7. Normal Pregnancy and Prenatal Care Flashcards
Preconception care is to reduce risk of adverse effects for the woman, fetus, or neonate by optimizing patients health before conception, although 49% of pregnancies are unplanned, stop smoming and drinking, kick DM, and reduce?
STRESS prior to birth
Preconception care would also include taking folic acid supplements at 1 month before conception to reduce neural tube defects NTD (spina bifida/anecephaly), along with adequate control of what?
glucose - decreases maternal morbidity and SABs
Normal PE findings associated with pregnancy include systolic murmurs (exaggerated splitting and S3), palmar erythema, spider angiomas, striae gravidarum, chadwicks sign and?
Linea Nigra (darkening of skin)
Prenatal labs at 1st visit includes CBC, type and screen, rubella, syphilis, Hep B, HIV, diabetes, urine cultures, all pregnant women are screened for what at week 28?
Diabetes
Fibrinogen is usually increased during pregnancy due to the hypercoaguable state, also on first prenatal visit, confirm pregnancy and viability- estimate gestational age and due date… gestational age is the # of weeks that have elapsed between the first day of the LMP and the?
delivery date
**US first day meeting preg patient
hCG is important on first visit, less than 5 is negative, 25 is positive and >100 is reached by time of expected menses, most urine tests can detect hCG at what level?
25!
**hCG doubles every two days !!! (in first 30 days)
Gestational sac is seen at 5 weeks (1500-2000hCG), fetal pole at 6 weeks, cardiac activity at 7, gestation age can be estimated via US, what length between 6-11 weeks can determine due date within 7 days?
Crown Rump Length CRL
12-20wks femur length, biparietal diameter and abd circumgerence can determine due date within 10days
Fetal demise can be diagnosed if the CRL is greater than 5mm with absence of ?
fetal cardiac activity (missed abortion :( )
Chormosomal disorders are found in 50% of spontaneous abortions, women that are 35 and older are at an increased risk of autosomal trisomies, 95% of downs syndrome is due to meitoic nondisjunctional events leading to 47 chromosomes with an extra copy of?
Chr 21
4% d/t unbalanced translocations
A couple who previously has had a child with downs syndrome has about what % risk to another affect child with a chromosomal abnormality?
1% risk
Most common CLASS of spontaneous abortions SABs are the autosomal trisomies (16 MC), and the most common SINGLE chromosomal abnormality found in SABs is?
45XO Turner Syndrome
Autosomal dominant disorders that could be passed on include tuberous sclerosis, achondroplasia and muscular dystrophy, some AR DOs include tay-sachs, sickle cell, and CF. Carrier screening of heterozygotes is done for what AR disease because it is greater than that of the general population?
Tay-sachs in Eastern european jews
What is a sex linked disorder caused by recessive genes on the x chromosome, usually affecting males and is the MC form of inherited mental retardation (after downs?)?
Fragile X Syndrome
broad forehead, large ears, elongated face, tall
Multifactorial disorders include cleft lips/palate, congenital heart defects and NTD. what has an incidence of 1 per 1000 live births and folic acid supplementation has been shown to lower the risk, women w affected child should take 4mg in subsequent pregnancies before conception*?
Neural Tube Defect
What causes fetal aneuploidy?
DES
First trimester screening includes maternal age, fetal nuchal translucency thickness (inc=congen/chrom abnl), b-hCG, and pregnancy associated plasma protein -A PAPP-A…. Elevated bhCG and low PAPP-A is associated with Downs with 79% correct, if there is absence of nasal bone then there is a detection rate of?
93%
Second trimester triple screen includes b-hCG, estriol, maternal serum alpha fetoprotein (AFP) between 16-20 weeks, 70% detection of Trisomy 21, the following is termed what? b-hCG, estriol, AFP and inhibin A*
Quadruple Screen (80% detection of trisomy 21)
What noninvasive prenatal testing is done at 9-10 weeks and tests cell free fetal DNA thought to be derived from apoptosis of throphoblastic cells that have entered circulation, with trisomy 21/18 detection rate of 99.4%?
