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6011 Clinical Reasoning Final Exam COMPLETE ☑️ > Module 13: Prenatal Assessment > Flashcards

Module 13: Prenatal Assessment Flashcards

1
Q

Pregnancy

-Hormonal Changes

A
  1. Estrogen & Progesterone — Most important role in Pregnancy
    - Estrogen has Steady increase throughout pregnancy and causes hypercoagulable state
    - Progesterone increases steadily. Can cause respiratory alkalosis and SOB - Relaxes uterus & bladder
    - Both E & P cause decrease sphincter tone causing increase Heart burn and reflux
  2. HCG - Peaks in 1st trimester - procured by placenta
  3. Thyroid - Pregnancy can cause a hyperthyroid state — TSH is stimulated by HCG - TSH decreases and increased levels of T3 and T4 are present
  4. Relaxin - Secreted by corpus lutem and placenta - Relaxes any connective tissue
  5. Erythropoietin (EPO) - Steady increase throughout pregnancy — results in hemodilution and anemia in pregnancy
    - Body is in an inflammatory state during pregnancy - Delayed normal healing response
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2
Q

Anatomic Changes in Pregnancy

A
  1. Breast - Enlargement, tenderness, possible colostrum in 3rd trimester
  2. Uterus - Growth and shift in position
  3. Vagina - Increased D/C, thicker mucosa, Chadwick sign (Bluish color)
  4. Cervix - Softens, edema, bluish, Hegar sign
  5. Adnexa - corpus luteum
  6. External abdomen - Stretch marks, linea negra, diastasis recti
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3
Q

Why is Prenatal (Antenatal) care important

A
  1. Prenatal care determines the well-being of the mother and fetus while optimizing their health and reducing their health risks
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4
Q

Pregnancy

-Health Hx

A
  1. Desire for Pregnancy?
  2. LMP
  3. Gravidity & Parity
    - G- total number of pregnancies
    - T- number of full term pregnancies (37-40 wks)
    - P- Preterm deliveries (20-36 wks)
    - A- Abortions and miscarriages (Before 20 wks)
    - L- Living
  4. Medical Hx — HTN, DM, Autoimmune, Substance abuse, Psych
  5. Surgeries - Gyn surgeries, bariatric
  6. OB hx - previous VBAC
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5
Q

Dating Ultrasound

A
  1. Used to conform how far along the patient is
    - Delivery date
    - Determines viability of pregnancy
  2. Schedule around 5 to 6 weeks — Earliest time to see a fetal heart beat
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6
Q

OB labs

A
  1. CBC, Blood Type —ABO & Rh
  2. Rubella & Varicella
  3. Urine culture
  4. STI panel
  5. Genetic screening <20 wks
    - Non-invasive prenatal testing (NIPS) - Down syndrome, Trisomy 18 - offered at or after 10 wks. Only SCREENING and not diagnostic, Blood test
    - Nuchal Translucency — thickened fold could indicate genetic abnormality
  6. Amniocentesis — DIAGNOSTIC
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7
Q

Pregnancy Counseling

-To Do and Avoid

A
  1. Get baseline BMI
  2. Diet recall and prenatal vitamins
  3. Limit caffeine 1 cup daily
  4. Increase protein

AVOID

  • Lunch meat & hot dogs
  • High mercury fish
  • Raw/undercooked foods
  • Unpasteurized food
  • NSAIDS, herbs, and other teratogenic medications
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8
Q

Pregnancy Counseling

-Weight Gain

A
  1. BMI <18.5 - Underweight - Gain 28-40 lbs
  2. BMI 18.5 - 24.9 - Normal weight - Gain 25-35 lbs
  3. BMI 25-25.9 - Overweight - Gain 15-25 lbs
  4. BMI > 30 - Obese - Gain 11-20 lbs
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9
Q

Screening for Drugs

A
  1. Urine Drug Testing requires CONSENT from mother***

- State based mandatory reporting

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10
Q

Prenatal Visit Schedule

A
  1. Every 4 wks until 28 weeks
  2. Every 2 wks until 36 wks
  3. Every week until delivery

EVERY VISIT

  • Collect weight, BP, FHR, bleeding, cramping, leakage of fluid, FM (after 20 weeks)
  • Safety and emotional well-being
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11
Q

First Trimester (Weeks 1-12)

A
  1. Every 4 weeks visits
  2. Confirmation of pregnancy
  3. Subsequent visits - Weight, BP, Sx’s, emotional well-being, AB precautions (Bleeding & cramping)
  4. Dating ultrasound — confirms viability and helps establish EGA/EDD
  5. Genetic Testing — NIPS (after 10 wks) nuchal translucency (11 wks + 3 days up to 13 wks +6 days
  6. FHR - normal range 110-160’s w/ Doppler starting at 10 wks
    —Pregnancy loss most commonly occurs in 1st trimester
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12
Q

