Pregnancy & Prenatal Care (Moulton) Flashcards
How soon should you recommend starting folic acid to someone who is planning to get pregnant?
at least 1 month before conception; reduces neural tube defects (NTDs)
Gravidity
the number of times a woman has been pregnant
Parity
number of pregnancies/deliveries that led to a birth; FPAL (full, preterm, abortions, living) twins count as one pregnancy and delivery
A woman has given birth to one term infant, and one set of preterm twins, and has had 1 miscarriage and 1 ectopic pregnancy. She has 3 living children.
G4P1123
Normal physical findings of pregnancy
systolic murmurs; exaggerated splitting of S3
palmar erythema
spider angiomas
linea nigra
striae gravidarum
chadwicks sign
When should a RH negative mom get Rhogam
at 28 weeks and/or anytime sensitization occurs (threatened abortion, amniocentesis, abd trauma/MVA)
Gestational age
the number of weeks that have elapsed between the first day of the last missed period and the date of delivery
When can serum hCG be first detected?
6 to 8 days after ovulation; a level above 25 IU/L is positive (less than 5 IU/L is negative)
Naegel’s rule
minus 3 months + 7 days = expected date of delivery; only useful w regular periods
Crown rump length (CRL)
US taken in the first trimester (best time to determine due date); can determine due date within 7 days
What patients needs genetic counseling?
35 yrs +; previous baby w birth defects/known genetic disorder/mental disorder; exposure to teratogens
What is the most common sex chromosome aneuploidy?
Turner’s syndrome 45 XO
What is the risk of a couple who previously had a child with Downs syndrome have another one?
1% risk of giving birth to another affected child
When should chromosomal studies be considered?
couples after 3 or more spontaneous abortions
Most common cause of spontaneous abortions?
Trisomy 16 - most common
What is the most common form of inherited mental retardation?
Fragile X syndrome; located on X chromosome; no male to male transmission
First trimester screenings
- Fetal nuchal translucency (NT)
- b-hCG
- PAPP-A (pappa got her pregnant first)
Second trimester screenings
- b-hCG
- maternal alpha-fetoprotein (AFP)
Quadruple screen: b-hCG, AFP, estriol and inhibin A (higher detection rate for trisomy 21)
Noninvasive prenatal testing
Cell-Free Fetal DNA; 9-10 weeks; tests free fetal FNA through the maternal circulation; does NOT test for NTDs - will need to get serum AFP or US
Teratology definition
abnormal fetal development
Teratogen definition
any agent or factor that can cause abnormalities of form or function in an exposed fetus
Thalidomide
teratogen that caused phocomelia in newborns; given to moms for n/v
What are the 4 principles of teratology?
- Fetal susceptibility (genetic make-up of mother and fetus)
- Dose (low dose vs high dose)
- Timing (day 17 to 56 post-conception - organogenesis)
- Nature of teratogenic agent
When is the most vulnerable stage to be exposed to a teratogen?
day 17 to 56 post-conception - the period of organogenesis
What is the most common teratogen that is exposed to a fetus?
Alcohol
Fetal alcohol syndrome
most common teratogen exposed to a fetus; growth restriction; facial abnormalities - low set ears, smooth philtrum, thin upper lip; CNS dysfunction - microcephaly/mental retardation
Heparin
category B; does NOT cross the placenta; can be given during pregnancy
Fetal hydantoin syndrome (FHS)
teratogen; Diphenylhydantoin (Dilantin); category D; craniofacial abnormalities, limb reduction defects; growth restriction; mental deficiency
Retinoids (Accutane)
teratogen; CNS - hydrocephaly, facial nerve palsies and cortical blindness; risk of spontaneous abortion or congenital malformation is 50%
Rule of thumbs for radiation exposure
less than 5 rads of exposure = no risk
Frequency of prenatal visits
Every 4 weeks until 28 weeks
Every 2 weeks from 28 - 36 weeks
Weekly until delivery
When does a mother typically start to feel fetal movements?
first sensation occurs around 20 weeks
Routine screening throughout pregnancy
20 weeks - US
28 weeks - Rhogram, screening for diabetes, hematocrit and hemoglobin, and given Tdap
36 weeks - screening for GBS
Kick counting
you want 10 movements in 2 hours
Nonstress test (NST)
2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 min of monitoring
Contraction stress test (CST)
given oxytocin; at least 3 contractions in 10 min period
