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ENRP Exam 1 > Pregnancy and Antepartum Care > Flashcards

Pregnancy and Antepartum Care Flashcards

1
Q

what is the goal of preconception care?

A

reduce risk of adverse effects for mom and baby

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2
Q

what risks need to be addressed prior to conception?

A 
smoking cessation
EtOH cessation
illicit drug cessation
folic acid supplementation
proper nutrition
weight issues
diabetes management
stress reduction
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3
Q

why is folic acid supplementation vital to fetal health?

A

reduces risk of neural tube defects

  1. 4 mg/day without hx of NTD
  2. 0 mg/day with hx of NTD
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4
Q

Gravidity

A

number of times a woman has been pregnant

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5
Q

parity

A

number of pregnancies that result in a birth beyond 20 weeks

can be broken down into full-term, pre-term, abortions and living

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6
Q

abortions

A

include ectopic, spontaneous, and elective pregnancy loss prior to 20 weeks

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7
Q

woman has given birth to a set of twins at term and both are currently living. what is the GPA?

A

G1P1002

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8
Q

woman has given birth to one term infant, one set of preterm twins, 1 miscarriage and 1 ectopic pregnancy. she has 3 living children. GPA?

A

G4P1123

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9
Q

history obtained on first prenatal visit

A

medical (DM, HTN)
reproductive (GPA)
family (DM)
nutritional (folic acid, weight gain)
social (EtOH, drugs, smoking, employment)
psychosocial issues (depression, anxiety, domestic violence)

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10
Q

normal prenatal exam findings

A 
systolic murmurs, exaggerative splitting and S3
palmar erythema
spider angiomas
linea nigra
striae gravidarum
chadwicks sign
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11
Q

labs obtained at first prenatal visit

A 
CBC
type and screen (Rh factor)
rubella
syphilis
Hep B surface Ag
HIV
DM screen
urine culture
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12
Q

what lab values tend to increase with pregnancy?

A 
fibrinogen
urine protein
amylase
leukocyte count
clotting factors 7-10
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13
Q

fetal monitoring during first prenatal visit

A 
confirm pregnancy and viability
estimate gestational age and due date
genetic counseling if necessary
discuss teratogens
advice on decreasing early pregnancy sx
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14
Q

when can hCG first be detected in serum?

A

6-8 days after ovulation

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15
Q

what hCG level is considered positive for pregnancy?

A

25 IU/L

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16
Q

hCG trend within first 30 days of pregnancy

A

doubles ever 2.2 days

*can determine early IUP vs ectopic

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17
Q

transvaginal US findings and hCG level at 5 weeks

A

gestational sac

hCG = 1500-2000

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18
Q

transvaginal US findings and hCG level at 6 weeks

A

fetal pole

hCG = 5200

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19
Q

transvaginal US findings and hCG level at 7 weeks

A

cardiac activity

hCG = 17,500

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20
Q

estimating due date based on last menstrual period

A

Naegels rule!

minus 3 months + 7 days

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21
Q

what US findings are best for estimating due date?

A

crown rump length (CRL)
femur length
biparietal diameter
abdominal circumference

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22
Q

who needs genetic counseling?

A 
advanced maternal age (35+)
previous hx of birth defects or genetic disorder
previous child with MR
previous neonatal death
multiple fetal losses
abnormal serum marker screening
consanguinity
maternal conditions
teratogen exposure
abnormal fetal US
parent is a known carrier of a genetic disorder
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23
Q

what is the miscarriage rate of fetal chromosomal disorders?

24
Q

who is most at risk for chromosomal disorder development?

