Module 2 Flashcards by Kristin Godsey

GTPALM

G= # of pregnancies
T= # of births @ term
P= # of births pre-term (20.0-36.6 wks)
A= # of abortions/miscarriages/ectopics (prior to 20 wks)
L= # of children currently living
M= # of births resulting in multiples (twins, triplets, etc.)

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uterus fruit size @ 6 weeks

small orange

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uterus fruit size @ 8 weeks

large/navel orange

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uterus fruit size @ 10 weeks

grapefruit

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uterus fruit size @ 12 weeks

cantaloupe

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confounding variables to palpating the uterus in the 1st trimester

 Uterine position
 Bladder status
 Maternal habitus

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anatomical location of uterus @ 12 weeks

@ the symphysis publis

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anatomical location of uterus @ 14 weeks

2-3 fingerbreadths above the symphysis publis

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anatomical location of uterus @ 16 weeks

½ way between symphysis pubis and umbilicus

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anatomical location of uterus @ 20 weeks

@ the Umbilicus

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fetal movements felt by almost all pregnant women at this gestation

20 weeks

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Process of protecting infants too young to be vaccinated by vaccinating all those in contact with the infant.

cocooning

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vaccine given @ 27-36 weeks for every pregnancy to build up baby’s antibodies to help prevent pertussis (whooping cough)
 Passive antibody transfer

Tdap

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cannot give ______ vaccines in pregnancy

live

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S.H.A.R.E acronym for vaccine education in pregnancy

o Share the reason why vaccine is recommended
o Highlight positive personal experiences with vaccination
o Address the woman’s questions and concerns
o Remind that vaccine-preventable diseases still exist
o Explain potential costs of getting disease

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Risk Factors for ___________:

Preterm birth, underweight, smaller lungs, sick more often, increased risk of SIDS

Smoking in pregnancy

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5 A’s of smoking cessation education

	Ask
	Advice
	Assess
	Assist
	Arrange

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5 R’s of smoking cessation education

	Relevance
	Risks
	Rewards
	Roadblocks
	Repetition

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o Tolerance: How many drinks does it take to make you feel high?
o Annoyed: Have people annoyed you by criticizing your drinking?
o Cut Down: Have you ever felt that you should cut down on your drinking?
o Eye Opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

T-ACE Tool to evaluate alcohol use in pregnancy

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Another way to discuss substance use in pregnancy

The AUDIT Tool

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Non-Pharm Remedies for _________:

Acupuncture, acupressure, ginger root (250mg capsules QID), vitamin B6 (pyridoxine, 25mg 2-3 times a day)

Nausea

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interferes with organogenesis during the embryonic period – birth defects (cleft palate, cardiac anomaly, facial abnormality, or dysmorphic effect)

teratogenesis

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1st discovered teratogen

rubella (viral)

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Mechanisms of most \_\_\_\_\_\_\_:
o	Folate antagonism
o	Neural crest cell disruption 
o	Endocrine disruption of sex hormones
o	Oxidative stress
o	Vascular disruption
o	Specific receptor- or enzyme-mediated reactions

teratogens

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exerts effects on growth or fetal development in 2nd or 3rd trimester (i.e. fetal growth restriction) • Example: Tetracycline • Can also be teratogens

fetotoxicity

Background risk of congenital anomalies secondary to unknown causes

~3-4% of all births

Drugs & chemicals account for ~__% of all identified birth defects

period b/t fertilization and implantation | • “all or none” effect

Pre-embryonic

period b/t implantation & 9 post-conception weeks | • Period of greatest concern for exposure to pharmaceuticals

Embryonic

period after 10 post-conception weeks | • Time when fetus is most susceptible to growth restriction & developmental or behavioral abnormalities

Fetal Period

like other rare adverse drug effects, these are a post hoc phenomenon

teratogens

higher doses of _________ are needed for pregnant women

antibiotics and other hydrophilic drugs

``` absorption of: inhaled drugs intramuscular drugs transcutaneous lipphilic and hydrophilic drugs are all ___________ during pregnancy ```

increased

__________ of absorption occurs in pregnancy due to calcium and iron in PNV

inactivation

there is a potential need to increase dose of hydrophilic drugs in pregnancy due to:

dilutional effect of plasma volume increase

increased incidence of free drugs if highly protein bound (highly protein bound drugs will have more pharmacologic activity) in pregnancy due to:

plasma albumin concentrations decrease

-tripling of half-life of caffeine -increased half-life of other agents such as sertraline (Zoloft) in pregnancy due to:

CYP450 enzyme activity changes because of increased estrogen and progesterone levels

decreased effect of renal drugs because of rapid clearance in pregnancy is due to:

GFR increases throughout pregnancy by 50% at term

