Clinical Flashcards
First second and third trimester last how long
0-12 wks
13-27 wks
28-delivery
It’s easier to asses gestational age earlier in the pregnancy, however many patients present for care in the 2nd trimester, some even present with labor having had no prenatal care. What are the goals/purpose of prenatal care?
Confirm gestational age, identify risk factors, health assessment, education. Rx, domestic concerns, delivery plan.
What is gravid and parity?
gravid is the state of being pregnant
parity is delivering a fetus past 20 wks.
Broken into TPAL for the number of pregnancies that are:
full term, preterm (
G1P0102 is what?
One birth of preterm twins that are living
What information do you want from the patient in order to calculate their child’s gestational age?
FDLNMP first day of last normal menstrual period
What drug counseling do you give a woman who recently became pregnant?
Check with you before taking any new drugs, herbal supplements etc. Start prenatal vitamin, Fe if necessary. Natural isn’t always safe. Co-manage medication for chronic conditions with specialist. Limit coffee and salt.
What are generally and specifically unsafe vaccinations to give a pregnant woman?
live or attenuated virus strains
MMR
VZV
Oral polio
BCG for TB
What’s the likely US modality used to visualize a fetus in the first trimester?
TVUS
Later TAUS abdominal
Blood work is an important part of prenatal care and should be done in first trimester ideally but in labor if necessary. What are your big concerns?
HTN-pre-ecclampsia Seizure-ecclampsia HELLP DM Drug exposure-recreational or prescription STI and fetal risk Genetic disorders
You have an obese mother whose last baby was 11lbs. She presents this time in the first trimester. When should her glucose screen be done?
First trimester because she’s high risk. Usually this is done at the end of the second or first week of the third trimester. There are exceptions like obesity, large prior baby, and FH
Amniocentesis can be done when, via what methods, and can give you what information?
15+ wks
transabdominal
Genetics, lung maturity, chorioamnionitis, NTD, hematologic abnormalities, polyhydramnios.
CVS can be done when, and how. What should you do of ran Rh- mother with an Rh + fetus?
wk 9+
transcervical or abdominal
Rhogam
Look for abnormalities via FISH or PCR
You screen a first trimester fetus that has low PAPP-A and high beta HCG (US shows some impedance of the ductus venosus) what should you do next? What if the serum results were normal?
CVS test
If results were normal screen again in the second trimester
When is a cell free fetal DNA test indicated and how does it work? What information can it give you?
Maternal age greater than 35 at delivery, US findings indicate increased risk for aneuploidy, or hx of trisomy, or positive screen for aneuploidy.
Indicates if a woman is at increased risk of the big 3 trisomies.
If positive follow up with CVS/amniocentesis
What basic traveling restrictions do pregnant women have?
No prolonged sitting b/c DVT risk
No plane travel after 36 weeks delivery risk
Toxin exposure can have various effects for a pregnant woman depending on when they were exposed. Would a 50 day old fetus be more likely to have a structural, functional, or lethal exposure risk?
Neural tube closes when?
28 days after conception about 4 weeks
Rx categories ABCD and X mean what?
A adequate studies have failed to demonstrate risk to the fetus
B Beasts studies have failed to demonstrate risk
C Animals studies have shown adverse effects to the fetus but benefits may warrant use of the drug in pregnant women
D Definite risk to human fetus, may still need to take the drug depending on the condition
X Human and animal studies say risk clearly outweighs the benefit
What are some of the complications that can occur in women who delay childbearing until their mid 30s
Increased risk of infertility and as they age increase risk of: Ectopic, spontaneous abortion, chromosomal abnormalities like trisomy, placenta prevue, gestational diabetes, preeclampsia, C-section, pre-term birth.
What does paternal age matter?
Increase risk of autosomal dominant mutations, congenital defects, schizo, autism, child cancer, miscarriage. AND x-linked gene mutations maybe more common leading to the grandfather effect. (carrier daughters to affected grandsons? not sure whats up with that)
consanguinity?
inbreeding “God my first cousin is hot”
