CH 21 Woman during pregnancy Flashcards
(115 cards)
1
Q
WHAT should you screen for in pregnancy when adding a new member to the family?
A
physical, emotional, and/or financial abuse during preg and postpartum period
2
Q
zygote and blastocyst
A
at fertilization it’s a zygote
then blastocyte up to 2 weeks (ball of cells)
3
Q
embryo weeks
A
embryo is 2-8 weeks
4
Q
fetus in weeks
A
8 weeks to term
5
Q
early term in weeks
A
37 weeks (lungs are now mature) through 38 weeks plus 6 days
6
Q
full term in weeks
A
39 weeks through 40 weeks plus 6 days (Estimated date of delivery (EDD)) = 40 weeks)
-most women give birth at 40 weeks
7
Q
Late-term in weeks
A
41 weeks through 41 weeks plus 6 days
-more awake and hungry; more neurological development
8
Q
Post-term in weeks
A
42 weeks and beyond
-do not encourage beyond 42 weeks, placenta deterioriates
9
Q
at what stage of development is baby not susceptible to teratogens?
A
first 2 weeks; blastocyst stage
no organ system for teratogen to damage
10
Q
implantation bleeding
A
~2 week after conception, when fertilized egg implants to uterus = light bleeding
Ask how many days lasted? timing normal? duration of menses?
“last period came 1 week early and lasted 1 day and was very light”
11
Q
when is fetus most susceptible to teratogenic drugs?
A
week 3-8 is most intense organogensis (organs developing)
12
Q
stages of human development
A
brain develops throughout pregnancy
13
Q
naegele’s rule
A
expected date of delivery EDD by last menstrual period
- substract 3 months from 1st day of LMP, add 7 days = 40 weeks from LMP or 38 weeks from date of conception
can be inaccurate if have irregular menses or unclear LMP
14
Q
when is the MOST accurate source for EDD?
A
1st trimester ultrasound
-using crown-rump measurement
-accurate with potential of 7 day error mragin
15
Q
what is another way to estimate EDD by ultrasound that is not accurate?
A
2nd trimster ultrasound (up to 22 weeks)
using multiple fetal measurements BUT 14 day error
16
Q
why evaluate uterine size?
A
provides info during antepartum period about fetal growth and maternal well being
17
Q
size of non gravid and at 8 weeks old?
A
non gravid - lemon
8 weeks - tennis ball/orange
18
Q
when can you hear fetal heart sounds?
A
starting at 10 weeks and fersure at 12 weeks via doppler
-baseball size
19
Q
what week is when the fetus is rising above symphysis pubis?
A
- at 12 weeks (can also reliably hear FHT)
- softball/grapefruit
20
Q
at what week is fundal height halfway between symphysis pubis and umbilicus?
A
16 weeks
21
Q
at what week is fundal height at umbilicus?
A
20 weeks
22
Q
from 20 weeks to 36 weeks, how high does fundal height grow per week?
A
1 cm per week *correlates to gestational age plus or minus 1 cm
-ex: 28 week gestion, u anticipate fundal heigh t is 28 cm above umbilicus + or - 1 cm
23
Q
when does fundal height drops?
A
-at term. uterus dips into pelvis with fetal head engagement
-vertex (cephalic) position by 36 weeks
24
Q
how much calories does she need during pregnancy?
A
-additional 300 calories/day over baseline
-need more calories if 1-2 years from menarche (mom is still growing) and w/ mult gestation
25
how much calories does she need during lactation?
additional 500 cal/day above baseline
26
how much calcium in pregnancy needed per day?
1,000-1,500 mg/day
age 14-18 need minimum 1,300 mg /day
age 19-50 need minimum 1,000mg/day
27
how much folic acid needed during pregnancy?
0.4 -1 mg/day if without history of neural tube defect
28
if have history of neural tube defect or family hx of NTD (anencephaly, myelomeningocele, spinal bifida), how much folic acid?
