Lecture 11: Normal Pregnancy: Antepartum Care Flashcards
When should women start folic acid supplementation when planning to conceive; what are recommended doses in someone w/ no hx of NTD vs. hx of previous child w/ NTD?
- Begin at least 1 month before conception
- No hx of NTD, folic acid 0.4 mg
- Hx of previous child w/ NTD ↑ to 4.0 mg
List some of the normal PE findings assoc. w/ pregnancy which may be considered abnormal in a non-preg. pt?
- Systolic murmurs w/ exaggerated splitting and S3
- Palmar erythema + Spider angiomas
- Linea nigra
- Striae gravidarum
- Chadwicks sign –> a bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow.
What value of hCG is considered a positive test and is when most urine hCG tests can detect it?
25 IU/L 6-8 days post ovulation
Gestational sac is seen around how many weeks?
5 weeks when mean hCG is 1500-2000 IU/L
What is Naegels rule for estimating the expcted day of delivery for a lady who is normally cycling every 28 day?
(LMP - 3 months) + 7 days = expected date of delivery
What can be meaured on U/S between 6-11 weeks and can determine due date within 7 days?
Crown Rump Length (CRL)
Based on measurement of uterine size what is indicative of 20 weeks?
20 weeks at the umbilicus
What can be measured on U/S at 12-20 weeks and can determine due date within 10 days?
- Femur length
- Abdominal circumference
- Biparietal diameter
What is considered advanced maternal age when genetic counseling should be offered?
35 y/o +
After how many spontaneous abortions should chromosomal studies (karyotyping) be done on a mother and father?
After 3 or more
What is the most common form of inherited mental retardation?
Fragile X syndrome
What 4 things are included in the first trimester screening for fetal aneuploidy?
- Maternal age
- Fetal nuchal translucency (NT) thickness
- Maternal serum b-hCG
- Pregnancy associated plasma protein-A (PAPP-A)
Which finding of fetal nuchal translucent (NT) thickness is associated with both chromosomal and congenital anomalies?
Increased thickness
Which finding of b-hCG and PAPP-A is associated with down syndrome; measurement of what can increase the detection rate?
- ↑ b-hCG and ↓ PAPP-A assoc. w/ Down’s Syndrome
- Addition of nasal bone assessment (absence of) to nuchal translucency measurement ↑ detection rate
What is included in the quadruple screen for second trimester testing of fetal aneuploidy?
- b-hCG
- Estriol
- Serum AFP
- Inhibin A
When is screening for cell-free fetal DNA done and why is it so hyped?
- At 9-10 weeks, looks for cell free fetal DNA, thought to be derived from apoptosis of trophoblastic cells that have entered maternal circulation
- Detection rates for trisomy and sex chromosome disorders are very high
What does cell-free fetal DNA not test for?
- Does NOT test for open neural fetal defects
- Continue to evaluate for NTD w/ maternal AFP or U/S
Cell-Free fetal DNA screening should only be ordered in high risk patients, list 5 situations.
- Advanced maternal age
- Hx of prior pregnancy w/ a trisomy
- Family hx of chromosomal abnormalities
- Fetal U/S abnormalities suggestive of aneuploidy
- Positive serum screening test including 1st trimester, triple or quad screen
If Cell-Free fetal DNA screen is positive what is next step in confirming results?
- Proceed w/ invasive diagnostic test to confirm results:
- Amniocentesis or chorionic villi sampling
The teratogen, Thalidomide, is associated with what congenital deformity?
Phocomelia
Which risk factor category for medications during pregnancy states that adequate well-controlled studies or observations in pregnant women have demonstrated a risk to fetus; but the benefits of therapy may outweight potential risks?
Category D
When is the most vulnerable stage in terms of effects of teratogens?
Day 17 to day 56 post-conception = organogensis
In general what kind of effect do teratogens have after the 4th month up to the end of gestation?
Usually results in delayed growth of organs and not in a malformation
Which anti-coagulant does and which does not cross the placenta?
- Coumadin (D) crosses the placenta –> SAB, IUGR, CNS defects
- Heparin (B) does not cross
The anticonvulsant, Diphenylhydantoin, is a known teratogen which may cause what?
Fetal hydantoin syndrome (FHS) which is characterized by carniofaical abnormalaties, limb reduction defects, pre-natal onset growth restriction, mental deficiency, and cardiovascular abnormalities
Which 2 anti-convulsants are associated with spina bifida?
Valproic acid and Carbamazepine
If radiation exposure occurs during the first 2 weeks post-conception what is the response like?
Either all or none = will be lethal or no effect
What are some recommendations you can give to pregnant woman who is suffering from nausea and vomiting?
- Eat small but frequent meals
- Avoid greasy, fried foods
- Room temperature sodas and saltines
- Accupuncture
- Meds = antihistamines, vit B6, and antiemetics (phenergan, zofran)
What is the frequency of prenatal office visits throughout the pregnacy?
- Every 4 weeks until 28 weeks
- Every 2 weeks from 28-36 weeks
- Weekly until delivery
At how many weeks gestation do you obtain fetal survery ultrasound?
20 weeks
What routine screening and management is completed at 28 weeks gestation?
- Screen for gestational diabetes and repeat hemoglobin and Hct
- Rhogam injection to Rh negative pt’s
- Tdap give between 27-36 weeks
What is the recommended amount of kick movements a mom feel around 28 weeks
10 movements in 2 hours
What is done if nonstress test is nonreactive?
Further evaluation is warranted w/ a contraction stress test or biophysical profile
What is a contration stress test (CST) and what is considered a positive test?
- Give oxytocin to establish at least 3 contractions in a 10 min period
- If late decelerations are noted w/ the majority of contractions the test is positive and delivery is warranted!
What are the 5 components of the biophysical profile for assessing fetal well-being?
- Nonstress test (NST)
- Fetal breathing movements
- Fetal movement
- Fetal tone
- Amniotic fluid volume
Which score on a biophysical profile for assessing fetal well-being is reassuring, equivocal, and non-reassuring?
- 8-10 is reassuring
- 6 is equivocal; deliver if pt is at term
- 4 or less is nonreassuring; consider delivery
