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Antepartum (UPenn) > Antepartum Care > Flashcards

Antepartum Care Flashcards

1
Q

Define: live birth

A
  • Irrespective of length of gestation, a birth where there is any sign of life (ie heart beat, umbilical cord pulsation, movement of voluntary muscles). Even if umbilical cord hasn’t been cut.
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2
Q

Define: stillbirth/fetal death

A
  • Fetal loss after 20 completed weeks or 400 g.
  • No signs of life after extraction
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3
Q

Define: perinatal period

A
  • 28 weeks gestation to <7 days post-birth
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4
Q

Define: neonate

A
  • within 28 days of life
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5
Q

Define: infant death

A
  • within 1st year of life
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6
Q

Define: gravida

A
  • Gravida – the total number of times a person has been pregnant , regardless of the outcome. Current pregnancy counts.
    • Nulligravida – never been pregnant
    • Primigravida – first pregnancy
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7
Q

Define: parity

A
  • Parity – # of times a woman has given birth to a fetus > 20 weeks gestation (viable or not), multiple gestation counts as 1 birth
    • Nulliparity – never been pregnant beyond 20 weeks
    • Primiparity – 1 pregnancy beyond 20 weeks. Has given birth once (possibly to twins, etc)
    • Multiparity – 2 or more pregnancies beyond 20 weeks. Has given birth more than once
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8
Q

Decode GTPAL

A
  • G = gravida
  • Para split into 4 categories:
    • Term – births after 37 weeks
    • Preterm – births between 20 – 37 weeks
    • Abortions – miscarriage/abortion before 20 weeks
    • Living – number of children living
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9
Q

Name some Healthy People 2020 goals

A
  • Reduce rate of fetal and infant deaths
  • Reduce rate of maternal mortality by 10% (currently 12.6/1,000)
  • Reduce maternal illness and complications due to pregnancy (complications during hospitalized L&D) currently 31.1%
  • Reduce cesarean birth among low-risk women (full-term, singleton, vertex)
  • Reduce low birth weight and very low birth weight
  • Reduce preterm births
  • Increase proportion of women who receive early and adequate PNC
  • Increased abstinence of cigarettes, alcohol, and illicit drugs among pregnant women
  • Increase proportion of mothers who achieve recommended weight gain during pregncy
  • Increase proportion of women of childbearing potential having:
    • at least 400 mcg folic acid from fortified foods or dietary supplements
    • adequate RBC folate concentrations
  • Increased proportion of women who had preconception care and followed advice.
  • Increased number of women who took folic acid/MV supplement and didn’t smoke or drink before pregnancy and had a healthy weight
  • Increase number of women who use good birth control post partum
  • Reduce post partum smoking relapse
  • Increase number of women attending post partum visit
  • Reduce number of women with PPD
  • Increase number of babies put back-to-sleep
  • Increase breastfeeing: even, through 6 months, through 1 year, exclusively breastfed x 3 months/x 6 month
  • Increase employee lactation programs
  • Reduce formula in first 2 days of life
  • Increase number of women giving birth at facilities that promote breastfeeding
  • Reduce FAS
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10
Q

Leading causes of mortality in US in pregnant people

A
  • Cardiovascular (15.5%)
  • Non-cardiovascular (14.5%)
  • Infection/sepsis (12.7%)
  • Hemorrhage (11.4%)
  • Cardiomyopathy (11%)
  • PE (9.2%)
  • Hypertensive disorders (7.4%)
  • CVA (6.6%)
  • Amniotic fluid embolism (5.5%)
  • Anesthesia complications (0.2%)
  • Unknown 6.1%
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11
Q

Components of an inital visit:

Health Assessment

A
  • Pregnancy dating (LMP/menstrual assessment)
  • Pregnancy history: GTPAL, operative procedures (ie cesarian) and indication, other labor/pregnancy complications, history of infertility treatments, circumstances of prior loss (GA, what precipitated it, evaluations like genetic testing/autopsy)
  • Medical history: may need to consult/co-manage/refer if preexisting diabetes, HTN, or other condition associated with poor maternal or fetal outcome
    • ***MEDICATIONS: make sure they are safe for pregnancy
    • ***ALLERGIES: document
  • Infection history: Assess for childhood illnesses, need for immunizations
  • Family history: evaluate for high risk for maternal complications (like GDM) or genetic issues
  • Sexual history: evaluate risk for STIs (partners, practices, protection, previous hx of STI)
  • Nutritional history: identify any dietary deficiencies that can benefit from intervention
  • Psychosocial history: life, work, financial concerns, stress, social support
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12
Q

