Clinical Care of the Pregnant Person Flashcards
4 methods to diagnose a pregnancy
History
Physical
Beta hCG
Ultrasound
3 methods to date a pregnancy
History (LMP, IVF)
Physical (uterine size)
Ultrasound (transvaginal or transabdominal)
Where should the uterus be at
- 12 weeks
- 16 weeks
- 20 weeks
- Symphysis
- Mid-way to umbilicus
- Umbilicus
GTPAL
Gravida (number of pregnancies)
Term (number of pregnancies delivered at term)
Preterm (number of pregnancies delivered at preterm)
Abortus (prior to 20 weeks)
Living (# of living children)
Beta hCG is made by __ and its function is __
Made exclusively like syncytiotrophoblasts
Role is to rescue and maintain corpus luteum and therefore production of progesterone until placenta takes over progesterone production
Ultrasound is used for… (4)
Dating pregnancy
Confirming viability
Assess for early complications
Assess for multiple gestations
What is transvaginal ultrasound good for?
Early pregnancy assessment (under 10 weeks)
Obese women
What is the gold standard for dating a pregnancy?
Ultrasound
Unless IVF!
Dating ultrasound
First scan after 7 weeks
Do before 14 weeks because thats when we start our own individual growth potential
Asses crown rump length
Also gestation sac, yolk sac, fetal cardiac activity
Are yeast infections risky in pregnancy?
No!!
Is it normal to have bleeding in early pregnancy?
Yes
But these signs/symptoms will likely need investigation
To assess viability and rule out ectopic pregnancy
Abnormal rise of beta hCG is suggestive of…
Non-viable pregnancy
Does not distinguish location of pregnancy
Who should be offered genetic screening?
All patients!
Difference between SIPS and IPS
IPS has nuchal translucency scan (for downs and cardiac abnormalities)
Screening programs integrate what various components? (6)
Maternal age Maternal medical conditions Maternal ethnicity Gestational age Serum analytes Ultrasound
5 analytes produced by fetal-placental unit
PAPP-A AFP hCG Estriol DIA
Nuchal translucency scan
Thickness of tissue in nuchal area between 11-14 weeks
Increased NT with aneuploidy and cardiac anomalies
What is the second trimester ultrasound looking for?
Structural abnormalities, growth, fluid, placenta
Ex: congenital heart anomaly, GI anomalies
NIPT
Non-invasive prenatal testing
Detection of cell free fetal DNA in maternal serum
Abnormal results should be confirmed with a diagnostic test
Only covered if you have a positive SIPS and IPS
Amniocentesis
Ultrasound guidance, needle procedure
Amniotic fluid contains fetal cells
> 15 weeks gestation
Risk 1/200 spontaneous abortion
Chorionic villus sampling
Ultrasound guidance, needle or biopsy forceps
Chorionic villi = placenta
11-13 weeks
Risk 1/100 of spontaneous abortion
How can the patient measure fetal well being?
Fetal movement counting
After ~26 weeks expect consistent fetal movement 6X in 2 hours
4 methods care providers can use
Fetal movement counting
Non-stress test
Contraction stress test
Ultrasound/biophysical profile
Non-stress test
Very common use in obstetrics
Continuous monitor of fetal HR over 20-40 mins
During period of non-stress (no induced contractions)
Assess multiple parameters
Indirect assessment of fetal oxygenation and well being
Contraction stress test
Assesses similar patterns as NST but during contractions
Induce contractions by administering IV oxytocin or endogenous oxytocin
How can ultrasound assess fetal well being?
Assesses growth, amniotic fluid volume, anatomy
