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OB > exam one: class two > Flashcards

exam one: class two Flashcards

1
Q

probable signs of pregnancy

A
  • objective
  • the things the provider can observe measure
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2
Q

Presumptive signs of pregnancy

A
  • subjective
  • the things the women experiences and reports
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3
Q

what are some positive signs of pregnancy (4)

A
  • fetal heartbeat per doppler or fetoscope
  • fetal movement that is palpated and visualized by trained professional
  • visualization of fetus on ultrasound
  • delivery
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4
Q

what are presumptive signs of pregnancy (9) and what else could be causing that sign

A
  • amenorrhea- stress weight changes
  • nausea - gastritis, food poisoning
  • vomiting - gastritis, food poisoning
  • urine frequency - UTI
  • breast tenderness- PMS
  • darkened areola - oral contraceptive pills, sun peristalsis
  • quickening (feeling movement) - gas
  • weight gain - excessive caloric intake
  • fatigue-virus
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5
Q

what are probable signs of pregnancy (10) and what else could be causing it

A
  • goodwells, hegars sign - pelvic congestion (tumor)
  • chadwhicks sign - infertility medications
  • braxton hicks - fibroids
  • uterine souffle - maternal pulse
  • linea nigra - birth control pills
  • abdominal striae - sudden weight gain
  • ballottement - fibroid, tumor
  • palpation of the fetal outline - fibroids, tumor
  • abdominal enlargement - fibroids, tumor
  • positive pregnancy test - medications (valium, Phenobarbital, promethazine)
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6
Q

what is uterine souffle

A

whoosing sound of blood moving into the placenta

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7
Q

what is ballottement

A
  • where the provider puts their fingers into the vagina and pushed on the head and the baby bounces up and away then comes back down and hits the fingers
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8
Q

what are fibroids

A
  • tumors that are benign and can grow very large (even the size of a fetus)
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9
Q

psychosocial adaptations to the pregnancy for the patient in the first trimester

A
  • surprise, even when planned
  • ambivalence and acceptance
  • focus on discomforts of pregnancy
  • fears and fantasies
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10
Q

psychosocial adaptations to the pregnancy for the patient in the second trimester

A
  • accept growing fetus as separate from self
  • introversion, self engrossment, mood swings
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11
Q

psychosocial adaptations to the pregnancy for the patient in the third trimester

A
  • prepare for birth
  • focus on physical discomforts
  • contemplation of her assumption of maternal role
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12
Q

psychosocial adaptations to the pregnancy for the partner in the first trimester

A
  • excitement
  • feel excluded
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13
Q

psychosocial adaptations to the pregnancy for the partner in the 2nd trimester

A
  • sense of engagement with felt fetal movement
  • adapt to physiologic changes in pregnant patient
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14
Q

psychosocial adaptations to the pregnancy for the partner int he 3rd trimester

A
  • prepare for role of the coach during birth
  • assumption of role of parent, may not occur until after birth
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15
Q

partner couvade

A
  • unintentional taking on the physical symptoms of the pregnant partner
  • low back pain
  • nausea
  • weight gain
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16
Q

hormonal causes of pregnancy discomforts

A
  • estrogen
  • progesterone
  • relaxin
  • human placental lactogen
  • prolactin
  • oxytocin
  • human chorionic gonadotropin
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17
Q

mechanical issues that cause common pregnancy discomforts

A
  • enlarging uterus
  • weight gain
  • postural changes
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18
Q

other physiologic causes of pregnancy discomforts

A
  • emotional stress (nausea, HA, difficulty, sleeping, etc.)
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19
Q

vagina and uterus changes

A
  1. caused by estrogen and progesterone:
    - chadwhicks sign
    - goodells sign
    - hegars sign
  2. enlarging uterus- hypertrophy estrogen and progesterone
  3. leukorrhea (white creamy discharge)- estrogen
  4. braxton hicks- estrogen and oxytocin
  5. mucus plug (bottom of the cervix that protects things from moving up into the uterus)- estrogen
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20
Q

