Lecture 5 - Prenatal Care Flashcards
What are early signs of prengnancy?
amenorrhea N/V/food aversions breast enlargement and tenderness increased frequency of urination without dysuria fatigue cramping constipation heartburn nasal congestion mood changes
Serum Bhcg can confirm pregnancy how long after conception?
1 week
Urine Bhcg levels need to be how high to confirm a positive pregnancy?
> 25-50 mIU/mL
EGA
estimated gestational age
ideally determined between 6-8 weeks GA (confirming viability - fetal pole and fetal heartbeat)
EDD = EDC
estimated date of delivery
estimated date of confinement
Naegele’s Rule
Used to determine the estimated date of delivery
EDD = (LMP - 3 months) + 7 days
What provides accurate EDD?
Crown Rump Length
What weeks are considered first trimester?
13 weeks
If the LMP (Naegele’s Rule) doesn’t match the ultrasound in regards to EDD, what do you base the EDD on?
US
also if the pts doesnt know her LMP you solely base the EDD on the US
Gravida and Para
Gravida - how many times pt has been pregnant Para - what are the outcomes of those pregnancies - broken down into T (term), P (preterm), A (abortion), L (living) G P(TPAL)
What is considered to term?
> 37 weeks
What is considered preterm?
20-37 weeks
G3 P2012
G P(TPAL)
3 pregnancies
2 term pregnancies
1 abortion
What are the components of the first prenatal visit?
Med Hx Surgical Hx Genetic Hx Domestic Violence screening Teratogen exposure screening Vitals (BP, BMI) PE -thyroid -heart and lungs -breast -abdomen -pelvic US - determine EDD Labs -ABO, antibody -CBC -Hep B -Rubella -Syphilis -HIV -Pap smear -Urine Culture (we treat asymptomatic bacteruira in pregnant pts only) CF screening SMN screening
What are the two most common cancers dx during pregnancy?
breast and cervical
When do pts typically start showing during pregnancies?
20 weeks
What can you tell a pt in regards to weight gain during pregnancy?
if their BMI is: <18.5 -- 25-40 lbs 18.5-25 -- 25-35 lbs 25 - 29.9 -- 15-25 lbs >30 - 10-20 lbs
Is there a specific max HR for pregnant pts to avoid during exercise while pregnant?
no
What foods do you need to advice your pts to avoid during pregnancy?
undercooked meat (no pink d/t risk of toxoplasmosis)
cold deli meat
unpasteurized cheese or dairy
high mercury fish (shark, tilefish, mackerel, swordfish, tuna)
raw sprouts
raw eggs
EtOH, smoking, and dugs
Cat litter (esp. outdoor cats)
Hot tubs and saunas - NTD risk with hot environments
Which vaccinations are NOT to be given during pregnancy?
MMR, varicella
any live vaccines
Which vaccinations are given during pregnancy?
influenza Tdap Vaccine (during third trimester 28-35 weeks) --this is given during EVERY pregnancy
Why is travel avoided >36 weeks?
risk of delivering somewhere without care
What prenatal vitamins should be taken and when?
ideally 1 month prior to conception to help decrease N/V and NTD risk
folic acid 400 ug( increase to 4mg if hx of NTD)
DHA
Iron
What vitamins should pregnant pts avoid?
fat soluble vitamins
ADEK
How much caffeine is can a pregnant pt be allotted?
<200 mg/day
When are the prenatal visits
every 4 weeks until 28 weeks
every 2 weeks from 28 - 36 weeks
weekly after 36 weeks
What are the 6 main things you check at every prenatal visit?
weight BP urine dipstick (protein, glucose) fetal heart rate fundal height (>20wk)
What is the best way to measure if the fetus is growing properly?
fundal height
Fundal height
measured via the top of uterus to pubic bone
cm should equal roughly the number of weeks gestation (+/-2)
What labs are done 15-20 weeks of pregnancy?
Genetic - MSAFP, QUAD screen, amniocentesis
What labs are done 24-28 weeks of pregnancy?
GCT, ABO, antibody, CBC, HIV, RPR
When is chromosomal screening done?
aneuoploidy screening
screened <20 weeks
What are the 4 main things we test for with genetic screening?
Trisomy 21, 18, 13 and NTD
How is genetic screening done during the first trimester?
Nuchal translucency (neck pole of the baby) and PAPP-A and Bhcg of the mother
What is the genetic screening done during the second trimester?
QUAD screen msAFP Bhcg Estriol Inhibin
During the first trimester, what does it mean if PAPP-P is low, Bhcg is high, and NT is high?
Trisomy 21
During the first trimester, what does it mean if PAPP-P is low, bHcg is low and NT is low?
either trisomy 18 or 13 depending on how much of NT is high and bhcg is low
msAFP
genetic screen for NTD
NIPT
noninvasive prenatal testing
cell free fatal DNA (in maternal blood)
> 9-10 weeks
only offered if >35yo, US findings, hx of trisomy, +FTS, balance Robertsonion translocation
this can also tell you the sex of the baby by 10 weeks rather than 18 weeks based on anatomy
What is the difference between genetic screenings like QUAD, NIPT from CVS?
CVS - chronic villus sampling
along with amniocentesis
are genetic dx rather than screening - 100%
What is tested on routine anatomy US?
18-20 weeks
growth anatomy sex determination placentation cervical length screening
this allows you to check congenital anomalies that arent chromosomal
short cervix (<2.5cm) = increased risk of preterm birth
What is the first line treatment for N/V in pregnancy?
vitamin B6 and Doxylamine (unisom)
What is the MC pain seen in first and second trimester?
first trimester - N/V
second trimester - round ligament pain
When do you start the discussion of birthing, breastfeeding, infant CPR?
once the gestation has become viable - 24 weeks
5/1/1
rule of contractions >37 weeks
contractions every 5 minutes lasting 1 minutes for 1 hour
Before 37 weeks, when should a pt come in for contractions?
if they have contractions every 15 minutes that have not improved with rest and hydration
Kick counts
10 kicks/2 hours
a rule you can tell pts to help relieve them of worry that something is wrong
have them drink something sugary and lay down for 2 hours
they should feel at least 10 kicks
if not–come in
then get
NST
BPP
NST
fetal non-stress test
performed after 28 weeks
monitoring for baby HR and contractions
checks for acid//base, oxygination
BPP
biophysical profile
30min US test to check for NST Breathing Tone AFI Movement
Score 8-10 = low risk
6 = monitor and redo test in 6-12 hours
<4 - move towards delivery - baby is at risk of hypoxia
How can you prevent post-term pregnancies?
sweeping of membranes
ambulation
intercourse
nipple stimulation
induction recommended >42 weeks
