pregnancy Flashcards
preggo dx
Fetal heart tones by ultrasound: 5-6 weeks
Fetal heart tones by Doppler: 10-12 weeks
Fundus above pubic symphasis: 12-15 weeks
Fundus at umbilicus: 20 weeks
Pregnancy: dating
Last menstrual period
Naegele’s rule: LMP + 7 days – 3 months
Eg LMP 1/11 + 7 days = 1/18 – 3 months = 10/18
Pregnancy wheel
PLUS ultrasound
First trimester: 1 week variation (most accurate)
Second trimester: 2 week variation
Third trimester: 3 week variation
HCG
Identical alpha subunit as: LH, FSH, TSH
Maintains corpus luteum progesterone: 8-10 wks
- Elevated: multiples, hydatidiform moles, choriocarcinoma, Down syndrome
- Decreased: abnormal pregnancy, Edward syndrome, Patau syndrome
HCG secreted by ??
Secreted by syncytiotrophoblasts in the placenta
Double every 29-53 hours
Blood: within 1 week
Urine: within 2 weeks
Peak at 8-10 weeks
Around 60,000-90,000
slide 9
gestational landmarks
trimester definitions
First trimester: 0-12 weeks
Second trimester: 12-28 weeks
Third trimester: 28-42 weeks
term definitions
Full term: 37 weeks Late preterm: 34 – 36 6/7 wks Early term: 37 – 38 6/7 wks Full term: 39 – 40 6/7 wks Late term: 41 – 41 6/7 wks Post term: ≥ 42 wks
Fetal “viability”: 24 weeks (can be resuscitated)
Initial laboratory tests:
Blood type Rhesus type Antibody screen Hemoglobin/Hematocrit Sickle cell screening? Rubella immunity Varicella immunity Urinalysis and urine culture STIs Gonorrhea/Chlamydia Syphilis (RPR) Hepatitis B (HBsAg) HIV Cervical cytology
optional lab tests
Fetal aneuploidy screening Invasive: CVS or amniocentesis Noninvasive: -“First trimester screening” (nuchal translucency (12wks, PAPP-A, HCG) ~90% sn -Quad screen (2nd trim.: maternal a-FP, UC estradiol, HCG, ??) 60-70% sn. -Cell free fetal DNA Screening for CF, SMA Fragile X
Tay-Sachs, Canavan dz, familial dysautonomia for Ashkenazi Jewish population
Ovulation–> Fertilization
Occurs in ampulla of fallopian tube
Occurs within 1 day of ovulation
Fertilization–>Implantation
Occurs in the wall of the uterus
Occurs within 6 days of ovulation
s/s preggo dx
labs??
imaging??
Amenorrhea Nausea/vomiting Breast tenderness Urinary frequency/urgency Fatigue Vaginal cyanosis Enlarged/globular uterus Softened cervix
labs: HCG
imaging: U/S
prenatal visits
Q4 weeks – until 28 weeks
Q2 weeks – until 36 weeks
Q1 week – until delivery
every prenatal visit
Weight BP Fundal height FHTs Urine protein Urine glucose
6-12 weeks ??
12 weeks ??
16-20 weeks??
20 weeks ??
Confirm dates
CVS
First trimester screening
AFP or Quad screen
Amniocentesis
Fetal anatomy ultrasound
Cervical length
24-28 Weeks
28 weeks?
35-36 wks?
41 wks?
Gestational Diabetes screening
Rh0 (D) Immune Globulin
Tdap
GBS screening
Antepartum fetal testing
patient education: diet
Folic acid: 0.4mg/day
Weight gain:
BMI 30: 11-20 lbs
patient education: caffeine and foods to avoid
Caffeine: 200-300mg/day
Avoid: Raw meat, Raw fish, Unpasteurized cheese, Deli meat, Fish with high mercury level
Thoroughly wash fruits/veggies
-to avoid Toxoplasmosis, Listeriosis, Brucellosis
pt education: etOH and smoking
Alcohol: Fetal alcohol syndrome: growth restrictions; facial, skeletal and cardiac abnormalities; CNS dysfunction Cigarette smoking: Placental abruption Placenta previa PROM, PTD Low birth weight
drug use
Cocaine: PROM (prem. rupture of membranes), PTD, abruption, IGUR, neurobehavioral deficits, SIDS
Amphetamines: PROM, PTD, abruption, IGUR, neurobehavioral deficits, SIDS
Opioids: IUGR, PTD, fetal death
radiation
Excessive radiation
-less than 0.05 Gy (5 rads): no problem, carcinogenesis? (unclear)
-0.05 – 0.50 Gy (5-50 rads): unknown
-First 14 days: “all or nothing”: 1 Gy kills 50% of embryos
-14 days – 20 weeks
Possible malformations, mental retardation or growth restriction more than 0.1-0.2 Gy
-Ultrasound/MRI: no problem
other things to avoid
Excessive heat (hot tubs/saunas)
Radiation or chemical hazards
Cat litter/feces
Rhesus alloimmunization: IF Rh0 (D) negative mother has Rh0 (D) positive fetus
Fetal red cells enter the circulation
Rh0 (D) antibodies are formed
These antibodies can cause hemolytic disease for subsequent Rh0 (D) positive fetuses
Rh0 (D) immune globulin = concentrate of antibodies against Rh0 (D) antigen
Destroy fetal Rh0 (D) positive cells
Mother does not form antibodies
300 mg
Lasts 12 weeks