4 mg/day for 1 month BEFORE pregnancy and DURING first 3 months gestation, then resume 0.4-1 mg per day to promote placental/fetal growth
29
iron supplements in pregnancy
-if not anemic in preg, little evidence it's needed unless in prenatal vitamin (NO excess supp needed = free radical damage)
-if Hgb < 11 in 2nd trimester or < 10.5 mg in 3rd trimester = need 30 mg elemental iron PO per day
-recheck 1 month after therapy, if still low check ferritin to confirm iron def and adjust iron dose
-divide dose if >30 mg daily for better absorption; add zinc or copper (prenatal vitamins)
30
recommended total weight gain for underweight (BMI < 18.5) mom?
28 - 40 lbs (12.7-18.14 kg)
for 2nd & 3rd trimester: gain 1lb / week
31
**recommended total weight gain for healthy BMI (18.5-24.9)?
25 - 35 lbs (11.34 -15.88 kg)
for 2nd & 3rd trimester: gain 1lb / week
32
recommended total weight gain for overweight (25-29.9) mom?
15-25 lb
2nd & 3rd tri: gain 0.6 lb / week
33
recommended total weight gain for obese (BMI 30 +)
11-20 lbs
2nd & 3rd trimester: 0.5 lb/week
34
maternal prepregnancy OBESITY
risk to mother:
INCREASED risk of...
- gestational DM
- hypertensive disorders
- C- section birth
- PP complications (higher rates of post surgical birth infections)
- hospital length stays
- anesthesia related problems
35
maternal prepregnancy OBESITY
risk to fetus/neonate:
INCREASED risk of...
- congenital anomalies
- macrosomnia
- neonatal hypoglycemia
- preterm birth, neonatal and infant mortality
- insulin resistance
lower rates of successful breastfeeding
36
in utero, how does the baby grow in the 2nd trimester? 3rd trimester? brain?
grows length wise in 2nd trimester, weight wise in 3rd and brain throughout pregnancy
37
. A 21-year-old woman with normal
BMI prior to pregnancy is now
38-weeks pregnant. Her weight gain
up to 28 weeks was 12 lbs (5.45 kg)
and she has gained 2 lbs (0.9 kg) from 29 weeks to 38 weeks. Her weight gain pattern is most likely to affect
her baby’s:
A. Birth weight.
B. Head circumference.
C. Birth length.
D. APGAR scores.
up through 2nd tri weight gain was good but poor in 3rd tri
A: birth weight
most likely to have a long, slender baby
38
Felicia is 18-weeks pregnant with
her first child. Which of the
following is most consistent with her gestational age?
A. Uterine fundus palpable through the abdominal wall
B. Nausea and breast tenderness
C. Report of quickening
D. Fetal heart tones detectable by
abdominal Doppler
A. Uterine fundus palpable through the abdominal wall SHOULD HAVE HAD THIS MILESTONE BY 12 WEEKS; so would have anticipated already = "gotcha" answer = poor answer
B. Nausea and breast tenderness = non specific
C. Report of quickening = feeling baby move = ANSWER!
D. Fetal heart tones detectable by
abdominal Doppler = anticipated by 10-12 weeks but NOT a new finding by 18 weeks
39
when is quickening reported?
- when baby moves
- by 18 weeks
- if have more gestations, can feel it sooner bc knows the feeling
40
nausea and vomiting during pregnancy: when? which hormones & why?
during 1st trimester!
