Antepartum Flashcards
Goal of prenatal care
Ensure a healthy baby and minimize maternal risk
How much more likely is a baby to have a low birthweight if the mother does not receive prenatal care?
3x more likely
How much more likely is a baby to die if the mother does not receive prenatal care?
5x more likely
When is the ideal time for the first prenatal visit?
6-10 weeks
How often should a pregnant woman be visiting the ob doctor throughout pregnancy?
Every 4 weeks up until 28 weeks, every 2 weeks between 28 and 36 weeks, and every week from 36-40 weeks
Which prenatal visit will be the most comprehensive?
1st
What information should be gathered for a woman’s prenatal history?
LMP, EDD, GA, G/P, G-TPAL, GYN history, STD history, medical/surgical history, genetic history, occupation, medications, if contraceptives were used, allergies, significant FOB health history, social profile
What tests are run when bloodwork is done during the 1st prenatal visit?
Blood type, rubella titer, syphilis, hep b, HIV, CBC baseline, serum glucose
Which immunizations are recommended during pregnancy?
Influenza, tdap(2nd or 3rd trimester), hep A and b, covid-19
What is included in the physical examination at the first prenatal visit?
Vital signs, height/weight, head to toe assessment, pelvic and breast exam, ultrasound
Which test is performed at every prenatal visit?
Urinalysis
What is examined in the pelvic exam?
Vulva and cervix
Is ultrasound dating or LMP dating for EDD more accurate?
Ultrasound
why is folic acid important in pregnancy?
Prevents neural tube defects
What is prescribed to decrease likelihood of preeclampsia in at risk women?
Low dose aspirin
At 32 weeks pregnant, how often should prenatal visits be scheduled?
Every 2 weeks
When is a late preterm baby born?
34 weeks to 36 6/7 weeks
What is considered early term?
37 - 38 6/7 weeks
What is considered full term?
39- 40 6/7 weeks
What is considered late term?
41-41 6/7 weeks
What is considered post term?
> 42 weeks
Are twins/triplets considered as multiple para in the G/P system?
No
What does G/TPAL stand for?
Gravida/term, preterm, abortion, living
what type of history is gathered for prenatal visits after the first visit?
Interval history
What things are assessed at prenatal visits following the first visit?
Vital signs, height, edema, fundal weight, FHR, fetal movement
Why is it important to take vital signs at every prenatal visit?
To assess for preeclampsia
Why is a fever of 101°f a concern in pregnancy?
Infection
Why is sudden severe of continuous pain or cramping in the lower abdomen a concern in pregnancy?
Ectopic pregnancy, preterm labor, placental abruption, non-pregnancy causes such as: UTI or appendicitis
why can bleeding or spotting from the vagina be a cause of concern for a pregnant woman?
Could be a spontaneous abortion, abruption, placenta previa, friable cervix, labor
What can severe headaches or visual disturbances be a sign of?
Pre-eclampsia
What can sudden, severe swelling of hands, feet, face, or generalized edema be a sign of?
Pre-eclampsia
Why is persistent vomiting a concern?
Can cause a risk of dehydration
4 or more uterine contractions per hour before 37 weeks can be a sign of____?
Preterm labor
A continuous leaking of small amounts of fluid from the vagina or a gush or water from the vagina may be a sign of _____?
PROM
What are 6 common discomforts of the first trimester?
Nausea/vomiting, urinary frequency increases, fatigue, breast tenderness, increased vaginal discharge, nasal stuffiness and nosebleed
Common discomforts of pregnancy in the second and third trimesters
Heartburn, ankle/mild edema, faintness, dyspnea, carpaI tunneI syndrome, varicose veins, hemorrhoids, constipation, leg cramps, round ligament pain, backache-sciatica, SI joint, flatulence
Fundal height at 10 weeks
An orange
Fundal height at 12 weeks
A grapefruit
Fundal height at 16 weeks
Midway between symphysis pubis and umbilicus
Fundal height measurement at 22-34 weeks
Measurement in centimeters roughly corresponds with weeks’ gestation
Fundal height measurement at 38 weeks
@Xiphoid process
Normal FHR range
110-160 bpm
When can you hear the fetal heart rate on the ultrasound?
6-7 weeks
When can the fetal heart rate be heard on the Doppler?
10-12 weeks
When can a fetal heartbeat be heard with a fetoscope?
17-20 weeks
When will mothers be able to feel the fetus moving?