Components of an inital visit:

Physical Exam

A
  • Height/weight
  • BP, HR, RR
  • Pelvic exam: uterine size. Clinical pelvimetry not super accurate (according to Jordan)
  • Auscultation of fetal heart tones (if at least 11-12 weeks)
  • Fundal height (if >20 weeks)
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13
Q

Components of an inital visit:

Labs

A
  • Hgb/Hct/MCV (CBC)
  • Blood type & Rh
  • Rubella/Varicella titer if unknown immunity
  • TB, GC/CT/RPR/HIV/HbsAg
  • Urine: dip for protein/glucose, culture.
  • Pap if due
  • Hemoglobin electrophoresis and Cystic fibrosis (if not previously done)
  • HA1C/Thyroid/Lead/HCV if at increased risk for each, respectively
  • History of aneuploidy: CVS or amniocentesis
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14
Q

Components of an return visit:

Health Assessment

A
  • Maternal perception of fetal movement
  • Signs/symptoms of common pregnancy problems
  • Premature labor
  • Vaginal bleeding, Leaking of amniotic fluid
  • Changes in lifestyle, exposures, illnesses.
  • Assess for violence, substance use, depression prn
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15
Q

Components of an return visit:

Physical Exam

A
  • BP
  • Weight
  • Fundal height
  • FHR assessment with Doppler
  • Leopold’s maneuvers (3rd trimester)
  • No routine cervical check until 41 weeks
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16
Q

Components of a return visit

Labs and Ultrasound

A
  • 16 - 20 weeks: Quad/penta screen
  • 18 - 20 weeks: Dating and anatomy ultrasound
  • 24 – 28 weeks: Glucose tolerance, repeat H/H, Ab screen if Rh negative
  • 35 – 37 weeks: GBS screen
  • 3rd trimester: rescreen GC/CT/HIV/RPR if at increased risk
17
Q

Appropriate spacing of visits:

A
  • q month up to 28 weeks
  • q 2 weeks until 36 weeks
  • q week until 40
  • then twice a week until delivery?
18
Q

Presumptive signs of pregnancy

A

Presumptive signs: subjective signs noticed by mother

  • Amenorrhea
  • Breast changes
  • Skin changes
    • Chloasma – face darkening
    • Pigmentation changes in breasts, axilla, genitals, linea alba → linea negra
    • Striae on breasts, abdomen, maybe thighs/buttocks
    • Skin vasculature changes → spiders and palmar erythema
  • Vaginal symptoms
    • leukorrhea – increased vaginal discharge (odorless, nonirritating)
  • Subjective sensations – ie nausea/vomiting, urinary frequency, fatigue
    • Quickening – usually first felt sometime between 15 – 22 weeks
19
Q

Probable signs of pregnancy

A

Probable signs: objective signs noticed by provider

  • Enlargement of abdomen – uterus generally not palpable in abdomen until 12 weeks
  • Vaginal changes
    • Chadwick’s sign – bluish color eventually spreads to all of vaginal mucosa (as early as 6 weeks gestation)
  • Cervical changes – also becomes bluish in color
    • Goodell’s sign – softening of the cervix
  • Uterine changes
    • Hegar’s sign – LUS so soft it can be compressed during a bimanual (?)
  • Ballottement of the fetus (palpation technique to feel something floating in the body, ie a fetus or floating kidney)
  • BBT elevation – progesterone makes temp go up
  • Endocrine pregnancy tests
20
Q

Positive signs of pregnancy

A
  • Identification of fetal heart activity
    • Doppler placement during early pregnancy: in center of abdomen slightly above symphysis pubis
    • Should be heard by Doppler by 12 weeks (can as early as 10) and by ultrasound as early as 6 weeks. Not until 15-22 weeks by fetoscope
  • Detection of fetus/embryo by ultrasound or xray
    • Gestational sac detectable by 4 weeks
    • Embryo detectable by 6 weeks
  • Detection of fetal movement by the examiner – usually not until 2nd half of pregnancy
21
Q

Naegele’s rule

A

EDD = LMP + 7 days – 3 months

  • Add 1 year if LMP not in 1st 3 months of year
  • Careful with months that have 30 vs 31 days.
  • 90% of women with known LMP will deliver by 41 wks.
  • Assumes a 28 day cycle.
22
Q

What is the fetal lie?

A
  • Lie: relationship of fetal spine to the maternal spine (longitudinal, transverse, oblique)
23
Q

What is the fetal presentation?

