Childbearing Flashcards
Full term vs early term vs late term vs post-term
Full term → 39 - 40 weeks 6 days
Early term → 37 weeks - 38 weeks 6 days
Late term → 41 weeks - 41 weeks 6 days
Post-term → after 42 weeks
Common signs occurring at 8 weeks of pregnancy
- Hegar sign: softening of uterine isthmus
- Goodell sign: softening of vaginal portion of cervix
- Chadwick sign: blue-violet vaginal color
Common signs occurring at 10 weeks of pregnancy
First fetal heart tone can be heart via abdominal US at 10-12 weeks
Common signs occurring at 12 weeks of pregnancy
Uterine fundus palpable through abdominal wall as it rises above symphysis pubis
Common signs occurring at 16 weeks of pregnancy
- Uterine fundus halfway between symphysis pubis and umbilicus
- Quickening (fetal movement) during weeks 16 and 17 if second pregnancy
- Week 18 if first pregnancy
Common signs occurring at 20-36 weeks of pregnancy
- 1 cm gain in fundal height per week
- Uterine fundus at umbilicus at 20 weeks
CDC recommendation of folic acid intake/supplementation during pregnancy
400 mcg supplementation daily
- 4 mg/day for one month before pregnancy and during first 3 months of gestation if previous history of neural tube defect
Recommended range of total weight gain during pregnancy
- Underweight vs normal vs overweight vs obese
Underweight (BMI <18.5) - 28-40 lb
Normal (BMI 18.5-24.9) - 25-35
Overweight (BMI 25-29.9) - 15-25
Obese (BMI >30) - 11-20
Frequency of prenatal visits
- Up to 28 weeks, 28-36 weeks, 36 weeks or more
Up to 28 weeks → every 4 weeks
28-36 weeks → every 2 weeks
36 weeks or more → every week
Prenatal care - testing at 10-13 weeks
- First trimester screen with plasma protein A (PAPP-A)
- hCG
- US nuchal translucency for trisomy
Can proceed with Quad screening at 15-21 weeks (
Prenatal care - testing at 15-21 weeks (ideally 16-18 weeks)
- Quad screen/AFP4/tetra marker for trisomy or neural tube defect
- US to detect physical defects
Prenatal care - testing at 24-28 weeks
- One hour glucose tolerance test
- If Rh-neg, will need antibody screen and given RhoGAM at 28 weeks
Prenatal care - testing at 28-32 weeks
- Hemoglobin
- STIs
- Administer RhoGAM, if needed, at 28 weeks
Prenatal care - testing at 32-36 weeks
- Fetal presentation
- Kick count
- 4+ in 1 hour
- 10+ in 2 hours
Prenatal care - testing at 35-37 weeks
- Group B strep culture (rectal and vaginal)
Prenatal care - testing at 40-42 weeks
- Vaginal examination to assess cervical ripeness
- Fetal station
Prenatal care - testing at 41+ weeks
- Nonstress test and BPP to check fetal status
- BPP consists of five components:
- Fetal breathing movements
- Gross body movements
- Tone
- Amniotic fluid index
- Nonstress test
Instead of a Quad screen, when can the provider offer a cell-free fetal DNA test for pregnant mothers?
- Maternal age 35+ years
- Fetal US findings indicating increased risk of aneuploidy
- History of prior pregnant with trisomy
- Positive test result for aneuploidy
- Parental balanced Robertsonian translocation with increased risk of fetal trisomy 13 or 21
Diagnostic criteria for preeclampsia
- Elevated BP diagnosed after 20th week of pregnancy
- 140/90 or greater on two readings at least 4 hours apart
- 160/110 or higher for one reading)
- Proteinuria
- >300 mg per 24 hour urine collection
- Protein/creatinine ratio of 0.3 mg/dL or more
- Dipstick of 2+
Other findings:
- Thrombocytopenia (less than 100,00 platelets)
- Renal insufficiency
- Impaired liver function
- Pulmonary edema
- New onset headache unresponsive to medication and not accounted for by another diagnosis
What syndrome can preeclampsia progress to?
HELLP syndrome
- Elevated lactate dehydrogenase
- Elevated AST/ALT
- Platelets less than 100,000
Preeclampsia treatment and management
- Definitive treatment = birth
- Considered after 34 weeks gestation
- Referral to expert obstetrics
- Supportive → rest, ongoing maternal and fetal monitoring
- Antihypertensives and/or anticonvulsants
GBS treatment
Intrapartum IV antibiotics (PCN) - beings at onset of labor and continues through delivery
Stages of labor: early labor (also called latent phase of labor)
- Longest part (lasts 2-3 days)
- Mild to moderate contractions lasting 30-45 seconds, 5-20 minutes apart
- Cervix dilates to 3 cm
- Membranes intact
Stages of labor: active labor
First stage
- Cervix dilates to 3-4 cm or more
- Contractions every 2-3 minutes and last 50-70 seconds or more
- Go to hospital or birthing center when contractions are every 5 minutes apart and last 1 minute
Final stage
- Cervix dilates to 7-10 cm
Stages of labor: second stage of labor
Actual birth
Stages of labor: third stage of labor
Placenta detaches and expelled from uterus
When can labor inductions occur?
No sooner than 39 weeks or if pregnancy goes beyond 41 weeks
When does postpartum blues typically resolve?
Beings a few days after giving birth and goes away after 14 days
