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TEST 2 > Antepartum 2 > Flashcards

Antepartum 2 Flashcards

1
Q

Preconception care

A

health of women and partner- BEFORE PREGNANCY

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2
Q

What info is reviewed?

A

Personal and family history, physical examination, laboratory screening, reproductive planning, nutrition, supplements, weight, exercise, vaccinations, and injury prevention

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3
Q

GREATESTS risk time-frame

A
  • Between 17 & 56 DAYS AFTER conception
  • Up to wk. 14 of gestation
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4
Q

prenatal visits:

from conception up to week 28

A

evry 4 weeks

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5
Q

Prenatal visits:

Week 28 up to week 36

A

every 2 weeks

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6
Q

prenatal visits:

week 36 up to week 40

A

weekly visits

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7
Q

First prenatal visit consists of

A
  • Counselling & education (Nutrition, do’s & don’ts)
  • Laboratory Tests
  • Threshold for Dx of GDM in pregnancy
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8
Q

Lab tests taken in FIRST prenatal visit

A
  • Urine or Blood test
  • hCG
  • Diabetes Mellitus – Tight control
  • Gestational Diabetes (GDM)- on the rise
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9
Q

estimated due date (EDD) usinmg NAGELES RULE

A
  • FIRST DAY of LAST menstrual period
  • Subtract 3 months
  • Add 7 days
  • Adjust year if needed
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10
Q

Terms to know:

GTPAL is used todocument a woman’s obstetric history

A

G= gravida
T= term births
P= Preterm pregnancies
A= abortions
L= living children

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11
Q

Total number of pregnancies

A

Gravida

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12
Q

Term gestations delivering between 38-42 wks OR after 37 wks.

A

Term

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13
Q

Number of preterm pregnancies delivering between 20 & 37 wks.

A

Preterm

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14
Q

Number of pregnancies ending before 20 wks. or elective abortions

A

Abortion

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15
Q

Number of living children

A

Living

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16
Q

HEAD-TO-TOE assessment:

Head and neck

A
  • prev. injuries
  • sequelae
  • limitations of ROM
  • enlarged lymph nodes or sweeling?
  • edema of nasal mucosa
  • hypertorphy of gingival tissue (increased estrogen levels)
  • thyroid gland enlargment
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17
Q

HEAD-TO-TOE assessment:
Chest

A
  • soft systolic murmur=. normal (incr in blood volume)
  • incr heart rate
  • incr chest diameter
  • incr RR
  • fuller breasts
  • striae gravidarum (stretch marks)
  • darker nipple and areola
  • enlargement of montgomery glands
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18
Q

HEAD-TO-TOE assessment:
extremities

A
  • edema
  • pulses
  • varicose veins
  • 3rd trimester edeam =only normal
  • pain in calf
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19
Q

HEAD-TO-TOE assessment:
Abdomen

A
  • rounded and nontender
  • decreased muscle tone
  • 12 weeks: fundus @ symphysis pubis
  • 16 weeks: fundus b/t symphysis and umbilicys
  • 20 weeks: @ umbilicus
  • 36 weeks: just below xiphoid process
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20
Q

Pelvic exam:

3 measurements are assessed:

A
  1. Diagonal conjugate (DC)
  2. true conjugate (aka obstetric conjugate)
  3. ischial tuberosity (transverse diameter of pelvic outlet)
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21
Q

Pelvic exam consists of

A
  1. External genitalia: lesions, discharge, inflammation, STI (visual)
  2. Internal Genitalia: goodell sign, hegar sign, chadwick sign (blue cervix)
  3. Pap smear
  4. bimanual examination

PELVIC EXAM DONE BY HCP ONLY!!

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22
Q

type of pelvic measurement:
* Distance b/t anterior surface of sacral prominence & anterior surface of inferior margin of symphysis pubis.

