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ENRP II > normal pregnancy: antepartum care > Flashcards

normal pregnancy: antepartum care Flashcards

1
Q

what is preconception care

A

care to reduce the risk of adverse effects for the woman, fetus, neonate, and optimizing health

everyone considering pregnancy should get an appointment to go over risk assessment, health promotion, medical intervention, and stress reduction

however 50 % of pregnancies are unplanned

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2
Q

starting folic acid supplementaiton at leadt 1 month before concception reduces incidence of?

A

neural tube defects like spina bifida and anecephaly

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3
Q

if there is no history of neurl tube defects how much folic acid should be give 1 month before conception

A

0.4 mg

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4
Q

if someone has a history of a birth with a neural tube defect how much folic acid should we give them?

A

4.0mg of folic acid

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5
Q

adequate _ control in a pt before conception and throughout pregnancy can decrease maternal morbitiy, SABs, fetal malformations, fetal macrosomia and intrauterine fetal demiase

A

glucose

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6
Q

gravidity

A

number of times a women has been pregnant

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7
Q

parity

A

number of pregnancies that led to a birth at or beyond 20 weeks or an infant weighing more than 500 grams

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8
Q

parity can be broken down into ?

A

FPAL

full term (37-42)
perterm (20-36)
abortions (includes pregnancy loses before 20 weeks, ectopic, spontaeous, elective)
Living

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9
Q

the first prenatal visit should consist of?

A

thorough history

medical history, reproductive history, family history, nutritional status, social history (drinking, smoking), and psychosocial issues (depression/anxiety)

physical exam

Labs

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10
Q

what physcial exam findings are normally associated with pregnancy

A

systolic murmurs, exaggerated splitting and s3
palmar erythema
spider angiomas
linea nigra- belly button line
striae gravidarum- stretch marks
chadwicks sign (bluish hue to the cervix)

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11
Q

what labs should be done at the 1st prenantal visit

A

CBC, Type and screen (RH), rubella, syphyllis, hepatitis B, HIV, cervical cytology and STD (chlamydia and gonorrhea), screen for obesity, urine culutre

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12
Q

Rh negative patients recieve _ at 28 weeks and anytime sensitization may occur (threatned abortion, amniocentesis, abdominal trauma)

A

rhogam

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13
Q

if a pregnant patient isnt immune to rubella when should you give the vaccine?

A

postpartum

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14
Q

how would you screen diabetes based on risk factors in a pregnant patient

A

obesity, previous history of gestational diabetes, previous macrosomia (over 4,500 grams)

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15
Q

what is a lab that increases in pregnancy

A

fibrinogen (it is a hypercoaulable state), protein, amylase, leukocyte count, factor 7-10

typically everything else decreases or stays the same

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16
Q

how do platelets, hematocrit, and hemoglobin change in pregnancy

A

they decrease: physiological anemia

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17
Q

during a first prenantal visit you must also confirm _ and _ of the baby

A

pregnancy and viability

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18
Q

gestational age and due date is taken at the first prenantal visit what is gestational age?

A

the number of weeks that have elapsed between the first day of the last menstural period and the date of delivery

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19
Q

what are some additional things you should be doing at a virst prenatal visit?

A

provide genetic counseling
discuss teratology medications
advice onmanaging early pregnancy symptoms like nausea

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20
Q

how do you confirm pregnancy and viability

A

pregnancy test to detect hCG in the blood of urine

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21
Q

hCG can be first detected in the serum when?