chadwhicks sign

A
  • blue tinge to cervic and vagina
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21
Q

goodells sign

A
  • cervical softening
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22
Q

hegars sign

A
  • softening lower segment of uterus
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23
Q

the enlarging uterus

A
  • pay special attention to the effects on:
    1. lungs/diaphragm and stomach: gets pushed up (28 weeks) which causes heartburn, SOB until about 40 weeks when the baby drops down into the pelvis and feels like have bowling ball between the legs causing pelvic pressure
    2. intestines: get smashed (around 36 weeks)
    3. bladder: early on (6 weeks) it compresses the bladder causing urinary frequency then this will go away (28 weeks) and come back (40 weeks)
    4. spine curvature: gets worse the farther along you get causing pain
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24
Q

HEENT

A
  • eyes may change shape = vision changes (educate them not to spend money on glasses because this will likely get better after pregnancy)
  • ptyalism (hyper salvation)
  • bleeding gums and nose bleeds from the vessel dilation- estrogen and progesterone
  • nose bleeds- estrogen and progesterone
  • feeling of fullness/stiffness in ears, nose, and sinuses
  • sense are heightened (taste and smell)= n/v and aversions
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25
Q

skin and hair

A
  • due to estrogen (causes changes in melanocyte production= darkening) and progesterone:
    1. linea nigra
    2. melasma (aka chloasma)- darkening on cheeks
    3. darkening areolae, vulva, axilla
    4. acne vulgaris- cystic acne on back and chest especially
  • spider nevi- progesterone
  • striae
  • increased hair and nail growth- estrogen
  • palmar erythema (red palms) - estrogen
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26
Q

breasts

A
  1. estrogen and progesterone cause:
    - enlargement
    - tenderness
    - nipple sensitivity
  2. human placental lactogen- breast development and getting ready for milk production
  3. vein prominence- progesterone
  4. nipple become more erect
  5. areolar changes- darkening, enlargement- progesterone
  6. Montgomery tubercles- lubricate areola
  7. colostrum (first milk)- from 12 weeks- prolactin
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27
Q

respiratory

A
  • alkalosis: increased RR and increased 02 consumption
  • capillary enlargement and swelling nasal passages, epistaxis- estrogen
  • upward discplacement of diaphragm especially as the uterus grows
  • rib cage flare
  • increased RR
  • 20% increased o2 consumption
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28
Q

endocrine

A
  1. metabolic rate increases
    - thyroid increases size and activity
    - TSH will decrease in first trimester
  2. body temp:
    - increase in basal body temp
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29
Q

cardiovascular

A
  • lateral displacement of heart
  • increased SV, HR, CO
  • vasodilation with subsequent drop in BP (especially in 1st trimester)- progesterone
  • increase in resting HR by 10-15 bpm
  • systolic murmor
  • increase in Blood volume, max at 32 weeks (50% increase in plasma volume)
  • increasing in clotting factors to help prevent hemorrhage in labor
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30
Q

hematologic

A
  • increase in plasma and RBC but not proportional (dont go up at the same rate)
  • physiologic anemia of pregnancy because there may be more blood volume but not more RBC since they dont go up at the same time
  • fetus will store iron after 20 weeks
  • immuno compromised which causes elevated WBC= more prone to illness
  • increase in clotting factors
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31
Q

in 1st trimester when do you treat anemia

A
  • <11
  • tx: iron supplement
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32
Q

in 2nd trimester when do you treat anemia

A
  • <10.5
  • iron supplement
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33
Q

