normal pregnancy: antepartum care Flashcards
what is preconception care
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
starting folic acid supplementaiton at leadt 1 month before concception reduces incidence of?
neural tube defects like spina bifida and anecephaly
if there is no history of neurl tube defects how much folic acid should be give 1 month before conception
0.4 mg
if someone has a history of a birth with a neural tube defect how much folic acid should we give them?
4.0mg of folic acid
adequate _ control in a pt before conception and throughout pregnancy can decrease maternal morbitiy, SABs, fetal malformations, fetal macrosomia and intrauterine fetal demiase
glucose
gravidity
number of times a women has been pregnant
parity
number of pregnancies that led to a birth at or beyond 20 weeks or an infant weighing more than 500 grams
parity can be broken down into ?
FPAL
full term (37-42)
perterm (20-36)
abortions (includes pregnancy loses before 20 weeks, ectopic, spontaeous, elective)
Living
the first prenatal visit should consist of?
thorough history
medical history, reproductive history, family history, nutritional status, social history (drinking, smoking), and psychosocial issues (depression/anxiety)
physical exam
Labs
what physcial exam findings are normally associated with pregnancy
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)
what labs should be done at the 1st prenantal visit
CBC, Type and screen (RH), rubella, syphyllis, hepatitis B, HIV, cervical cytology and STD (chlamydia and gonorrhea), screen for obesity, urine culutre
Rh negative patients recieve _ at 28 weeks and anytime sensitization may occur (threatned abortion, amniocentesis, abdominal trauma)
rhogam
if a pregnant patient isnt immune to rubella when should you give the vaccine?
postpartum
how would you screen diabetes based on risk factors in a pregnant patient
obesity, previous history of gestational diabetes, previous macrosomia (over 4,500 grams)
what is a lab that increases in pregnancy
fibrinogen (it is a hypercoaulable state), protein, amylase, leukocyte count, factor 7-10
typically everything else decreases or stays the same
how do platelets, hematocrit, and hemoglobin change in pregnancy
they decrease: physiological anemia
during a first prenantal visit you must also confirm _ and _ of the baby
pregnancy and viability
gestational age and due date is taken at the first prenantal visit what is gestational age?
the number of weeks that have elapsed between the first day of the last menstural period and the date of delivery
what are some additional things you should be doing at a virst prenatal visit?
provide genetic counseling
discuss teratology medications
advice onmanaging early pregnancy symptoms like nausea
how do you confirm pregnancy and viability
pregnancy test to detect hCG in the blood of urine
hCG can be first detected in the serum when?
6-8 days after ovulation
hcg less than _ is negative
5
hcg level above _ is considered posititve
25
a level of HCG about _ is reached by the time of expected menses
100