A

6-8 days after ovulation

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22
Q

hcg less than _ is negative

A

5

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23
Q

hcg level above _ is considered posititve

A

25

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24
Q

a level of HCG about _ is reached by the time of expected menses

A

100

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25
Q

most urine tests can detect hCG at about _

A

25

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26
Q

in the first 30 days of a normal pregnancy HCG _ every _ days (this is used to evaluate for eary intrauterine pregnancy vs ectopic)

A

doubles

every 2.2 days

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27
Q

a transvaginal ultrasound can also be used to confirm pregnancy and viability:

the gestational sac is seen around _

the fetal pole is seen at _

cardiac activity is seen at _

give corresponding HCG levels

A

gestational sac at 5 weeks : hcg around 1500

fetal pole at 6 weeks: hcg at 5200

cardiac activity at 7 weeks: hcg at 17,500

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28
Q

how can you determine the due date based on naegels rule

A

the last menstrual period minus 3 months + 7 days = expected date of delivery

only helpul if patient has regular 28 day cycles

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29
Q

how can you use physcial examination to determine the gestational age

A

size of uterus : halway uterus is at the umbilicus (22 weeks)

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30
Q

how can you use ultrasound to determine the gestational age/ due date

A

crown rump length between 6-11 weeks and can determine due date within 7 days

femus length/biparietal diameter/abdominal circumference at 12-20 weeks and can determine due date within 10 days

third trimester due date can be off by 3 weeks

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31
Q

what is used for gestational age in first trimester

2nd trimester?

A

crown rump length-1st

snd- bipariteal diameter, femur lenght, abdominal circumference

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32
Q

who needs genetic counseling during pregnancy?

a lot of reasons

A
  1. advanced maternal age
  2. previous child/history of birth defects or genetic disorders
  3. previous child with undiagnosed mental retardation
  4. previous baby who dies in neonatal period
  5. multiple fetal losses
  6. abnormal serum marker screening
  7. consanguitity (sex with family)
  8. maternal conditions
  9. exposure to teratogens
  10. abnormal ultrasound findings
  11. partent who is a known carrier of a genetic disorder
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33
Q

chromosomal disorders occur in .5 live births what is the most common sex chromosomal abnormality, what is the most common trisomy?

A

turners syndrome: chromsome anueploidy

downs syndrome: trisomy

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34
Q

chromosomal disorders have a 50% rate for sponatneous aboritons: women that are _ years of older are at an increased risk for _ or _

A

35 years or older

trisomies (13,18,21) or sec chromsome abnormalities

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35
Q

the single most common reason for spontaneous miscarriages is

A

chromosomal abnormalities- turner syndrome

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36
Q

what class is the most responsible for sponatneous micsarriages

A

trisomy 16

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37
Q

as _ increases there is a higher risk for spontaneous miscarriages

A

age

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38
Q

what is down syndrome? what is it caused by?

A

extra copy of chromsome 21 (long arm) - most is from meiotic nondisjunction leading to 47 chromsomes

4% are unbalanced translocations

characterisitcs: flattned nose and face, single palmar crease, wide space between first toe

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39
Q

what are the chances that a couple who previously has a child with downs dynsrome will have another child with down syndrome

A

about 1% chance

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40
Q

about 1 in 500 people carry a balanced structural chromosomal rearrangement like a translocation or inversion, chromosomal studies (karyotype) should be done on couples after _ or more spontaneous abortions

A

3 or more spontaenous abortions

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41
Q

baalanced translocations couples should recieve _ regarding possibility of having a child with an _ translocation and therefore be offered a prenatal diagnosis ( diagnosis through chorionic villous sampling or amniocentesis)

A

counseling

unbalanced

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42
Q

autosomal dominant disorders is when there is _ abnormal gene to manifest disease and the affected indivudal has _ percent chance of passing on the disorder to their offspring.

is this influence by gender?

A

one abnormal gene

50%

no not influenced by gender

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43
Q

examples of autosomal dominante disorders

A

tuberous sclerosis, musclar dystrophy

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44
Q

in autosomal recessive disorders _ genes must be present for manifestations of diease, there is usually no _ _, and consanguineous couples are at increased risk for homozygous recessive gene.

examples:

A

2

family history

tay-sachs, sickle cell disorders, thalasemias, cystic fibrosis

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45
Q

genetic screening for autosomal receissive disorders have a carrier screening program that focuses on _ _ populations

this is because the frequency of heretozygotes is greater than that of the general population

A

high risk populations

*tay sachs- higher in eastern european jewish population

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46
Q

_ _ is the most common gene carried in north american whites

A

cystic fibrosis

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47
Q

genetic counseling for _ screening is important becuase 15 % of carriers are undetected

A

CF

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48
Q

who should be offerend CF screening

A

all pregnant women, people with a family history of CF, partners of known CF carriers, ultrasound findings of echogenic bowel, any patient requesting screening

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49
Q

sex linked disorders are caused by _ genes located on the X chromsome, they primarily affect _ , and unaffected females carry the _. There is not _ to _ transmission of X linked recessive disorders.