GI

A
  • displaced stomach and intestines
  • decreased GI motility and emptying (gas, constipation)- progesterone
  • N/V- HCG
  • decreased gallbladder muscle tone = delayed emptying (risk for stones)- progesterone
  • valve between stomach and esophagus to soften = heartburn - progesterone
  • dilated vessels- hemorrhoids: progesterone and mechanical pressure
  • elevated alkaline phosphatase
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34
Q

renal

A
  • increased renal blood flow (decreased tone and dilation of ureters= urine retention)
  • dialation and urinary staisis in renal pelvis (droppy uterus from decreased tone) = risk for UTI/pylenonephritis- progesterone
  • increased GFR (though sloppy so glucose and traces of protein may be spilled-= traces in urine normal since the GFR isnt as efficient)
  • increase frequency (decreased bladder tone):
    1. mechanical compression
    2. increased urine output by 200 ml per day
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35
Q

MSK

A
  • loosening of joints- relaxin, progesterone, estrogen causing:
    1. widening/ increased mobility of symphysis and sacroiliac joints, useful to fit out babies
    2. causes loosening of knees, ankles, wrists
    3. postural changes with associated lower back pain
    4. exaggerated lordosis
  • altered sense of gravity
  • prone to slips, trips, and falls
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36
Q

round ligament pain

A
  • As the uterus and surrounding ligaments stretch to make room for baby, it can cause short, painful spasms
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37
Q

what causes edema in feet and other areas

A
  • estrogen and progesterone and the mechanical pressure
  • feet = cankles
  • hands = carpal tunnel
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38
Q

vena cava syndrome

A
  • enlarged uterus compresses the inferior vena cava and the lower aorta when patient is supine causing:
    1. reduced venous return to heart
  • causes implications for prenatal care and labor
    -avoid laying flat on back (15 degree off back is enough to prevent)
  • once 20 weeks should be laying on side at night
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39
Q

symptoms of vena cava syndrome

A
  • decreased BP
  • light headedness
  • syncope
  • racing heart
  • sweating
  • fetal heart rate changes
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40
Q

describing the pregnancy

A
  1. gravidity: any pregnancy regardless of duration (including current pregnancy)
  2. parity- number of times the uterus has emptied after 20 weeks (number of births after 20 weeks) regardless of the outcome ( doesn’t include miscarriages or abortions before 20 weeks)
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41
Q

nulligravida

A
  • never been pregnant
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42
Q

nullipara/nullip

A
  • never given birth to fetus > 20 weeks
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43
Q

primigravida

A
  • pregnant for the first time
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44
Q

primipara/primp

A
  • has given birth once to a fetus > 20 weeks
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45
Q

multigravida

A
  • pregnant more than once, irrespective of outcome
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46
Q

multipara/ multip

A
  • two or more births > 20 weeks gestation
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47
Q

grand multipara

A
  • five or more births >20 weeks gestation
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48
Q

describing the pregnancy 2 digit system

A
  • gravidity and parity “g’s and p’s”
  • G2P1 = currently pregnant, one 37 week birth
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49
Q

describing the pregnancy 5 digit system

A
  • gravidity x parity term/preterm/abortions/living “G TPAL “ (usually written GX PXXXX)
  • gravidity: number of pregnancies had including this one
  • term: number of births >/= 37 weeks regardless of outcome
  • preterm: number of births from 20 weeks to <37 weeks
  • abortions: loss of pregnancy less than 20 weeks; spontaneous (miscarriage), therapeutic (abortion)
  • living: number of children currently living
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50
Q

Pre conception:

What is considered normal BMI?

overweight

obese

A
  • 18.5-24.9 = normal
  • 25-29.9 = overweight
  • > /= 30 = obese
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51
Q

Pre conception:

how much daily exercise daily

A
  • 30 min/ day
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52
Q

Pre conception:

vaccines that should be up to date

A
  • rubella
  • varicella
  • covid
  • flu
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53
Q

Pre conception:

dental work up that should be up to date

A
  • have dental work and appointments up to date as infection can cause PTL
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54
Q

Pre conception:

GYN care

A
  • STI can cause infertility, PTL; pap
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55
Q

Pre conception:

menses

A
  • begin tracking as we need accurate dating
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56
Q