-progesterone = delays gastric emptying = heart burn
-hCG = morning sickness; mechanism unclear; trophoblast at day 8 = sx's worsen when hcg peaks ~ 10 weeks
41
interventions for nausea/v in preg
- frequent small meals
- no high fat or large meals that can further delay gastric emptying
- avoid aggravating foods (diary)
- avoid rapid intake of large amt of liquids = freq sips ok; avoid high fat liquids
-vitamin B6 supplements (25 mg 3-4x/day helps with nausea (not vomiting) for milder sx's
- ginger ale or powder capsules (1-1.5 mg/24 hrs)
- Last: antiemetics (ondansetron/Zofran, metoclopramide/Reglan, phenothiazines/Phenergan)
42
frequency of visits for prenatal visits?
prenatal visit every 4 weeks up to 28 weeks
28 weeks - 36 weeks = every 2 weeks
≥36 weeks = every week
43
genetic screening before and early pregnancy
Tay Sachs disease
Cystic fibrosis
sickle cell trait
44
prenatal care, 1st visit/early in pregnancy
- pap test if due gonorrhea/chlamydia
-rubella (measles), varicella, rubeola status if not previously known
- syphilis, HIV, HBsAg, consider HCV testing
- CBC, blood type, antibody screen
- screen domestic violence, depression, substance abuse
-update immunization status
- Tb test
- genetic screening
- 1st trimester ultrasound if unclear EDD
-UA, urine C&S (tx asx bacteremia)
45
when do you treat asymptomatic bacteria in the urine from a urine C&S?
one of the few times you actually need to treat!
during pregnancy, dilation of renal pelvis, more reflux into renal pelvis = higher risk of pyelonephritis
46
chorionic villus sampling & when is it done?
at 10-12 weeks
DIAGNOSTIC prenatal test taking a sample of placenta to test for chromosomal abnormalities
-no info on neural tube defects (need f/u blood test at 16-18 weeks)
47
amniocentesis and when is it done?
15-20 weeks
DIAGNOSTIC procedure to check chromosomes (down syndrome), neural tube defects
48
prenatal care in 3rd trimester in pregnancy
24-28 weeks = screen gestational DM (screen earlier if BMI
≥30); Rh neg- Type & screen
28-32 weeks = Hg; STI testing as indicated (syphilis, HIV, HBsAg, GC, chlamydia)
RhoGAM as indicated
32-36 weeks = fetal presentation; kick count (fetal movement ≥4 in
1h, ≥10 in 2 h)
35-37 weeks = Group B strep culture (rectal and vagina) -> treat intrapartum if positive
40-42 weeks = vaginal exam to assess cervical ripeness, fetal station
41 weeks = non stress test, biophysical profile to check fetal status; offer induction
49
biophysical profile consists of
5 components:
1. fetal breathing movements
2. gross body movements
3. tone
4. amniotic fluid index
5. nonstress test
each score is 0 or 2
max score of 10.
50
PREconception immunizations
if needed:
-update Td/Tdap
-MMR
-Hep B
-varicella immunity
at 6-8 weeks of pregnancy:
- flu vaccine
51
immunizations at 16-18 weeks pregnancy
progesterone for women that had hx of preterm labor (specialist would do this)
52
immunizations at 28 weeks of pregnancy
- Rho gam shot if indicated
- Tdap (b/t 27-36 weeks gestation, with each pregnancy)
53
postpartum visit immunizations
-MMR or varicella if needed (if previously was not immune and did not get immediately PP)
= live viruses = can't be given during preg
54
woman 28 weeks preg, what are her immunization needs? rubella immune, heb b series, influ vaccine, and had a baby a year ago and got tdap. what would u give her?
give her ANOTHER tdap! give tdap with EACH pregnancy in 3rd trimester, regardless of how recent tdap. want to pass on pertussis to the unborn child so baby has pertussis antibodies. any family members
55
family members and immunization
All household members of the newborn
should receive seasonal influenza vaccine
and be up-to-date with pertussis
immunization (Tdap in adult household
members).
