Normal pregnancy/ Prenatal Care Flashcards
At how many weeks and level of bhCG will you see a gestational sac?
5 weeks
bhCG: 1500-2000
At how many weeks and level of bhCG will you see the fetal heart?
6 weeks
bhCG: 5000-6000
“Abortion” is used to describe pregnancy losses at < ____ weeks
<20 weeks
“Embryo” vs “Fetus” timeline
0- 8 weeks = embryo
8 weeks - birth = fetus
1st, 2nd, and 3rd trimester dates
0 to 12-14 weeks = 1st trimester
12-14 to 24-28 weeks = 2nd trimester
> 24-28 weeks = 3rd trimester
Viability is at >___ weeks
Term is ___ weeks
Postterm is ___ weeks
24 weeks
Term at 37 to 42 weeks
Post term at >42 weeks
Dating with US; take LMP if within __ weeks of 1st, 2nd, and 3rd trimesters
1 week
2 weeks
3 weeks
*the earlier the US, the more accurate
Record fundal heights after ____ weeks, doppler for fetal heart beat after ____
20 weeks
10-14 weeks
CV phsyiology changes in pregnancy
- CO increases 30-50%, mostly in 1st T (SV, then HR)
2. SVR decreases 2/2 progesterone
Pulm physiology changes in pregnancy
- Tidal volume increases
- TLC decreases
- Respiratory rate same
- Minute ventilation increases
- PaO2 increases, PaCO2 decreases
GI physiology changes in pregnancy
- N/V in first trimester (should resolve by 14-16 wks ow hyperemesis gravidarum)
- Prolonged gastric emptying/ GES tone lowered 2/2 Proges> GERD
- Decreased mobility of large bowel, increased H20 absorption, constipation
Renal physiology changes in pregnancy
- Kidneys bigger, ureters dilate > pyrelonephritis
2. GFR increases 50%, BUN and creatinine decrease
Heme physiology changes in pregnancy
Plasma volume increases 50% RBC mass increases 20-30% Dilutional anemia WBC to 10.5, platelets drop by still >100 Hypercoaguable state (PTT/INR same) Decreased oncotic pressure
Risk of tocolysis with terbutaline
Pulmonary edema (due to decreased oncotic pressure)
Endocrine physiology changes in pregnancy
Lots of estrogen from adrenal precursors converted in placenta
hCG maintains corpus luteum in early pregnancy
human placental lactogen (HPL) ensures nutrient supply, diabetogenic
Prolactin increases
Thyroxine-binding globulin (TBG) increased by estrogen, total T3/T4 increase, fT4 same
Glucosuria common!
Folate recommendations
4 mg/ day: hx NTD, on carbamazepine, valproate, pregestational DM
400 mcg/ day: all other women
Weight gain recommendations
Underweight: 25-40 lbs
Normal: 25-35 lbs
Overweight: 15-20 lbs
Obese: 11- 20 lbs
+ 300 cals/ day in pregnancy
+ 500 cals/day in breast feeding
Antenatal Screening Recs:
First Trimester screen: NT, PAPP-A, bhCG @ 11-13 weeks
CVS: if concerns 9-12 wks
Quad screen: MSAFP, bhCG, estriol, inhibin A @ 15-20 wk
Amnio: if concerns >15 weeks
Anatomy Screen: US @ 18-20
Glucose Tol Test: 26 weeks
Glucose Tolerance Testing
GLT: 50 g challenge, check 1 hr, >135-140 go to OGTT
OGTT: 100 g challenge, check fasting, 1, 2, 3 hr. Should be less than 95/180/155/140
6 week PP: 75g challenge, measure 2 hours >140`
Biophysical profile (BPP)
Done for: High-risk pregnancy,
fetal growth problems, Rh sensitization, or high blood pressure, decreased movement of the fetus, postterm pregnancy
Started: ~32-34 weeks, repeated as needed
Includes:
1. Fetal heart rate
2. Fetal breathing movements
3. Fetal activity
4. Fetal muscle tone
5. Amount of amniotic fluid
Each of the five areas is given a score of 0 or 2 points, for a possible total of 10 points.
What is a Doppler ultrasound exam of the umbilical artery?
Doppler ultrasound is used to check the blood flow in the umbilical artery, a blood vessel located in the umbilical cord. Doppler ultrasound is used with other tests when the fetus shows signs of not growing well.
Non- stress test
Measures the fetal HR in response to fetal movement over time.
A belt with a sensor that measures the fetal HR is placed around pt abdomen. The fetal heart rate is recorded by a machine for 20 mins.
If two or more accelerations that are 15 bpm above baseline x 15 seconds occur within a 20-minute period, the result is considered reactive or “reassuring.”
US if worrisome
Contraction stress test
Get 3 contractions in 10m, analyze FHR
If the fetal heart rate does not decrease after a contraction, the result is normal (negative). A decrease in heart rate after most contractions is a positive result. Early decels are less worrisome than late decels
Fetal lung maturity
L/S ratio >2 = RDS is rare
Can also use phosphatidylglycerol, saturated phosphatydal choline, surfactant/albumin ratio, lamellar body CT
Treatments for common pregnancy problems: Lower back pain
Stretching, gentle exercise, Tylenol, massage, heating pads
Treatments for common pregnancy problems: constipation
water, colace, avoid laxatives in 3rd trimester (increase pre term labor?)
Treatments for common pregnancy problems: Contractions
If Braxton-Hicks, drink lots of water (vasopressin > oxytoxin receptors)
If q 10 m of less, think PTL and check cervix
Treatments for common pregnancy problems: Edema
Due to compressed IVC
Elevate legs, sleep on side, worry for PEC if hands/face
Treatments for common pregnancy problems: GERD
Many small meals, start antacids, dont lay down right after eating; H2 blockers/PPI if persists
Treatments for common pregnancy problems: Hemorrhoids
Due to IVC compression
Topical anesthetics, steroids, prevent constipation
Treatments for common pregnancy problems: Pica
Stop, good nutrition instead
If poisonous, call poison control or toxicology consult
Treatments for common pregnancy problems: Round ligament pain
late in 2nd tri/early in 3rd
Adnexa/lower abdomen/shoots to labia
Warm compresses or acetaminophen
Treatments for common pregnancy problems: Urinary frequency
Check urine, keep up PO hydration
Treatments for common pregnancy problems: Varicose veins
LE or vulva
Elevate, use compression stockings
