Antepartum Care and Fetal Assessment -Castro

Question 1

What is the ideal time span of antepartum care?

Answer 1

3 months preconception to 6-8 weeks post-delivery

Question 2

What are PE findings in pregnancy at 6 weeks? 12-13 weeks?

Answer 2

6 weeks gestation: softening and slight enlargement of uterus, softening of cervix (Hegar’s sign), bluish tint to vagina (Chadwick’s sign)

12-13 weeks: palpation of uterus or auscultation of the fetal heart tones with doppler

Question 3

When does hCG peak?

Answer 3

1st treimester

Question 4

If beta hCG levels are 2500+, what should be seen on transvaginal ultrasound? What is there is nothing?

Answer 4

an intrauterine gestational sac

if nothing, consider an ectopic pregnancy

Question 5

What are the normal cardiovascular changes seen in pregnancy?

Answer 5

• Increased blood volume (plasma vol > RBC increase)
• increase cardiac output
• decrease in resistance –> decrease in BP
• venous stasis ==> predispose to DVT and edema
• possible systolic murmur

Question 6

How is the renal system affected by pregnancy?

Answer 6

increase in renal blood flow, renal plasma flow and GFR
–> decrease in BUN and Creatinine (1 is abnormal in pregnant women)

dilation of the ureters and enlarged kidneys==> hydronephrosis (right> left)

Question 7

How is the respiratory system affected by pregnancy? What does that leave the woman predisposed to?

Answer 7

• increased tidal volume and minute ventilation –> resp alkalosis
• compensatory decrease in bicarb

-pregnant women can develop metabolic acidosis easily

Question 8

How is the estimated date of delivery (EDD or EDC) derived?

Answer 8

from the LMP using Naegele’s Rule (add 7 days to 1st day of LMP and count back 3 months)

this is what the pregnancy wheel is based on

Question 9

When should quickening begin?

Answer 9

18-20 weeks

unreliable

Question 10

How is the gestational age estimated? What do we use to “confirm” this in the 1st trimester? 2nd trimester? 3rd trimester?

Answer 10

GA estimated based on LMP

1st trimester: crown rump length (CRL) ultrasound measurement. If within 1 week of GA by LMP, the US confirms the LMP

2nd trimester: Average of head, abd, and long bone measurements (considered accurate +/- 2 weeks)

3rd trimester: average or head, abd, and long bone measurements (accurate within +/- 3 weeks)

(growth varies much more as move into 3rd trimester)

Question 11

What are the routine initial OB lab tests?

Answer 11

• CBC (look for hemoglobin <11=work up for anemia)
• UA, culture and sensitivity for UTI
• Blood group, Rh
• antibody screen
• syphilis tests (RPR, VDRL)
• Hep B surface antigen
• Rubella titer
• cervical cytology
• cervical culture for chlamydia and neisseria
• HIV titer by EIA
• 1st tri screening for aneuploidy
• 2nd tri screen for aneuploidy: quadruple screen at 15-20 weeks
• hematocrit at 28 weeks (r/o anemia)
• gestational diabetes
• vag culture for group B strep at 35-37 weeks

Consider:

• hemoglobin electrophoresis for sickle cell grate or thalassemias
• hgbA1c

Question 12

What is the expected weight gain for a normal weight patient?

Answer 12

25-35 lbs total weight gain

or 1 lb/week in 2nd trimester

Question 13

When is air travel not advised? Why?

Answer 13

after 36 weeks because increased odds of DVT from sitting