A

Diagonal conjugate

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23
Q

Diagonal Conjugate- things to know

A
  • DC usually 11.5 cm or >
  • represents anteroposterior diameter (AP) of pelvic inlet which fetal passes FIRST.
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24
Q

type of pelvic measurement:

  • measurement from Ant. surface of Sacral prominence to the Post . surface of inferior margin of symphysis pubis.
  • Can not be measured DIRECTLY.
A

True conjugate
(aka obstetric conjugate)

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25
Q

Type of pelvic measurement:

  • Measurement made OUTSIDE the pelvis at the LOWEST aspect of the ischial tuberosities
A

ISCHIAL TUBEROSITY

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26
Q

Things to know about True conjugate

A
  • roughly 11.5 cm
  • SMALLEST Anteroposterior diameter
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27
Q

Ischial Tuberosity is best when

A
  • diamter of 10.5 cm or > = adequate passage of the fetal.
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28
Q

Additional lab studies include

A
  • Rh status-mom
  • Rubella titer
  • HIV testing
  • STI screening
  • Cervical smears
  • UA
  • Glucose
  • CBC
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29
Q

What to know about RH

A
  • Mom NEEDS to be Rh-sensitive
  • If not Rh sensitive you administer RhoGAM
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30
Q

Rh-NEG mother will receive testing (mom not sensitive)

A
  • at 28 weeks and again within 72 hrs AFTER childbirth (if she is RH-sensitive)
31
Q
  • Rubella Titer detects antibodies for virus that causes German measles.
  • Things for mom to keep in mind:
A
  • titer is 1:8 or < = mom is nOT IMMUNE.
  • requires immunization AFTER birth.
  • Mom is advised to AVOID people with undiagnosed rashes.
32
Q

If mom is HIV +

A
  • Requires more testing, counseling, and tx.
  • Rx to prevent transmission to fetus
33
Q

STI screening include following tests

A
  • veneral diseases researh laboratory (VDRL)
  • rapid plasma reagin (RPR)
  • cultures
  • lesions
34
Q
  • cervical smears test for
A

for syphilis, herpes, HPV, gonorrhea

35
Q

UA tests for

A
  • albumin
  • glucose
  • ketones
  • bacteria
36
Q

Glucose is tested on patients

A

that are high-risk

37
Q

What is this called?

A

Leopold’s manuevers

38
Q

Describe each pic

A
  1. locate FUNDUS
  2. find ant and post of baby by pressing SIDES
  3. Cervical area- find presenting part (head- harder or butt-squishy)
  4. Checking position of baby (vertex or breach)- Symphysis pubic
39
Q

fetal heart rate should be

A
  • Fetal HR (110 to 160 bpm)
40
Q

Fundal Height measurement

A
  • Reflects fetal growth
  • Gross estimate of duration of pregnancy
  • Fundal height = # of wks. until 36 wks.
41
Q

Fundal height measured in what position?

A

“Mcdonalds Method”
-supine position
-knees slighly flexed

42
Q

Fetal movement:

Quickening occurs during (baby movements)

A

2nd TRIMESTER.

43
Q

Fetal movement:

When to start counting fetal movement

A

28 weeks OF PREGNANCY

44
Q

HOW to count fetal movement

A
  • sit or lie on side
  • record time of 1st mvmnt
  • count until 10 mvmnts
  • record time of 10th mvmnt
  • NORM: 10 mcmnts in 2 hrs or SOONER
45
Q

When to call HCP regarding FETAL MVMNTS

A

more than 2 hrs and only felt 10 movements

46
Q

Call HCP if women experiences MENTRUAL-LIKE CRAMPS that are

A
  • occurring every 10 mins
  • low, dull backpain
47
Q

IF menstrual like cramps occur, what should the mother do?

A
  • Stop activity & lie down on left side for 1 hr.
  • Drink two or three glasses of water
  • If symptoms worsen or DO NOT subside after 1 hr. - Contact health care provider
48
Q

Dx test that
* Measure velocity of blood flow through umbilical cord
* Detect fetal compromise
* ID abnormalities in diastolic cord flow

A

DOPPLER FLOW STUDIES.

49
Q

when performing ULTRASOUND during EARLY pregnancy, what is needed?

A

A FULL BLADDER

50
Q

ALPHA FETOPROTEIN ANALYSIS: if found in mothers serum (blood), is this considered normal?

