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EndoRepro 2 Exam 1 > Clin: Normal Pregnancy and Prenatal Care - Moulton > Flashcards

Clin: Normal Pregnancy and Prenatal Care - Moulton Flashcards

1
Q

what should be started at least 1 month prior to conception to reduce the risk of neural tube defects?

A

folic acid

  • if no history of NTD, 0.4mg folic acid
  • if hx of previous child with NTD, increase to 4mg folic acid
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2
Q

what should diabetics be counseled on preconception?

A

adequate glucose control before and throughout pregnancy can decrease maternal morbidity, SAB, fetal malformations, fetal macrosomia and IUFD

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3
Q

what is FPAL?

A

Full term: 37-42 weeks
Preterm: 20-36+6 weeks
Abortions: all pregnancy loses prior to 20 weeks (<500g)
Living

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4
Q

what is the GP of a woman who has given birth to 1 set of twins at term and both are living?

A

G1P1002

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5
Q

the number of pregnancies that led to BIRTH at or beyond 20 weeks, or an infant weighing more than 500 grams

A

parity

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6
Q

what is the GP of a woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriage, and 1 ectopic pregnancy. She has 3 living children

A

G4P1123

ectopic pregnancy and miscarriage in same spot

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7
Q
  • systolic murmurs, exaggerated splitting and S3
  • palmar erythema
  • spider angiomas
  • linea nigra (darkened areolas)
  • striae gravidarum (stretch marks)
  • chadwicks sign (bluish hue of vagina/cervix)
  • malasma/chalasma (red “mask” over cheeks ad nose)
A

normal finding associated with pregnancy

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8
Q
  • CBC
  • blood type and screen
  • Rubella (vaccinate postpartum if not immune)
  • Syphilis
  • Heb BsAg
  • HIV
  • cervical cytology, gonorrhea and chlamydia
  • diabetes screen based on risk factors
  • urine culture
A

prenatal labs done at 1st visit

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9
Q

what common lab value will increase during pregnancy?

A

fibrinogen (pregnancy is a hyper-coagulable state), plasma, amylase, leukocytes
- most other lab values will decrease

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10
Q

when is the most important time to get an US?

A

1st trimester, gives most accurate estimation of gestational age and due date

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11
Q

when can hCG first be detected in serum?

A

6-8 days after ovulation

  • less than 5 IU/L = NEGATIVE
  • level above 25 IU/L = POSITIVE
  • level of about 100 is reached by time of expected menses
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12
Q

what level do most urine pregnancy tests detect?

A

hCG at about 25 IU/L

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13
Q

in the first 30 days of a normal pregnancy, what happens to the hCG level?

A

it doubles every 2 days (used to evaluate for early IUP vs ectopic pregnancies)

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14
Q

when can a gestational sac be seen on transvaginal ultrasound?

A

5 weeks

- mean hCG of 1500-2000 IU/L

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15
Q

when can a fetal pole be seen on transvaginal ultrasound?

A

6 weeks

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16
Q

when can cardiac activity be seen on transvaginal ultrasound?

A

7 weeks

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17
Q

what is Naegels rule?

A

estimates gestational age/due date

  • LMP - 3 months + 7 days = EDD
  • useful ONLY for patients with regular 28 day cycles
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18
Q

when can crown rump length (CRL) be used to measure due date?

A

between 6-11 weeks, can determine due date usually within 3-5 days

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19
Q

when can US be used to measure femur length, biparietal diameter and abdominal circumference to determine due date?

A

12-20 weeks, can determine due date within 10 days

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20
Q
  • advanced maternal age (35+)
  • previous child/family history of birth defect
  • previous child with undiagnosed mental retardation
  • previous baby died in neonatal period
  • multiple fetal losses
  • abnormal serum marker screening
  • consanguinity (marrying cousins)
  • exposure to teratogens
  • abnormal uS findings
A

recommend genetic counseling

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21
Q

what are the most common chromosomal disorders?

A

sex chromosome aneuploidy: Turners (45XO), Kleinfelters (47XXY), balanced Robertsonian translocations

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22
Q

what are moms over 35 at an increased risk for?

A

autosomal trisomies (13, 18, 21) or sex chromosome abnormalities

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23
Q

what is the risk that a couple who previously has had a child with Downs syndrome has another affected child with chromosomal abnormality?

A

1%

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24
Q

what causes 95% of cases of Down syndrome?

