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Women's Health > Lecture 2: Prenatal Care > Flashcards

Lecture 2: Prenatal Care Flashcards

1
Q

What are the 4 Parity subtypes?

A
  • Term = born post 37wks
  • Preterm = born 20-37 wks
  • Abortion = All pregnancies lost prior to 20 wks
  • Living = Any infant that lives beyond 30 days

Written as G1T1P0A0L1 for a woman pregnant once, gave birth to a term baby once, and has 1 living child.

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2
Q

Define gravity/gravida

A

The # of times a woman has been pregnant

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3
Q

What is considered first trimester?

A

14 wks of gestation

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4
Q

What is amenorrhea?

A

Abrupt cessation of menses in healthy, reproductive aged woman with previous spontaneous, predictable menses

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5
Q

When is amenorrhea a reliable indicator for pregnancy?

A

10 days after expected menses

Implantation bleeding from blastocyst.

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6
Q

What is a chadwick sign?

A

Vaginal mucosa change of dark-bluish/red.

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7
Q

What can change in the lower reproductive tract due to pregnancy?

A
  • Chadwick sign
  • Cervical softening
  • Cervical mucus thinning (due to progesterone)
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8
Q

What is a hegar sign?

A

Isthmus softening in the uterus

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9
Q

Who is more likely to feel fetal movement earlier, multigravida or primigravida?

A

Multigravida, maybe around 16-18 wks vs 20 wks.

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10
Q

Why is the beta-hCG test used?

A
  • Similar to LH, FSH, and TSH
  • Detectable in both blood and urine 8-9 days post ovulation
  • False positives are rare

Produced by syncytiotrophoblasts post implantation

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11
Q

What is the MCC of a false positive b-hCG?

A

Heterophilic antibodies

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12
Q

How quickly should b-hCG double once pregnant?

A

Doubles every 1.4-2 days

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13
Q

What is some key patient education for home pregnancy tests?

A
  • Needs a decent level of 12.3 to detect
  • Use first urination of the day
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14
Q

What is the first sonographic evidence of pregnancy seen on TVUS?

A

Gestational sac of small, anechoic fluid

4-5 weeks

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15
Q

What confirms that a pregnancy is not ectopic via US?

A

Yolk sac = bright echogenic ring with an anechoic center

5-6 weeks gestation

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16
Q

What is crown rump length used for?

A

Prediction of pregnancy due date

First trimester length = most accurate tool for gestational age.

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17
Q

Fetal Pole US

A
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18
Q

What rule estimates delivery date?

A

Naegele’s Rule: LMP + 7 days - 3months = EDD (estimated date of delivery)

Pregnancy must have begun 2 weeks prior to ovulation.

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19
Q

What fruit size corresponds to a 12 week uterus on bimanual exam?

A

Grapefruit

Uterus should begin exiting bony pelvis

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20
Q

What maternal Rh blood type is concerning? Tx?

A
  1. Rh-
  2. Give RhoGAM at 28 wks to prevent alloimmunization
  3. Also give earlier if trauma or vaginal bleeding
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21
Q

What test is used to check fetal RBCs present in maternal circulation?

A

Kleihauer-Betke

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22
Q

How much rhoGAM eradicates fetal RBCs?

A

0.3mg of Rh IgG eradicates 15mL of fetal RBCs (30mL of fetal blood)

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23
Q

How is rubella diagnosed?

A

Serology

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24
Q

What fetal effects can rubella cause?

A
  • Eye defects (Cataracts)
  • Congenital Heart Defects
  • Sensorineural deafness
  • CNS
  • Hepatosplenomegaly and jaundice
  • Pigmentary retinopathy
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25
Q

How is rubella prevented?

A
  • MMR for non-pregnant
  • Avoid 1 month before or during pregnancy (live virus)
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26
Q

How is syphilis diagnosed?

A
  • VDRL(Venereal disease research lab test)
  • RPR (rapid plasma reagin)
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27
Q

How is syphilis treated?

A

Penicillin G

Desensitization if allergic

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28
Q

What historical fact may increase need for folic acid during pregnancy?

A

Hx of neural tube defect in previous child.

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29
Q

What does obesity increase the risk of in pregnancy?

A
  • Gestational HTN
  • Preeclampsia
  • Gestational diabetes
  • Macrosomia (big baby)
  • C-section
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30
Q

What seafood should be avoided in pregnancy due to high mercury levels?

A
  • Shark
  • Swordfish
  • King mackerel
  • Tile fish
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31
Q

Up to what week of gestation is airline travel ok?

A

Up to 35 weeks

I assume that after this, risk of contractions on a flight is high

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32
Q

What specific hobby should be avoided in pregnancy?

A

Scuba diving due to decompression sickness

33
Q

What is the most ideal way to counsel smoking cessation for pregnancy?

A

Person to person

5 As of smoking: ask, advise, assess, assist, arrange

34
Q

When is exclusive breastfeeding preferred?

A

Up to 6 months!

35
Q

When is BFeeding CId?

A
  • Drugs/alcohol
  • Infant with galactosemia
  • HIV
  • Hep C with cracked nipple
  • Active TB
  • Meds
  • Breast cancer tx
  • Active herpes
36
Q

What is the new method of med labeling for pregnancy and lactation use?

A

PLLR (pregnancy and lactation labeling rule)

37
Q

What is checked at prenatal visits?

A
  • FHTs
  • Fetal growth via fundal height
  • US for dating and anatomy
  • Maternal BP and wt
  • Symptoms
38
Q

What symptoms should be asked at every prenatal visit?

A
  • Leakage of fluid
  • Contractions
  • N/V
  • Pelvic pain
  • Bleeding
39
Q

How is gestational diabetes screened for?