A

NO! it is a GLYCOPROTEIN which in high levels are related to failure of neural tube to close.

51
Q

Alpha Fetoprotein Analysis is TESTED on what weeks?

A

16-18 weeks

52
Q

Transabdominal puncture of amniotic sac drawn for analysis.

A

Amniocentesis

53
Q

Amniocentesis test for

A
  • Chromosomal abnormalities
  • Evaluate fetal condition
  • Diagnose intrauterine infection
  • Investigate AFP if MS levels HIGH
54
Q

when is Amniocentesis RECOMMENDED

A

15-20 weeks
Results in 3 weeks!!!

55
Q

Amniocentesis:

Normal color

A

clear, white flecks of vernix caseosa in mature fetus

56
Q

Amniocentesis:
Bilirubin levels norm is

A

absent at term

57
Q

Amniocentesis:
Meconium

A

absent

58
Q

Amniocentesis:
creatinine should be

A

> 2 mg/dL in mature fetus

59
Q

Amniocentesis:
Lecithin/ Sphyngomyelin should be

A

> 2 fetal pulmonary maturity

60
Q

Amniocentesis:
Bacteria

A

absent

61
Q

Amniocentesis:
chromosomes

A

normal karyotype

62
Q

At ANY PRE-PROCEDURE YOU ALWAYS NEED ___ SIGNED

A

Informed consent

63
Q

Administer RhoGAM IM if woman is

A

Rh -ve

(Rh-pos = dnt do anything)

64
Q

AFTER A AMNIOCENTESIS procedure what symptoms should be notified to HCP

A
  • Fever
  • Leaking amniotic fluid
  • Vaginal bleeding
  • Uterine contractions
  • Changes in fetal activity - increased or decreased
65
Q

Chorionic Villus Sampling to know

A
  • 10-13 weeks.
  • Few risk than amniocentesis
  • Results within 48 hrs.
  • Lithotomy position
65
Q

What to explain to pt with CHORIONIC VILLUS SAMPLING

A
  • Informed consent – witness sign NEEDED
  • Urge not to engage in any strenuous activity for next 48 hrs.
  • Administer RhoGAM if Rh-negative

Notify HCP:
* Fever
* Cramping
* Vaginal bleeding

66
Q

ANY test that goes thru amniotic sac a _____ test is done

A

RhoGAM

67
Q

Test done to/for:

  • Measure PERFUSION
  • Recommended 2 X week (after 28 wks.)
  • WHO has:
    -Diabetes
    -Other high-risk conditions
  • Mom presses button every time theres movement
A
  • NON-STRESS TEST

EMPTY BLADDER
MEASURES BABYS HEART RATE

68
Q

The NORMAL for Non-Stress TEst (NST)

A

2/15/15

  • 2 fetal heart beat acceleration from baseline
  • > 15 beats per min
  • last 15 seconds

in 20 min recording
anything outside this NEEDS ADDITIONAL TESTING

69
Q

Best time to travel

A

18-24 weeks.
(roughly 5 months)

70
Q

IMPORTANT:

IMMUNIZATION while pregnant

A
  1. Avoid LIVE virus (MMR & varicella)
    or
  2. Avoid pregnancy within 1 M of live vaccines
71
Q

Medications to AVOID while pregnant

A
  1. Midazolam
  2. corticosteroids
  3. ticagrelor
  4. ace-inhibitors (-pril)
  5. ARBS
  6. Statins
  7. NSAIDS (after 24 weeks)
  8. Aspirin (after 24 weeks)
  9. ASA/Caffeine
  10. Tetracyclines
  11. Warfarin
  12. Lithium
  13. CT/IV contrast
72
Q

What is this method called?

A

*Goodells and hegars method
* test for pregnancy (not 100% method to prove pregnancy)

73
Q

Lab results that states you are positive for GESTATIONAL DIABETES MELITIS

A
  • Fasting plasma glucise: 126 mg/dL
  • HbA1c: 6.5% or higher
  • Random plasma glucose: 200 mg/dL

TEST 2 (6 decks)

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