Pre conception:

folic acid

A
  • 800 mcg daily to help prevent neural tube defects
  • start a month before trying to conceive
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57
Q

Pre conception: other

A
  • D/C: caffeine, tobacco, ETOH, illegal drug use, some RX meds
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58
Q

lack of preconception care causes

A
  • many of the preconception goals to not be addressed until the first prenatal visit (NOB) after the patient is pregnant
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59
Q

what is addressed at the NOB visit

A
  • establish and accurately date the pregnancy
  • review all preconception/NOB goals
  • health history
  • evaluate risk factors and try to prevent risks
  • give support form common discomforts
  • anticipatory guidance for birth, parenting, role change, breastfeeding, etc
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60
Q

establishing the pregnancy

A
  • missed menses
  • positive home urine pregnancy test
  • positive lab hCG test
  • positive lab blood hCG
  • fetus noted on ultrasound
61
Q

how long does a pregnancy last

A
  1. term pregnancy: 37-42 weeks
    - due date is 40 weeks after LMP (first day of LMP) or 280 days from the LMP
62
Q

due date definitions

EDD
EDC
EDB

A
  • Estimated due date
  • estimated date of confinement
  • estimated date of birth
63
Q

nursing caveat and due dates

A
  • only 3-4% of babies are born on the due date
  • 75% of first time moms go 7-10 days past due date
64
Q

pre term

A

before 34 weeks
- 20-34 weeks

65
Q

late pre term

A

34 w 0 days- 36 weeks and 6 days
- 34-36

66
Q

early term

A

37-38 w 6 d
- 37-38

67
Q

Full term

A

39 w 0 d - 40 w 6 d
-39-40

68
Q

late term

A

41 w 0 d - 41 w 6 d
-41

69
Q

post term

A

42 w 0 d and beyond
- 42 +

70
Q

method to calculate due date: naegeles rule

A
  • need a known LMP for accuracy
  • LMP + 1 year - 3 months + 7 days = EDD
  • always do calculation in the above order
  • problems: doesn’t account for cycle length (late ovulation), doesn’t account for variation in length of months ot leap years (not always exactly 280 days from LMP)
71
Q

method to calculate due date: wheel

A
  • quick
  • can use conception date, adjust for cycle length
  • can estimate current gestation within pregnancy
  • online versions
72
Q

other ways to calculate due date

A
  • ultrasound
  • online applications
73
Q

calculating the due date by US

A
  • if patient has a LMP we can use the EDD based off of that (but an US is usually done at the first prenatal visit to confirm the accuracy of the EDD from the LMP
  • IN 1ST trimester (<13 weeks) the US measurement of fetus is from the crown rump length and is the most accurate method to confirm or establish a gestational age and due date
74
Q

rules for using US to calculate the due date

A
  • in the 1st trimester: if the LMP GA/EDD and the US GA/EDD are within 7 days of eachother = keep the GA/EDD based on LMP
  • if the first US is in the second trimester: the LMP GA/EDD has to be within 14 days to keep the EDD based on the LMP
  • if the first US is in the third trimester: the LMP GA/EDD has to be within 21 days to keep the EDD based on the LMP
  • if there is a discrepancy outside of the 7, 14, 21 days we used the EDD based off US
  • if patient is unsure or unknown LMP the US dating is ALWAYS used
    *if an EDD is calculated based on an earlier US don’t change it
75
Q

initial labs

A
  • CBC
  • Blood type, Rh, ABS
  • syphilis
  • rubella status: cant get the vaccine during pregnancy as it is live
  • hepatits
  • HIV
  • Hep C
  • Urine culture
  • gonorrhea and chlamydia
  • pap smear if hasn’t been done within 1-3 years
  • tb testing (high risk pt)
  • varicella titer if not immunized or havent had chicken pox as child
76
Q

28 week labs

A
  • CBC
  • glucose tolerance test
  • ABS (if Rh negative): have they been exposed to positive blood type and have the antibodies
  • syphilis (high risk)
77
Q

