preconception/ Conception Flashcards
what is preconception considered?
Primary Care
what age women should receive preconception care?
All women ages 15-44
what should you counsel women who have had bariatric surgery?
avoid pregnancy for 12 months
Oral contraceptives absorption may be affected by bariatric surgery-> risk of vitamin deficiency. These patients should take two multivitamins daily
how do mood disorders affect preconception counseling?
Anticonvulsants and medications for bipolar disorder pose risk to fetus in first trimester
Depression is a/w preterm birth
nutritional deficiencies associated with conception/ preconception
Vitamins A, C, B, & E.
Calcium, iron, zinc, magnesium, and folic acid
FOLIC ACID- some contraceptive have added folic acid, however increase risk of blood clots in first year of use
how does being overweight/ obese cause conception difficulty
insulin resistance and oligomenorrhea cause conception difficulty
what problems can occur with pregnancy in an underweight mom?
preterm birth and low birth weight. Nutrient deficiencies, osteoporosis, amenorrhea, infertility, arrhythmias. Gastroschisis.
what problems can occur with pregnancy in a diabetic mom?
increased risk of miscarriage, congenital fetal abnormalities, perinatal death
what problems can occur with pregnancy in a mom with thyroid disease
Hypothyroidism in first trimester a/w cognitive impairment. Hyperthyroidism can result in maternal and neonatal morbidity
Increased risk of preterm birth, low birth weight, placental abruption, and fetal death
Thyroid replacement therapy should be increased during pregnancy
what problems can occur with pregnancy in a mom with asthma
symptoms worsen during pregnancy if poorly controlled
Risk to fetus: neonatal hypoxia, IUGR, preterm birth, low birth weight, and death
what problems can occur with pregnancy in a mom with thrombophilia
can you take coumadin while pregnant?
increased risk of clots during pregnancy; at risk for preeclampsia
Placental infarct, IUGR, placental abruption, recurrent miscarriage, fetal stroke, and fetal death
COUMADIN is teratogenic
can a pregnant woman w/ thrombophilia take coumadin?
NO= teratogenic
what problems can occur with pregnancy in a mom with seizure disorder
may have more frequent sz during pregnancy. A/w miscarriage, low birth weight, developmental disabilities, microcephaly, and hemorhagic disease of newborn.
what can occur in mom to be taking seizure medication? what to recommend?
Increased rates of neural tube defects with antiepileptic drugs
→ increase folic acid supplementation to 4mg daily at least one month prior to conception and continue through first trimester
how does zika virus affect fetus?
Passed to fetus→ causes microcephaly and brain development problems
Often asymptomatic
Sx includes mild illness, rash, fever, joint pain, or red eyes. Lasts one week
things to help prevent infirtility in men?
Obesity, smoking, T1D, radiation, mumps, hormone replacement, maintain healthy weight
what do males need to remember if exposed to zika virus
wait 3 months from initial symptoms or diagnosis -> if no sx wait 3 months regardless
use condoms with sex
what do females need to remember if exposed to zika virus
wait 2 months after initial symptoms or diagnosis - if no sx wait 2 months
use a condom with sex
In preconception how much folid acid supplementation should a woman take? why?
400mcg daily → reduce risk of neural tube defects
What to counsel women with DM before getting pregnant?
importance of glycemic control before conception to reduce risk of congenital abnormalities
what can toxoplasmosis cause?
fetal blindness and brain damage
what to counsel men before conceiving?
Avoid hot tubs, tight clothing, bike riding, immunizations, mental health, lifestyle
when is HCg test usually postive?
one week after missed perioid
when can FHT be ausculatated?
10-12 weeks
Rh-D negative woman carrying Rh-D positive child. Give RhoGam at 28 wks and within 72 hours of delivery
alloimmunization
screened during first prenatal visit. Do not vaccinate while pregnant, wait until after delivery. Safe during lactation.
Rubella
can have sig. Fetal effects. No vaccine while pregnant; avoid exposure and vaccinate postpartum
varicella
the ultimate goal of prenatal care?
reduce mortality of mom and baby
when to Screen all for bacteriuria? why?
b/t 11-16wks and tx → reduce risk of recurrent UTI, pyelonephritis, preterm labor
Nageles Rule
LNMP -3 mon + 7 days + 1 year
what is prenatal visit schedule?
before 28 weeks:
weeks 28-36:
weeks 36-birth:
before 28 weeks: monthly
weeks 28-36: every 2 weeks
weeks 36-birth: weekly
when to screen pregnant women for Group Beta strep
increased screening 35-37 weeks to decrease neonatal mortality
when to screen pregnant women for gestational diabetes?
24-28 weeks glucose tolerance test
how to tx pregnant woman with HTN?
calcium supplementation if low (dietary Ca to reduce risk of preeclampsia 30-50%)
Low-dose ASA 12-36 weeks in women with hx preeclampsia, HTN, diabetes, autoimmune disease, renal disease, or current gestational HTN
what is considered preterm birth?
how to prevent it?
birth before 37 weeks
Progesterone injections weekly from 16-37 weeks if hx of preterm birth or SROM
what needs to be looked at during prenatal visits?