A

recessive

males

gene
male to male transmission

50
Q

what are some examples of recessive x linked disorders

A

duchenne muscular dystrophy and fragile X syndrome

51
Q

what is the most common form of inherited mental retardation

A

fragile X syndrome

52
Q

many sex linked disorders can be diagnosed prenatally via _ or _

A

chronionic villus sampling or amniocentesis

53
Q

features of fragile X syndrome

A

-male
-broad forehead
-elongated face
-large prominent ears
-strabismus
-MVP
-flat feet
-mental retardation

54
Q

many birth defects are inherited _

A

multifactorally

genetic + environment

55
Q

multifactorial birth defects examples

A

cleft lip, congenital heart defects, Neural tube defects

56
Q

mutlifactorial disorders have a _ percent recurrence rate

A

3%

57
Q

NTD examples

A

spina bifida, anencephaly

58
Q

what are the first semester screening tools for fetal aneuploidy

A

maternal age (not at an increased risk so younger than 35)

fetal nuchal translucency (NT) which measures the echo area at the back of the fetal neck)

maternal HCG- bhCG
pregnancy associated plasma protein A (PAPP-A)

59
Q

what are the second trimester screening for fetal aneuploidy

A

triple screen-b-hCG, maternal serum alpha fetoprotein (AFP) , estriol

quadruple screen- bhCG, estriol, AFP , inhibin A-

60
Q

what does maternal AFP test for?

A

neural tube defects

61
Q

what is cell -free fetal DNA

A

this is a way to check for fetal anueploidy, chromsomal abnormalities but NOT Neural tube defects (used by AFP in the second trimester)

tests cells free fetal DNA from apoptosis of trobphoblastic cells that are int the maternal circulation

replacing amniocentesis

62
Q

cell free fetal DNA is ordered in who?

A

high risk patients (like older age, prior history of trisomy, family chromosomal abnormalities, fetal ultrasound abnormaliites-nuchal translucency) abnormal serum testing in first trimester or triple/quad screen)

63
Q

if a cell free fetal DNA is positive you can proceed with what for diagnosis

this is just a screening tool

A

amniocentesis (2nd trimester)

chorionic villi sampling (11 weeks)

64
Q

amniocentesis can be done at _ weeks and has a _ % miscarriage rate

A

16-20 weeks

.03% miscarriage rate

65
Q

chorionic villi sampling can be preformed at _ weeks and has a _ % miscarriage rate

A

11 weeks

1%

66
Q

what is a teratogen, what can it cause?

what is the most important histoical teratogen and what does it specifically cause

A

a teratogen is any agent or factor that can cause abnormalities of form or function in a fetus (fetal loss, growth restriction, malformations, abnomral CNS)

thalidomide can cause phocomelia (flipper like limbs)

thalidomide was used for nausea

67
Q

40% of women take medication during the first timester when _ occurs

A

organogenesis

68
Q

what is the pregnancy lactaction labeling rule (PLLR)

A

changed from the letter categories , changed the content and format for information presented in prescription drug labeling to assist health care providers in figuring out the risk vs. benefit of medications in pregnant women and nursing mothers

69
Q

what are the subsections of the pregnancy and lactation labeling rule

A

pregnancy

lactation

females and males of reproductive potential

70
Q

what are the princples of teratology (4)

A

fetal susceptibility- efficacy of the teratogen is dependent on the genetic makeup of mother and fetus and maternal-fetal environment (multifactorial)

dose- drug can be dose dependent (low dose- no effect, intermediate dose- organ malformation, high dose-spontaneous abortion

timing- most vulnerable during 17-56 days which is organogensis , which organ systems are affected

nature of teratogenic agent- can cause malformations by itself or with another agent. (how potent the agent is)