~ 16 weeks
How many fetal movements should be felt in 1 hour/2 hours?
4/10
When can a noninvasive prenatal test be done to determine genetic abnormalities?
10 weeks (results in 5 days)
When can an ultrascreen for chromosomal abnormalities be performed?
11 1/7 weeks to 13 6/7 weeks
What can maternal serum alpha-fetoprotein indicate if it is too high/low at 15-20 weeks?
Chromosomal trisomies/NTDs
When is the diabetes screen for gestational diabetes performed?
24-28 weeks (at the end of 2nd trimester)
When would a 3 hour glucose tolerance test be performed?
If 1 hour glucose test is ≥ 140
What lab screenings are done in the 2nd trimester?
Diabetes screen, hemoglobin/hematocrit, antibody screening for Rh neg patients, rhophylac (RhoGAM) administration
What is one of the most important lab screening to be done in the third trimester?
Group B streptococcus culture
Barriers to prenatal care
Financial, systemic, attitudinal, may not realize She’s pregnant
Types of prenatal tests
Nonstress test (nst), contraction stress test (CST), biophysical profile (bpp), ultrasound, Doppler ultrasound blood how assessment, chorionic villus sampling (CVS), fetal movement counts, alpha-fetoprotein screening, multiple marker screening
What is considered a geriatric pregnancy?
≥ 35 yo
What age is considered a young mom?
<16
Can you confirm abnormalities with screening tests?
No. Only diagnostic tests can confirm abnormalities
Which pregnancies are considered to be at risk?
Young/old mom, maternal diseases, Rh isoimmunization, previous poor pregnancy outcomes, suspected intrauterine growth restriction, post-dates pregnancy, multiple gestation
What happens to fetal oxygenation during contractions?
Oxygenation stops
What pattern of loss is observed in a fetus that is hypoxic?
FHR reactivity is lost, sucking stops, breathing movement stops, general movement stops, muscle tone is no longer detected
When can muscle tone be detected?
7-8 weeks
When can fetal movement be detected on an ultrasound?
8-9 weeks
When can fetal breathing movement be detected on an ultrasound?
11-12 weeks
When can sucking be seen on an ultrasound?
12-14 weeks
When can fetal heart rate reactivity be detected?
28-32 weeks
What is done in a nonstress test?
External fetal heart rate monitor observes fetal heart rate reactivity
What is considered a reactive non-stress test?
Increase of 15bpm for 15 seconds with 2 episodes in 20 minutes
Why is a contraction stress test used?
To determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow
What is the ideal result of a contraction stress test?
No fetal heart rate decelerations with 3 contractions lasting at least 40 seconds
What are the 5 parts of a biophysical profile?
Fetal heart rate accelerations, fetal breathing movements, gross fetal movement, fetal tone, and amniotic fluid index
What is the ideal range for amniotic fluid?
500-1000 mL
What does a modified biophysical profile include?
Combination of a non stress test and an amniotic fluid index
How does an ultrasound work?
Sound waves bounce off fetus and anatomical structures, creating a “picture”
How does an ultrasound determine the fetal age?
Crown rump length
what is an ultrasound used for in the second trimester?
Confirm due date, observe fetal anatomy, location of the placenta, multiple gestation, adjunct to amniocenteses
What is an ultrasound used for in the third trimester?
Fetal growth and presentation, biophysical profile/amniotic fluid index, suspected intrauterine fundal development, adjunct to external version
When will Doppler ultrasound umbilical blood flow studies be done?
Pregnant mothers with Hypertension, fetal growth restriction, placental insufficiency
Why would an amniocentesis be performed in early pregnancy /late pregnancy?
Early: diagnose neural tube defects& Down’s syndrome
Late: lung maturity
Can also be used to test for intrauterine infections and hemolytic disease
what lecithin/sphingomyelin ratio indicates lung maturity?
2:1
What does a positive pg/pi test indicate?
Fetal lung maturity
What is chorionic villus sampling used for?
Prenatal genetic diagnosis
How is percutaneous umbilical blood sampling done?
Aspiration of fetal blood from the umbilical cord near the placenta
What does umbilical blood sampling detect?
Blood disorders, acid-base imbalance, infection, or fatal genetic disease
Which test predicts severe fetal anemia?
Delta OD 450 (middle cerebral artery doppler ultrasound study can also predict fetal anemia)
How is the due date calculated using Nagaele’s rule?
LMP minus 3 months plus 7 days
