intro to OB-Table 1 Flashcards
What is the definition of preconception counseling?
Health of women and men during reproductive years
What issues should you address in women ages 15-44 in order to improve outcomes in event of pregnancy?
- ID/stabilize chronic conditions
- Minimize med risk
- Maintain IZ
- Address weight, nutrition, exercise
- ID potential genetic disorders
What should be weight loss goal for obesity?
5-10% of baseline 6mo prior to pregnancy
What is the first change women will notice when preggo?
Breast tenderness
What are clinical S/S of a suspected preggo lady?
Fatigue, N/V, breast tenderness, frequent urination, missed menses
When is there enlargement and softening of the uterus?
6 weeks
What are PE findings in a newly preggo lady?
Congestion and bluish discoloration of the vagina (Chadwick sign)
Softening of the cervix (hegar sign)
How should you confirm a suspected pregnancy?
UCG and beta- HCG
What does a UCG measure?
hcg/alpha unit which overlaps w/LH structure
What does the Q/Q beta-hCG measure?
Beta subunit
What can you visualize on US at 5-6 wks?
- embryonic cardiac activity at >4000 mIU/mL
- gestational sac (beta-hCG 5000-6000 mIU/mL)
What can TVUS detect at 3-4 wks gestation?
GA (beta-hCG 1000-2000 mIU/mL)
When can the Doppler detect fetal heart tones?
10-12 wk GA
What are the risks you want to assess during antepartum care?
- advanced maternal age (>35) and or paternal age (>50)
- hx of early preggo loss
- previous IUP complicated by chromosomal abnormality
What are genetic testing options when assessing for risk?
- carrier testing
- CVS
- Amniocentesis
What are the common chromosomal abnormalities we want to screen for?
Trisomy 21, fragile X, turner syndrome, klinefelter syndrome, and cri du chat
What weeks during the first trimester can you do screening? What tests are you going to do?
10-13 week GA
obtain beta-hCG and preggo associated plasma protein A ( PAPP-A) and a CVS
When during the second trimester do you screen? What tests do you run?
15-20wk GA
triple(no inhibin) or quad marker( AFP, estriol, hCG, and inhibin A marker)
-need maternal age, wt, ethnicity, and EGA
amniocentesis
What is the integrated 1st and 2nd trimester screen?
Combines PAPP-A plus triple or quad
What is nuchal translucency? What is it used for? When do you screen this?
Early US at initial prenatal visit
Fluid collection at the back of the neck used as a marker for Downs( 10-14wk GA)
What A/P needs to be addressed during the initial prenatal visit?
—RTC q 4 weeks until 28-30 weeks GA
—RTC q 2 weeks 28-30 to 36 weeks GA
—RTC q week >36 weeks GA
What initial labs do you want to run on the mother at the first prenatal visit?
CBC, glucose, blood type/Rh, urinalysis, Pap, STD: RPR/FTA, HIV, gc, chlamydia, hepatitis B
What are some common symptoms in preggo?
—Headache —Edema —N/V —Heartburn —Constipation —Fatigue —Leg cramps —Back pain —Round ligament pain —Varicose veins, hemorrhoids —Vaginal discharge
What should be done at all the subsequent antenatal visits?
BP, wt
Fundal ht
FHR ( tachy >160, brady
Whats the scoop with Leopold?
What are the goals of antenatal care?
—Maternal state of health —Favorable in utero fetal environment —Placental positioning —Fetal growth & development —Healthy birth passage —Successful L&D progression
What is normal birth weight? Low? Very low? Extremely low?
—5.5 lbs = 2,500 grams or 2.5 kg; > 2,500 grams (> 5.8 lbs) = normal BW
What is large for GA?
9lbs or 4800 grams or 4.8kg
MACROSOMIA- pathology counterpart
What is low birth weight? Very? Extremely?
—
What is the pathology counterpart for SGA?
IUGR
What are EGA specific tests and when are they performed?
