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ENRP > Normal Pregnancy > Flashcards

Normal Pregnancy Flashcards

1
Q

What is the goal of a preconception visit?

A

Decrease risk of adverse effects by optimizing WOMAN’s health before conception

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2
Q

What are some examples of things to do a a preconception office visit?

A

Start folic acid supplementation
Glucose control for a diabetic patient
= Optimizing woman’s health before conception

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3
Q

Gravidity (G)

A

Number of pregnancies

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4
Q

Parity (P)

A

FPAL

  • Full term pregnancies
  • Preterm pregnancies
  • Aborted pregnancies
  • Living children
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5
Q

Parity components

A

FPAL

  • Full term pregnancies
  • Preterm pregnancies
  • Aborted pregnancies (loss < 20 weeks)
  • Living children
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6
Q

A woman has had 1 term child, 1 set of preterm twins, 1 miscarriage, 1 ectopic pregnancy and has 3 living children. Document with Gravidity and Parity.

A

G4 P1123

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7
Q

What are some things to do at a Prenatal office visit?

A
  • History/physical
  • Labs are drawn
  • Estimate gestational age and due date
  • Possible genetic counseling, teratology and pregnancy symptom discussion
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8
Q

Gestational age

A

of weeks between 1st day of last missed period and due date

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9
Q

What does a Pregnancy test detect?

A

hCG in serum/urine

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10
Q

For a pregnancy test to be positive, what level must the hCG be above?

A

> 25

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11
Q

In the first 30 days of pregnancy, what occurs with the hCG?

A

DOUBLES every 2 days!

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12
Q

What doubles every 2 days in the first 30 days of pregnancy?

A

hCG

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13
Q

With a Transvaginal US, what can be seen at 5, 6, and 7 weeks respectively?

A

5 weeks = gestational sac
6 weeks = fetal pole
7 weeks = cardiac activity

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14
Q

How do you calculate due date with a patient that has about 28 day menstrual cycles?

A

Last menstrual period - 3 months + 7 days

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15
Q

When is an US the most accurate for estimating the due date and what does it measure?

A

1st trimester

– measures crown rump length

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16
Q

In what patients should genetic counseling be recommended?

A

Advanced maternal age (>35)
Multiple fetal losses
Previous children with abnormalities

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17
Q

With advanced maternal age and other conditions that require genetic counseling, what are they at risk for with the next pregnancy?

A

Aneuploidy

  • trisomies
  • sex chromosome abnormalities
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18
Q

What are 1st trimester screening options for fetal aneuploidy? (3)

A
  • Fetal Nuchal Translucency
  • Maternal b-hCG
  • PAPP-A
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19
Q

What is fetal nuchal translucency and what may it indicate?

A

Thickness/translucency at the back of the fetal neck

–> aneuploidy

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20
Q

What levels of maternal b-hCG and PAPP-A could indicate aneuploidy?

A

Increased maternal b-hCG

Decreased PAPP-A

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21
Q

What are 2nd trimester screens for aneuploidy?

A

Triple or Quadruple screens

- b-hCG, estriol, AFP +/- Inhibin

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22
Q

What is a NON-invasive screening option for HIGH risk patients for aneuploidy?

A

Cell-Free Fetal DNA

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23
Q

Cell - Free Fetal DNA test can be done at any time after 9-10 weeks. What does it measure?

A

Tests cell-free fetal DNA from apoptosis of trophoblastic cells that are in maternal circulation

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24
Q

When should you order a Cell-Free Fetal DNA test?

