OB/Prenatal Care Basics Flashcards
1
Q
Important tests/tx for 0-12 wks preatal visit
A
- one visit every 4 weeks
- First prenatal visit:
- prenatal profile labs (blood type/antibodies, CBC, rubella status, HIV, hepatitis B, syphilis screen)
- Pap (if indicated)
- GC/CT, urine culture
- Rx for prenatal vitamins
- early glucola if risk factors
- Every visit – gestational age, weight, blood pressure, update labs
- Flu shot as early in pregnancy as possible during flu season
- If unsure dating, may need dating ultrasound
2
Q
Important tests/tx for 13-24 wks prenatal visit
A
- one visit every four weeks (more frequently if high risk or diabetic)
- Genetic Screening: MSAFP/Quad Screen @ 15-22 weeks;
- if covered by insurance, may qualify for sequential screen – blood draw and U/S @ 10 – 14 weeks
- second blood draw @ 15 – 22 weeks
- Materni21 or cell free DNA testing if history indicated
- Anatomy ultrasound @ 18-22 weeks
- Fetal movement @ 18-20 weeks
- Every visit – gestational age, weight, blood pressure, urine dip (DG), update labs, refill PNV if needed
3
Q
Important tests/tx for 25-40 wks prenatal visit
A
- one visit every 4 weeks until 32 weeks, q2wk visits 32-36 weeks, weekly visits 36-40 weeks (may be more frequent if high risk &/or diabetic)
- Glucola, CBC @ 24-28 weeks
- Tdap > 27 weeks, indicated in every pregnancy
- RhoGam @ 28 weeks for Rh negative patients
- CBC @ 28 weeks: repeat HCT or reticulocyte count at 34 weeks to eval response to therapy if on iron
- Start once to twice weekly NSTs/weekly AFI if indication (DM, HTN, IUGR, etc.) Breastfeeding info @ 36 weeks if indicated
- GBS culture @ 35-37 weeks; if PCN allergy add sensitivity
- Fetal kick counts BID @ 37 weeks
4
Q
Important tests/tx for 40+ weeks prenatal visit
A
- one visit q week, or more frequently if desired by MD/NP/CNM
- NST’s 2x weekly start 40 5/7, with 1x AFI
- Fetal kick counts BID
- Each visit – gestational age, weight, blood pressure, urine dip, update labs.
- Refill PNV if needed
- Schedule IOL between 40 3/7 - 41 0/7
- Schedule IOL @ 37 weeks for GHTN, 38weeks for CHTN, and 39 weeks for wellcontrolled A2GDM. 36 to 37 weeks for previa. 37 weeks for h/o myomectomy
5
Q
Calculate Estimated Date of Delivery
A
pregnancy = 280 days, 9 months or 10 lunar months from LMP
Nagele’s rule: 1st day of LMP + 7 days + 1 year - 3 months
-if cycle not 28 days adjust +7 days
6
Q
First Prenatal Visit: History
A
- Calculate gestational age
- History of present pregnancy
- History of all previous pregnancies:
- -GTPAL, year, sex, weight, gestation age, mode of delivery, length of labour, complications with pregnancy or delivery
- Gynecological and Past Medical History
- Medications/OTC/Herbal
- Family History: ethnicity, genetic disease, birth defects, multiple gestation
- Social History: current situation, smoking, ETOH, drugs, violence/abuse
7
Q
Symphysis Fundal Height
A
12 weeks: at pubic symphysis
20 weeks: umbilicus
27 weeks: sternum
SFH should be within 2cm of GA between 20 and 37 weeks
8
Q
Term =
A
>= 37w 0d
9
Q
“TPAL” system (GsPs)
A
- Gravidity = # pregnancies
- P = parity = pregnancy outcomes
- T = term >= 37w
- P = pre-term = 20w - 36w6d
- A = spontaneous or induced loss <20w
- L = living children
10
Q
EDD determination
A
- 1st day of LMP +/- US confirmation
- US most accurate < 12w
11
Q
- Viability
- Early vs. Full vs. Late Term
- Post Term
A
- Viability: ∼24 w0d. Previable: <∼24 w0d
- Early term: 37 w0d–38 w6d. Full term: 39 w0d–40 w6d. Late term: 41 w0d–41 w6d
- Post term: ≥42 w0d, ↑ stillbirth risk
12
Q
• IUGR =
A
<10%ile for gestational age
13
Q
GBS prevention
A
- Pregnant women should routinely be screened by rectovaginal swab at 35–37 w. Culture results are valid for up to 5 w, then should be repeated at >5 w.
