Pregnancy 101 Flashcards
Pre-Conception Counseling
o Drug use; 800mg folic acid intake for one month (decreases risk of neural tube defect)
o Ideal body weight; exercise minimum of 30 minutes a day
o Family history, drug history, genetic screening
Smoking During Pregnancy
– congenital anomalies, intrauterine growth restriction (IUGR) or fetal growth restriction (FGR), prematurity, still birth, sudden infant death
FGR
– fetal weight in utero or after delivery as %ile for their gestational age
o 90% = large gestational age = macrosemia
Fetal Alcohol Spectrum Disorder
o FGR (<10%ile) o Microcephaly and central nervous system dysfunction o Facial anomalies (thin upper lip, elongated/poorly formed philtrum (vertical groove in upper lip), short palpebral fissures, flat nasal bridge, short nose
Risk of Obesity in Pregnancy
o Difficult to become pregnant (under 35 try for 1 year; over 35 try for 6 months before IVF)
o Gestational diabetes
o Hypertensive disorders of pregnancy
o Deep venous thrombosis, pulmonary embolism
o Preterm delivery
o Increase risk of C-section
o Increased risk of shoulder dystocia (can cause permanent injury to baby)
Teratogens
o Warfarin (Coumadin) – blood thinner
o Valproic acid (valproate) – for seizures
o Carbamazipine (Tegretol) – for seizures
o Isotretinoin (RetinA) – for acne
o ACE inhibitors (Lisinopril, captopril, enalapril) – for high blood pressure
Highest Risk Time for Malformations
o 0-3 weeks: death of embryo may occur
o 3-8 weeks: malformations of embryo may occur; maximal sensitivity to abnormal development
o 8-38 weeks: functional disturbance of fetus may occur; growth and maturation of organ systems
Preconception Medical Consultation
– diabetes, seizure disorders, thyroid disease, phenylketonuria, chronic hypertension, thrombophilias (clotting disorders), hemoglobinopathies (ex: sickle cell)
Fetal Complications of Uncontrolled Pre-gestational Diabetes
– hypoglycemia/hypoxia, polyhydramnios, preterm delivery, neonatal respiratory distress syndrome, stillbirth
Menstrual Dating of Pregnancy
o Ovulation occurs day 14
o Implantation 5 days after conception
o Obstetricians – pregnancy = first day of last normal menstrual period; including 2 weeks when woman was not pregnant
o Embryologists – pregnancy = time from fertilization
Abortion
– any pregnancy loss before 20 weeks; includes miscarriages, induced abortions, ectopic pregnancies, and “molar pregnancy”
Preterm, Term, Postterm
• Preterm – between 20-36 weeks 6 days;
• Term – between 37 weeks and 41 weeks 6 days
o 37-38.6 weeks = early term
o 39-40.6 weeks = full term
o 41-41.6 weeks = late term
• Post-term – 42+ weeks – increased risk of stillbirth and cerebral palsy
Diagnosis of Pregnancy
o Symptoms: nausea/vomiting, tender breasts, fatigue, urinary frequency
o Blood pregnancy test – diagnostic as early as 8 days past conception
o Urine pregnancy test – may be positive on day of anticipated menses
o Ultrasound may detect cardiac motion 6 weeks after last menstrual period
Recommendation for Nutrition in Pregnancy
– folic acid, calcium, vitamin D, iron, protein
Foods to avoid in pregnancy
– alcohol, soft cheeses from unpasteurized milk, unpasteurized milk/juice, raw/undercooked fish/poultry/meat, mercury containing fish, deli meat, hot dog, salads made in store
1st Trimester Complications
o Pregnancy of unknown location – time of conception until implantation can be identified
o Missed abortion (blighted ovum) – pregnancy loss without an embryo present
Managed expectantly (wait), medically (misoprostol), surgically (Dilation & Curretage)
o Ectopic pregnancy in fallopian tube, ovary, or abdomen
Major cause of maternal death in 1st trimester
Treat medically with methotrexate or surgically via laparotomy/laparoscopy
2nd and 3rd trimester complications
– preterm labor and delivery (45%), preterm rupture of membranes (25%), obstetric intervention for maternal or fetal problems (30%)
Preterm labor and delivery
o Premature activation of maternal or fetal hypothalamic-pituitary-adrenal (HPA) axis
o Exaggerated inflammatory response or infection
o Abruption-premature separation of normally implanted placenta
o Pathologic uterine over distension (multiple gestation, polyhydramnios, macrosemia)
o Treatment: steroid given to mother help fetal lung maturity; magnesium sulfate given to mother to help protect brain of fetus;
Can only prevent delivery for one or two days
Preterm Premature Rupture of Membranes
- rupture of membranes more than 1 hour before onset of labor along with pregnancy between 20-37 weeks
o Prior to 34 weeks try to delay birth; after 34 weeks induce labor to prevent infection
Placenta previa
– placenta implants in lower part of uterus and covers the cervix so the placenta comes out before the baby
Up to 24 weeks of pregnancy many placentas are in lower part of uterus but many times the placenta moves away from cervix as the uterus grows (self resolves)
Treatment: C-section
Placental abruption
– premature separation of normally implanted placenta; associated with bleeding either visible or hidden; spectrum of changes depending on how much of placenta is interrupted
Can cause stillbirths
Gestational hypertension
- new onset of BP >140/90 at least twice with 4+ hours between after 20 weeks gestation
• Becomes chronic hypertension if not resolved by 6 weeks post-partum
Pre-eclampsia
– hypertension diagnosed AFTER 20 weeks gestation plus 1 of following:
• Platelet count <100k; impaired liver function; new development of renal insufficiency; pulmonary edema; new onset cerebral or visual disturbances
• May result in: pulmonary edema, heart attack, stroke, kidney failure, retinal injury/blindness, death-leading cause of maternal&perinatal morbidity& mortality
• Eclampsia - presence of new seizures; treatmen – magnesium sulfate parenterally
Chronic hypertension with superimposed pre-eclampsia
– PRIOR to 20 weeks