A
  • Part of the fetus presenting at pelvic inlet (96% cephalic)
  • Cephalic presentations:
    • Vertex – head tucked
    • Sinciput (median vertex) – head not completely tucked
    • Face – head somewhat extended
    • Brow – head very extended
  • Breech presentations:
    • Complete – legs crossed
    • Incomplete – one leg crossed, one extended
    • Frank – both legs extended
    • Footling – leg presenting first (single or double)
24
Q

What is the fetal position?

A

Relation of presenting part to the left or right of maternal pelvis. Occiput is the reference (ie LOP, ROP)

25
Q

What is the fetal variety?

A

Relationship of presenting part to anterior, posterior, or transverse part of the maternal pelvis

26
Q

What is the fetal attitude?

A

Position of the head with regards to the fetal spinal column. Flexion or extension

  • vertex, sinciput, face/brow
27
Q

Expected uterine size by weeks: 1st trimester

A
  • 4-5 weeks = pear
  • 6 weeks = juice orange
  • 8 weeks = naval orange
  • 12 weeks = grapefruit
28
Q

Location of fundus by weeks: after 1st trimester

A
  • 12 weeks – symphysis pubis
  • 16 weeks – halfway between symphysis pubis and umbilicus
  • 20 weeks – umbilicus
  • 28 weeks – halfway between umbilicus and xyphoid process
  • 36 weeks – xiphoid process
29
Q

Guidelines for safe exercise

A
  • General
    • Avoid exercising while fasting or in hot/humid conditions
    • Adequate hydration (monitor urine color)
    • Exercise in loose, comfortable clothing (heat/sweat dissipation)
  • Movements
    • Avoid jumpy/jerky movements that could result in abdominal trauma, also no horseback riding or skiing
    • Strength training: keep weight light (don’t want to overload joints) and preferably use resistance bands (so free weights don’t hit stomach)
    • Avoid walking lunges (risk of groin strain)
    • Avoid supine position after 16-20 weeks
    • Avoid valsalva maneuver
  • Exertion
    • Listen to your body
    • “Talk test” should be able to comfortably carry on a conversation during exercise, if not, intensity is too high
    • Heart rate monitors: guidelines different by age and fitness
    • Borg Rating of Perceived Exertion (scale of 1 – 20), don’t go over 14 (aim for 12 – 14).
  • Warning signs to stop exercising while pregnant: bleeding, dyspnea prior to exertion, dizziness, headaches, chest pain, muscle weakness, calf pain/swelling of unknown origin, PTL, decreased fetal movement, ruptured membranes
30
Q

Recommended physical activity/exercise

A
  • 30 minutes or more of moderate intensity exercise most days recommended (same as non-pregnancy)
  • If not used to exercise, start walking 10 min at moderate intensity 4-5x/week, work up to 30 min at least 4x/week
  • Low-impact aerobics (ie group fitness classes), swimming/water aerobics (esp good if submerged to chest → improves venous return, decreases lower back pain, etc)
  • HIIT training good. More time spent at high intensity, the shorter interval needed for good effect
31
Q

Describe treatment modalities for musculoskeletal discomforts during pregnancy, including alternative and complementary therapies.

A
  • Kegels
  • Pelvic tilts
  • Swimming/aquatic therapy
  • Chiropractic
  • Short term acetaminophen
32
Q

Review the CDC recommendations for immunizations in pregnancy

A
  • MMR vaccine: live vaccines contraindicated during pregnancy. Need to wait 4 weeks after to get pregnant
  • TDAP and flu (if in season) recommended during pregnancy
  • Other inactivated or toxoid as indicated
33
Q

Define: birth rate

A
  • The number of live births in a defined administrative jurisdiction, in a calendar year divided by the midyear population of the jurisdiction, with the customary multiplier of 1,000 to produce a whole number rather than a decimal or fraction
34
Q

Define: fertility rate

A
  • A measure of the fertility of a population using the annual number of live births as the numerator and the number of women in the reproductive age group (15–44 or 15–45 years) as the denominator.
35
Q

Define: early neonatal death vs late neonatal death

A
  • early - first week
  • late - second, third, and fourth weeks
36
Q

Define: maternal mortality rate/ratio

A
  • Rate:
    • # of maternal deaths / # women of reproductive age
  • Ratio:
    • # of maternal deaths / # live births
37
Q

Define: low/very low/extremely low birthweight

A
  • Low = < 2500g
  • Very low = < 1500g
  • Extremely low < 1000g

Antepartum (UPenn) (26 decks)

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