an unbalanced translocation and thus, offere prenatal diagnosis via [chorionic villus sampling/amniocentesis]
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25
Q

What is the most common form of inherited mental retardation?

A

Fragile X syndrome

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26
Q

AR disorders (4)

A
  1. CF
  2. Tay-Sachs
  3. Sickle cell
  4. Alpha and beta thalassemia
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27
Q

What is focused on genetic screening for AR disorders?

A
  1. Carrier screening in high-risk population because frequency of heterozygotes is greater than that of general population
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28
Q

Why is genetic counseling for CF so important?

A

15% of carriers are undetected.

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29
Q

Who gets genetic counseling for CF?

A
  1. ALL pregnant people
  2. Ppl with family hx/partners of known carriers
  3. Parents w echogenic bowel on US
  4. Sperm donors
  5. Any pt who wants it
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30
Q

Neural tube defects

  • Inheritance:
  • Factors that lower risk:
  • If woman has affected child, how much should they take in next PGcies and when?
A
  • multifactorial
  • folic acid
  • 4mg before conception since neural tube closes at 28 days.
31
Q

Screening for fetal aneuploidy can be done when?

A

1st and 2nd trimester

32
Q

4 things included in the 1st trimester screening for fetal aneuploidy

A
  1. Maternal age
  2. Fetal nuchal translucency (NT) thickness = echo free area @ back of neck seen at 10 - 14 weeks.
  3. Maternal serum b-hCG
  4. plasma protein-A (PAPP-A)
33
Q

Which finding of fetal nuchal translucent (NT) thickness => both chromosomal and congenital anomalies?

A

Increased thickness

34
Q

1st trimester screening of Down Syndrome has a accuracy of _____%, and can be done how?

A

79%

High b-hCG and low PAPP-A

35
Q

Which finding of b-hCG and PAPP-A is associated with down syndrome; measurement of what can increase the detection rate?

A
  • ↑ b-hCG and ↓ PAPP-A
  • Nasal bone assessment (absence of) in nuchal translucency measurement ↑ detection rate
36
Q

How can we detect fetal aneuploidy in 2nd trimester?

A
  1. Triple screen (b-hCG, estriol, serum AFP) between 16-20 weeks
    1. 70% chance of detecting DS
  2. Quadruple screen (b-hCG, estriol, serum AFP, inhibin A)
    1. 80% detection rate of DS
37
Q

When is screening for cell-free fetal DNA done and why is it so hyped?

A
  • 9-10 weeks (1st or 2nd trimester), looks for cell free fetal DNA, thought to be due to apoptosis of trophoblastic cells that have entered maternal circulation
  • Very high detection rates for trisomy and sex chromosome disorders
38
Q

What does cell-free fetal DNA not test for?

A
  • Open neural fetal defects; thus, evaluate for NTD w/ maternal AFP or US
39
Q

Cell-free fetal DNA screening should only done in high risk patients, list 5 situations.

A
  1. Advanced maternal age
  2. Hx of prior pregnancy w/ a trisomy
  3. Family hx of chromosomal abnormalities
  4. Fetal US abnormalities suggestive of aneuploidy
  5. Positive serum screening test including 1st trimester, triple or quad screen
40
Q

If Cell-Free fetal DNA screen is (+), what is next step in confirming results?

Which has a higher rate of miscarriage?

A

Conduct invasive diagnostic test to confirm results:

  1. Amniocentesis at 16-20 weeks
  2. Chorionic villi sampling at 11 weeks
    1. (high rate of miscarriage)
41
Q

Teratogens cause major defects in 3% of population; 97% are NL.

The teratogen, Thalidomide, is associated with what congenital deformity?

A

Phocomelia

42
Q

Which risk factor category for medications during pregnancy states that adequate well-controlled studies or observations in pregnant women have demonstrated a risk to fetus; but the benefits of therapy may outweight potential risks?

A

D

43
Q

What class?

Controlled studies show NO risk in pregnancy in ANY trimester

A

A

44
Q

What class?

  • Animal studies show no harm to fetus, but no adequate/well-controlled studies are done in PG women
    • or
  • Animal studies have AE, but studies in PG women do not show risk to fetus in any trimester
A

B

45
Q

What class?

Drug is CI in women who are or may become PG because adequate well-controlled/observational studies in animals or PG women show risk for risks to fetus/abnormalities

A

X

46
Q
  • Animal studies = AE or not conducted and no adequate/well-controlled study in PG women
A

C

47
Q

Pregnant patient needs anti-seizure medications for a life-threatening contion, even though there are studies that show there is a risk to the fetus.

A

D

48
Q

When is the most vulnerable stage in terms of effects of teratogens?

A

Day 17 => 56 post-conception= organogensis

49
Q

PLLR (Pregnancy and Lactation Labeling Rule) removed FDA letter categories for drugs and to help better ID risk/benefit and counseling in PG/nursing moms.

What are the 5 subsections it includes?

