normal pregnancy Flashcards
Gravid?
=pregnant, total number of pregnancy regardless of the outcome
Parity is
the number of birth 1-Full term birth. 2-Preterm Births.3-Abortions.4-Living Child
Gestational Age Ultrasound measures
*crown rump length CRL
*head circumference
identifying prenatal risk factors according to:
*Obstetrical history (classical/transverse)
*Medical and surgical history(HT,DM,MS..)
*Family history(thrombophilia…)
*Lifestyle(smoking,alcohol,…)
*Teratogenic exposure (radiation,chemotherapy ,drug …)
first trimester weeks
1-13
second trimester weeks
14-26
3rd trimester weeks
27-40
tests in first trimester
*Offer nuchal translucency scan ( NT). (11-14 weeks) (>3=abnormal)
*Complete Blood Count (CBC)
*Urine analysis and urine culture
*Rubella IgG Antibody
*Hepatitis B Virus (HBV)
*Blood group, Rh type , and Antibody Screening
*STD screening ( syphilis, chlamydia , gonorrhea ,,)
abortion
before 20 weeks
term
37-42 weeks
post term
after 42 weeks
CRL crown rump length normal value,when we do it
45-84 ml
* between 11-14 weeks
head circumference when to start doing it?
after 14 weeks
Fetal heart motion is expected in embryos ?
*with a crown to rump length of >5 mm
*or at 6–7 weeks’ gestation.
**If a repeat ultrasound in 1 week does not show embryonic cardiac activity, the diagnosis of embryonic demise is made.
pregnancy duration in most cases is determined to be
be 280 days or 40 weeks from the LMP.
EDD->Estimated due date
date+9months+7daysاول يوم في اخر دورة اجتك
nuchal translucency scan ( NT ,why? what is normal value?
for risk of trisomy , especially down syndrome
NT=11-14 weeks
NT >3mm is abnormal
chorionic villus sample weeks and Complications and application
*10-13 weeks
*abortion, failure to diagnose
* 2 ways of application : transabdominal cvc and transvaginal cvc
SECOND TRIMESTER LABORATORY TESTS :
**Quadruple Marker Screen 15–20 weeks, for trisomies :
AFP
hCG
estriol
inhibin-A
**analyse for chromosomes and genes(amniocenteses)
quadruple screening values in trisomy 18
MSAFP-low
BETA HCG-low
ESTRIOL-low
INHIBIN A- normal
**everything is low except inhibin
quadruple screening values in trisomy 21
MSAFP-low
BETA HCG-high
ESTRIOL-low
INHIBIN A-high
letter H =high
quadruple screening values in NTD or abdominal wall defect
MSAFP-high
BETA HCG-normal
ESTRIOL-normal
INHIBIN A-normal
**تشوه في الجنين=fetus=fetoprotein=high **
detection of HCG in serum/blood ?when?
8-11 days after fertilization
or
22 days after LMP (at least)
**it is the earliest way to detect pregnancy
what is the gold standard diagnosis of pregnancy ?
transvaginal ultrasound
heparin or warfarin in pregnancy ?
*we give LMWH
*warfarin is teratogenic
what is next step if NT scan is abnormal ?
*first next step : fetal karyotyping (by amniocenteses or CVS)
if high NTS high ,but amniocenteses and CVS NORMAL , and we suspect down syndrom , next step?
*echocardiography to the fetus heart
vaccines universally given in pregnancy
influenza vaccine(in winter )
TDAP(tetanus, difteria ,pertussis)
vaccines not given in pregnancy
measles,mumps,rubella,varicella,polio
vaccines to high risk patient
hepatitis A
hepatitis B
meningococcal
killed polio
combined test/biochemical test
*only in first trimester
(NT scan+hcg+papp-a)
CVS VS amniocentesis
CVS:in first trimester
amnio: in second
CVS: high risk for failure and abortion
amnio:less risk to abortion and more diagnostic
cvs: to ways of application
amnio:only one way
