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OB/GYN > Pregnancy Care > Flashcards

Pregnancy Care Flashcards

1
Q

Preconception History

A 
Chronic diseases
Medications known to be teratogens
Reproductive history
Genetic conditions in the family
Substance use
Infectious diseases & vaccinations
Folic acid intake & nutrition
Environmental hazards & toxins
Mental health & social health concerns
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2
Q

Goals of Prenatal Care

A

Ensure birth of a healthy baby
Minimize risk to mother
Early, accurate estimation of gestational age & due date
Identification of patient risk for complications & continuing risk assessment
Ongoing evaluation of health status of mother & baby
Patient education & communication

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3
Q

Preconception Interventions

A 
Folic acid supplementation
Glycemic control in women with DM
Abstinence from alcohol & illicit & prescription drugs
Smoking cessation
UTD vaccinations
Weight management (18-30)
Absence from depression
Teratogen avoidance
Absence of STIs
Planned pregnancy with early prenatal visit
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4
Q

Antepartum Care

A

Diagnosing pregnancy & determining gestational age
Monitoring the ongoing pregnancy with periodic exams & appropriate screening tests
Providing patient education that addresses all aspects of pregnancy
Preparing the patient & family for management during labor, delivery & postartum period
Detecting medical & psychosocial complications & instituting indicated interventions

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5
Q

Initiating Prenatal Care

A

Ideally prenatal care initiated in 1st trimester

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6
Q

Determining Gestational Age

A

IMPORTANT

Need to determine due date (EDC)

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7
Q

Usual Methods of Determining Gestational Age

A

History: date of LMP
Uterine size
Ultrasound (US)

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8
Q

Most Accurate Time Frame for Crown Rump Length

A

6-11 weeks

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9
Q

Most Accurate Time Frame for Biparietal Diameter

A

13-25 weeks

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10
Q

Most Accurate Time Frame for Femur Length

A

13-25 weeks

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11
Q

Assessment at First Prenatal Visit

A 
Medical history
Reproductive history
Family history
Genetic history
Nutritional history
Psychosocial history: domestic violence
Contact information
Prenatal menstrual history
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12
Q

Factors that Increase the Likelihood of Twins/Multiples

A 
Advancing age
Increased parity
Family history from either parent
Obese & tall women
Fertility drugs
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13
Q

Risks of Multiple Gestations

A

Preterm birth can lead to bed rest early

Intrauterine growth retardation or unequal growth

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14
Q

Physical Exam at First Assessment of Pregnant Woman

A 
Baseline BP
Height & weight
General PE
Pay attention to oral hygiene
Cardiac exam
DTR's
Breast exam
Pelvic exam
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15
Q

Lab Tests for First Trimester

A 
UA + pregnancy test + culture
CBC
Rubella immunity
Varicella immunity
Syphilis test
Hepatitis B antigen test
Blood type & Rh determination
HIV
Lipids, PPD, HgbA1C, thyroid testing, Hep C, Zika if indicated
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16
Q

Why obtain a urine culture?

A

Asymptomatic bacteriuria

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17
Q

Asymptomatic Bacteriuria

A

Associated with increased risk of preterm birth, low birth weight, & perinatal mortality
Need repeat after treatment

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18
Q

Treatment of Asymptomatic Bacteriuria in Pregnancy

A 
Sulfisoxazole
Amoxicillin
Amoxicillin-clavulanate (Augmentin)
Nitrofurantoin
Cefpodoxime proxetil
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19
Q

Treatment of Acute Cystitis in Pregnancy

A

Augmentin
Nitrofurantoin
Cephalexin
Amoxacillin

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20
Q

Indications for Rhogam

A 
At 28 weeks of gestation
Spontaneous abortion, threatened abortion, induce abortion
Invasive procedures
Hydatidiform mole
Fetal death in 2nd & 3rd trimester
Blunt trauma to abdomen
Antepartum hemorrhage in 2nd or 3rd trimester
External cephalic version
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21
Q

First Trimester prenatal Genetic Screening

A

Define risk in low-risk population

Can assess for down syndrome, trisomy 18 & trisomy 13

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22
Q

Combination of what factors increases detection of down syndrome?

