Pre-partum OB Flashcards
Explain GPtpal
Gravida: how many times you were pregnant
Para: how many times you have given birth
term: # of full term babies, 37-42 weeks
preterm: # of deliveries 20-36 weeks
abortion: spontaneous or induced prior to 20 wks
live: # of living kids (if twins, 2)
A fetus is considered viable at
> 23 weeks or >500 g
What are the stages of a baby from conception
Embryo: fertilization-8 wks Fetus: 9 wks-birth Preterm: born prior to 37 wks Neonate: birth-28 days Infant: 28d- 1 y/o Post-term: live born after 42 wks (increased perinatal mortality)
What is Nagele’s rule
a way to determine the due date! Date of LMP + 7 days - 3 months ex: LMP was on 2/20/2018 20+7=27 Due date= Nove,ber 27, 2013
Standard pregnancy is
280 days (40 weeks)
Explain gestational age vs fetal age
Gestational: age of fetus is calculated from 1st day of LMP and includes 2 weeks that woman is not pregnant
Fetal: age of fetus is calculated from implantation (2 weeks less than G age)
What are the trimesters in pregnancy
First: 1-12 weeks
Second: 13-28 weeks
Third: 29-40 weeks
How does mom’s physiology change with pregnancy (by system)
- Skin: melasma, linea nigra, striae
- Resp: increased VT and O2, decreased ERV and CO2
- Cardio: increased CO and SV, decreased systemic vascular resistance
- GI: slow motility, delayed gallbladder emptying
- GU: increased GFR
- Heme: increased plasma volume and WBC
How much folic acid do moms need
Low risk: 0.4mg (400 mcg)
High risk: 4mg (4000 mcg)
How does a home pregnancy test work
measures HCG (picks up level of 25) most are + by the time of missed menses
Where is HCG made
By the placenta!
It rises exponentially for the first 10 weeks, then plateaus (doubles every 48 hours)
-HCG and progesterone are what cause morning sickness usually
Where is progesterone made
By the corpus luteum until 6 weeks post-fertilization
Then placenta takes over
Sypmtoms of pregnancy include
amenorrhea n/v breast tenderness fatigue urinary frequency/nocturia increased incidence of UTI Linea nigra (umbilicus-pubis) Melasma (at 16+ weeks) Leukorrhea (white discharge) Striae
PE findings in pregnancy include
Systolic ejection murmur
Goodell’s sign (cervical softening at 4-6 wks)
Hegar’s sign (uterine isthmus softening at 6-8 wks gestation)
Chadwick’s sign (cervix looks blue from 8-12 wks gestation)
At your initial OB visit, these labs should be done
CBC blood type and Rh Ab screen Rubella immunity Syphilis testing Hep B antigen testing HIV UA C&S Chlamydia/gonorrhea Pap (if they fall into guidelines)
At the first OB appointment, docs should get this confirmation test
US!
can detect a fetal heart (but not get a full heart tone) at 5-6 weeks gestation
What genetic screening is available in the first trimester (11-13 wks)
US for nuchal translucency (if thick, trisomy 21) and fetal nasal bone
Maternal blood (very high hCG, trisomy 21) (low plasma protein A, trisomy 21)
-Chorionic villus sampling at 10-12 weeks, extract cells from placenta
What genetic screening is available in second trimester (16-18 wks)
Quad screen: maternal blood + AFP, HCG, Estriol, and inhibin A
AFP (increase if w/ neural tube defects or twins)
-Amniocentesis: 15-20 weeks, extract amniotic fluid
How often do pregnant women go to visits
First: 6-8 weeks after LMP
Monthly until 28 weeks (7 months)
2x month from 28-36 weeks
weekly from 36 weeks-delivery
How much weight should mamas gain
1st trimester: 1.5-3 lbs
2nd trimester: 0.8lb x week
Total pregnancy weight gain: 25-35 lbs
Prenatal monitoring tests
Fetal heart tone (handheld doppler): start at 10-12 wks (120-160 is NL)
Fundal height: start at 20 wks
Cervical exams: start at 37 wks
What is “quickening”
first perception of fetal movement by mama
Primigravida: 18-20 wks
Multigravida: 16-20 wks
What is the count to 10 method
Should have 10 fetal movements over 2 hours OR 4 over 1hr while mom rests
(activity is higher at night)
What are normal fundal height measurements
12 weeks: pubic symphysis
20 weeks: umbilicus
ad 1cm for each week after 20 wks
DROP: 36-38 weeks
When do you do specific prenatal screenings
24-28 wk: Gestational diabetes
26-28 wk: Repeat Ab test if Rh negative
35 wk: H&H
35-37: GB strep
How do you screen for gestational diabetes
50g 1 hr glucose challenge test. If >130, do the 3hr
100g 3 hr glucose test; get BG at fasting, 1, 2, and 3hr
2+ abnormal results= GD!
How does antibody screening work
If mom is Rh NEGATIVE, repeat screen at 26-28 weeks
If Ab test is still negative, give RhoGAM at 28 weeks (it attaches to the Rh+ antigen to prevent mom from recognizing an intruder)
If (+ for group b strep, how do you proceed
mom needs IV Abx if a vaginal delivery is planned (do NOT need if c-section is planned)
- Ampicillin 2g initially, then 1g q4 hrs until delivery
- Clinda 900mg q 8 hrs (allergic to penicillin)
- If you have NOT had a GBS screen prior to delivery, you get empiric Tx
MCC of bacterial illness in neonates are
Sepsis
PNA
Meningitis
How should nutrition change in pregnancy
\+ 350 kcal/day 1g/kg/d of protein extra 175g CHO x day 30mg iron x day 250mg calcium x day 0.4mg folic acid x day 600IU vitamin D If vegan/vegetarian, increase calcium, B12, iron, and zinc
Diet restrictions in pregnancy
- Avoid high mercury contect fish (shark, swordfish, marlin, bigeye tuna)- 8-12 oz x wk of acceptable fish (crab, salmon, lobster, scallop, tilapia, canned light tuna)
- <200mg caffeine x day (can do decaf)- high caffeine= high risk spon. abortion, premie, or low birth weight
- Unpasteurized dairy, undercooked meat (hot dogs, deli meat, soft cheeses, smoked seafood)- listeria monocytogenes, toxoplasmosis (meat). brucellosis (raw milk/cheese)
What is a good exercise regimen in pregnancy
continue what you are currently doing!
30 min x day on most days
20+ weeks: avoid lying on back
STOP if you are fatigued, uncomfortable, dehydrated, or overheated
What vaccines should pregnant women get
Updated Tdap and INACTIVE flu shot
-Avoid all live vaccines; wait until postpartum to give MMR, varicella, and live flu, even if mom is due for them
Travel restrictions in pregnancy
Avoid known Zika virus areas (if you do, wait 90 days to conceive for women, 9-12 months for men)
Avoid travel >35 weeks
