Module 5: Preconception Care Flashcards
1
Q
Opportunities to Talk about Pre-Conception Planning?
A
- Well-woman visit
- Post-partum visit
- Contraception visit
- Visits with the CC of vaginitis/STI Sx’s
- Visits where the CC is a request for a pregnancy test
2
Q
Goals for Preconception Care
A
- ID health risks r/t pregnancy by taking a health hx
- Biological
- Genetic
- Social/behavioral
- Medications
- Work-place exposures - Assess for acute and chronic diseases
- Initiation of interventions to ensure optional pregnancy outcomes — Health promotion & weight management
3
Q
Pre-Conception Immunization Status
A
- Varicella & Rubella CANNOT be given in pregnancy
- TDAP
- Influenza
- COVID-19
- Pneumococcal
4
Q
Thyroid Medication
A
- Hypothyroid can cause intertility
- PCPs should monitor thyroid levels prior to conception
- Maternal thyroid changes are substantial in pregnancy
- Thyroid hormone replacement doses are INCREASED during pregnancy
5
Q
Medication Guidelines in Pregnancy?
A
- Asthma — ICS and beta agonists are OKAY
- DM — MOST oral diabetic agents should be DISCONTINUED — Metformin and sulfonylurea can be used during preconception
- HTN — AVOID ACE-i, ARBs, and atenolol
- Seizure disorder — Many major antiepileptic drugs are teratogenic
- Coagulopathy — Avoid Warfarin — Heparin is PREFERRED
6
Q
Medication Safety in Pregnancy Part 2
A
- Asthma — Albuterol is rescue therapy of choice — Budesonide is ICS of choice — Salmeterol is LABA of choice for controller therapy **
- Bacterial Vaginosis — Tx of all pregnant women w/ sx’s = Metronidazole or clindamycin
- Chlamydia — Azythromycin
- Cholestasis of pregnancy - Ursodeoxycholic acid (UDCA)
- Chronic HTN — Labatelol OR/AND Methyldopa OR/AND Nifedipine slow-release preparation
7
Q
Folic Acid in Pregnancy
A
- Early supplementation reduces Neural tube defects by 70%
- ALL women of childbearing age should take 0.4 mg daily, beginning at least 4 weeks prior to conception and ideally 12 weeks prior
- Food sources
- Breads
- Grains
- Cereals
8
Q
Pre-Conception Counceling
A
- Smoking Cessation
- Recreational Drug Cessation
- Limit ETOH to <4 drinks/week
- Limit caffeine consuption to <250 mg/day
- Males should wear boxers and avoid hot tubs/saunas
- Supplements
- Males — Multivitamin, Vitamin C 500 mg, Zinc 25 mg
- Females — Multivatamin, Folic Acid 0.4 mg
9
Q
Spacing of Pregnancies
A
- An interpregnancy interval of 18-23 months has the lowest risk of adverse perinatal outcomes
10
Q
DIAGNOSIS OF PREGNANCY AND GESTATIONAL AGE
A
DIAGNOSIS OF PREGNANCY AND GESTATIONAL AGE
11
Q
Presumptive signs of Pregnancy
A
- Amenorrhea
- Breast changes
- Skin changes — Linea nigra; melasma
- Subjective sensations — Nausea, urinary frequency, fatigue
- Quickening — Fetal movement (Approx. 20 weeks estimated GA) — Presumptive sign and NOT a probable or positive sign**
12
Q
Probable Signs of Pregnancy
A
- Probable signs of pregnancy are MORE objective and Obervable however they are NOT ABSOLUTE signs
- Enlargement of the abdomen
- Goodell’s sign - observable at 4 wk gestation - Cervical softening
- Chadwick’s sign - 6-8 wk gestation - bluish discoloration or cervix and vagina - caused by mild cyanosis of cervical and vaginal tissue - Probable sign
- Hegar’s sign - 6-8 wk gestation - Softening of the lower uterine segment or uterine ismus - happens after goodell’s sign
- Ballotement of the fetus - Palpation of fetal parts
7, Endocrine pregnancy tests — Serum or urine HCG
-Hormone producing tumor can cause HCG +
13
Q
HcG Testing in Pregnancy
A
- HCG can be qualitative (+/-) or quantitative (Hcg level).
- In early pregnancy, serum Quantitative HCG will double q48-72 hrs** Draw to confirm pregnancy, ectopic or threatened abortion - Positive urine Qualitative test = HIGH probability of pregnancy
- False negative tests can occur and are MORE COMMON in early pregnancy - reasonable to repeat in 4-7 days
14
Q
HCG - Info
A
- HCG is released following fertilization when the blastocyst implants in the lining of the endometrium
- HCG is not produced until implantation occurs (8-9 days after ovulation)
- HCG test will NOT be positive for 8-9 days after ovulation*** - HCG prevents involution of corpus luteum, the corpus luteum produces progresterone, the hormone that supports early pregnancy development
- False positive results may occur d/t: Molar pregnancies/cancer, HCG injections used for weight loss, HCG producing tumors
15
Q
Positive signs of Pregnancy are considered ABSOLUTE**
A
- Only 3 signs are POSITIVE/ABSOLUTE
- Auscultation of fetal heart tones ** — 10-12 wks by handheld doppler OR 20 wks by fetoscope/stethoscope
- Detection of fetus/embryo by ultrasound (or xray)
- Fetal movement detected by examiner (Not patient)
TEST***
16
Q
Estimating Gestational Age
A
- Best way to Estimate GA is Known date of conception or Ultrasound if conception date is Unknown
- US can be w/ or w/out a sure last known menstrual period
17
Q
Important Timepoints for Estimating GA
-12 weeks
A
- Fundus rises above symphysis pubis
2. Fetal heart tones heard by doppler
18
Q
Important Timepoints for Estimating GA
-16 weeks
A
- Fundus between symphysis and the umbilicus
19
Q
Important Timepoints for Estimating GA
-20 weeks
A
- Fundus @ Umbilicus
2. FHT’s heard w/ fetoscope
20
Q
Important Timepoints for Estimating GA
-20-35 weeks
A
- Fundal height should match EGA in centimeters
- Ex: 32 wk gestation has fundal height of 32 cm
21
Q
Important Timepoints for Estimating GA
-Size/date discrepancy
A
- Size of uterus does not match gestational age
- Difference of plus or minus 2cm from expected measurement
- > 2 cm = fetus larger than expected — Think dating error or large fetus (macrosomia)
- <2 cm = think dating error, small fetus (growth restriction)
22
Q
Board Exam Question
-Calculate EDD using Naegele’s Rule
A
- Subtract 3 months from the date of the sure last menstrual period
- Add 7 days to the end of the LMP
- Adjust the year if needed