A

women who are 35+

25
what is the chance that a couple who previously had a child with Down syndrome would have another child with a chrom abnormality?
1%
26
when should a chromosomal study/karyotype be performed on couples?
3 or more spontaneous abortions *may have balanced translocation
27
first trimester screening
maternal age fetal nuchal translucency thickness (increased associated with abnormalities) maternal serum b-hCG pregnancy-associated plasma protein A (PAPP-A)
28
what could an elevated b-hCG and low PAPP-A indicate?
Down Syndrome
29
second trimester screening
Triple screen = b-hCG, estriol and maternal AFP Quadruple screen = b-hCG, estriol, AFP and inhibin A
30
what is a noninvasive test to screen for fetal abnormalities?
cell-free fetal DNA detected in maternal blood *can detect chrom abnormalities but not NTD
31
when would a cell-free fetal DNA be ordered?
``` advanced maternal age hx of prior pregnancy with trisomy fam hx of chrom abnormalities fetal US abnormalities + serum screening test ```
32
what is the next step if you have a positive cell-free fetal DNA?
invasive diagnostic test such as amniocentesis or CVS
33
when can you perform an amniocentesis?
16-20 weeks | 0.3% miscarriage rate
34
when can you perform a chorionic villi sampling?
11 weeks | 1% miscarriage rate
35
teratogen
any agent or factor that can cause abnormalities of form or function in an exposed fetus
36
describe the medication risk factor categories for pregnancy and breast feeding
``` A - its fine to take B - no human studies have shown fetal harm C - no studies have been conducted D - studies have shown risk X - dont fucking take it ```
37
fetal susceptibility to teratogenicity
dependent on genetic make-up of mother and fetus
38
dose dependence and teratogenicity
obviously small dose has lower risk vs high dose has greater risk
39
timing and teratogenicity
fetus is most vulnerable at 17-57 days post-conception (organogenesis)
40
what drugs are considered teratogens?
``` alcohol tobacco illicit drugs anti-anxiety anti-neoplastic anti-coagulants anti-convulsants Diethylstilbestrol (DES) retinoids (accutane) ```
41
fetal alcohol syndrome
``` growth restriction low set ears smooth philtrum thin upper lip short palpebral fissures flat midface microcephaly MR behavioral disorders ```
42
fetal hydantoin syndrome (FHS)
``` caused by Dilantin during pregnancy: craniofacial abnormalities limb reduction defects pre-natal onset growth restrictions MR CV anomalies ```
43
valproic acid and carbamazepine are associated with what specific fetal defect?
spina bifida
44
are OCPs teratogenic?
meh not really may cause masculinization of fetal female external genitalia
45
what infectious agents are teratogens?
TORCH ``` toxoplasmosis other (syphilis, parvo B19, zoster) rubella CMV herpes ```
46
what is the rule of thumb for radiation exposure for pregnancy women?
less than 5 rads of exposure has no risk of teratogenicity
47
unpleasant sx of pregnancy
``` nausea/vomiting constipation heart burn hemorrhoids leg cramps backache ```
48
frequency of prenatal visits
every 4 weeks until 28 weeks every 2 weeks from 28-36 weeks weekly until delivery
49
normal pregnancy weight gain for BMI < 19
28-40 lbs
50
normal pregnancy weight gain for BMI 19-25
25-35 lbs
51
normal pregnancy weight gain for BMI > 25
15-25 lbs
52
what normally occurs during routine prenatal office visits?
``` BP weight urine protein measure uterine size fetal heart rate fetal movement/kick counts educate on complications discuss lifestyle ```
53
what is evaluated for near term office visits?
``` fetal lie (longitudinal, oblique or transverse) fetal position (vertex or breech) ```
54
what tools are used to assess fetal well-being?
kick count (10 movements in 2 hours) nonstress test contraction stress test (oxytocin)
55
what is a normal nonstress test result?
2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 mins of monitoring
56
what are the components of the reassuring biophysical profile?
1. nonstress test 2. fetal breathing movements 3. fetal movement 4. fetal tone 5. amniotic fluid volume *correlates to incidence of stillbirth
57
reassuring biophysical profile results
8-10 = good 6 = okay, deliver if patient is at term 4 or less = very concerning, consider delivery

ENRP Exam 1 (20 decks)

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