Exam 2 Prenatal Care Flashcards
Reasons for prenatal care? (5)
1) Early, accurate estimate of gestational age
2) Identify at-risk pts
3) Eval/follow health of mom/baby
4) Anticipate/intervene problems
5) Pt education
Preconception exam should include?
General physical (check for cavities)
Preconception exam should always include what lab?
When indicated? (10)
HIV
Rubella/Varicella titer Hep B/C Gonorr/Chlam cx TB RPR CBC Fasting blood sugar Hgb A1C Cystic fibrosis carrier Tay Sachs
Preconception care should include what immunizations? (6)
MMR (NOT if already pregnant/must wait 1 mo post) Varicella Hep B Flu Tdap \+/- pneumococcal
Preconception folic acid dose?
0.4 -0.8 mg/day
4 mg if neural tube defect hx
Prenatal care 1st visit should occur when?
By week 10 (1st trimester)
Prenatal care 1st visit history should include? (7)
Full hx including: STD, PID, Abn paps Planned vs unintended preggo Domestic violence Tobacco/alcohol/drugs Inheritable dzs Barriers to care
Prenatal care 1st visit Obstetric Hx includes?
G: # of pregnancies P: TPAL T = Full term P = Preterm (<37wks) A = Abortions (spont, induced, ectopic) L = Living
Prenatal care: Estimated Date of Confinement (Delivery) is calculated how?
(LMP + 7 days) - 3 months
Early Term is?
37 0/7 - 38 6/7 weeks
Full Term is?
39 0/7 - 40 6/7 weeks
Late Term is?
41 0/7 - 41 6/7 weeks
Postterm is?
42 0/7 weeks on
Prenatal care 1st visit Physical Exam should include? (2)
General
Pelvic
Prenatal care 1st visit Pelvic Exam should include? (4)
Uterine size/shape/adnexa (parts joining it)
Chadwick’s Sign
Hegar’s Sign
Specimen collection
Chadwick’s Sign is?
Blue coloring of vagina/cervix from ↑ blood flow
Indicates pregnancy
Hegar’s Sign is?
Softening of isthmus (where cervix meets uterus)
What specimens should be collected during 1st visit pelvic? (2)
pap
gonor/chlam
Prenatal care 1st visit labs should include? (11)
hCG (ALWAYS!) Blood type/Rh Anitbody screen Rubella/Varicella titers Syphilis Hep B HIV CBC UA w/ C&S TSH Cystic Fibrosis if pt wants it
Prenatal care 1st visit additional lab for at-riskers? (5)
TB Hep C Trichomonas HSV Hgb A1C
Prenatal care 1st visit US done how?
Why?
Cardiac motion visible how soon?
Transvag US
Confirm estimated delivery date (IMPORTANT!)
5 - 6 weeks
1st trimester is?
2nd trimester is?
3rd trimester is?
1 to end of wk 12
13 to end of week 26
27 on
Prenatal F/U care schedule?
1st 28 wks = Q 4 wks
28-36 wks = Q 2wks
36 wks = Q 1wk
Quickening is?
1st fetal movements:
@ 18-20 wks w/ 1st preg
@ 16-18 wks w/ add’l pregs
Prenatal F/U visits should include? (5)
Hx BP Fetal Heart Tones Fundal height Extremities
Fetal Heart Tones measured how?
When?
Normal bpm?
Doppler
wks 10 - 12
120-160 bpm
Fundal Height at 12 weeks?
20 weeks?
After 20 weeks?
Drops when?
12 wks = pubic symphysis
20 wks = umbilicus
1 cm additional height for each week after 20
Drops @ 36-38 weeks
Prenatal Care 3rd Tri should include? (2)
Leopold’s Maneuvers
Cervical exam
Leopold Maneuvers are?
Method of feeling for baby’s position during 3rd trimester
Cervical Exam during 3rd Tri assesses what? (4)
Effacement (thinning/shortening)
Dilation
Station
Presenting parts
Station is?
Measured how?
“Engaged” means?
Position of baby’s head in relation to ischial spines of pelvis
Measured -5 to +5
Measurement of 0
Head entered vaginal canal w/i pelvic bones
Prenatal Care Routine Screening labs? (6)
Urine protein/sugar EVERY time Down's @ 1st tri Gestational DM @ 24-28 wks CBC for anemia @ 3rd tri Repeat Rh @ 3rd tri Group B strep (vag/rectum) @ 35-37 wks
If Rh screen is negative, next step?
Rh IG @ 28-30 wks
Aneuploidy screening is for?
Neural tube
Down
Tri 18
Aneuploidy screening done when/how? (3)
1st tri
Sonogram for nucal translucency w/ blood markers
Maternal Quad Screen for markers AFP, uE3, hCG, inhibin A
Cell Free DNA testing is? (5)
Optional for: 35+ yo Fetal US = ↑ aneuploidy risk Hx of trisomy \+ test for aneu Robertsonian translocation
US schedule/purpose? (3)
1st tri: dating, location, eval bleeding/pain
2nd tri (18-20wks): growth, anatomy, placenta, P gender
3rd tri: growth, presentation, bleeding, Biophys Profile
Biophysical Profile includes? (5)
Non-Stress Test Fetal Breathing Movements Fetal Movement Fetal Tone Amniotic fluid vol
Appropriate Weight Gain by BMI:
<18.5?
18.5 - 24.9?
25 - 29.9?
30+?
<18.5 = underweight
gain 28-40 lbs
18.5 - 24.9 = normal
gain 25-35 lbs
25 - 29.9 = overweight
gain 15-25 lbs
30+ = obese
gain 11-20 lbs
Fetal Wellbeing Tests? (4)
Fetal mvmt/Kick counts
Non-stress Test
Contraction Stress Test
Biophys Profile
Compound presentation causes risk of what?
Anterior tear of vulva
Posterior tears are more common
Parts of pelvis:
Inlet landmarks?
Midpelvis landmarks?
Outlet landmarks?
Inlet = Symphysis (top), Sacral promontory (post), pectinate lines (lateral)
Midpelvis = Mid symphysis (top), Midpoint of sacral curve (post), Ischial spines (lateral)
Outlet = Inferior symphysis (anterior), tip of sacrum (post), Ischial tuberosities (lateral)
Passage shape best for pregnancy/delivery?
Gynecoid
Acceptable meds for HTN in pregnancy?
NOT ACE inhib! (-prils)
Methyldopa
β-block
CCB
Acceptable ABX for pregnancy?
NOT TCN (Doxy) during preg and breast feeding!
Topical Erythro, Clinda
Systemic Azythro, Amox
Acceptable meds for Bipolar in pregnancy?
NOT Valproate Carbamazepine Lithium Lamotrigine
Anti-depressants
Anti-psychs (not during 3rd tri)