BP Weight FHT (fetal heart tones) 120-160 bpm UA (ketones, glucose, proteins, nitrites) Fundal Height GBS Screen Vaccines
what is recommended for pregnant women regarding vaccines
Tdap every pregnancy and flu shot if pregnant during months of nov- march
vaccines contraindicated during pregnancy
Active Immunizations
- MMR, Varicella, Zoster
First trimester tests
- 8-12 weeks
- 10 weeks
- 11-13 weeks
ultrasound for size and date (8-12 weeks)
noninvasive prenatal testing (10 weeks)
nuchal translucency (11-13 weeks)
CVS (11-13 weeks)
2nd trimester tests
____________(15-18 weeks)
_____________ (15-19 weeks)
_______________________(18-20 weeks)
Quad Screening (15-18 weeks)
Amnio (15-19 weeks)
Anatomy scan ultrasound (18-20 weeks)
what does quad screen test?
what does it tell us
alpha-fetoprotein (AFP) , HCG
estriol, inhibin A
combined with moms age and ethnicity to assess probability of genetic disorders
diagnostic tests that will confirm if there’s any genetic abnormalities that are present in the fetus
CVS and amniocentesis
how to complete oral glucose tolerance
when in pregnancy?
24-26 weeks
drink Glucola (50g of glu) -> check serum glu 60 min later *if glu >130 mg/dl -> 100g oral glu tolerance test when fasting
how much protein should a pregnant mom eat per day?
what else do they need?
60-75 g/day
Prenatal vitamin
folic acid, vit b12, Fe, Ca, vit D
how to recommend a diet for pregnant women?
Dietary recommendations must be personalized to the woman’s age, to her pre-pregnant BMI, and to her rate of weight gain
how much folic acid is needed per day for pregnancy?
at least 40mcg
400-800 recommended
when is the postpartum visit?
4-6 weeks after giving birth
- physical and emotional concerns
- contraception
- breastfeeding and infant
What laboratory tests were ordered at the initial prenatal visit?
Blood type Rh Rubella titer CBC UA RPR VDRL - Venereal disease research lab (syphillis) HBsAg Varicella titer HIV
what should be included in fetal assessment?
fundal height
FHT
kick counts
what is considered a high risk pregnancy
any maternal condition that increases risk of uteroplacental insufficiency (GDM, HTN)
hx previous stillbirth
advanced maternal age (>35)
SAB risk
genetic abnormalities
nutritional deficiencies
psychosocial concerns (hx substance abuse)
examples of high risk pregnancies
multifetal pregnancy post-term pregnancy decreased fetal movement intrauterine growth retardation oligohydramnios hx congenital abnormalities hx chronic disease in mother
screening exams for pregnant women deemed high risk
Nonstress test (NST)
US biophysical profile
contraction stress test (CST)
what is included in US biophysical profile
FHR, fetal breathing movements, fetal body movements, fetal muscle tone, amniotic fluid
what should you do at preconception visit?
- > Ask about intention to become pregnant. Contraceptive counseling
- > importance of glycemic control before conception to reduce risk of congenital abnormalities
- > Check for use of teratogenic meds and ensure pt is on fewest amount of drugs at the lowest doses possible
- > Screen for STI and communicable diseases
- > Update hep B, influenza, measles, mumps, rubella, Tdap, varicella as needed
how can poor oral health affect a pregnancy?
low birth weight and preterm labor
total # pregnancies (including current)
Gravidity
total pregnancies beyond 20 weeks (the time pregnant, not number of fetuses; ie twins, triplets…) does not include current if not born yet
Parity
Contraindication vaccines during pregnancy:
MMR Varicella Herpes Zoster HPV Live, attenuated flu → live inactivated flu safe
when should mom get Rubella and varicella ?
immediately after delivery if not immune
What mom should get hep B?
if at high risk (STI, risky sexual behaviors)
what should be done if irregular menses, if pt is uncertain when LMP was, or discrepancy in size of uterus and gestational age
Early Ultrasound
what is considered part of initial prenatal/pre-conception H&P
Complete H&P including periodontal exam (more acid in mouth d/t changing hormones)
Labs (BHCG, US, Blood type, Rh, Rubella titer, (CBC)Hgb/Hct, UA C/S, pap smear, RPR (syphilis), VDRL, HepBsAg, HIV, Antibody screen, CF screen, Varicella titer, Tb, GC/chlamydia
BP, weight, FHT, UA (check protein), Fundal height, GBS screen, vaccines (flu, Tdap), fasting glucose
Depression, IPV, oral health
Weight gain goal for normal BMI during pregnancy
25-35 lbs
how long does WHO recommend breastfeeding?
6 months
GDM test
BG of 140 after GTT identifies 80% of women with GDM, if BG is 130, catches 90% of people with GDM
Greater than 130, another screening test fast and do 3hr 100gm
If 2 out of 4 blood tests are abnormal they have GDM
conditions that increase the risk uteroplacental insufficiency
GDM, HTN
Nutritional deficiencies that can cause high risk pregnancy
(bariatric surgery, celiac, IBD)
HCG, estrodial, alpha-feta protein, inhibin a → blood test
Quad Screen
when should you start screening tests for high risk pregnancy
start around 26-34wks
FHR will accelerate with movement in fetus; accelerations 15 BPM above baseline for 15 secs in a 20-40 min period considered reactive. Predictor of fetal wellbeing
Nonstress Test
done when results of nonstress test are concerning
FHR, fetal breathing movements, fetal body movements, fetal muscle tone, amniotic fluid
US biophysical profile (BPP) →
Diagnostic Tests→ does the fetus have specific disorders?
CVS
Amniocentesis
(10-13 weeks) sample of tissue taken from placenta
CVS
chorianic villi sampling
L/S ratio (15-20 wks, or until birth) Amniotic fluid withdrawn under US guidance
amniocentesis
