Antepartum Care Flashcards
Preconception Care
goal to reduce risk of adverse effects by optimizing ps health b/f conception
- risk assessment
- health promotion
- medical intervention (diabetes management, folic acid supplementation)
- psychosocial intervention (stress reduction)
G and P
- gravidity- number of times pregnant
- parity- number of births (>20 wks or >500 gms)
- FPAL:
- full term (37-42 wks)
- preterm (20-36)
- abortions (< 20 wks)
- living
normal PE findings assoc with pregnancy
- systolic murmurs
- palmar erythema
- spider angiomas
- linea nigra
- striae gravidarum
- chadwicks sign
confirming pregnancy and viability
- HCG
- TVUS- gestational sac seen around 5 wks (HCG 1500-2000), fetal pole at 6 wks, cardiac activity at 7 wks
estimating gestational age and due date
- LMP minus 3 months + 7 days= expected date of delivery
- crown rump length b/w 6-11 wks can determine due date within 7 days
chromosomal disorders
- 0.5% of all live births
- spontaneous abortions- 50%
- > 35 yo- inc risk of autosomal trisomies or sex chrom abnormalities
Down syndrome
- 95% of cases due to meitotic nondysjxnal events- 47 chrom with an extra copy of chrom 21
- 4% due to unbalanced translocations
- a couple with a child with Downs syndrome- has 1% risk of giving birth to another child with Downs syndrome
chromosomal studies done when?
- in couples after 3 or more spontaneous abortions- 3% will e dx with a balanced translocation
- most common class of SABs- autosomal trisomies (16 most common)
- most common single chrom abnormality in SABs- 45XO
most common gene carried in N Am whties
CF- 1 in 25
sex linked disroders
- primarily affects males
- recessive genes on X chromosomes
- ex- Duchenne muscular dystrophy, Fragile X syndrome
multifactorial disorders
-Neural tube defects- folic acid supplementation lowers risk
first trimester screening
-maternal age
-fetal nuchal translucency thickness
-HCG
-PAPP-A (pregnancy assoc plasma protein-A)
(elevated HCG and low PAPP-A- down syndrome)
second trimester screening
- HCG, estriol, AFP- b/w 16-20 wks- 70% detection rate of trisomy 21
- HCG, estriol, AFP, inhibin A- 80% detection of trisomy 21
free fetal DNA testing
- 9-10 wks
- detects trisomy 21, 18, 13, sex chromosomes (95% detection)
- doesnt test for open neural fetal defects
- order only in high risk pts
second trimester testing- dx procedures
- amniocentesis- 16-20 wks
- chorionic villi sampling- 11 wks
teratogenic agents
- drugs
- infectious agents
- radiation
teratogenic agents- Drugs
- alcohol- most common- Fecal alcohol syndrome
- antianxiety- Fluoxetine drug of choice during pregnancy
- antineoplastic- Aminopterin and methotrexate are folic acid antagonists; Alkylating agents
- anticoagulants- coumadin (crosses placenta), heparin doesnt cross placenta
- anticonvulsants- diphenylhydantoin- fetal hydantoin syndrome
fetal alcohol syndrome
- growth restriction
- facial abnormalities- low set ears, smooth philtrum, thin upper lip, shortened palpebral fissures, flat midface
- CNS dysfxn- microcephaly, mental retardation, behavior disorders
Fetal hydantoin syndrome
-anticonvulsant- Diphenylhydantoin
Anticonvulsants
- Diphenylhydantoin
- valproic acid- open spina bifida
- carbamazepine
- phenobarbital
Hormones
DES- T-shaped uterus, vaginal cell cancer, cervical and uterine malformations
radiation
- dose dependent
- critical period- 2-6 wks postconception
- most cases- diagnostic levels of radiation dont have a teratogenic risk
- rule of thumb- <5 rads of exposure = no risk
unpleasant sx’s of pregnancy
- N/V- eat small meals, avoid greasy foods, room T sodas and saltine crackers, acupuncture, meds (antihistamines, vit B6, antiemetics)
- heart burn- relaxation of esophageal sphincter by progesterone
- constipation- dec in colonic activity
- hemorrhoids
- leg cramps
- backache
prenatal office visits- freq of visits
- every 4 wks until 28 wks
- every 2 wks from 28-36 wks
- weekly until delivery
- BP, weight, urine protein, uterine size, fetal heart rate, fetal movement
20, 28, 35 wks- routine screening
- 20- fetal survey US
- 28- screen for gestational diabetes, rhogram injection to Rh neg parents, Tdap
- 35- screen for group B strep carrier with vaginal culture
assessment of fetal well being
- kick counting
- nonstress test
- contraction stress test