Mother also needs to receive
influenza vaccine during pregnancy.She needs Tdap with each pregnancy
56
high risk women at risk for neural tube defects, down syndrome:
- age ≥35 years when baby is due
- family hx of birth defects
- previous pregnancy bb had birth defects
- mom has hx of DM 1
57
1st trimester testing for trisomy 21 (down syndrome)
measuring nuchal translucency (NT)/gestational age
AND
serum pregnancy associated plasma protein, beta hCG levels (decrease preg a/s plasma protein-A and increased free B-hCg at 9-11 weeks or total at 11-13 weeks = effective screening test (effective to do both than NT alone)
58
what is nuchal translucency?
ultrasound exam mearsuring thickeness of back of neck of fetus
59
2nd trimester screening for genetic/congenital anomalies
multiple or quadruple (Quad) marker screening (at 15-18 weeks) [not diagnostic]
-screens for trisomy 21 and NTD
60
components of quad screening
"HI" q"AU"d screening!
1. alpha fetoprotein (AFP): protein made by fetal liver
2. unconjugated estriol (uE3): protein made by placenta and fetal liver
3. human chorionic gonadotropin (hCG): hormone made by placenta
4. inhibin-A: hormone made by placenta
61
abnormal quad screen results for neural tube defect
AFP: Increased
uE3: normal
hCG: normal
inhibin-A: normal
62
in 1st trimester, screen women for DM if:
-severe obesity
-Gestational DM during previous preg
-large for gestational (LGA) infant
-presence of glycosuria
-PCOS (insulin resistance)
-strong hx family DM 2
then screen ALL pregnant women AGAIN at 24-32 weeks pregnant (even with negative test in 1st trimester)
63
screening tests for gestational DM
-overnight fast with 2 hr (75g oral glucose tolerance test) for ALL women during 1st trimester
64
gestational DM diagnosis criteria
any of these 3 tests is abnormal:
1. fasting plasma glucose ≥92 but < 126
2. 1 hour glucose after a 75 g oral glucose load ≥180
3. 2-hour glucose after a 75-g oral glucose
load ≥153
65
screening tests NOT recommended for gestational DM
-HbA1C
-randon postprandial or fasting blood sugar level
fructosamine levels
all not rec for GMD screening
66
intervention for Gestational DM
#1: nutritional therapy by registered dietician/nutritionist
-No single large meals with large % simple carbs
-A total of 6 feedings per day preferred, with 3 major meals and 3 snacks, to limit amount of energy intake in any interval so pancreas can release enough insulin to cover those carbs
-complex carbs/cellulose (whole grains, legumes) NOT exceed 50% of total intake
-increase physical activity to ≥30
minutes per day, ≥5 days per week, no
more than 2 days without exercise
Pharmacologic options depend on nutrition/lifestyle therapy:
-insulin (big molecule = doesn't cross placenta)
-sulfonylureas
-metformin
67
additional care of women with gestational DM
-periodic ultrasound (fetal growth)
-fetal surveillance (NST every week starting at 36 weeks), BPP q week starting at term
-birth at 39-40 weeks to avoid macrosomia
68
**care of gestational DM woman post partum
at 6-12 weeks PP, mom should get screened for diabetes with a test other than A1C; comanage with OB
-ongoing counseling for avoiding developing of DM2 and encouraged if PP glucose WNL
69
when to HIV screening in pregnancy?
-1st prenatal visit (4-6 weeks)
-repeat screening in 3rd trimester based on risk factors (risky sex)
70
HIV management in pregnancy
-if HIV + from screening, refer to HIV specialist!