A

hCG level
Pregnancy associated plasma protein A (PAPP-A)
Nuchal transparency (NT)

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23
Q

Define Chorionic Villous Sampling

A

Get fetal DNA for testing for Down Syndrome & other abnormalities

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24
Q

Quadruple Screen in the Second Trimester Screening

A

Serum alpha-fetoprotein (AFP)
hCG
Unconjugated estrodiol
Inhibin A

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25
Q

Define Nuchal Translucency (NT) Measurement

A

Width of the translucent space at the back of the fetal neck determined by ultrasound

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26
Q

What defects can occur when maternal serum alpha fetal protein (MSAFP) is high?

A

Neural tube defects
Anencephaly
Multiple gestation

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27
Q

What defect can occur when MSAFP is low?

A

Down syndrome

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28
Q

Indications for Amniocentesis

A

Prenatal genetic studies
Assessment of fetal lung maturity
Evaluation of fetus for infection
Degree of hemolytic anemia
Evaluation of diagnosed neural tube defects
Therapeutic: removal of excess amniotic fluid

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29
Q

Risks of Amniocentesis

A 
Leakage of amniotic fluid
Fetal injury (rare)
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30
Q

1st Visit Prenatal Education

A

At each visit maternal weight, BP, uterine growth, urine dipstick, fetal activity, & fetal HR
Every 4 weeks until 28 weeks; every 2 weeks until 34-36 weeks; every week until term
How to reach provider after business hours
Avoid hot tubs & saunas
Avoid substance use
Wear seatbelt
Infection precautions
Exercise: moderate, 30 minutes
Work: okay unless excessive lifting or standing
Sexual activity: risk of STI or vaginal bleeding
Travel: increased risk of DVT
Medications: check with provider
Weight gain counseling
Breast Feeding
Childbirth classes/hospital facilities
Diet

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31
Q

Education on Warning Signs of 1st Visit Prenatal Education

A 
Vaginal bleeding
Cramping
Fever
Passing clots or tissue (save)
Dizziness
Fainting or abdominal pain
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32
Q

Diet During Pregnancy

A

High dose iron, vitamin A, selenium may be teratogenic
Fully cooked meats, fish, poultry, & eggs
Unpasteurized dairy products or fruit/vegetable juices
Can get listeria from processed deli meats
Fish
Increased daily calories
Breastfeeding

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33
Q

Common Symptoms of Pregnancy

A 
Headaches
N/V
Heartburn
Constipation
Fatigue
Back pain
Round ligament pain: sharp groin pain
Edema
Hemorrhoids
Increased vaginal discharge
Pica
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34
Q

Define Pica

A

Inclination for non-nutritious substances such as clay or dirt is is often associated with anemia

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35
Q

Complications of the First Trimester

A

Vaginal bleeding

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36
Q

Types of Vaginal Bleeding in the First Trimester

A 
Ectopic pregnancy
Threatened miscarriage
Inevitable miscarriage: incomplete/complete
Vanishing twin
Vaginal tract bleeding
Implantation bleeding
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37
Q

What needs to be ruled out with first trimester bleeding?

A

Ectopic pregnancy

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38
Q

Unstable Patient with Bleeding in First Trimester

A

Check ABCs
Pay attention to CV status
Start fluids
Get to OR

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39
Q

Stable Patient with Bleeding in First Trimester

A 
History of bleeding
Pain or cramping
LMP
Any prenatal care
Blood type & Rh
40
Q

Evaluation of First Trimester Bleeding

A

Pelvic US
Transvaginal US
CBC with type & cross & Rh
Serum quantitatve beta hCG

41
Q

Second Trimester Evaluations

A 
Fundal height
Fetal movement
Maternal BP & weight
Urine dip for glucose & protein
Documentation of fetal cardiac activity
Assessment of significant events: travel, illness, stressors, infections, abuse
42
Q

Fundal Height at 20 weeks, up to 36 weeks, & later

A

20 weeks: uterus reaches umbilicus
36 weeks: grows up to 1 cm/week after 20 weeks
Then baby drops into pelvis