Cell-Free fetal DNA
does not test for NTD, AFP does !
Cell-Free fetal DNA is only ordered in high risk patients including advanced age, hx of prior trisomy, fam hx, etc, if a positive test result, proceed with invasive diagnostic test to confirm, such as CVS or?
amniocentesis
Second trimester DIAGNOSTIC procedures include an amniocentesis at 16-20 weeks, or chorionic villi sampling at 11 weeks (CVS)
MEOW
Teratology is defined as the study of abnormal fetal developent, what is no longer used for nausea in pregnant women but when used causes phocomelia?
Thalidomide
the most vulnerable stage of a fetus to teratogens is day what to what day, a period known as organogenesis, determining which organs are affected, from the fourth month to end of gestation development consists primaruly of increasing organ size, not development?
Day 17-56
Teratogenic agents consist of drugs, infectious agents and radiation. What is the most common teratogen to which a fetus is exposed and may cause a fetal syndrome?
Alcohol- Fetal Alcohol Syndrome
What describes the followiing….
growth restriction, low set ears, smooth philtrum, thin upper lip, shortened palpebral fissures, flat midface, and CNS dysfunction including microcephaly, mental retardation and behavior disorders
Fetal Alcohol Syndrome
What drug crosses the placenta and causes SABs, intrauterine growth restriction, CNS defects like mental retardation, stillbirth and craniofacial features known as fetal warfarin syndrome…?
Coumadin (crosses placenta… Heparin does not!!!)
1 in 200 women are epileptic, benefits of seizure prevention needs to be weighed against teratogenicity of the drug, what is the name of the drug, which causes fetal hydantoin syndrome FHS causing craniofacial abnormalities, limb reduction defects, prenatal onset growth restriction mental deficiency and CV anomalies?
Diphenylhydantoin (Dilantin)
What hormone used to be used for threatened abortion, and causes T shaped uterus, along with cervical abormalities, uterine malformations, F are more likely to get vaginal cell cancer and M are at risk for testicular abnormalities and malignancies?
Diethylstilbestrol DES
What intereferes with fetal growth as in weight length and head circumference, increased risk of SABs, fetal death, neonatal death and prematurity?
Smoking Tobacco
Radiation may be teratogenic, it is dose dependent, with a critical period between 2 and 6 weeks post conception, if exposure before 2 weeks = lethal or not lethal… in most cases diagnostic radiation has no effect… less than how many rads?
less than 5 rads = no risk
Heartburn in pregnancy is caused due to relaxation of esophageal spincter by progesterone. Constipation due to decreased colonic activity, hemorrhoids due to increased venous pressure in rectum, what sx is more common in last half of pregnancy and more frequent in calves at night?
Leg cramps *50% of women experience this
***MC sx of pregnancy is what in late pregnancy, avoid excess weight gain, excersing, wear comforatble shoes, heat, massage
Back pain -90%
Visits: q 4 wks until 28, then q 2 weeks til 36, weekly til delivery
At said visits: BP, weight, urine protein (preeclampsia), measurement of uterus and fetal heart rate… how many kicks should be felt per hours?
10 kicks per 2 hours
What screening should be done at 35 weeks?
Group B strep carrier with vaginal culture - tx in labor if possible
What test if reactive means 2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes of monitoring? (if nonreactive further evaluation is warranted w contraction stress test or biophysical profile)
Nonstress Test NST (assesment of fetal well being)
What test consists of giving oxytocin to establish at least 3 contractions in a 10 min period, if late deceleration are noted with the majority of contractions the test is POSITIVE and delivery is warranted?
Contraction Stress Test CST (assesment of fetal well being) BADDDD
The biphysical profile has 5 variables that are compared to normal results, if the baby meets all 5 = 2 per section = 10 =reassuring, 6 is equivocal-deliver if patient is at term and 4 or less is non reassuring and should consider?
Delivery
