Keppler - Lecture 2 Flashcards
SVD
spontaneous vaginal deliveries
most tests in pregnancy are
screening tests
many decisions about screening are based on
prior hx
risk factors
common screening tests
DM/GDM
anemia
hemoglobinopathies
genetic syndromes/dz
infectious dz
alloimmunization
HTN/preeclampsia
aneuploidy
fetal anomalies
fetal growth abnormalities
substance use/abuse
mental illness/dpn
STDs
steps in prenatal care (6)
- establish estimated due date (EDD)
- identify rf
- PE +/- cervical ca screening
- prenatal screening labs
- counseling/ed
- schedule f/u
US is most accurate to establish EDD in
first trimester
what 2 pe exams are recommended for routine prenatal care
breast
pelvic: uterine size, adnexal masses, cervical ca screen, STDs, +/- clinical pelvimetry
screening based on rf
early GDM
hbg electrophoresis → hemoglobinopathies
genetic
aneuploidy
urine drug screen
t/f clinical pelvimetry can accurately predict woman’s likelihood of delivering vaginally
f
what is clinical pelvimetry
estimating the size of a woman’s pelvis → not very accurate
t/f: most tests done in pregnancy are diagnostic tests
f!
most are screening tests
only way to predict if a woman can delivery vaginally
try it!
if it happened before in a pregnancy…
risk that it will happen again
2 abnormal findings during pregnancy
vaginal bleeding
severe pain
first trimester bleeding ddx (3)
ectopic pregnancy
spontaneous abortion (miscarriage)
gestational trophoblastic dz
2nd and 3rd trimester bleeding ddx (3)
preterm labor/labor
placental abruption
placenta previa/vasa previa
mc cause of bleeding in pregnancy
trick question dummy!
no vaginal bleeding during pregnancy is common/normal
expected wt gain during pregnancy for normal weight woman
25-35 lb
most wt gain during pregnancy is during
second/third trimester
normal weight gain for pregnancy underweight woman
35-45 lb
normal weight gain during pregnancy for overweight/obese woman
15-25 lb
normal wt gain during pregnancy for morbidly obese pt
11-20 lb
nutrients to focus on for pregnant pt
fiber
proteins
carbs
folate needs for pregnant pt
400 mcg
4 mg if hx NTD
does sex increase risk to uncomplicated pregnancies
no!
t/f high risk pregnancy should consider not traveling
t!
which of the following is not a common complaint of pregnant pt
a. breast tenderness
b. dysuria
c. nausea
d. GERD
b. dysuria
t/f bleeding is always considered abnormal in pregnancy
t!
for which class of drugs should you increase folate micronutrient supplementation in pregnancy
a. anticholinergics
b. antihypertensives
c. anticonvulsants
d. antidepressants
c. anticonvulsants
general rule for prescription meds in pregnancy
less or none is better
highest teratogenic risk of prescription meds in pregnancy
organogenesis (2-10 weeks)
meds w. withdrawal risks (3)
opioids
antidepressants
antipsychotics/mood stabilizers
which med is related to neonatal withdrawal syndrome
opioids
also antidepressants and mood stabilizers/antipsychotics
drugs commonly used in pregnancy
acetaminophen
antihistamines
H2 blockers
topical tx: inhaled corticosteroids
bp
what 2 bp meds are commonly used in pregnancy
labetalol
nefedipine
most pregnancy meds are class
C: lacking good evidence of safety but no e.o harm in retrospective studies
prescription meds generally contraindicated in pregnancy
anticonvulsants
renal meds
NSAIDs
retinoids
certain abx → doxy
what class of meds can cause closure of the ductus arteriosus
NSAIDs
tobacco/nicotine increase risk for (5)
IUGR and low birth wt
placental abruption
preterm delivery
fetal demise/perinatal mortality
SIDS
t/f: opiates in pregnancy increase risk of teratogenesis if given during embryogenesis
F → but risk for fetal withdrawal
prenatal visits in uncomplicated pregnancy occur
monthly thru 32 weeks
then q 2 weeks until term
then weekly thru delivery
most practices recommend inducing delivery at/after __ if labor has not occurred spontaneously
41 weeks
cutoff for advanced maternal age
35 yo
the majority of prenatal care involves (3)
screening
counseling
education
__ and
__ complications help identify risk and screening for current pregnancy
maternal morbidity
prior obstetric complications
routine labs at onset of care (6)
CBC
STI
infectious dz screening
rubella immunity
blood type
abs screen
t/f some common symptoms during pregnancy may indicate underlying dz and should not be ignored
t!
__ is never normal in pregnancy
bleeding
the greatest risk of teratogenesis is btw __
and __ weeks
2
10 (13)