Weeks 15-24 of Pregnancy

A
  1. Every 4 wks through 28 wks
  2. Genetic Testing - Quad screen (Trisomy 21) and AFP (Neural tube defects)
  3. Fundal Height — Start measuring at 20 wks
  4. Anatomy Ultrasound - start at 20 wks
    - Gender, EGA, fetal cardiac activity, fetal growth and movement, placenta, amniotic fluid, Umbilical cord, fetal biometry, fetal number/presentation
    - Eval uterus, cervix, and adnexa
    - Complications and/or birth defects
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13
Q

Weeks 24-28 of Pregnancy

A
  1. Every 4 weeks through 28 weeks
  2. Fetal movement - Start to feel as early as 16 wks but closer to 24-25 wks
  3. Gestational diabetes screen - 1 hr GTT done at this time
  4. Rhogam administration - If mother is Rh negative — Give Rhogam at 28 wks
  5. Screening labs - CBC or PCV to screen for anemia
  6. Pre-term labor signs - Low backache, menstrual-like cramps, increased pelvic pressure, vaginal leaking or clear fluid, spotting/bleeding, contractions
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14
Q

Weeks 28-36 of Pregnancy

A
  1. Every 2 weeks through 36 weeks
  2. GBS - Vaginal and rectal swab collected at 35-37 wks to see if + or - ) If positive, pt will receive prophylaxis antibiotic during delivery
  3. If high risk for complications - Repeat fetal US, determine antenatal surveillance through BPP and or NSTs
  4. Planning for delivery and postpartum - Birth plan, pediatrician, tour of hospital, breastfeeding, contraception, PCP care after delivery
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15
Q

Leopold Maneuvers

A
  1. Assessment of Fetal position — Most useful after 36 weeks
  • First maneuver — Fundus
  • Second maneuver — Maternal abdomen - fetal front/back
  • Third maneuver — Pubic symphosis
  • Fourth maneuver — Maternal abdomen - fetal head
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16
Q

Weeks 36 through Delivery

A
  1. Every week until patient delivery
  2. Planning delivery and postpartum
  3. Fetal Kick Counts — 10 movements w/in 2 hours
  4. Labor signs — Timing contractions, become more regular and painful— Bloody show
  5. Pregnancy Complications — Pre-Eclampsia
    - BP >140/90, HA unresponsive to acetaminophen, visual changes, persistent RUQ pain, edema
17
Q

OB Documentation

A
  1. Age, Gs/Ps & IGA
  2. Type of OB visit - Any pregnancy complications and Sx’s
  3. FHR, fetal height, fetal movement
18
Q

CC In Pregnancy

-Nausea & Vomiting

A
  1. Mainly in 1st trimester but may persist through 16-20 weeks or longer
  2. S/Sx’s — Nausea w/ or w/out vomiting, decreased appetite, unable to eat/drink
  3. HPI
  4. Treatment
    - Small, frequent meals, ginger ale/tea, mint tea, pedialyte pops
    - OTC Vit B6/Unisom
    - Rx — Zofran ODT, promethazine
  5. Emergent Referrals
    - Hyperemesis
    - Severe dehydration
19
Q

CC In Pregnancy

-GERD

A
  1. Occurs in all trimesters
  2. Caused by relaxation of esophageal sphincter, grávid abdomen
  3. PE — Epigastric tenderness
  4. Treatment
    - HOB elevation & triger avoidance
    - antacids (famotidine)
    - PPI (Omeprazole)
20
Q

CC In Pregnancy

-Constipation

A
  1. Occurs in all trimesters
  2. Treatment
    - Increase fluid and fiber intake
    - Modify iron supplement source
    - Occasional use of milk of magnesium or Dulcolax
21
Q

CC In Pregnancy

-Hemorrhoids

A
  1. Can occur in all trimesters, most common in third trimester and postpartum
  2. Caused by constipation, increasing pressure and compression as pregnancy progresses
  3. Treatment
    - Fiber and water intake
    - Refrain from straining or lingering
    - Low impact exercise
    - Topical hydrocortisone (Mainly in PP)
  4. Emergent Referral
    - Intractable bleeding
    - Severely thrombosis hemorrhoids

DIGITAL Rectal exam is NEVER recommended for hemorrhoids in pregnancy

22
Q

CC In Pregnancy

-Muscular Pain

A
  1. Can occur in all trimesters
  2. Caused by relaxation s/p hormonal changes, lordosis, round ligament pain
  3. Treatment
    - Heat/cold application and massage
    - Gentle stretching, PT
    - Rest, good footwear
    - Sleep on side w/ pillows for support
    - Acetaminophen
  4. Emergent Referral
    - Abdominal pain w/ bleeding and cramping
23
Q 
Spontaneous Abortion (Miscarriage)
-Types
A
  1. Threatened AB — Vaginal bleeding w/ closed cervical OS
  2. Inevitable/incomplete AB
    - Vaginal bleeding, pelvic cramping, cervix dilated, products of conception can sometimes be seen at OS
  3. Missed AB — SAB w/ or w/out Sx’s w/ closed cervical OS
  4. Complete AB
    —POC completely passed, bleeding light/mild, cervical OS closed
24
Q 
Spontaneous Abortion (Miscarriage)
-Info
A
  1. Most common in 1st trimester
  2. S/Sx’s - pelvic cramping, bleeding/spotting
  3. Plan & Treatment
    - Serial HCGs and US depending on gestational age
    - Expectant vs medication vs surgical management (D&C)
  4. Maternal & partner mental health
    - Offer support
    - Counseling resources
    - Follow-up