A

meiotic nondisjunctional events leading to 47 chromosomes with an extra copy of chromosome 21

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25
Q

what should be done on couples after 3+ SAB?

A

karyotyping

  • 3-5% of these couples will be dx with balanced translocation
  • those couples should receive counseling regarding possibility of having a child with an unbalanced translocation and therefore be offered prenatal diagnosis (chorionic villus sampling/amniocentesis)
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26
Q

what is the most common autosomal trisomy?

A

trisomy 16

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27
Q

what are the examples of autosomal dominant disorders that Moulton mentioned?

A

tuberous sclerosis, achondroplasia, muscular dystrophy

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28
Q

what are the examples of AR disorders that Moulton mentioned?

A

Tay-Sachs, sickle cell, alpha and beta thalassemia, cystic fibrosis

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29
Q

what is the most common gene carried in North American whites, with a frequency of 1 in 25?

A

cystic fibrosis

  • genetic counseling is important for CF screening because 15% of carriers are undetected
  • should offer CF screening to all pregnant women
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30
Q

what are the examples of sex-linked disorders that Moulton mentioned?

A
  • Duchenne muscular dystrophy
  • Fragile X syndrome most common form of inherited mental retardation, and second most common form of mental retardation after trisomy 21
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31
Q

how are sex linked disorders diagnosed prenatally?

A

by chorionic villus sampling or amniocentesis

32
Q

cleft lips or palates, congenital heart defects, pyloric stenosis and neural tube defects are examples of what?

A

multifactorial disorders

33
Q

what is the recurrence rate of multifactorial disorders?

A

3%

34
Q

which screening includes:

  • maternal age
  • fetal nuchal translucency (NT) thickness (echo-free area at the back of the fetal neck between 10-14 weeks)
  • maternal serum b-human chorionic gonadotropin (b-hCG)
  • pregnancy associated plasma protein-A (PAPP-A)
A

first trimester screening

35
Q

what is an elevated b-hCG and low PAPP-A associated with?

A

Down’s

  • first trimester screen has detection rate of 79%
  • addition of nasal bone assessment (absence of) to nuchal translucency measurement and serum biochemistry can increase the Down syndrome detection rate to 93%
36
Q

b-hCG, estriol, and maternal serum alpha fetoprotein (AFP)

  • between 16-20 weeks
  • 70% detection rate of trisomy 21
A

triple screen (second trimester screening)

37
Q

b-hCG, estriol, AFP and inhibin A

A 
quadruple screen (second trimester screening)
- 80% detection rate of trisomy 21
38
Q
  • 9-10 weeks
  • tests cell free fetal DNA, thought to be derived apoptosis of trophoblastic cells that have entered the maternal circulation
  • does NOT test for open neural fetal defects
A

noninvasive prenatal testing, cell-free fetal DNA

39
Q

when would you order a cell-free fetal DNA?

A

ONLY in high risk patients, including one or more of the following

  • advanced maternal age
  • history of prior pregnancy with a trisomy
  • family history of chromosomal abnormalities
  • fetal ultrasound abnormalities suggestive of aneuploidy
  • positive serum screening test including first trimester, triple or quad screen
40
Q

what’s the next step if cell-free fetal DNA comes back positive?

A

proceed with invasive diagnostic test to confirm results

- amnoicentesis or chronic villus sampling (CVS)

41
Q

which second trimester screen is performed at 16-20 weeks, and has a 0.3% miscarriage rate?

A

amniocentesis

42
Q

which second trimester screen is performed during the 11th week, and has a 1% miscarriage rate?

A

chorionic villi sampling

- can still do D&C at 11 weeks, less traumatic

43
Q

what is the study of abnormal fetal development?

A

teratology

44
Q

what does thalidomide cause?

A

phocomelia (flipper babies)

45
Q

what is risk factor category X?

A

the use of the product is contraindicated in women who are or may become pregnant

46
Q

what changed the content and format for information presented in prescription drug labeling to assist health care providers is assessing benefit vs. risk of medications?

A

Pregnancy and Lactation Labeling Rule (PLLR)

47
Q

which subsection of PLLR includes pregnancy exposure registry risk summary, and clinical considerations?

A

pregnancy (8.1) subsection

48
Q

which subsection of PLLR provides information about the use of drugs while breastfeeding, such as amount of drug in breast milk and potential side effects to breastfed infants?

A

lactation (8.2) subsection

49
Q

which subsection of PLLR includes information about the need for pregnancy testing, contraception recommendations, and information about infertility as it relates to the drug?