36-37 week labs

A
  • GBS testing (will treat at labor if positive)
78
Q

optional labs

A
  • antenatal screening
  • carrier screening (CF, SMA, ETC)
79
Q

Rh issue: rh disease- hemolytic disease of the newborn

A
  • Rh - mom and Rh + dad conceive
  • the baby may be Rh+ (inside an Rh- mom)
  • cells from Rh+ baby enter moms bloodstream
  • woman is sensitized from antibodies that formed to fight the Rh positive blood cells
  • in next Rh + pregnancy maternal antibodies will attack fetal RBC
80
Q

if have Rh- mom and Rh + dad how do you prevent the issues with second pregnancy

A
  • prevent antibody formation by giving Rho (D) immune globulin (rhogam) when:
    1. mixing is suspected: trauma, bleeding
    2. prophylactically at 28 weeks in each pregnancy she has
    3. within 72 hours of delivery if baby is Rh + or status of fetus is unknown (miscarriage abortion)
81
Q

which are the torch infection causing disease

A
  • toxopasmosis
  • other: varicella, parvo, syphilis, listeria, coxsackie virus, zika
  • rubella
  • cytomegalovirus
  • herpes simplex virus
82
Q

torch infections

A
  • all of them are associated with potential for significant negative fetal outcomes including death if infection occurs during pregnancy
  • often mild or no symptoms in mother
  • often limited or no treatment available
  • PREVENT
83
Q

torch prevention and counseling for toxoplasmosis

A
  • Avoid eating raw or undercooked meat, avoid contact with feces of infected cats
84
Q

TORCH prevention and counseling for parvo, coxsackle, CMV

A
  • Check status of those with high exposure risks-day care workers, etc. Precautions if non-immune.
85
Q

TORCH prevention and counseling for listeria

A
  • Avoid eating unpasteurized cheeses (cantaloupe outbreak in 2011)
86
Q

TORCH prevention and counselig for rubella and varicella

A
  • Immunization available but not given during pregnancy – check status, precautions if non-immune, immunize postpartum.
87
Q

TORCH prevention and counseling for syphilis and herpes

A

Safe sex practices (condoms), suppressive therapy for HSV in the weeks before labor to prevent an active outbreak and transmission to baby.

88
Q

prevention with immunizations- influenza

A

-IM injection not live
-Given in pregnancy at any time during flu season
-Cannot give nasal spray vaccine as live

89
Q

prevention with immunizations: TDAP

A

-Prevention of Pertussis (whooping cough) infection
-Booster recommended at 27-36 weeks to all pregnant patients in each pregnancy
-Antibodies passed through placenta into fetus to help reduce risk within first 2 months of life until baby able to get vaccine (Dtap)
-Recommended for all people who will are around newborns who have not had Tdap booster in last 10 years

90
Q

prevention with immunizations: COVID

A

-Vaccination available and safe in pregnancy
-SE of virus: miscarriage, PTL, pre-E. stillbirth

91
Q

what type of vaccines can pregnant women not have and why

A

No live virus immunizations during pregnancy due to the theoretical risks of congenital infection

92
Q

desirable weight gain in pregnancy based on pre pregnancy BMI

A

-Underweight (less than 18.5)= 28-40 lbs
-Normal weight (18.5-24.9)= 25-35 lbs
-Overweight (25-29.9)= 15-25 lbs
-Obese (greater than 30)= 11-20 lbs
-Morbid obesity > 40=no weight gain

93
Q

maternal and fetal complications related to weight

A

-Underweight- potential for increased risk of PTL, low birth weight infants
-Obesity- increased risks of HTN, DM/GDM, macrosomia, injury, c/s, postpartum hemorrhage, stillbirth, miscarriage
-Inadequate weight gain- potential for increased risk of fetal growth restriction

