Normal Pregnancy, Prenatal care, Labs - Moulton Flashcards
Never had a baby with neural tube defect…recommended folic acid dose?
If you HAVE had a child with a neural tube defect…recommended folic acid dose?
- 4 mg
4. 0 mg
Normal potential PE findings associated w/ pregnancy
- Systolic murmurs (splitting, S3)
- Palmar erythema
- Spider angiomas
- Linea nigra
- Striae gravidarum
- Chadwicks sign (blueish hue of vagina/cervix
- Abdominal striae
If nothing happens where RH sensitization would occur, when is RhoGAM normally given?
Things that could result in sensitization?
28 weeks
Threatened abortion, amniocentesis, abdominal trauma
Which has a higher risk of coagulation…pregnancy or OCP?
Labs that show this?
Pregnancy
High fibrinogen and clotting factors
A patient has regular 28 day cycles and is pregnant. How to calculate expected delivery date?
LMP - 3 months + 7 days
Ultrasound measuring of baby is MOST accurate in terms of estimating due date when?
6-11 weeks (off by only 7 days)
Pregnant woman ultrasound shows crown-rump length (CRL) > 5mm w/ no fetal cardiac activity. Dx?
Missed abortion (100%)
Flattened nose and face, upward slanting eyes, palmar crease, spaced 1st-2nd toes
Most common molecular cause?
Down syndrome (trisomy 21)
Meiosis error
***When should a couple do chromosomal karyotyping?
3 or more spontaneous abortions
Cystic fibrosis has what inheritance pattern?
Autosomal recessive
Most common X-linked diseases
Duchenne muscular dystrophy
Fragile X syndrome
Elongated face, prominent ears, flat feet, seizure activity, broad forehead
Fragile X syndrome
3 tests for fetal aneuploidy (abnormal # of chromosomes) in FIRST trimester
- ***Pregnancy-associated plasma protein A (PAPP-A)
- Nuchal translucency (ultrasound)
- b-hCG
2nd trimester – tests for fetal aneuploidy
Quadruple screen
- b-hCG
- Estriol
- AFP
- ***INHIBIN A
MOST accurate test for fetal aneuploidy today
What is NOT tested for?
***ONLY in who?
MaterniT 21 plus
Neural tube defects (keep checking AFP)
HIGH RISK PATIENTS
Test for neural tube defects
AFP
If positive MaterniT 21 Plus, what next?
Verify w/ amniocentesis or chorionic villi sampling
Flipper-like limbs (phecomelia)
Thalidomide in utero
***Most CRUCIAL period of development for teratogens to cause major issues
Only things that can be majorly affected after this
Day 17 - 56
Brain and gonads
Teratogenic drugs
- Alcohol
- Anti-anxiety
- Anti-neoplastic (ex. MTX)
- Anti-coagulants (Coumadin)
- Anti-convulsants
Smooth philtrum, thin upper lip, underdeveloped jaw, short nose, epicanthal folds, low nasal bridge, small head
Fetal alcohol syndrome
Proptosis, depressed nasal bridge, triangular mouth
CMV teratogenesis
How much radiation is considered a risk for issues in pregnancy?
More than 5 rads (total)
Pregnant woman has N/V. How to “treat”? (5)
- Small frequent meals
- No greasy/fried foods
- Room temp sodas and saltines
- Accupuncture
- Meds (antiemetics, other)
Pregnant woman has heartburn. Why?
How to “treat”? (5)
Relaxed esophageal sphincter by progesterone
- Don’t lie down after meals
- Elevate head of bed
- Small frequent meals
- Antacids
- H2 blockers
Pregnant woman w/ constipation. Treatment? (2)
- More water, fiber, fruits, veggies
- Stool softener
Pregnant woman w/ hemorrhoids. Treatment?
Rest, stool softeners, elevate legs, avoid constipation
Pregnant woman w/ leg cramps. Treatment?
Massage, stretching
Pregnant woman w/ backache. Treatment?
Avoid excess weight gain, exercise/stretching, comfy shoes, good pillow use, heat/massage
Frequency of prenatal office visits
q4wks until 28
q2wks until 36
qWk until delivery
Things done at routine pregnancy office visit?
BP, weight, urinalysis, uterine measurement, fetal HR, fetal movement, education, lifestyle situations
At 20 weeks, do what? (1)
Fetal survey ultrasound (anatomy, etc.)
At 28 weeks, do what? (3)
Screen for GDM, check H&H, RhoGAM if Rh-
At 35 weeks, do what? (1)
Screen for group B strep via vaginal culture
****Kick counting (normal)
10 movements in 2 hours
If abnormal kick/movement count, then what?
****What is a REACTIVE (good) nonstress test?
Nonstress test
2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes of monitoring
**If NONREACTIVE nonstress test, then what? What is it?
**BAD (positive) test result?
If positive, do what?
Contractions stress test (CST) - give oxytocin to get 3+ contractions in 10 min period
LATE decelerations are noted w/ most of them
DELIVER
**Components of biophysical profile (5)
- NST
- Fetal breathing mvmts
- Fetal movement
- Fetal tone
- Amniotic fluid volume
- ***Good values for…
- Fetal breathing mvmts
- Fetal movement
- Fetal tone
- Amniotic fluid volume
- 30 sec of rhythmic breathing in 30 minutes
- 3+ discrete movements in 30 minutes
- 1+ extremity extension and flexion or hand open/close in 30 minutes
- A pocket that is 2+ cm in 2 planes perpendicular to each other
***How to score biophysical profile?
***Meanings of scores?
2 pts for every positive sign
8-10 = GOOD 6 = Deliver IF at term 0-4 = Deliver