-start antiretroviral ASAP pregnancy confirmed (*reduces risk giving to baby*) if + HIV status known or as soon as dx confirmed, REGARDLESS of CD4 count
-educate HIV prevention with neg screen
-once baby born, started on antivirals asap
71
GC/Chlamydia trachomatis screening and management in pregnancy
screen 1st prenatal visit
repeat at 28 weeks if higher risk
if + GC: ceftriaxone 250 mg IM and azithromycin 1 g PO, if PCN allergy, azithromycin 2g
if + C alone: azithromycin 1 g PO
in pregnancy, we want to do a test of cure in 3-4 weeks and rescreen in 3 months for new infection acquisition. Expedited partner therapy recommended
72
syphilis screening and management in pregnancy
screen 1st prenatal visit
again at 28-32 weeks, at delivery if at risk
unless confirmed early infection, treat ALL as latent phase [consult expert]
-early: benzathine PCN G IM x 1-2 doses
latent: benzathine PCN G IM weekly x 3 weeks
If woman has PCN allergy, needs PCN desensitization program since PCN's efficacy for syphilis
73
HSV, HHVS-2 genital herpes screening and management in pregnancy
no routine screening, only test if sx's present
tx: acyclovir or valacyclovir
suppression: acyclovir or valacyclovir from week 36 until delivery to minimize transmission to baby
74
HPV, abnormal pap screening and management in pregnancy
screen same as non preg
no pap before 21 years old
if > 30 years old, pap test with primary HPV testing recommended
75
anogenital warts screening and management in pregnancy
visual screening and appropriate hx obtained
often worsen's with pregnant
symptomatic lesions and lesions that lie in birth canal = TCA topical, cryotherapy = can still transmit to baby even if visually gone
c section if wart obstructs canal
-high rates in HIV + women
76
placenta previa and risk factors
implantation of placenta over or near internal cervical os
advanced age
multiparity
smoking
cocaine use
prior hx of placenta previa
77
bright red blood; painLESS vaginal bleeding in late 2nd tri or and part of 3rd trimester
placenta previa
transvaginal US confirms dx
78
placenta previa intervention
maternal stabilization (uterine not contracting)
fetal evaluation
c section
79
placental abruption and risk factors
premature separation of normally located placenta after 20th week and before birth
advanced age
multiparity
smoking
cocaine use
trauma
HTN
80
vaginal bleeding in 2nd or 3rd part of trimester; painful, tender, contracting uterus (in most cases)
placental abruption
get transvaginal US to rule out placenta PREVIA as the cause of bleeding
81
placenta abruption intervention
– Maternal stabilization
– Fetal evaluation
– Cesarean birth
82
postpartum "baby blues"
occurs days w/in birthing
-emotional liability, sleep disturbance, difficulty concentration
-80% resolve by week 2, if beyond = alt dx
-20% go to PP Depression
support and reassurance! get helpers so she can get rest
83
postpartum "baby blues"
-26-85% incidence
occurs days w/in birthing
-emotional liability, sleep disturbance, difficulty concentration
-80% resolve by week 2, if beyond = alt dx
-20% go to PP Depression
support and reassurance! get helpers so she can get rest
84
postpartum depression & tx
10-20% incidence
-most common 2-4 months PP but can also be anytime in 1st year after birth
-depressed mood 2 or more weeks with changes in appetite, sleep, disturbance, guilt, worthlessness
-risk of suicide
tx: psychotherapy, psychopharmacology medical therapy (will be secreted in breast milk)
-hospitalization if needed
85
if depression occurs RIGHT after childbirth, the depression most likely came from..
antepartum depression (before birth) that's worsening in PP period
86
postparum psychosis
0.2% incidence
-early onset! usu 3 days PP
-delusions, hallucinations, agitation, insomnia, confusion
-infanticide! delusions about baby by "God" or "devils baby"
-suicidal risk
87
postpartum psychosis treatment
hospitalization needed for mother and baby safety
antipsychotics, mood stabilizers, benzos, antidepressants, etc
can be successfully treated
88
teratogenic risk
for a teratogen to exert it's effect, it must be taken at point in pregnancy when affected organ system is developing
week 3-4 = when neural tube is forming
89
greater molecular weight makes it more ____ to pass during pregnancy and lactation
difficult
greater than 1000 Da: no passage!
