Pregnancy - L&D Flashcards
The leading cause of secondary amenorrhea is _____?
PREGNANCY!!!!
goals of prenatal care
- Early, accurate estimate of gestational age
- Deliver healthy, term infant without impairing maternal health
- Identify and optimally treat patients at high-risk for complications
- Patient education
How to Confirm Pregnancy
- Confirm pregnancy - Urine Hcg is as sensitive as serum Hcg
- Can be positive 1 week after fertilization
Viable pregnancy
- TVUS showing gestational sac as early as 5wks or Hcg of 1,500-2,000
- TVUS showing fetal heart as early as 6wks or Hcg of 5,000-6,000
Dating a Pregnancy
•Nagele’s Rule: calculate EDC by subtracting 3 months from the LMP and adding 7 days
•Uncertain LMP
- Ultrasound used to determine EDC
- Most accurate in 1st trimester
- Dating done by crown-rump length in the 1st half of 1st trimester is usually accurate to within 3 to 5 days
prenatal vitamins to take and avoid
take -
800 mcg folic acid – most effective when given 2 months prior and during 1st month
- Green leafy veggies
- Oranges
- Cantaloupe
- Bananas
- Milk
- Grains and organ meats
avoid excessive fat-soluble vitamins = D, A, K, E
effect of pregnancy on CV system
•Systolic ejection murmur &/or S3 gallop
INC -
CO (30-50%)
SV (10-15%
HR by 15-20 bpm
DEC - PVR
effect of pregnancy on Hematologic system
•Placental production of plasminogen activator inhibitor
INC
plasma volume by 50%
- RBC volume by 30%
- WBC count
- fibrinogen & factor VII-X
DEC - Plt count
effect of pregnancy on
Respiratory system & GI
Respiratory system:
DEC - FRC, ERV, RV, & TLC
INC - IC & TV
GI - DEC motility & gastric acid secretion
effect of pregnancy on renal system
Ureteral dilation
INC
kidney size & weight
- GFR by 50%
- CrCl (150-200 cc)
- resorption of Na
- renin & angiotensin
- glucose excretion
DEC - BUN and Cr by 25%
Preeclampsia Risk Assessment:
High Risk Factors:
Moderate Risk Factors:
asa reccomendation?
High Risk Factors:
- High BP (chronic or in prior pregnancy)
- Diabetes Type 1 or 2
- Twins/triplets
- Renal disease
- Autoimmune disease (ie lupus)
Moderate Risk Factors:
- 1 st baby
- BMI>30
- Mother or sister with pre-eclampsia
- African American
- Receive public health insurance
- 35 y/o or older
- History of low birth weight baby
- Previous miscarriage or complicated pregnancy
- > 10 years since your last pregnancy
Daily ASA 81mg orally from 12 weeks until delivery is recommended for prevention of preeclampsia if patient has
- ANY high-risk factor for pre-eclampsia
- or if patient has > 2 moderate risk factors.
Pregnancy Signs
•Chadwick’s sign: bluish discoloration of vagina and cervix
•Hegar’s sign: softening of uterine consistency and ability to palpate or compress the connection between the cervix and the fundus
•Goodell’s sign: softening and cyanosis of cervix at or after 4 wks
•Ladin’s sign: softening of uterus after 6 wks
•Breast swelling and tenderness
•Linea nigra
•Telangiectasias
•Palmar erythema
Third Trimester Labs (27-29 wks)
- CBC
- GLT/GTT
- RPR/VDRL
•Group B strep (36 wks) - Screen all patients at 36 wks
- Culture from lower vagina and anus (swab must go through sphincter)
- If PCN allergic, ask for sensitivities
reccommended vaccines in pregnancy
Ci vaccines
Flu
Tdap –Recommended for all pregnant patients from 27-36 weeks, ideally earlier during that time period
CI - Any other vaccine using live virus
- MMR
- Varicella
GDM SCREENING
Screening recommended for all patients at 24-28 weeks
1. GLT: glucose loading test IF >130 –>
2. GTT: glucose tolerance test – diagnostic
- Elevation of 2 or more values = GDM
- Fasting >95mg/dL, 1 hr >180mg/dL
2 hr >155mg/dL, 3 hr >140mg/dL
If passes 1st trimester -> repeat at 24-28 weeks
I_f fails 1st trimester_, -> 3hr GTT is done.
If passes 3 hr GTT, -> repeat 3hr GTT is done at 26-28 weeks. - Do not repeat 1hr
If 1st trimester DS > 200, diagnosed with GDM
prenatal visit timeline
- Less than 28 wks: every 4 weeks
- 28 – 36: every 2 weeks
- > 36 wks: every week
