Antepartum Care and Testing Flashcards
outline what GTPAL means
G= gestations (number of pregnancies regardless of outcome) T= term births
P= para (number of pregnancies >20 weeks), regardless of outcome
A= abortions
L= live births and live children
EIDIH checklist you should do on initial visits for trimesters
Estimated Due Date EDD: 280 days form 1st day of LMP.
- Use gestational wheel
Immunity screening: rubella and varicella
Dating ultrasound: transvaginal ultrasound done in the 1st trimester. Can also confirm the number of fetuses.
The later we do the dating ultrasound, the less accurate it is.
Hematological: CBC, RH, antibody screen, consider hemoglobinopathies (sickle cell, thalassemia screening)
Infection screening: gonorrhea, syphilis, HIV, hepB, chlamydia, urinalysis to avoid pyelonephritis from a UTI.
key vaccines to incquire about
rubella and varicella
at 14-24 weeks, each visit should invovle:
you should stard measuring the __ ___ ___ after 20 weeks. If it’s off by 2-3 cm, consider booking ___.
Each visit: blood pressure, weight, review new and known concerns, FHR assessment- start >12-13 weeks
Start symphysis fundal height (SFH) after 20 weeks.
Distance between pubic bone and top of uterus.
30 weeks = 30 cm. Each cm should correspond by week.
Good for singleton pregnancy in non obese people.
- Limitations:
- Limited to singleton pregnancy
- Patient body habitus
- Uterine fibroids
- Provider variation
- Unable to assess if fluid or fetal weight is an issue.
If the SFH is off by 2-3 cm, consider booking another ultrasound
limitations of symphysis fundal height
Limitations:
Limited to singleton pregnancy
Patient body habitus
Uterine fibroids
Provider variation
Unable to assess if fluid or fetal weight is an issue.
what gestational age is anatomical sceening done
18-22 weeks. – cann detect sex of fetus and do anatomical screening ultrasoun; look for anatomy and location of placenta
Leopold maneuvers start at ___ weeks: what do you assess with these maneuvers?
Assess uterine fundus: look for fetal lie
Palpate sides of fundus: fetal back
Assess presenting part: fetal presentation (cephalic or breech)
Assess degree of descent
when do you give whinrho
At 28 weeks; if Rh negative, repeat testing +/- whinrho.
when do you do GBS swab
36-37 weeks GBS swab: part of normal biome. Transient or chronic colonizer.
Id positive, PenG is given in labour
Treatment reduces early onset GBS infection in neonates.
Membrane sweep after 36 weeks– optional.
frequency of visits depedning on gestational age
Frequency of visits
Every 4 weeks up to 28 week
Every 2 weeks up to 36 weeks
After 36 weeks, weekly up to delivery.
T/F: can give varicella and measles vaccine in pregnancy
false. LIVE VACCINATIONS are NOT given in pregnancy: varicella, measles, mumps, rubella, HPV, TB.
Vaccinations recommended in pregnancy: influenza, TDap, HebB, COVID19 mRNA vaccine.
teratogenic meds
ACEi/ARB, methotrexate, Warfarin, valproic acid, accutane, some immunosuppressants (MMF, cyclophosphamide)
Associated with microcephaly, cranial nerve blindness for accutane.
Management of morning sickness/nausea and vomiting in pregnancy
Dependent on severity
**Make sure to do US to ensure singleton and rule out molar pregnancy
Maintain PO intake: bland foods
Antinauseants (diclectin vitamin B6), dimenhydrinate, metoclopramide, ondansetron (Zofran), +/- PPI
outline Biophysical Profile Scoring; 4 elements, each with either 0 or 2 points
Breathing movements: 1 episode of at least 30 seconds of fetal breaths (2 points)
Movements: 3 body or limb movements
Tone: 2 points if 1 episode of active extension or opening and closing of the hand
Amniotic fluid: at least 1 cord and limb-free fluid pock
If you add an NST to the BPP, you get a score of 10 rather than 8.
Abnormal BPP:
Term >37 weeks: deliver
Preterm <37 weeks: depends on gestational age, maternal and fetal risk factors
normal fetal movement awareness threshold
All patients should be aware of their fetal movements (FM), most can feel around 26-32 weeks.
Recommend counting 6 FM over 2 hours (once a day).
If <6FM, should be assessed with NST +/- US
Decreased placental perfusion and fetal acidemia is associated with decreased featal movements.
outline the normal definitions of baseline, variability, accelerations and decelerations on an NST
Baseline: normal FHR is between 110-160bpm, where there is no accelerations or decels.
