Antenatal care Flashcards
presumptive signs of preg (7)
- amen
- chadwicks (discoloration of mucus)
- breast changes
- subective - tired, nausea
- fetal movement
- skin color changes
- abdomental striae
3 probable signs
- enlarged abdo
- enlarged uterus
- softening of cervix
4 positive signs
- pos. preg tests
- fetal heart beat
- fetal movement by examiner
- US of fetus
3 ways to assess GA
- LNMP + 40weeks
- US - more accurate earlier
- bimanual exam - symphysis- fundal height
6 preexisting risk factors
- maternal medical
- uterine anomalies
- losses before
- late maternal age
- multiple preg
- social issues
3 subsequent maternal at risks
- gest. hypertension
- gest. diabetes
- cholestasis of preg.
5 fetal risks
- growth restricton
- chromo or structural abnorm
- hydrops
- cardiac
- malpresentation
7 placental/cervical issues
- short cervix
- preterm labor
- PPROM
- abnormal placenta
- antepartum hemorrage
- ploy.ogliohydramnioa
- post term preg
4 ways to assessfetal well being
- growth rate
- kick counts - 6/hour
- non-stress fetal heart monitor
- contraction stress test - heart with oxytocin
6 times/ways to assess at-risk preg
- ultrasound assemment in first trimester
- complete anatomical scan (18-20)
- growth charting
- biophysical profile (movement, breathing, tone, fluid)
- doppler flow studies (umbilcal and MCA)
- third trimester scan
goals of routine care
- heathiest mom and bebe possible
- education
- psychosocial support
- anticipate complicstions
prenatal visit schedule
First visit: 8‐12 weeks
• Every 4 weeks until 28 weeks gestation
• Every 2 weeks from 28‐36 weeks gestation
• Every week from 36 weeks to delivery
• 11‐14 weeks: IPS Part 1 or FTS / NIPT
• 15‐20 weeks: IPS Part 2 / MSS / Quad screen
• 18‐20 weeks: Anatomical U/S
• 27‐29 weeks: GCT, Rhogam, Repeat CBC
• 36 weeks: GBS, Vagino‐rectal swab
• 40+ weeks: Weekly biophyscial profile for post‐dates
what is test for gest. DM
glucose challenge test
when to give Rh IG
- Rh -ve mother
- @ 28 weeks or whenever possibility of hemmorage
what is GBS tests
group B strep
- done at 35-37 weeks
- if neg - no ABs
routine investigations at first visit
– CBC
– Rubella status
– Hepatitis B Surface Antigen
– VDRL
– Blood Group and Rh status, Antibody Screen
– Urinalysis and Urine culture (2‐7% of women have
asymptomatic bacteriuria)
– Pap smear
– Cervical cultures for gonorrhea and Chlamydia
– TSH
2 consented investigations
- HIV
2. hepC
what is non-invasive screeing
first trimester screen for downs and 18
what is tested in non-invasive first trimester screening
- nuchal translucency
- free HCG
- maternal PAPP
what does FTS not test
open neural tubes
what is intergrated prenatal screening
US and blood test
what is tested in T2 screening
AFP, BhCH, estiol
what is quad screen
only in those that missed FTS
- maternal alpha fetoprotein
- beta HCG
- unconjugated estriol
- serum inhibin A
what is non-invasive prenatal testing
testing fetal DNA in maternal blood
- trisomy 21,18,13, sex, Rh
2 types of invasive testing
- CVS - higher risk, but done earlier
2. amniocentesis
2 types of previous loss to assess
pre and post 20weeks
4 things to assess in uterus
- size, shape symterrty
- adnexa
- bony pelvic
- pelvic inlet
what can be done for NVP
common
- rule out other causes
- diet and lifestyle
- diclectin
nutrition for mom
- folic acid
- 3-4 servings of milk
- increase calories a bit
what vaccines are safe
killed only
- non-immune rubella are given MMR
- NOT - BCG, MMR, varicella
what to give for PPdepresion
SSRI, not paxil