A
  1. Pregnancy subsection
  2. Lactation subsection
  3. Females and Males of reproductive potential
50
Q

In general what kind of effect do teratogens have after the 4th month => end of gestation?

A

Delayed growth of organs, NOT malformation (except brain and gonads)

51
Q

Which anti-coagulant does and which does not cross the placenta?

A
  • Does = coumadin (D) = teratogen
  • Does not = Heparin (B)
52
Q

What is the drug of choice for anxiety and depression during pregnancy?

Which drugs are class D teratogens?

A

Fluoxetine

  • Class D teratogens: Meprobamate and Chlordiazepoxide
53
Q

The anticonvulsant, Diphenylhydantoin (D), is a known teratogen which may cause what?

A

Fetal hydantoin syndrome (FHS)

54
Q

How is tobacco smoke a teratogen?

A
  • Interferes with growth of bb (IURGR and LBW); increased risk for spontaneous abortion, fetal/neonatal death and prematurity
55
Q

What infectious agent causes proptosis, depressed nasal bridge and a triangular mouth?

A

CMV

56
Q

What are the 3 dose dependent effects of radiation exposure to a fetus during the 2-6 weeks critical period post-conception?

A
  1. Teratogenesis
  2. Mutagenesis
  3. Carcinogenesis
57
Q

If radiation exposure occurs during the first 2 weeks post-conception what is the response like?

A

Either all or none = will be lethal or no effect

58
Q

What is the rule of thumb for how much radiation to mother poses no risk to fetus?

A

<5 rads of exposure = no risk

59
Q

What are some recommendations you can give to pregnant woman who is suffering from nausea and vomiting?

A
  1. Eat small but frequent meals
  2. No greasy, fried foods
  3. Room temperature sodas and saltines
  4. Accupuncture
  5. Meds = antihistamines, vit B6, and antiemetics (phenergan, zofran)
60
Q

What is the cause of frequent heartburn during pregnancy?

A

Progesterone relaxes esophageal sphincter

61
Q

50% of pregnant women will experience what unpleasant symptoms?

A

Leg cramps, most common in last 1/2 of PG and more frequent in calves at night.

62
Q

What is the frequency of prenatal office visits throughout the pregnacy?

A
  • Every 4 weeks until 28 weeks
  • Every 2 weeks from 28-36 weeks
  • Weekly until delivery
63
Q

What occurs at routine prenatal office visit?

A
  1. BP/ weight
  2. Urine protein
  3. Measure size of uterus (20 weeks at the umbilicus)
  4. Check fetal HR
  5. Check fetal movements and kicks
  6. Educate on preterm and lab and complications of PG
  7. Discuss lifestyle sitations
64
Q

The first sensation of fetal movement (quickening) begins to occur when?

A

20 weeks

10 times/ 2 hours

65
Q

Near term, what should you do at the prenatal office visit?

A
  1. Discuss fetal lie
  2. Discuss fetal position (vertex, breech)
66
Q

At how many weeks gestation do you obtain fetal survery ultrasound?

A

20 weeks

67
Q

What routine screening and management is completed at 28 weeks gestation?

A
  1. Screen for gestational diabetes and repeat hemoglobin and Hct
  2. Give rhogam injection to Rh (-)
  3. Give Tdap give between 27-36 weeks
68
Q

At how many weeks gestation is screening for group B strep carriers w/ culture of vagina done?

A

36 weeks

69
Q

How can we assess fetal health?

A
  1. Assess kick counting of BB by conducting NST (non-stress test)
    1. Reactive/NL => During 20 minutes of monitoring, 2 accelerations of at least 15 beats above baseline lasting for at least 15 seconds
    2. Non-reactive=> further evaluate with
      1. Contractions stress test (CST)
      2. Biophysical test
70
Q

What is a contration stress test (CST) and what is considered a positive test?

A
  • Give oxytocin and try to cause at least 3 contractions in a 10 min
  • Postive: late decelerations are seen w/ the majority of contractions
  • => DELIVER BB
71
Q

What are the 5 components of the Biophysical profile for assessing fetal well-being when NST is non-reactive?

A
  1. Nonstress test (NST)
  2. Fetal breathing movements
  3. Fetal movement
  4. Fetal tone
  5. Amniotic fluid volume
72
Q

Which score on a biophysical profile for assessing fetal well-being is reassuring, equivocal, and non-reassuring?

A
  • 8-10 = reassuring
    • If NST is (-) = max is 8
  • 6 = equivocal; deliver if pt is at term
  • 4 = less is nonreassuring; consider delivery
73
Q

What is the most reassuring of no stillbirths with 1 week of NL test in a NL antepartum test?

A
  • Negative Contraction Stress Test - CST (0.3 per 1000) stillbirths
74
Q

  1. During a prenatal visit a patient tells you her last menstrual period was May 21, 2016. Based on the Naegele’s Rule, when is the estimated due date of her baby?*

A. February 27, 2016

B. March 19. 2017

C. February 28, 2017

D. April 16, 2016

A

C

Endo/Repro II Test 1 (23 decks)

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