``` Increased caloric intake for a singleton pregnancy and normal BMI o Standard increase: ____ kcal/day o 1st trimester: _____ kcal/day o 2nd trimester: ____ kcal/day more o 3rd trimester: _____ kcal/day ```

o Standard increase: 300 kcal/day o 1st trimester: NONE kcal/day o 2nd trimester: 340 kcal/day more o 3rd trimester: 450 kcal/day

Increase water intake in pregnancy because:

increase in blood volume increase inamniotic fluid production increase in BMR **Prevents UTIs and constipation

This forms structural basis for new cells and tissues in mother and fetus o RDA = 71g/day

Protein

Carbohydrates RDA in pregnancy =

175 g/day

__________ women are more likely to be lactose intolerant than America women of northern European descent

African American Hispanic American American Indian

o Can decrease childhood asthma | o Essential for brain & eye development & neurodevelopment

Fatty acids

o Important for structure, growth, and development of fetal central nervous system and retina o Forms a major part of fetal neural tissue that maintain optima neurotransmitter function o Maternal benefits  Decreases risk of PTB, LBW, preeclampsia o Infant/child benefits  Increased IQ, fine motor, social development, decreased asthma, increased visual acuity

DHA and EPA

RDA of DHA and EPA =

500-600 mg daily

Be wary of ________ supplements though to obtain DHA because of high levels of vitamin A

cod liver

Sources of DHA and EPA

Cold water fish & breastmilk

pregnanc women should eat ___ fish meals per week

Caffeine intake should not exceed _____ mg/day

200

``` What to check in _________ assessment: o Weight & BMI o Skin o Hair o Nails o Thyroid o Heart o Mucosa o Assess for nutritional risk factors based on assessment ```

Nutritional

``` Subjective Date for ______ Assessment o Diet recall o Hominy days eat fast food o Food purchase/storage ability o Cultural/religious/ethnic food preferences o Food intolerances (likes/dislikes) o Supplements & meds o Substance abuse o Activity levels o Who cooks/does food shopping ```

Nutritional

``` ___ Trimester Dietary Counseling Considerations: o Protein o Folic acid o Vitamin B12 o Zinc ```

1st

``` ___ Trimester Dietary Counseling Considerations: o Protein o Iron o Calcium o Magnesium o B vitamins o Omega-3 (DHA) ```

2nd & 3rd

Maternal ______ intake needs to double in pregnancy

iron

Need for additional _____ begins in 2nd trimester

iron

Iron RDA= ______ mg of daily

27-30

Vitamin ___ helps increase absorption of non-heme iron

If low iron, evaluate response to iron supplementation in ____ weeks

2-4 weeks

Sources of Vitamin A: _______ can be teratogenic vs ________ should not lead to toxicity

Retinols (can be teratogenic) | beta-carotenes/plant sources (should not lead to toxicity)

RDA = _____ IU/day (not to exceed ______ IU) for pregnant/lactating women 14-50 years old

600 (4000 IU)

Associated with a decrease in maternal hypertension and preterm birth when administered alone

Vitamin D

Vitamin D with added Calcium increases risk of:

preterm birth

``` ________ is important for:  Bone health  Glucose regulation  Immune function  Good uterine contractility in labor ```

Vitamin D

Calcium RDA = _____ mg/day for pregnant/lactating women aged 19-50 Calcium RDA = _____ mg/day for pregnant/lactating women aged 14-18

1,000 (not to exceed 2500) | 1,300 (not to exceed 3000)

o Associated with lower risk for neural tube defects | o Take as soon as start trying to conceive

Folic Acid

Folic Acid RDA= _____ mcg (_____ mcg if history of neural tube defects)

400 mcg (4000 mcg)

In pregnancy: at least _____ minutes of moderate-intensity physical activity most or all days of the week (_____ minutes/week)

20-30 (150 min/week)