—Labs 28-32 weeks: CBC, 1 hour glucose challenge, Rh status
—Labs 32-36 weeks: Group B strep
—Leopold maneuvers for fetal presentation > 34 wks EGA
—Term & post-term: non-stress test (NST), contraction stress test (CST) & biophysical profile (BPP)
When is the third trimester?
28-42 wks
What is happening in the 3rd trimester?
Fetal kick counts: indirect measure of fetal activity
FHR patters on NST
BPP
Dopler US of umbilical artery for placental blood flow
Assess fetal lung maturity for surfactant
What is the best way to measure the fetus well being?
BPP!
What is the BPP?
Biophysical profile
- amniotic fluid index, measures fluid pockets and volume of fluid
- fetal breath movement
- fetal tone (>/=1 episode extremity extension with 30 minutes)
- GBM, >/=3 gbm in 30 min
- NST, bradycardia 80-100= non-reassuring, 160 tachy
What is a reassuring score on the BPP?
8-10
if 6 repeat score or deliver baby if term
What is the appropriate wt gain in pregnancy?
—Underweight: 28-40 lbs.
—Normal: 25-35 lbs.
—Overweight: 15-25 lbs.
—Obese: 11-20 lbs.
In regards to exercise, what should women do if they don’t typically exercise?
Walking program
What should women not do exercise speaking?
Avoid supine position & crunches d/t placental blood flow & inferior vena cava compression; caution w/weight lifting
What are absolute CI for exercise in pregnancy?
lung dz, severe heart dz, incompetent cervix, multi-fetal gestation, vaginal bleeding, placenta previa, preterm labor, ROM, HTN dz of IUP
What are relative CI for exercise in pregnancy?
unevaluated arrhythmia, poor control DM type 1 & HTN, extremes of weight, IUGR, poor control seizures or hyperthyroid, chronic bronchitis
Should you be super preggo in a plane?
No that’s so dumb
CI in the last month
When is sexual activity restricted in pregnancy?
—No restricted coitus unless contractions, bleeding, previa
- don’t forget to change the positions up
What are maternal and newborn benefits from breastfeeding?
—Maternal benefits Uterine involution, economic, bonding, some BCM effect, facilitate wt loss —Newborn benefits Immunity, nutrition, bonding
How much radiation should you limit fetal exposure to?
When does radiation have the most major effects on the fetus?
> 10 rads: 1st 2 weeks after fertilization, > 25 rads 1st trimester or
100 rads 2nd & 3rd trimesters
Why should you not drink booze while preggo?
FAS
IUGR, stunted growth post-birth, FTT, facies: low set ears, mid-facial hypoplasia, microcephaly, mental retardation, learning disorders
What does nicotine do to the fetus?
IUGR, LBW, fetal death
What effects do illicit drugs have on the fetus?
SAB, preterm labor, neonatal withdrawal, birth defects
What is the time frame for effects from teratogens in utero?
- 1st 14 days = ‘all or nothing’ effect,
- 14-60 days - organ/structural abnormalities
- remaining IUP time – IUGR, cognitive and/or CNS anomalies
What category of pharmaceuticals is ok in pregnancy?
Category A!
B might be ok….animal studies ok and no harm to women who used them
C: not adequate study and harm in animals
D: risk, only use if benefit outweighs the harm
X: CI
What is the new FDA medication classification for teratogen exposure?
PLLR- pregnancy and lactation labeling rule
What has to be included for pregnancy?
Available drug exposure registries
Risk summary statement
Pertinent clinical considerations
Details on gathered pertinent data
“ “ lactation?
Risk summary Bioavailability Effect on infant Effect on milk production Details on gathered pertinent data
What do drugs for both men and females of reproductive potential need under the PLLR?
Need for BCM &/or pregnancy testing w/drugs known to have adverse developmental effects
Relevant data on fertility or pre-implantation viability effects on