A

1 hour glucola test

40
Q

What culture is checked at 35-37 weeks? Why?

A

Group B streptococcus, which can cause sepsis.

41
Q

When is TDaP given?

A

3rd trimester so immunity can be passed along.

42
Q

What is hyperemesis gravidarum and the danger?

A
  • Severe vomiting that can result in dehydration, electrolyte, and acid-base disorders
  • Can also result in Wernicke encephalopathy
43
Q

How is N/V generally treated in pregnancy?

A

Vit B6 (pyridoxine) +/- doxylamine

Puking needs dox

44
Q

Why does heartburn occur very commonly in pregnancy and how is it treated?

A
  • Upward displacement/compression of stomach by uterus
  • Relaxation of LES
  • Antacids > H2 blockers > PPIs
45
Q

A pregnancy woman presents with intense cravings for ice/dirt; what is the most likely underlying etiology?

A

Iron deficiency anemia

46
Q

What is leukorrhea and why does it occur?

A
  • Increased mucus secretion by cervical glands due to estrogen
  • Increased vaginal discharge
  • Usually not pathological
47
Q

When are most prenatal screenings done prior to in terms of gestational age?

A

Prior to 20 weeks.

48
Q

What maternal age is fetal trisomy risk increased?

49
Q

What are the 2 most common classes of birth defects?

A
  1. Cardiac
  2. Neural tube defects
50
Q

What serum/amniotic elevation is associated with neutral tube defects?

A

Alpha feto protein (AFP)

51
Q

What is the most sensitive test for NTDs in pregnancy?

A

2nd trimester fetal US

52
Q

What should be offered to all pregnant women in terms of screening?

A
  • Prenatal genetic screening
  • Diagnostic testing
53
Q

What tests are done in first trimester screening?

A
  • Nuchal translucency
  • Serum analytes

Down syndrome screening

54
Q

What serum analytes are associated with down syndrome?

A
  • Elevated hCG
  • Decreased PAPP-A

If both trisomy 13 and 18, both will be lowered.

One up one down for down syndrome

55
Q

What is in a quad screen in the 2nd trimester?

A
  1. hCG
  2. AFP
  3. Unconjugated estriol
  4. inhibin (elevated = down syndrome)
56
Q

What US finding may suggest aneuploidy?

A
  • Major structural abnormality
  • 2+ minor structural abnormalities
57
Q

If a fetus has a major anomaly on US, what is the next step? What if it is only a minor anomaly?

A
  • Major: Invasive testing
  • Minor: Genetic testing
58
Q

What is considered a minor US abnormality for a fetus?

A
  • Nuchal fold > 6mm
  • Pyelectasis
  • Hyperechogenic bowel
  • Choroid plexus cyst
59
Q

What is cell free DNA?

A
  • Fetal components in maternal circulation
  • Most sensitive and specific screening test for common fetal aneuploidies

Not equivalent to diagnostic testing

60
Q

What is the MC procedure to diagnose fetal aneuploidy?

A

Amniocentesis, performed at 15-20 wks

61
Q

What can amniocentesis measure?

A
  • Fetal karyotyping
  • Polyhydramnios (>25mm of amniotic fluid)
  • Fetal Anemia
  • Fetal lung maturity (L/S ratio)
62
Q

When is Chorionic Villus Sampling (CVS) done and why?

A
  • 10-13 weeks gestation (very early)
  • Used if high suspicion and if early termination may be desired.

Performed earlier than amniocentesis

63
Q

What are the complications of performing CVS?

A
  • Pregnancy loss
  • Limb-reduction defect
  • Vaginal spotting
  • Infection
64
Q

What is the MC indication for fetal blood sampling/cordocentesis?

A

Fetal anemia

65
Q

What are the complications of fetal blood sampling?

A
  • Fetal loss
  • Cord bleeding
  • Fetal-maternal bleeding
  • Fetal bradycardia
66
Q

Image of fetus response to stress

67
Q

What is antepartum fetal assessment mainly used to assess?

A
  • Risk of intrauterine death
  • Complications of intrauterine asphyxia
68
Q

What factors can affect fetal movement?

A
  • Amniotic fluid (less fluid = less activity)
  • Multigravida (earlier)
  • Gestational age (older = less space)
  • Fetus sleeps also
69
Q

On average, what is the normal amt of fetal movements daily?

A
  1. 10 mvmts in 2 hrs.
  2. Assess daily! (can just do 5 mvmts/hr)
70
Q

What is the next step if a fetus prevents with decreased # of movements?

A

Non-stress test.

71
Q

What is a normal/reactive Nonstress test (NST)?

A

2+ accelerations in a 20 min time span.

Under 32 wks = 10 bpm change for 10s or more
Over 32 wks = 15 bpm change for 15s or more

72
Q

When is a biophysical profile (BPP) performed?

A

Abnormal/nonreactive NST

73
Q

How is a BPP graded and what is part of it?

A
  1. NST
  2. Fetal Breathing via US
  3. Fetal Movement via US
  4. Fetal Tone via US
  5. Amniotic Fluid volume/index via US

0 = abnormal, 2 = normal.

74
Q

At what point is a BPP considered concerning for fetal asphyixa?

A

6/10, or 8/10 if AFI is abnormal

Amniotic fluid index

75
Q

What is the modified BPP?

76
Q

What 3 things are measured in doppler velocimetry?

A
  • Umbilical artery
  • Middle cerebral artery
  • Ductus Venosus
77
Q

When is umbilical artery velocimetry abnormal?

A

Absent or reversed end diastolic flow.

Used for fetal growth restriction

AREDV (velocity)

78
Q

When is middle cerebral artery velocimetry indicated?

A
  1. Fetal anemia
  2. Intrauterine growth restriction
  3. Isoimmunization

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