71
Q

from the fourth month to the end of gestations teratogens can affect _ size (not malformation)

A

organ

72
Q

what is the most common teratogen

A

alcohol- causes fetal alcohol syndrome

dose dependent

73
Q

what are the outcomes of fetal alcohol syndrome

A

growth restriction
facial abnormalities (low set ears, thin upper lip, underdeveloped jaw, short nose)
CNS dysfunction (microcephaly, mental retardation)

74
Q

what two antineoplastic durgs are teratogens and inhibit folate.

exposure to these before 40 days is _ to the embryo

later exposure causes IUGR, craniofacial abnormalities, and mental retardation

A

aminopterin and methotrexate

lethal to the embryo

75
Q

_ is the drug of choice in pregnancy for anxiety and depression

A

fluoxetine

76
Q

what anticoagulant do we use in pregnancy? why?

A

heparin

it does not cross the placenta

77
Q

anticonvulsants in pregnancy can cause what in pregnancy

example: diphenyhydantoid (dilantin)

considered a teratogen

A

fetal hydantoin syndrome

78
Q

what is fetal hydantoin syndrome ?

A

craniofacial abnormalities, limb reduction defects, pre-natal growth restrictions, mental deficinecy, cardiovascular anomalies

caused by dilantin (diphenylhydantoin)

79
Q

anticonvulsants like _ and _ can cause open spina bifida

A

valproic acids and carbemazepine

80
Q

what is the most common major congenital anomaly (birth defect)

2nd?

A

cardiac abnormalities

neural tube defects/spina bifida

81
Q

what is the possible abnormality associated with using higly androgenic progestin (combination birth control) during pregnancy

A

masculinization of female external genitalia

82
Q

diethylstilbesterol used to be used to treat _ but it causes what?

A

threatned abortions

can cause cervical abnormalities, uterine malformations, female offspring at greater risk for vaginal cell cancers, male offspring more at risk for testicular abnormalities

t shaped uterus

83
Q

are retinoids a teratogen?

A

yes they can cause central nervous sytem malformations, cardiovascular issues, and craniofacial defects

the risk of spontaneous abortion or congential malformations is 50% in women who take retinoids in their first trimester

84
Q

is tobacco smoke a teratogen?

A

yes it interferes with fetal growt and increased risk for spontenaous abotion, fetla death, and prematurity

85
Q

opiate exposed fetus may experience ?

A

withdrawl symptoms

(fetal drug exposure to illicit drugs is often unrecognized because there are no overt symptoms of strutrual abnormalities following birth)

86
Q

what infectious agents are teratogenic

A

some viruses, bacteria, parasites which can cause congenital malformations

CMV

87
Q

how does a baby exposed to CMV present

A

proptosis of the eye, depressed nasal bridge, and triagnular mouth

88
Q

radiation can cause teratogenicity/malformations in the fetus but it is usually dose dependent. what is the rule of thumb for radiation and risk to the baby

A

less than 5 rads of exposure is equal to no risk for teratogenicity

89
Q

how to treat Nausea and vomiting in pregnancy

related the HCG levels which peak in the first trimester

A

east small but frequent meals
avoid greasy foods
room temperature soda
accupunture
medications- antihistamines, vitamin b6, antiemetics (zofran, phenegren)

90
Q

heart burn in pregnancy is due to?

A

relaxation of the esophageal spinchter by progesterone

lower eshopageal sphincter cant collapse

91
Q

how to treat heartburn in pregnancy

A

do not lie doen after eating
elevate head of bead
eat smaller but frequent neaks
antacids
cimetidine or famotidine

92
Q

constipation in pregnancy is due to ?