Variability: range of amplitude of FHR fluctuation. Lowest and highest fetal heart rate with no accelerations or decelerations. Normal is 6-26BPM.
Accelerations; abrupt fetal heart rate increase that is over 15 bpm above the baseline for 15 seconds. There should be 2 of them in an NST
Deceleration: should be none.
a normal NST suggests normal fetal ___
normal fetal oxygenation
Indications for ANtenatal Fetal Surveillance
Any pregnancy where the risk of antepartum fetal demise is increased
Normal (low risk: FM counts/awareness
Increased risk: FM counts, ++/-NST, +/-growth US+ BPP
T/F we usually do intermittent fetal heart rate monitoring in labour
FALSE. only appropriate for LOW RISK sponatenous labour and term patients– we don’t really do IA. it’s hard for obese patients.
- most people do continuous electronic fetal monitoring
Continuous electronic fetal monitoring
- Everyone else gets EFM
- Extension of the NST criteria
- 4 elements (baseline, variability, accelerations, decelerations) + uterine activity (UA)
External monitoring: ultrasound transducer, less invasive. Cannot tell us how strong contractions are. Only tells us when they are occurring.
Internal monitoring: fetal scalp electrode (FSE), or intrauterine pressure catheter (IUPC). MOre invasive but more accurate. Pt needs to be dilated, membranes ruptured.
external vs internal monitoring for continuous electronic intrapartum fetal monitoring
External monitoring: ultrasound transducer, less invasive. Cannot tell us how strong contractions are. Only tells us when they are occurring.
Internal monitoring: fetal scalp electrode (FSE), or intrauterine pressure catheter (IUPC). MOre invasive but more accurate. Pt needs to be dilated, membranes ruptured.
Fetal scalp blood sampling.
Correlates with cord pH to guide fetal status.
Consider if: abnormal EFM tracing, intrauterine resuscitation/scalp stimulation failed, delivery is not imminent, but >3-4cm dilated, no contraindications (preterm, suspected coagulopathy, or other infections like HIV or HepB)
If PH is under ___, we gotta deliver NOW.
Fetal scalp blood sampling.
Correlates with cord pH to guide fetal status.
Consider if: abnormal EFM tracing, intrauterine resuscitation/scalp stimulation failed, delivery is not imminent, but >3-4cm dilated, no contraindications (preterm, suspected coagulopathy, or other infections like HIV or HepB)
If PH is under 7.2, we gotta deliver NOW.
causes of fetal bradycardia (what is fetal bradycardia)
VHF <110 bpm is brady. caused by hypoxia or fetal heart block
definition and causes of fetal tachycardia
tachycardia >160. caused by fever/infection, maternal dehydration, maternal anemia, chronic hypoxemia, fetal activity, fetal cardiac AbN
FHR Variability is controlled by ___ nerve. Normal is between 6 to 26 bpm.
Minimal variability: ___ minutes. caused by: Fetal ___, ___, medications (narcotics, __ ___, ___), hypoxic acidemia, maternal ____.
Marked Variability: >25 bpm, potentially due to hypoxia or fetal ___.
Variability is controlled by vagal nerve. Normal is between 6 to 26 bpm.
Minimal variability: <5bpm for >40 minutes. Fetal sleep, prematurity, medications (narcotics, beta blocker, MgSO4), hypoxic acidemia, maternal smoking.
Marked Variability: >25 bpm, potentially due to hypoxia or fetal gasping.
Identify the 3 types of fetal heart rate decelerations and explain their underlying pathophysiology.
Early: gradual drop and return to baseline, usually symmetric, shallow
Nadir occurs at the same time as the peak of contraction. ALways recovered by the end of contraction.
Late: gradual drop and return to baseline, usually symmetric, shallow.
Onset, nadir,and recovery occurs AFTER beginning, peak and end of contraction. Associated with fetal acidemia.
Variable
Abrupt drop and return to baseline. Can be due to cord compression.
Can have shoulders.
Managing decelerations
- fetal scalp stimulation: indirect measurement of acid-base status of the fetus. tells us that Ph is >7.2 hours and not acidemic.
- intrauterine resuscitaiton efforts to improve uterine blood flow
- Stop oxytocin
- Maternal positioning, IV fluids, consider O2
- Vaginal exam (ensure no cord prolapse
- intrauteirne pressure cateheter
- fetal scalp blood sampling (if pH is below 7.2, deliver)
steos of intrauterine resuscitation
Stop oxytocin
Maternal positioning, IV fluids, consider O2
Vaginal exam (ensure no cord prolapse)