94
Q

physical exam includes

A
  1. *Vital signs
  2. Basic measurements-height, weight, BMI
  3. Head to toe exam (most likely done by provider)
    -Quick mouth/dental check
    -Thyroid
    -Heart
    -Lungs
    -Abdomen
    -Lower extremity skin, edema, varicosities
95
Q

OBGYN specific assessment

A

-Leopold’s (presentation/position)- head down by 36 weeks
-Fundal height: where the uterus is
-FHT’s*
-Pelvic exam: (most often done by provider): Vulva, vagina, cervix (prn), Pap, GC/CT

96
Q

fundal hight landmark at 12 weeks

A

pubic symphysis

97
Q

fundal height at 16 weeks

A
  • between the pubic symphysis and belly button
98
Q

fundal height landmark at 20 weeks

A

umbilicus

99
Q

fundal height landmark at 36 weeks

A
  • xiphoid process
100
Q

fundal height landmark at 37-40 weeks

A

regression of fundal height b/w 36-32 cm

101
Q

fundal height postpartum (</= 24 hours)

A
  • umbiicus
102
Q

after the 20 week measurement

A
  • use tape measure and measure from the pubic symphysis to the top of the fundus
  • that measurement should be the same in cm as how many weeks (+/- 3 cm is okay)
103
Q

where is fetal heartbeat best heard

A
  • upper back of fetus
104
Q

when should fetal Heartbeat be seen on US

A

after 6 weeks
- dating US IS DONE BETWEEN 6-12 WEEKS

105
Q

when should fetal heartbeat be heard via doppler

A
  • 10-12 weeks
106
Q

when should fetal movement be felt

A
  • 18-22 weeks
107
Q

how often do you have prenatal care visits

A
  • Initial visit usually occurs @ 8-12 weeks
  • Q 4 weeks until 28 weeks
  • Visits Q 2 weeks until 36 weeks
  • Visits Q 1 week until birth
    -Subsequent visits may be needed for antenatal screening, BP checks, prn
108
Q

why good nutrition

A

-associated with good perinatal outcomes.
-Adequate weight gain and good nutrition helps decrease the incidence of:
1. Low birth weight (LBW)
2. Preterm delivery (PTD)
3. Congenital anomalies (think NTD/folic acid)
(All are leading causes of perinatal morbidity & mortality)

109
Q

calories/day

A

2,000 or 300/day

110
Q

protein/day

A

60 g (or extra 14/day)

111
Q

fat/day

A

unchanged

112
Q

iron per day

A

27mg

113
Q

Ca and PO4 (for bone mineralization) /day

A

1,000-1,200 mg

114
Q

vit. C

A

80-85 mg

115
Q

folic acid

A

minimum 400 mcg

116
Q

vit b6

A

1.9 mg

117
Q

vit. D

A

5 mcg

118
Q

how to do a nutritional assessment

A
  • 3 day dietary recall
  • Nutritional Questionnaire
119
Q

Sources for Nutritional Success

A

-WIC
-Weight Watchers
-24 Dietary Recall followed by nutrition counseling and planning

120
Q

Nutritional No-No’s

A

-Non-nutritive foods (Diet Coke and Skittles, etc.)
-Alcohol
-Illegal substances: Cocaine, Meth, etc.
-Many prescription or over the counter drugs, herbs, supplements
-Pica (craving and consuming of non-food substances: May be caused by iron deficiency anemia
-Food made with unsafe preparation techniques: Raw or undercooked meats and fish, unpasteurized dairy, excessive large mercury containing fish, etc.

