Exam 3 - Prenatal Care Flashcards
What are the five basic components of prenatal care?
- Early and accurate calculation of gestational age
- Identifying risk factors and potential complications
- Continuous assessment of fetal growth and well being
- Health promotion
- Interventions to treat identified problems
How often should nulliparous women attend prenatal visits?
8 total visits
How often should multiparous women attend prenatal visits?
6 total visits
How often should pregnant women beyond 40 weeks attend prenatal visits?
Add additional visits
What is the typical schedule for prenatal visits?
Every 4 weeks until 28 weeks
Every 2 weeks until 36 weeks
Every week until birth
Gravida
Total number of pregnancies, regardless of outcome
- Includes current pregnancy
Nulligravida
Has never been pregnant
Primigravida
Pregnant for the first time
Para
Number of times a woman has given birth to a fetus of at least 20 weeks (one birth for twins)
Nullipara
Has not remained pregnant beyond 20 weeks
Primipara
One pregnancy beyond 20 weeks (has given birth once)
Multipara
Has had 2+ pregnancies beyond 20 weeks and given birth more than once (counting multiple births as one event)
What does GTPAL stand for?
G: gravida or number of pregnancies
T: number of term pregnancies
P: number of preterm infants
A: number of spontaneous or induced abortions
L: number of living children
What happens during the first trimester of pregnancy?
At weeks 1-12
- Organogenesis completed by end of 12th week
- Risk of spontaneous abortion reduced past 12 weeks
What happens during the second trimester of pregnancy?
Weeks 13-28
- Point of fetal viability, but now reduced to 24 weeks d/t medical advacements
What happens during the third trimester of pregnancy?
Weeks 28-40
Typical labs drawn during prenatal visits
- Blood type, Rh factor, antibody screen
- CBC
- Hepatitis B surface antigen (HbsAg)
- HIV screening
- STI testing
- Rubella titer
- Varicella titer if status unknown or no history of chicken pox
Additional tests that could be obtained to rule out UTI during pregnancy
- Urinalysis for protein, glucose, or ketones
- Urine culture and sensitivity
Additional tests for pregnancy patients with risk of diabetes
Hemoglobin A1C and fasting blood glucose
What are risk factors for diabetes in pregnant patients?
- History of gestational diabetes
- History of glucose intolerance
- BMI >25
- History of macrosomia or stillbirth
- 1st degree relative with diabetes
- Non-white race
Required vaccinations
- Tdap
- Influenza
- Hep B
What should the provider assess for during the physical exam?
- Blood pressure
- Weight
- Fundal height
- Fetal heart tones
- Fetal presentation
What should be assessed during the third trimester of pregnancy?
- Birth plan
- Repeat STI testing
- Kick counts
- Group A beta strep
What tests should be done during weeks 18-20?
OB ultrasound for dating and anatomical survey
What tests should be done at weeks 24-28?
Glucose tolerance test to screen for gestational diabetes
What tests should be done at weeks 36-38?
Group B strep
Recommended weight gain for underweight patients (BMI <18.5)
28-40 lbs
Recommended weight gain for normal patients (BMI 18.5-24.9)
25-35 lbs
Recommended weight gain for overweight patients (BMI 25-29.9)
15-25 lbs
Recommended weight gain for obese patients (BMI >30)
11-20 lbs
When should pregnant patients take folic acid supplements?
3 months before pregnancy - helps prevent neural tube defects (neural tube closes by 4-6 weeks gestation)
What is the recommended dose of folic acid during pregnancy?
400 mcg/day
4 mg/day if prior infant with neural tube defect
How much caffeine intake is recommended during pregnancy?
No more than 200 mg/day