A

females and males of reproductive potential

50
Q

efficacy of a teratogen is dependent on the genetic make-up of a mother and fetus as well as on a number of factors related to maternal-fetal environment (multifactorial)

A

fetal susceptibility

51
Q

what period is known as organogenesis?

A

day 17-56 post conception, is the most vulnerable stage

52
Q

from the fourth month to the end of gestation, what goes development consist of?

A

increasing organ size
- with the exception of brain and gonads - teratogenic exposure after the 4th month usually results in delayed growth and not into malformation

53
Q

what is the most common teratogen to which a fetus is exposed?

A

alcohol

54
Q

exposure to what medication has been associated with a four fold increase in severe congenital anomalies?

A

anti-anxiety meds: meprobamate (D) or chlodiazepoxide (D)

55
Q

what is the drug of choice for anxiety and depression during pregnancy?

A

fluoxetine

56
Q

what two drugs are known folic acid antagonists and have been established as teratogens?

A

anti-neoplastic meds: aminopterin (X) and methotrexate (D)

  • exposure before 40 days is lethal to embryo
  • later exposure causes IUGR, craniofacial abnormalities, mental retardation, miscarriage, stillbirth and neonatal death
57
Q

what anticoagulant crosses the placenta and should NOT be used during pregnancy?

A
  • *coumadin**
  • causes spontaneous abortion, IUGR, central nervous system defects like mental retardation, stillbirth and craniofacial features known as fetal warfarin syndrome
58
Q

which anticoagulants do NOT cross the placenta and CAN be used during pregnancy?

A

herapin and lovanox

59
Q

craniofacial abnormalities, limb reduction defects, prenatal onset growth restriction, mental deficiency, and CV anomalies

A

fetal hydantoin syndrome (FHS)

- caused by diphenylhydantoin (Dilantin)

60
Q

what other anticonvulsants were mentioned as causing spinal defects?

A

valproic acid and carbamazepine

61
Q

what can cause the masculinization of female external genitalia?

A

highly androgenic progestins

62
Q

what malformations can retinoids (accutane) cause?

A
  • central nervous system (hydrocephaly, facial nerve palsy, cortical blindness)
  • cardiovascular
  • craniofacial defects (microcephaly with severe ear abnormalities)

NOTE: rate of SAB is 50% if retinoids taken in first trimester

63
Q

which miscellaneous agent is dose dependent

  • interferes with fetal growth - weight, length, and head circumference
  • increases risk of SAB, fetal death, neonatal death and prematurity
A

tobacco

64
Q

what is the critical period for radiation exposure?

A

between 2-6 weeks postconception

65
Q

what happens if exposure is before 2 weeks?

A

either lethal, or no effect at all

66
Q

what is the rule of thumb for radiation exposure?

A

less than 5 rads of exposure = no risk

67
Q

what causes constipation in pregnancy?

A

decrease in colonic activity

- tx: dietary changes, increase water, fiber, fruits, vegetables, stool softener

68
Q

what causes hemorrhoids in pregnancy?

A

increase in venous pressure in the rectum

- tx: rest, stool softeners, sitz baths, elevation of legs, avoid constipation

69
Q

how often should a woman been seen during pregnancy?

A
  • every 4 weeks until 28 weeks
  • every 2 weeks from 28 to 36
  • weekly until delivery
70
Q

what happens at prenatal visits?

A

BP, weight

  • urine protein
  • measurement of uterine size
  • fetal heart rate (doppler at 12 weeks, fetoscope 18-20 weeks)
71
Q

when does the first sensation of movement usually happen?

A

quickening occurs on average at 20 weeks

72
Q

what routine screening should be done at 20 weeks?

A

fetal survey US

73
Q

what routine screening should be done at 28 weeks?

A

gestational diabetes and repeat hemoglobin and hematocrit

  • Rhogam injection
  • Tdap
74
Q

what routine screening should be done at 36 weeks?

A

screening for GBS with vaginal culture

- if positive, treat in labor

75
Q

what is considered normal fetal movement?

A

10 movements in 2 hours

76
Q

what is a reactive NST?

A

2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes of monitoring
- if nonreactive, further evaluation is warranted (contraction test, biophysical profile)

77
Q

what is a contraction stress test (CST)?

A

give oxytocin to establish at least 3 contractions in a 10 min period
- if late decelerations are noted with the majority of contractions, the test is POSITIVE and delivery is warranted

EndoRepro 2 Exam 1 (25 decks)

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