A

HIGH risk patients for aneuploidy

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25
What does the Cell-Free Fetal DNA test NOT test for and what should you get for that?
Does NOT test for Neural Tube defects | -- Need AFP
26
If the Cell-Free Fetal DNA test is (+), what should you get next?
Amniocentesis or CVS (chorionic villi sampling) | -- INVASIVE
27
What risk does the Amniocentesis and CVS tests carry?
Risk of miscarriage
28
What is a Teratogen and are they commonly identified?
Any agent that causes abnormalities in the fetus | -- NOT usually ID'ed
29
Thalidomide is a Teratogen. What does it cause in the fetus?
Phocomelia
30
What is the current method of assessing meds and their teratology risk?
PLLR | = pregnancy lactation labeling rule
31
What does the PLLR do?
(pregnancy lactation labeling rule) | - assess benefit vs risk in pregnant women who need the medication
32
What subsections does the PLLR have?
- pregnancy - lactation - reproductive potential
33
What is the most vulnerable time when teratogens can impact fetal development?
Organogenesis stage = 17-56 days post conception
34
After the Organogenesis stage (17-56 days post conception), what usually occurs to the fetus if a teratogen is exposed?
Delayed growth
35
What is the most common drug that is a teratogen?
Alcohol
36
What are the signs of a Fetal Alcohol baby?
``` Growth restriction Low set ears Thin upper lip Smooth philtrum Flat face and small head Behavioral issues ```
37
What are the signs of a Fetal Alcohol baby?
``` Growth restriction Low set ears Thin upper lip Smooth philtrum Flat midface and small head Behavioral problems ```
38
Radiation exposure is also a teratogen. If exposure occurs before 2 weeks postconception, what are the options of what can occur?
NO effect | Lethal
39
What level of radiation carries NO risk of being a teratogen for the fetus?
< 5 rads of radiation is no risk
40
Are most diagnostic tests with radiation safe to order for pregnant ladies?
YES | -- < 5 rads is acceptable
41
List some unpleasant symptoms of pregnancy
``` N/V Heartburn Constipation and Hemorrhoids Leg cramps Backache ```
42
List some unpleasant symptoms of pregnancy and ways to treat them
N/V - small/frequent meals, avoid greasy foods, meds, acupuncture Heartburn - elevate head of bed, avoid greasy foods, antacids Constipation and Hemorrhoids - diet changes, stool softener Leg cramps - stretch/massage Backache - stretch, pillows, heat, etc.
43
Leg cramps and backaches occur when in pregnancy?
Later in pregnancy
44
Describe how often prenatal office visits should occur?
- Every 4 weeks until 28 weeks - Every 2 weeks from then until 36 weeks - Every week from then until delivery
45
What is quickening and around when does it occur?
First sensation of fetal movement | -- 20 weeks
46
What are 4 Antepartum tests?
- Kick counting - NONstress test - Contraction stress test - BPP (biophysical profile)
47
What are 4 Antepartum tests?
- Kick counting - NONstress test - Contraction stress test - Biophysical Profile (BPP)
48
What is Kick Counting?
Monitoring fetal movement
49
What is a normal result for Kick Counting?
10 movements within 2 hours
50
What is the expected result of a NONstress test?
Reactive = 2 accelerations of more than 15 beats above baseline lasting at least 15 seconds during a 20 minute period
51
If a Nonstress test is Reactive, what does that mean?
2 accelerations of more than 15 beats above baseline lasting for at least 15 seconds in a 20 minute period
52
If the Nonstress test is NONREACTIVE what is indicated?
Contraction Stress test
53
How do you perform the Contraction Stress Test?
Give oxytocin to establish at least 3 contractions in a 10 minute period
54
How do you perform the Contraction Stress Test?
Give oxytocin to establish at least 3 contractions in a 10 minute period
55
What is a (+) result of a Contraction Stress Test?
Late decelerations with majority of contractions
56
What is a (+) result of a Contraction Stress Test and what is then warranted?
Late decelerations with a majority of the contractions | --> Delivery is warranted
57
What does the Biophysical Profile (BPP) take into account?
Nonstress test Fetal attributes Amniotic fluid volume
58
A Biophysical Profile score of 8-10
Reassuring
59
A Biophysical Profile score of 6
Equivocal | -- consider delivery if at term
60
A Biophysical Profile score less than 4
NON-reassuring | -- Delivery warranted usually

ENRP (45 decks)

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