121
Q

causes of too little weight gain

A

-Anorexia/body image disorders
-Nausea, “morning sickness”
-Substance abuse, smoking
-Insufficient means: poverty, homelessness, etc.
-Pica (filling up on non-nutritive foods)

122
Q

causes of too much weight gain

A

-hidden calories
-“stress” eating, depression
-Poor dietary knowledge

123
Q

Consequences of Inadequate Weight Gain

A
  • Women who do not gain enough weight during pregnancy are more than 1.5 times more likely to deliver a low birth weight infant compared to women who gain enough weight.
  • Low birth weight babies are at increased risk for system wide complications such as Respiratory Distress Syndrome, Intraventricular Hemmorrhage, Patent Ductus Arteriosis, Necrotizing Eneterocolitis, and Retinopathy of Prematurity as newborns and at increased lifelong risk for hypertension, diabetes mellitus and heart disease.
124
Q

Complications of Obesity during pregnancy

A

increased risk:
-Birth Defects (Neural Tube Defects)
-Chronic Hypertension
-Pre-gestational diabetes
-Gestational diabetes
-Sleep disordered breathing

125
Q

Complications of Obesity during labor

A

increased risk:
-Primary and repeat cesarean section
-Medical induction/augmentation
-Prolonged first stage
-Excessive blood loss and longer operative time

126
Q

Complications of Obesity during postpartum

A

increased risk:
-Wound infection
-Urinary incontinence
-Postpartum hemorrhage (70% higher in obese women)
-Retained weight
-Failure to successfully initiate breastfeeding

127
Q

Complications of Obesity during nebowrn period

A

increased risk for:
-Large infants-macrosomia
-Intrauterine growth restriction (IUGR)
-Stillbirth
-Preterm birth

128
Q

nursing interventions and nutrition

A

-Calculate pre-pregnancy BMI, then recommend appropriate individualized weight gain recommendation
-For a woman with a normal BMI:
-Total gain : 25-35 pounds
-1st Trimester: .5-3 pounds total
-2nd/3rd Trimester: 1 pound/week
OR
-5-10 pounds by 20 weeks, then 1 pound/week

129
Q

Antenatal (Prenatal) testing

A

-many of the tests are covered by insurance.
-All testing is OPTIONAL

130
Q

what can antenatal testing be used to detect

A
  1. Birth defects
    -Heart defects, abdominal wall, or neural tube defects
  2. Chromosome problems
    -Down Syndrome (Trisomy 21)
    -Edwards Syndrome (Trisomy 18)
    -Patau Syndrome (Trisomy 13)
    -Turner’s Syndrome (X)
  3. Other genetic diseases
    -Cystic fibrosis
    -Sickle Cell Disease
    -Fragile X Syndrome
    -Tay Sachs Disease
131
Q

antenatal testing options

A

-Broken into 2 categories: Screening vs. Diagnostic

132
Q

screening category of antenatal testing

A

*only determines RISK
-Maternal serum Quad Screen
-Sequential Screen/First Trimester Screen
-Cell-Free DNA
-Carrier Screening (CF, Ashkenazi Jewish Panel, Fragile X, etc.)
-Review of systems sonogram

133
Q

when is it best to do maternal carrier screening

A

-prior to pregnancy if possible
If screening is not documented as offered and a women gives birth to a child affected, then is the healthcare provider legally liable?

134
Q

maternal carrier screening tests

A

Screens for recessive linked disorders where the parents are carriers and NOT disease affected

135
Q

issues with maternal carrier screening tests

A

Can be ethnically impacted such as with Tay-Sachs Disease (Ashkenazi Jewish, French Canadian, Cajun)

136
Q
A
137
Q

Maternal serum quad screen

A
  • screen for trisomy 18, 21
  • Collected between 15 and 23 (ideal is 16-18 weeks)
  • Higher false positive and false negative rates than other tests
  • influenced by: maternal weight, gestational age, and ethnicity
    1. Alpha-fetoprotein
    2. hCG
    3. Estriol
    4. Inhibin-A
  • Rarely used due to more accurate testing options but remains available for patient cost preference and for patients who miss the window of testing for the First Trimester Screen
138
Q

Sequential screen/First Trimester Screen

A

-Screens for trisomy 13, 18, 21, cardiac and neural tube defects
-11-13 weeks– nuchal translucency (by ultrasound) and maternal serum
-15-21 weeks– 2nd draw of maternal serum alpha-fetoprotein to screen for neural tube and abdominal wall defects: Spinal bifida, Gastroschisis
- 90-98% accurate depending on the disorder