- Intrapartum Abx indicated for:
- Positive rectovaginal culture during this Preg
- GBS bacteriuria at any time during this Preg
- H/o perinatal GBS dz in a prior Preg
- Culture data unavailable & <37 OR term w/rupture 18 h or temperature >100.4°F
- Intrapartum ppx NOT indicated at the time of cesarean deliv at any GA for women delivered prior to labor w/ intact membranes
14
Q
GBS Abx Rx
A
- Recommended PCN G 5 million U IV loading dose → 2.5 million U IV q4h until deliv
- Alternative Ampicillin 2 g IV loading dose → 1 g IV q4h until delivery
- If PCN allergic ==> alternative protocol
15
Q
Labor =
A
Regular uterine contractions & cervical change
16
Q
Labor stages overview
A
- 1st stage: onset of labor => full cervical dilation
- 2nd stage: full cervical dilation => delivery of infant
- 3rd stage: delivery of infant => delivery of placenta
- 4th stage: 1-2h following placental delivery
17
Q
1st stage of labor
A
- Latent phase: Early labor until acceleration of rate of cervical change
- Active phase: Period of accelerated cervical change until full dilation
- Historically, minimum rate of cervical change: Nulliparas ∼1.2 cm/h, multiparas, ∼1.5 cm/h (N Y Acad Med 1972;48:842)
- Labor curve: Friedman (1955) described ideal labor progress at term; Zhang (2002) showed women enter active phase at 3–5 cm, w/ variable labor course & no deceleration phase
18
Q
2nd stage of labor
A
- = Full cervical dilation → deliv of the infant
- Consider 2nd stage arrest in:
- nulliparas after 2 h (no epidural) or 3 h (w/ epidural)
- multiparas after 1 h (no epidural) or 2 h (w/ epidural
19
Q
Prenatal labs @ 0-12 weeks
A
- CBC
- Blood type/antibodies
- Rubella
- HIV
- HBV
- Syphillis
- GC/CT
- Urine cx
- Early glucola if indicated
20
Q
Prenatal screening 12-24 weeks
A
- Genetic screening: MSAFP/Quad screen @15w - 21w6d
- anatomy US @ 18-22w
- Fetal movement @ 18-20w
21
Q
Prenatal screening 25-40 weeks
A
- glucola, CBC @ 24-28 weeks
- Tdap > 27 weeks
- Rhogam @ 28 weeks for Rhneg
- GBS culture @ 35-27 weeks (add sensitivity if PCN allergy)
- IF DM/HTN/IUGR/other risk factor => NST 1-2x/week and/or weekly AFI
22
Q
Visit frequency in third trimester
A
- 3rd trimester = 25-40w
- one visit every 4 weeks until 32 weeks, q2wk visits 32-36 weeks, weekly visits 36-40 weeks (may be more frequent if high risk &/or diabetic)
23
Q
Timeline for induction of labor
A
- Schedule IOL between 40 3/7 - 41 0/7
- Schedule IOL @ 37 weeks for GHTN, 38weeks for CHTN, and 39 weeks for well-controlled A2GDM
- 36 to 37 weeks for previa.
- 37 weeks for h/o myomectomy
24
Q
Routine OB/Pre-natal visit questions
A
- A-amniotic fluid leakage?
- B-bleeding or spotting?
- C-contractions?
- D-dysuria or UTI symptoms?
- E-eclampsia symptoms (headache, vision changes, RUQ pain)?
- F-fetal movement?