If Rh Negative women starts bleeding GIVE RHOGAM Immediately

25
Q

CC In Pregnancy

-UTI

A
  1. Occurs in all trimesters
  2. CVA tenderness = Pyelonephritis
  3. Treat empirically — Macrobid 100 mg BID x 5 days is safe
    - Increase water intake
    - Avoid sugary or carbonated beverages
    - Monitor unresolved/worsening Sx’s
  4. Emergent Referral
    - No response to antibiotic Tx
    - Pyelonephritis
26
Q

CC In Pregnancy

-URI

A
  1. All trimesters
  2. R/O flu/strep and encourage flu shot
  3. Treatment
    - Rest & hydration
    - Humidified and saline nasal spray
    - Lozenges
    - OTC cold medication
    - Antibiotic - safety in pregnancy
27
Q

CC In Pregnancy

-Pre-Eclampsia

A
  1. Third Trimester
  2. S/Sx’s — Visual changes, persistent/worsening HA, Facial/LE edema, lingering RUQ or Epigastric pain
  3. PE - New onset elevated BP >140/90 and proteinuria
    - Emergent referral to L&D or ED **
  4. Assess onset and timing of Sx’s, FM, bleeding and/or pelvic cramping
28
Q

Special Populations

-Adolescent/teenager

A
  1. Consent to Prenatal care
  2. Increased Risk
    - PreE, IUGR, infant death, preterm birth
  3. Assisted deliveries may be needed
  4. Specific counseling
    - Termination
    - Support system
    - social stigma and fear
29
Q

Special Populations

-Advanced Maternal Age

A
  1. Age > 35 yrs
  2. High risk of miscarriages
  3. Complications -GDM, HTN, preterm birth, IUGR, LBW, stillbirth
  4. Specific counseling
    - Genetic testing
30
Q

Special Populations

-Ethnic Minorities

A
  1. AA and American Indian/Alaska native women 2-3x’s more likely to die of pregnancy related cause than white women
  2. Mental health - Increased rates of anxiety, depression and stress
  3. Nutrition and weight gain
    - Specific guidance on weight gain based on patient E’s diet
  4. Exercise - Emphasize at least 30 minutes of walking 3x week
  5. Smoking
    - Encourage cessation counseling and offer resources
31
Q

Special Populations

-Female Genital Mutilation

A
  1. Increased Complications
    - Recurrent UTIs, labor complications, perineal tears, increase C-section risk, postpartum hemorrhage
  2. Pelvic exam - DOCUMENT
  3. Episiotomy — FGM type 3 (88%)
  4. Connect w/ community support, providers, counseling/resources
32
Q

Special Populations

-Trauma and Interpersonal Violence

A
  1. Risks include - low socioeconomic status, housing instability, low education, h/o trauma & IPV
  2. Poor health outcomes
    - Maternal & fetal death
    - Mental health impairments
    - OB complications (high BP, vaginal bleeding, pre-term birth
    - 5x more likely placental abruption and fetal demise
  3. Screen - 1st prenatal visit, at least once per trimester, postpartum visit
  4. Increased risk in adolescent and minority women
33
Q

Special Populations

-Substance Abuse

A
  1. Delayed/lack of prenatal care
  2. Poor nutrition
  3. Increased risk for IUGR, placental abruption, fetal death, preterm labor, meco I um
  4. High risk activities — Prostitution, trading sex for drugs, criminal activities
    - Mental health conditions
  5. SCREEN
    - 4 p’s —
    - Parents had issues with drugs or ETOH
    - Partner has issues with drugs or ETOH
    - Past issues w/ drugs or ETOH
    - In the Past month has pt used drugs or ETOH
34
Q

Substance abuse

A
  1. GET consent prior to urine drug screen

SCREEN

  • 4 p’s —
  • Parents had issues with drugs or ETOH
  • Partner has issues with drugs or ETOH
  • Past issues w/ drugs or ETOH
  • In the Past month has pt used drugs or ETOH
35
Q

Health Promotion

A
  1. UTD Pap
  2. Immunizations
  3. EPDS - Depression
  4. Safety
  5. Nutrition and exercise
  6. Support system
  7. STIs

6011 Clinical Reasoning Final Exam COMPLETE ☑️ (3 decks)

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