43
Q

Fetal Movement

A

Begin to feel fetus & 18-29 weeks
Ask about fetal movement
Decreased movement: have mother come in

44
Q

Complications of 2nd Trimester

A 
Premature labor
Vaginal bleeding: placenta previa, placental abruption
Premature rupture of membranes
HTN in pregnancy
Pre-eclampsia
45
Q

Signs & Symptoms of Preterm Labor & Premature Rupture of Membranes

A

Uterine contractions, low back pain, cramping, diarrhea
Leakage or gushing of fluid from vagina
Low pelvic pressure, low back pain
Advised on selecting newborn care provider
Lamaze or similar type class especially for 1st time parents
Tobacco cessation if still smoking
Depression counseling if appropriate
Asked about intimate partner violence
Postpartum family planning/tubal sterilization
Patient to lay on left lateral side

46
Q

Third Trimester

A

28-36 weeks

Abdomen examined to determine of position

47
Q

Tests at 28 Weeks

A 
Random glucose >200
Fasting glucose >126
Glucose challenge test: abnormal >130 after 1 hour
Glucose tolerance test
Rhogham if Rh Negative
48
Q

Adverse Outcomes Associated with Gestational Diabetes Mellitus

A 
Pre-eclampsia
Polyhydramnios
Fetal macrosomia
Birth trauma
Operative delievery
Perinatal mortality
49
Q

Neonatal Metabolic Complications

A

Hypoglycemia
Hyperbilirubinemia
Hypocalcemia
Erythremia

50
Q

32-36 Week Screening Labs

A

CBC
US when indicated
HIV when indicated
Depression screening when indicated

51
Q

35-37 Week Labs

A

Group B strep (anal/vaginal swab)

Resistance testing if penicillin allergic

52
Q

3rd Trimester Education/Planning

A 
Anesthesia/birth plans
Labor signs
Vaginal bleeding
Signs & symptoms of pre-eclampsia
Post-term counseling
Circumcision
Breastfeeding
Postpartum depression
Intimate partner violence
Newborn education
Family medical leave or disability forms
53
Q

Braxton Hicks Contractions

A

Commonly last 2-3 weeks of pregnancy
Regular & strong
Don’t result in change in cervix
Not active labor

54
Q

When to come into the hospital?

A

Contractions every 5 minutes for an hour
Mother getting very uncomfortable or feeling pressure in pelvis
Sudden gush or leaking of fluid from vagina
Significant vaginal bleeding
Decreased fetal movement

55
Q

Complications of 3rd Trimester

A 
Pre-eclampsia/eclampsia
HELPP syndrome
Vaginal bleeding
Premature labor
Premature rupture of membranes
56
Q

Biophysical Profile

A 
Non-stress test
Fetal breathing movements (US)
Fetal movement (US)
Fetal tone (US)
Amniotic fluid volume (US)
57
Q

Common Topics of Birth Plan

A 
Mobility, massage, music
Pain relief, medical procedures
Positioning for pushing
Mother & baby together
Breastfeeding in first hour
Rooming in
58
Q

Define Labor

A

Physiologic process by which regularly occurring uncomfortable-to-painful uterine contractions result n progressive effacement & dilation of the cervix
Permits passage through the birth control
Increased synthesis of prostaglandins: stimulate contractions, soften cervix
Increase in myometrial oxytocin receptors: amplify biologic effect from oxytocin

59
Q

Exam for delivery

A

Determine presenting part
Digital vaginal exam
Fetal station

60
Q

Parts of the Digital Vaginal Exam

A

Consistency of cervix: hard vs. soft
Effacement: shortening of cervical canal to paper thin
Dilation

61
Q

Define Fetal Station

A

Position of fetal head in the birth canal in relation to the ischial spines

62
Q

Stages of Labor

A

1st Stage: leading up to delivery
2nd Stage: delivery of the infant
3rd Stage: delivery of the placenta
4th Stage: hour immediately after delivery

