B8.019 Maternal and Fetal Health Flashcards
typical pattern of prenatal care
every 4 weeks during 1st and 2nd trimester
every 2 weeks in 3rd trimester
weekly in last month
initiation of care in prgenancy
preferably no later than 10 wks GA
screening for underlying health issues at initiation of care
documentation of weight and BP screen for domestic violence/sexual abuse review of medications review of obstetrical history, PMH family/genetic history
establishing gestational age
first day of LMP, compared to early US looking at crown rump length
US very good at establishing due date in 1st trimester bc we all grow at the same speed
initial patient counseling
tobacco, alcohol, drug abuse weight gain recs exercise recs dietary restrictions travel precautions encourage breastfeeding
initial diagnostic studies
blood and Rh typing Ab screen hep B surface Ag rubella HIV RPR chlamydia and gonorrhea CBC (anemia and WBCs) A1C if at risk for DM urine analysis and culture cervical cancer screening if needed
Rhesus D alloimmunization
Rh neg women are given anti-D immune globulin with and bleeding during pregnancy and routinely around 28 weeks and again postpartum if the baby is Rh pos
why is Rhesus D alloimmunization important?
Rh neg women who have a fetus that is Rh positive are at risk for developing anti-D Abs
in subsequent pregnancies, when fetus is Rh positive, those Abs attack and can cause hemolytic disease of the newborn
who should be offered aneuploidy screening?
all women who seek prenatal care before 20 wks GA
when is nuchal translucency performed
11-13 wks GA
other components of first trimester screening
B-HCG and PAPP-A
second trimester screening
ideally between 15-18 wks GA quad screen -AFP -inhibin A -unconjugated estriol -B-HCG best available screen for Down syndrome
who does cffDNA screening have the most value for?
higher risk populations
for low risk populations, conventional screening is preferred
carrier screening
CF and SMA
ethnic specific
fragile X
how is zika acquired?
mosquito bite
can live in sperm and be transmitted sexually
zika complications
microcephaly
fetal brain malformations
fetal growth restriction
zika areas
central and south america
africa
india and pakistan
travel restrictions with zika
dont travel is pregnant or hoping to become pregnant
wait 8 wks to conceive if recent travel occured
if partner traveled, wait 6 months before conception
additional calories during pregnancy
340-450 extra cals per day 1.1 g/kg/day protein 175 g/day carbs min 28 g/day fiber 2.5 L/day water
supplements in pregnancy
folic acid: 0.4-0.8 mg iron: 30 mg calcium: 1000 mg/day iodine: 150 mcg vit D: 200-600 IUs
women at risk of micronutrient deficiency in pregnancy
multiples heavy smokers adolescents vegans substance abusers history of bariatric surgery GI disease women w lactase deficiency
is listeria scary?
not if something is pasteurized
caffeine intake
limit to 200 mg daily
weight gain BMI <18.5
28-40
weight gain BMI 18.5-24.9
25-35
weight gain BMI 25-29.9
15-25
weight gain BMI >30
11-20
recommended exercises in pregnancy
3 hrs per week
can do most stuff fine
activities to avoid in pregnancy
contact sports activities with a high risk of falling scuba diving sky diving hot yoga/pilates avoid sustained HR > 160
benefits of exercise in pregnancy
shorter labor times
improved glycemic control
reduced risk of GDM
what meds can/can’t you take in pregnancy
for pain: APAP, avoid NSAIDs
for constipation: docusate, senna, milk of magnesia
for cough: guafenasin
for heartburn: tums, famotidine, ranitidine
sleep: benadryl
what to evaluate regularly at subsequent prenatal visits
FHR
fundal height
BP
check urine for protein and glucose
anatomic US
20 wks
AFP testing
15-21 weeks
screening for neural tube
28 week testing
GDM screen
CBC
Ab screen, Rhogam if needed
RPR
36 week testing
GBS rectovaginal swab
assessment of fetal position
immunizations in pregnancy
avoid live vaccines (MMR)
flue during each flu season
Tdap between 27-36 wks
immediate postpartum adaptations
within first 10 min after delivery, CO and SV increase and remain increased until about 2 weeks postpartum
post delivery hemostasis
uterine involution: contraction of the interlacing myometrial muscle bundles
-constricts the intramyometrial vessels and impedes blood flow
main mechanism preventing hemorrhage
secondary mechanism: large vessels at the placental site thrombose
fundal assessment post delivery
fundus should be at the umbilicus 24 hours after delivery
decreases from 1000g immediately postpartum > 60g at 6-8 weeks
postpartum hormones
HCG levels return to zero within 2-4 weeks after the delivery
FSH, LH, P, and E are low 2-3 weeks after delivery
return to menstruation
average = 45-64 days
70% by 12 weeks
breast feeding disruption of ovulation
prolactin induced inhibition of pulsatile GRH release from the hypothalamus
objectives of postpartum recovery
discuss concerns expressed after delivery
describe physiological changes in postpartum period
explain benefits of breast feeding
discuss sexual health in postpartum period
emphasize importance of monitoring for preeclampsia in postpartum period
fourth trimester
views mother and infant as a mutually dependent unit which requires intense caregiving
demands difficult w pressure to return to work
maternal leave in US
12 weeks unpaid
23% return within 10 days
initial postpartum assessment
3 weeks
comprehensive after 12 weeks
postpartum hair and skin problems
striae and skin laxity persist
rectus diastasis can cause discomfort and cosmetic concerns
hair loss noted 1-5 months after delivery
prolactin
maintains lactation, decreases ovulation
oxytocin
assists in milk let down
causes uterine contractions
initiation of milk production
early in 2nd trimester
- can be expresses as early as 16 wks
- placental progesterone production inhibits milk production
activation of milk production
once placenta is delivered, negative feedback is removed and copious amounts of milk begin to be produced
avg time for this to occur = 2-3 days, but can take up to 7 or longer
properties of breast milk
ideal nutrition for infants
contain maternal Igs, mostly IgA, which confers passive immunity to infants
DO GIVE VIT D
contains minerals
how to regulate milk production
regular breast emptying
milk build up and distention
alveolar and mammary duct compression
disrupts connections between cells and their attachment to the BM, disrupting the synthesis and secretion of milk components
involution occurs when intervals of feeding/breast emptying are prolonged
benefits of breastfeeding for newborn
bacteriostatic and immune modulating properties
anti-inflammatory
growth promotion of crypt cells in infant’s gut or other cells in the body
aid in digestion
reported reductions in infant mortality
maternal benefits of breast feeding
reduction in stress lower rates of neglect and child abuse enhanced weight loss longer period of anovulation reduction in DM2 reduced long term risks for breast and ovarian cancer decreased risk for cardio disease
when to return to activities?
when comfortable
avoid pain and excessive fatigue
postpartum weight loss
mean postpartum weight retention is 11.8 lbs
50% of gestational weight gain is lost in the first 6 weeks after delivery
slower rate of loss through first 6 months
things to address at postpartum visit
health of infant patients mood contraception plan return to sexual activity breastfeeding difficulties review of complications that occurred during pregnancy or postpartum
optimal inter-pregnancy interval
18-59 months
