Normal Prenatal Care Flashcards
when do most of severe birth defects happen?
within the first 8wks
what things are emphasized in pre-conception health?
folate supplementation - prevent neural tube defects
optimization of medical conditions
transition from teratogenic meds to pregnancy-safe
improved lifestyle - smoking/alcohol cessation crutial
risk addressed in prenatal care of: safety and risk
genetic disease
carrier states
domestic violence
maternal complications
risk addressed in prenatal care of: folic acid
neural tube defects
risk addressed in prenatal care of: vaccinations
influenza
Hep B
MMR (live attenuated)
risk addressed in prenatal care of: lifestyle
smoking cessation alcohol cessation exercise sleep stress management
risk addressed in prenatal care of: optimize pre-existing disease
diabetes
hypertension
thyroid
when is the first visit for pregnancy?
10wks
what tests done at first visit
urine screen U/S confirms ß-HCG rarely needed establish baseline for vitals and weight bimanual exam
what is ultrasound used for
confirm IUP, assess gestational age, assess for aneuploidy
(G) TPAL
(G) = # pregnancies T = term; # births after 37wks P = preterm; # births before 37wks A = abortion; # pregnancies resulting in any outcome for any reason that did not count as a live birth (<20wks) L = living; # humans birthed alive
GPA nomenclature
Gravid = # pregnancies Para = # pregnancies brought to viable gestational age Abortus = # pregnancies that ended before viable gestational age for any reason
when is viability
<20wks
what labs at first visit?
immunity - rubella, varicella, Hep B maternal anemia alloimmunization - ABO type; Rh Ag infection (UTI/STI) baseline hemoglobin - Identify correctable anemia HIV - confirm and viral load if positive RPR - syphilis screen Hep B - antigen status; antibody status urine proteinuria baseline
how to handle asymptomatic bacteriuria
actively screen and treat
MMRV vaccine
live attenuated, so not given during pregnancy
know titers, specifically rubella and varicella
gonorrhea, chlamydia, and syphilis
assessed and treated if positive
HIV
confirmatory viral load/CD4 count
HAART as soon as possible - AZT is right in pregnancy
(ziduvidine)
Hep B status
can lead to vertical transmission
cytology at first visit
Pap if indicated by age and history
urine at first visit
urinalysis, culture - screen for and treat asymptomatic bacteriuria
protein - confounds eclampsia picture
GC/Chla - treat both if find one
genetic testing at first visit
Cystic Fibrosis (caucasians) and Sickle Cell (African Americans)
first trimester screens
nuchal translucency
serum HCG
PAPP-A levels
follow up appointments
q4 wks until 28wks
q2 wks until 36wks
q1 wk until birth