63
Q

1st Stage of Labor

A

Latent phase: cervical effacement & early dilation
Active phase: begins when cervix is 3-4 cm dilated
Onset of contractions to complete dilation & effacement

64
Q

Minimal Dilation During Active Phase

A

Primiparous: 1 cm/hr
Multiparous: 1.2 cm/hr
Not progressing need to evaluate

65
Q

Early Labor Contractions

A

Every 5-10 minutes

last for 30-45 seconds

66
Q

Late Labor Contractions

A

Every 2-3 minutes

Lasting 60-70 seconds

67
Q

Management of 1st Stage

A 
Ambulation if head engaged
Left lateral position
Membranes intact: bathe or shower
Hydration with IV fluids
NPO except for ice chips
68
Q

Fetal Monitoring

A

Continuous or intermittent monitoring of fetal HR

69
Q

Warning Signs of Fetal HR

A

Late decelerations
Bradycardia
Decreased variability

70
Q

Pain Control During Labor

A 
Systemic narcotics: early
Spinal anesthesia
Epidural block
Local block of vagina or perineum
General anestetic
71
Q

2nd Stage Management

A

Begins with complete dilation of cervix & ends with delivery of baby
Fetus needs to be monitored carefully

72
Q

Crucial Items for Delivery

A

Power
Passenger
Passage

73
Q

Cardinal Movements of Labor

A 
Engagement
Flexion
Descent
Internal rotation
Extension
External rotation or restitution
Expulsion
74
Q

Define Engagement

A

Biparietal diameter has passed the plane of the pelvic inlet

75
Q

Define Flexion

A

Forces cause descent of the fetus through the pelvis, soft tissue, & bony resistance is encountered

76
Q

Define Descent

A

Successful passage of the presenting part through the birth canal

77
Q

Define Internal Rotation

A

Facilitates optimal diameters of the fetal head to the bony pelvis

78
Q

Define Extension

A

Fetal head reaches introitus

Flexed head now extends

79
Q

Define External Rotation

A

Occurs after delivery of the head

Head rotates “face forward” relative to shoulders

80
Q

Define Expulsion

A

Rapid delivery of the body

81
Q

Continued Delivery

A 
Suction oral cavity & nares
Check nuchal umbilical cord
Deliver the shoulders, trunk & legs
Clamp & cut cord
Place infant on mom's chest
82
Q

3rd Stage

A 
Obtain cord blood
Check for lacerations
Don't pull on cord
Delivery placenta
Check cord & placenta
Give oxytocin after delivery of placenta
83
Q

Stage 4

A

Uterine relaxation
Retained placental fragments
Cervical or vaginal lacerations
Monitor pulse, BP, uterine blood loss

84
Q

Breastfeeding: Colostrum

A

Minerals, protein, & IgG antibodies

less fat & sugar

85
Q

Breastfeeding: Milk Production

A

Adequate insulin, cortisol, & thyroid hormone

Adequate nutrients & fluids in mother’s diet

86
Q

Breastfeeding: Nipple Care

A

Wash with water
Expose to air for 15-20 minutes
after feeding
Lanolin or A&D ointment

87
Q

Induction of Labor

A

When benefits of induction outweigh those of continuing the pregnancy

88
Q

Cervical Ripening for Induction of Labor

A

Misoprostol
Prostaglandin E2
Laminaria: mechanical dilation

89
Q

What medication stimulates uterine contractions?

A

Pitocin

90
Q

Involution of the Uterus occurs by what week post partum?

A

6 weeks

91
Q

Define Lochia

A

Discharge from the uterus after birth as the diced differentiates into a superficial layer which sloughs off

92
Q

Lochia PostPartum

A

Heavy at first
Rapid decreases in first 2-3 days
May last for several weeks
Breastfeeding: may occur more rapidly

93
Q

How long does it take the vulvar & vaginal tissue return to normal?

A

First several days

94
Q

General Rule for the Vagina

A

Nothing in the vagina for 4 weeks

95
Q

Ovarian Function PostPartum

A

Non-lactating woman: ovulate ~45 days

Lactating: 189 days

OB/GYN (12 decks)

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