A

decreased colonic activity

93
Q

how to treat constipation in pregnancy

A

increase water, increase fiber, fruits, veggies
stool softener

94
Q

hemorroids in pregnancy are caused by ? how do you treat

A

increase in venous pressure in the rectum

rest, stool softeners, sitz baths, elevate lgs, avoid constipation

95
Q

leg cramps in pregnancy are most frequent in _ (body part) how do you treat

A

calves

massage/stretching

96
Q

_ is common expecially in late pregnancy so we try to acoid excess weight gain, give comfortable shoes, use pregnancy pillows, and use stretching to help

A

backaches

97
Q

frequency of prenantal offcie visits after first pregnancy visit (pap smear, dating, CBC, history physical etc. )

A

every 4 weeks until 28 weeks
ebery 2 weeks from 28 to 36 weeks
weekly after 36 weeks until delivery

98
Q

what occurs at routine office visits?

A
  1. blood pressure (checking for gestational HTN)
  2. weight
  3. urine protein (looking for pre-eclampsia)
  4. uterine size measurement
  5. fetal heart rate
  6. fetal kick count
  7. educate on preterm/term labors
  8. discuss lifestyle situations
99
Q

20 weeks the uterine size is at the _

A

umbilicus

20cm=20 weeks pregnant

100
Q

fetal heart rate is determied by ?

@ 12 weeks
@18-20 weeks

A

12 weeks: doppler
18 weeks: fetoscope

101
Q

average weight of a baby

A

7.6 oz

102
Q

the first sensation of movement is known as quickening and occurs on average _ weeks

feeling baby kick

A

20 weeks

103
Q

near term you want to evaluate what two things?

A

fetal lie (longitudinal, oblique, transverse)
fetal position (vertex, breech)

104
Q

20 weeks you should obtain a fetal _ _

A

survey ultrasound

easiest time to see all little structures

105
Q

at 28 weeks you screen everyone for _ and repeat _ and _ , give rhogram injection to Rh _ patients and give them the _ shot

A

gestational diabets

hematocrit and hemoglobin

negative

TDAP

106
Q

at 36 weeks you screen for?

A

group B strep carrier with vaginal and rectal culute

107
Q

tdap is given in pregnancy between what weeks

A

27-36

108
Q

how do we assess fetal well being

A

with kick count, nonstress test, contraction test, biophysical profile

109
Q

what is a positive kick count

A

10 movements in 2 hours

110
Q

what is a positive nonstress test?

A

reactive: 2 accelerations of at least 15 beats per baseline lasting at least 15 seconds during 20 minutes of monitoring

111
Q

if the nonstress test (NST) is nonreactive you must do further evaluation with either a _ test or a _ profile

A

contraction stress test

biophyscial profile

112
Q

what is a contraction stress test

A

giving oxytocin or nipple stimulation to establish 3 contractions in a 10 minute period

113
Q

in a contraction stress test if late decelerations are noted with the majority of contractions then the test is _ and delivery is warranted

A

positive

concering

114
Q

what are the components of a biophysical profile (5 things)

A

nonstress test

fetal breathing

fetal movement

fetal tone

amniotic fluid volume

30 minute test with ultrasound !!! ( nonstess is 20 mins, contraction stress is 10 mins)

115
Q

what is a reassuring score in a biophysical profile

-equivocal

  • no reassuring
A

8-10 is reassuring

6- equivocal (may deliver if at term)

4 or less- nonreassuring (consider delivery)

116
Q

what is fetal breathing movements on biophyscial profile looking for

A

one or more episodes of rhythmic breathing movements for 30 seconds

117
Q

what is fetal movement in a biophysical profile looking for

A

three or more body movments or limb movement in 30 mins

118
Q

what is fetal tone looking for in a biophysical profile

A

one or morefetal extremity extension with return to flexion or opening and closing of hand in 30 minutes

119
Q

what is amniotic fluid volume looking for in biophysical profile

A

a pocket of amniotic fluid that measures at least 2 cm in two planes perpendicular to each other

120
Q

what are the rates of still births with good antepartum testing

A

reactive stress test- 1.9/1000
negative contraction stress test- .3/1000
reassuring biophysical profile - .8/1000

ENRP II (25 decks)

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