Normal Pregnancy And Prenatal Care Flashcards
Starting Folic Acid supplementation at least 1 month before conception reduces the risk of what congenital pathology?
Neural Tube Defects
What dose of Folic Acid would you want to give to a woman without a history of infants being born with Neural Tube Defects?
What about for a woman who DOES have a history of previous births with NTD’s?
O.4mg for a woman without previous NTD
4mg for a woman with a history of pregnancies with NTD’s
Managing Blood glucose control in pregnant patients with diabetes decreases the risk for what issues?
SAB’s Maternal Morbidity Fetal Malformations Fetal Macrosomia IUFD
What term refers to the number of pregnancies that led to a birth at or beyond 20 weeks, or an infant weighing more than 500 grams?
Parida (Parity)
In what order are the subsections of Parity listed in discussing a woman’s pregnancy history?
Full term, Pre-term (20wk-36wk+6days), Abortions (less than 20wk or 500g), Living
What are some of the normal findings of the PE associated with pregnancy?
Systolic Murmurs (exaggerated splitting and S3)
Palmar Erythema
Spider Angiomas
Linea Nigra
Chadwick’s Sign (bluish coloration of female’s genitals)
Melasma/Chloasma (“mask” of pregnancy rash)
What prenatal labs do you want to get at a Pregnant woman’s first visit?
CBC Blood Type and Screen Rubella (Vaccinate postpartum if not immune) Syphilis Hep B HIV Cervical Cytology (Chlamydia, Gonorrhea) Screen for Diabetes based on risk factors (obesity, previous history of gestational DM and/or macrosomia) Urinalysis
What serum values are we most likely to see an increase in, in the mother, during pregnancies?
Clotting Factors Leukocytes Amylase Fibrinogen (Uric Acid near term)
How is Gestational Age estimated?
Gestational Age is estimated as the number of weeks that have elapsed between the first day of the LMP and the date of delivery
Besides lab values, what other diagnostics would you absolutely want to do the first time you see a pregnant woman in the office?
Confirm pregnancy and viability Estimate gestational age and due date Discuss Teratology (meds) Provide genetic counseling if necessary Advice on how to reduce early pregnancy symptoms
What lab value do pregnancy tests evaluate?
Values below what are considered negative?
Values above what are considered positive?
How many days after ovulation may hCG first be detected in the serum?
HCG
<5 is considered negative
>25 is considered positive
HCG may be first detected i the serum 6-8 days following ovulation
What level of hCG is often present approximately at the time of a woman’s next expected menses?
A hCG value of 100 is often reached by the time of a woman’s next expected menses
Most urine pregnancy tests can detect hCG starting at what level?
Most urine pregnancy tests can detect hCG starting at about a level of 25
What is the Discriminatory Zone of hCG levels?
What finding may be seen on a Transvaginal U/S when a woman is within the Discriminatory Zone of pregnancy?
The Discriminatory Zone is seen usually around 5 weeks of gestational age, at hCG levels between 1500-200
The Discriminatory Zone often presents with a Gestational Sac present on Transvaginal U/S
When may the Fetal Pole be seen on Transvaginal U/S?
The Fetal Pole may be seen on TVUS at about 6 weeks of gestational age (mean hCG of around 5200)
When may cardiac activity be seen on Transvaginal U/S?
Cardiac Activity may be seen on TVUS at around 7 weeks (mean hCG at around 17,500)
What is Naegel’s Rule for Estimating Gestational Age and due date?
What limits the application of Naegel’s Rule to all women?
Naegel’s rule is used to estimate the expected due date of a pregnancy. It is calculate as the date of a woman’s LMP - 3 months + 7 days
Naegel’s rule has limited application as it only is useful in women with regular menstrual cycles
How can you use U/S to estimate a pregnancy’s due date during the first trimester?
If an U/S is performed within the first 6-11 weeks, Crown Rump Length (CRL, head as the distance from the fetal head to bottom) may be used to estimate the due date +/- 1 week. CRL is relatively accurate.
How may you use U/S during the Second trimester of a Pregnancy to estimate due date?
During the second trimester of pregnancy (12-20 weeks), measuring Femur Length, Biparietal Diameter, and Abdominal Circumference can determine a pregnancies due date within 10 days
How accurate is U/S during the third trimester for determining the due date of a pregnancy?
U/S during the third trimester of pregnancy may be inaccurate when determining the due date by +/- 3 weeks
Fetal Demise may be diagnosed if there is absence of Cardiac Activity and a Crown Rump Length (CRL) value greater than what?
Fetal Demise may be diagnosed if there is an absence of Cardiac Activity and a CRL >5mm
What are some indications for maternal genetic counseling?
Maternal Age >35
Multiple fetal losses previously
Family History or Pregnancy history of birth defects/mental retardation
Abnormal serum markers on screening or abnormal U/S
Consanguinity
Exposure to teratogens
maternal Conditions
Chromosomal Disorders occur in what percent of all live births?
Chromosomal Disorders occur in 0.5% of all live births
What Chromosomal Disorder is the most common in congenital disorders of pregnancies?
Turner’s Syndrome (45 X0 Aneuploidy) is the most common Chromosomal Disorder
What class of chromosomal Disorders is the most commonly occuring?
Trisomies (Aneuploidy with an extra chromosome copy) are the most commonly occuring class of Chromosomal disorders
What specific Trisomy is the most commonly occurring trisomy in human pregnancies?
Trisomy 16 is the most commonly occuring trisomy in human pregnancies