ie: insulin, unfractionated heparin, Low molecular weight heparin
-NOT orally bc it's too big to be absorbed by gut that's why it's given IV
90
drug properties that make it easily pass to fetus in breastmilk
1. 250-500 Da
alcohol, nictotine, cocaine (<100)
2. lipophilic (easier than hyodrphilic)
mammary alveolar tissue, placenta, blood brain barrier (think of exciting or sedating drugs (benadryl)
91
pregnancy fetal risk catergoies: A
the best!
well controlled study fails to demonstrate fetal risk in 1st trimester
-risk to fetus < 1% of all meds needed for health and produced by the body
-vitamins (except vitamin A if dose >8000 U it's category X)
-levothyroxine/Synthroid
92
levothyroxine requirements and pregnant hypothyroid women
requirements INCREASE by 30% at 5th week gestation/as soon as pregnancy is confirmed
93
pregnancy fetal risk catergoies: B
B = "B"eta lactam antibiotics (penicillins, cephalosporins)
-macrolides (azithro, erhtryo (not clarithro)
-tylenol
-nitrofurantoin (macrobid); avoid at term (hemolysis)
-specific steroids (budesonide/Pulmicort)
No fetal risk in animal studies but not used in humans
- Or-
Animal studies have shown adverse
effect but not demonstrated in
human study
94
pregnancy fetal risk catergoies: C
"C" = caution
- no human studies
- animal studies has adverse effects on fetus (teratogens)
-2/3 of all meds
-specific antibiotics: bactrim, Clarithromycin (C=C), ciprofloxacin
-most SSRI's, atypical antidepressants
95
pregnancy fetal risk catergoies: D
D= danger
-evidence of fetal risk!
-use may be acceptable if mom has life threatening disease
-ACE-I, ARB (fetal hypotension, IUFD, renal atrophy)
-tetracyclines (think D=doxycyclines)
-older antiepiletic: carbamazepine/Tegretol, Valproic acid/Depakote
-Lithium (ebstein anomaly with tricuspid/cardiac problems)
-paroxetine (cardiac defects)
96
pregnancy fetal risk catergoies: X
animal and human show fetal abnormalities
NO therapeutic indication in pregnancy
-isotretinoin (Accutane)
-thalidomide
-statins (3-4x inc in congenital statin syndrome)
97
When a pregnant woman takes a
teratogenic drug, the fetal effects are
usually seen in:
A. Certain target organs in a predictable
manner.
B. Random body systems without a
predictable pattern.
C. Select organ systems with random
outcomes.
D. A pattern of systemic injury
A. Certain target organs in a predictable
manner.
ie: lithium causes cardiac defects
valproic causes neural tube defects
98
Treatment options for uncomplicated
Chlamydia trachomatis infection in
pregnancy include:
A. Clarithromycin.
B. Doxycycline.
C. Azithromycin.
D. Ofloxacin.
C. Azithromycin
C=category C Clarithromycin
D = category D doxyclicine
ofloxacin = flouroquinolones (Category C bc clarithormycin is C)
99
Which of the following antimicrobials is preferred for the treatment of a UTI
during pregnancy?
A. Doxycycline
B. Levofloxacin
C. Cephalexin
D. TMP-SMX
choose antimicrobial that's safest for fetus and effective
-avoid D = doxycycline not for UTI and category D
-levofloxacin = fluoroquinolone category C
answer: cephalexin/keflex = category B
-TMP-SMX = category C
other UTI med that CAN be used for preg: nitrofurantoin (macrobid)
100
T/F
drugs get into milk and stay there
false
Diffusion from higher
concentration to lower concentration
* Two-way diffusion
– Serum to breast
– Breast to serum
– This area can be to the breast or from the breast.
