Aquifer Case 14 Flashcards
what are some good ways to diagnose pregnancy?
- blood tests of human chorionic gonadotropin (hCG) can identify pregnancy as early as 8 days post-conception (about 1 week prior to a missed period)
- the presence of a delayed menstrual period in a female with previously regular periods and symptoms of nausea, breast tenderness, and fatigue are classical indications of pregnancy
- transvaginal ultrasound is a useful method for dating early pregnancy but is not typically used to diagnose pregnancy
what are some signs of pregnancy?
- delayed period
- nause
- breast tenderness
- malaise
- Chadwick’s sign = blue discoloration of the cervix from venous congestion (8-10 wk)
- palpably gravid uterus (10-12 wk_
how do you calculate a due date?
month that they missed the period - 3 then add 7 days –> subtract 3 months and add 7 days
or determine the day 40 weeks after the beginning of the last menstrual period
the gestational age is calculated since the day of the start of the last period while the embryonic age is from the date of fertilization which about 2 weeks after the date of the LMP
which blood tests do you get done at the initial pregnancy visit?
- blood type/Rh status
- chlamydia screening
- Hb/Hct
- hepB surface antigen
- HIV test
you don’t need a hepC antibody, Herpes antibody, bacterial vaginosis, or toxoplasmosis test done
what are the chlamydia and gonorrhea screening guidelines?
screen in sexually active females 24 and younger and in older females at increased risk for infection
level B
how often do you HIV test pregnancy females?
all pregnant females
how often do you do a urinalysis for pregnancy women?
dipstick every visit for prenatal patients
checks for proteinuria and glycosuria
also screen for asymptomatic bacteriuria with a urine culture at 12-16 weeks
what are the HepB screening guidelines for pregnant people?
HepB surface antigen screening in pregnant females at first prenatal visit
which foods aren’t safe in pregnancy?
- shark, swordfish, king mackerel, and tilefish –> mercury poisoning
- unwashed fruits and vegetables –> toxo and listeria
- unpasteurized milk –> toxo and listeria
- raw eggs –> salmonella
- soft cheese –> listeriosis
- saccharin
what do you test for at the 10 week prenatal visit?
- weight
- BP
- fundal height
- auscultation of fetal heart tones
give the influenza vaccine and counsel about screening and prenatal diagnosis of fetal anomalies
when do you give the Tdap vaccine to pregnant women?
between 27-36 weeks
it’s recommended for all pregnant females, irrespective of when they last received this vaccine
when do you give the rhogam immunization to pregnant women?
if indicated, give at 28 weeks and within 72 hours after delivery and with any episodes of vaginal/intrauterine bleeding
when do you give the rubella vaccine to pregnant women?
after pregnancy; not safe to be given during since it’s a live vaccine
what is the sensitivity of a quad screen in detecting Down syndrome?
80%
AFP, estriol, hCG and inhibin-A
do placenta previa resolve on their own?
if they’re found at 21 weeks, they usually resolve on their own –> the later the placenta prevue is detected the lower the likelihood of it resolving
having previous pregnancies increases your risk
the most common time for bleeding from placenta prevue is during late pregnancy or delivery
what is defined as gestational HTN?
140/90 without proteinuria in a previously normotensive femal at/after 20 weeks gestation
what is preeclampsia?
140/90 with proteinuria
when do you screen for gestational diabetes?
24-28 weeks
1 hr oral glucose tolerance test should be under 130-140
if they fail the one hour, do the 3 hour which includes a fasting glucose, 1 hr, 2 hr and 3 hr test –> if 2 or more of the 4 glucose measurements exceed the cutoff then they have GDM
what are the cutoffs for a 3 hr OGTT?
fasting serum glucose concentration ≥ 95 mg/dL (5.3 mmol/L)
one-hour serum glucose concentration ≥ 180 mg/dL (10 mmol/L)
two-hour serum glucose concentration ≥ 155 mg/dL (8.6 mmol/L)
three-hour serum glucose concentration ≥140 mg/dL (7.8 mmol/L)
when do you test for GBS in pregnancy?
36 weeks
which interventions or tools have been shown to be likely beneficial during labor and delivery?
- attend childbirth education classes
- delivery in a home-like environment
- having a doula, birth coach or support person present during labor and delivery
- having a birth plan
which birth control is safe during breast fooding?
- copper-containing intrauterine device
- injectable medroxyprogesterone acetate (Depo-Provera)
- progestin-only oral contraceptive
combined OCPs are not safe for the first 21 days due to increased DVTs
how long do post partum blues last?
2 weeks
post partum depression shows up within first 4 weeks
which topics should be discussed post partum?
- breast feeding
- contraception
- mood
- sexual activity