139
Q

Free Fetal DNA (ffDNA)

A
  • Screens for trisomy 13, 18, 16, 20, 21, as well as sex chromosome aneuploidies and micro-deletions
    -After 10 weeks
    -Results not as accurate in low-risk women
    -Most accurate in high-risk women and women of advanced maternal age (35 years or older)
140
Q

Ultrasound (US)

A
  • US completed in 2nd or 3rd trimester can be used to identify:
    -Fetal presentation and number
    -Amniotic fluid index (how much fluid is around the fetus)
    -Placental location
    -Presence of cardiac activity
    -Fetal biometry (to confirm dating or measure interval growth)
    -Anatomy- “review of fetal systems”
    -Major organs (brain, heart, stomach, kidneys, etc.)
    -Spine
    -Extremities
    -Uterine/Pelvic anatomy including cervical length, ovaries, etc.
141
Q

Transvaginal vs transabdominal US

A
  • transvaginal used in early pregnancy
  • transabdominal used after 12 weeks
142
Q

What can be detected on US?

A
  1. Cranio-spinal defects
    - Anencephaly, microcephaly, hydrocephaly, neural tube defects
  2. Gastrointestinal malformations
    -Omphalocele, gastroschisis
  3. Cardiac defects
    -Transposition, 2-chamber heart
  4. Renal malformations
  5. Skeletal malformations
  6. Many other less common issues
143
Q

diagnostic testing

A
  1. Diagnostic tests are used to DEFINITIVELY confirm a chromosomal abnormality or inherited disorder
    -Chorionic villus sampling (CVS)
    -Amniocentesis
    -Percutaneous umbilical cord blood sampling
144
Q

Chorionic Villus Sampling

A

-Done at 10-12 weeks
-Detects genetic, metabolic, and DNA abnormalities
-Catheter biopsy of chorionic villi obtained from edge of developing placenta: Transabdominal or transcervical
-Does not detect neural tube defects: Will need Alpha fetoprotein (AFP) drawn between 15-20 weeks
-Done earlier than amniocentesis: Allows for termination before fetal movement felt

145
Q

risks of Chorionic Villus Sampling

A

-Increased risk of spontaneous abortion
-Twice the chance of loss when compared with amniocentesis (~1% risk of loss)
-Risk of fetal limb defects (finger or toe missing)
-Bleeding
-Infection
-Failure to obtain tissue
-Leaking of amniotic fluid

146
Q

Amniocentesis

A

-Done at 15-18 weeks
-Also detects genetic, metabolic, and DNA abnormalities
-Needle guided aspiration of amniotic fluid

147
Q

risks of amniocentesis

A

-Spontaneous abortion (0.5%)
-Infection
-Vaginal spotting
-Cramping
-Damage to fetus
-May also be used later in pregnancy to assess for infection, determine extent of fetal anemia, or assess fetal lung maturity

148
Q

Percutaneous Umbilical Blood Sampling

A
  • also called Cordocentesis
  • Procedure performed to obtain fetal blood from the base of the umbilical cord
  • Used to aid in diagnosis of hemophilia, hemolytic disorders, fetal infections, chromosomal abnormalities, fetal hydrops, and assessment of fetal Hemoglobin and Hematocrit
149
Q

recreational antenatal testing

A
  1. Home Doppler
    -No medical training may lead to misinterpretation: May cause increased unnecessary office visits or fetal risk depending on parental perceptions
  2. “Keepsake” Ultrasounds
    -Privately owned ultrasound services/maternal “Spas”
    -No medical regulation
  3. SneakPeek Gender test
    -Home maternal blood testing – ordered online
    -Detects free fetal DNA from maternal blood acquired from finger stick lancet
    -Reportedly 99.1% accurate
    -Offered after 8 weeks gestational age

OB (12 decks)

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