* Basic drugs, such as macrolides, trapped in breast milk
101
T/F
“Pump and dump” is helpful in
reducing drug levels in mother’s milk
false
Creates area of lower drug concentration in empty breast
–Drug diffuses from area of high
concentration (maternal serum) to area of low concentration (empty breast)
102
when is pump and dump helpful?
when women ingest contraindicated product during action
Need to continue for drug’s 3–5 T½
* Cocaine (T½= 1 hour)
– 3–5 T½=~3-5 h pump and dump
* PCP (T½=24–51 hours)
– Stored in fat
– 3–5 T½=~3–7 days
103
hale's rule
Infant receives ≤1% of maternal drug dose from lactation
Most models of drug ingestion
via lactation based on 1 liter/day
milk intake
– Can under- or overestimate infant
drug exposure
104
hale's lactation risk category L1
SAFEST controlled study
* Acetaminophen
* The penicillins
* Medroxyprogesterone acetate
(Depo-Provera®)
105
hale's lactation risk category L2
Safer
– Limited number of women studied
without risk
* Macrolides (azithromycin, clarithromycin, erythromycin)
* Nitrofurantoin (Macrodantin, Macrobid)
* Cephalosporins
* 2nd-generation antihistamines (loratadine [Claritin], et al.)
* Prednisone
* SSRIs
106
hale's lactation risk category L3
No controlled study or controlled study shows minimal, non life-threatening risk
* TMP-SMX (Bactrim)
* FQ antibiotics (-floxacin suffix,
ciprofloxacin, levofloxacin)
* 1st-generation antihistamines
(diphenhydramine [Benadryl], et al.)
* Doxycycline
107
hale's lactation risk category L4
– Hazardous
– Positive evidence of risk but may be used if maternal life-threatening situation
* Lithium
* Ergot preparations
* Daily high dose systemic corticosteroids
– Equivalent prednisone ≥10 mg/d long term
108
hale's lactation risk category L5
Contraindicated
* Radioactive isotopes (ie: imaging for thyroid)
* Cocaine
109
ectopic pregnancy
fertilization egg implantation outside of uterus
95% located in fallopian tube
thats why it's called tubal pregnancy somtimes
110
risk factors for ectopic pregnancy
Strongest risk factors:
- hx of salpingitis (inflammation of fallopian tubes from PID, chlamdydia, gonorrhea infection) (most common risk factor)
-Prior ectopic pregnancy
-History of tubal surgery
-Assisted reproduction
-History of infertility
-Cigarette
Less potent risk factors:
*Maternal in utero DES exposure
*Progestin use
*Current IUD/ IUS use
*Vaginal douching
*Tubal ligation failure (3% of all ectopic
pregnancies)
111
ectopic pregnacy clinical presentation
-Abdominal pain (often bilateral)
-Adnexal tenderness
-Menstrual irregularity (weird off and on period)
-Uterus size ≤gestational age
-Adnexal mass (only felt 50% of women)
-progesterone – ≤15 (not enough of chorion to growing the tube)
-low hCG <6000, most < 2000
Serum HCG positive but doesn't increase
112
ectopic pregnancy diagnosis
-transvaginal dx can't identify intrauterine
gestational sac
– hCG > 1,500
113
Ectopic Pregnancy Management
Majority actually resolve without
intervention. if the tube tears and with ovarian artery = life threatening
Salpinostomy, salpinectomy
or Methotrexate med therapy but must meet ALL the criteria:
*Conceptus <3.5 cm with no evidence of
cardiac activity
*Unruptured tube
*hCG level< 15,000 IU/L
*Hemodynamically stable with no signs or
symptoms of active bleeding or hemoperitoneum
*Available for close follow-up
114
Rh compatibility
1st pregnancy with RH + fetus with RH - mom. RH + RBC enter mom's blood and anti RH antibodies are made.
GIVE RHOGAM at 28 weeks pregnancy AND 72 hrs after pregnancy so it can
2nd pregnancy with RH + fetus, it will attack and destroy fetal RH + RBC = hemolytic. Anti RH antobides remain in mother's circulation and cross placenta.
each pregnancy & delivery of RH + baby need repeated dose
115
what supplements do breastfeeding infants need?
iron and vitamin D 200 IU
