Pregnant Flashcards
Hypertension in Pregnancy
Hypertensive Moms Love Nifedipine
Hydralazine
Methyldopa
Labetalol
Nifedipine
Pregnancy Trimesters
First Trimester: 1-12 weeks
Second Trimester: 13-28 weeks
Third Trimester: 29-40 weeks
Pregnancy Signs
presumptive
Probable
Positive
Presumptive: Subjective symptoms that patients report
Probable: Hegger’s, Chadwick, Goodall and Pregnancy Tests (HCG - probable because it can be atopic)
Positive: Objective or clinical signs that patient is pregnant
- PUF: Palpation of fetus (Leopold maneuvers), ultrasound of fetus, Fetal heart tones, ultrasound confirmation
Pregnancy and Folic Acid
Folic acid - 400 mcg daily to prevent neural tube defects
Human chorionic gonadotropin (hCG)
Human chorionic gonadotropin (hCG) = PREGNANCY HORMONE = Serial β-hCG levels
‣ Negative: < 5 mlU/ml
‣ Positive: > 25 mlU/ml
◦ Hormone for maternal recognition of pregnancy
‣ Produced by trophoblast cells of embryo
‣ Thickens uterine lining to support the embryo
‣ hCG levels rise with conception and continue to rise until about 10 weeks
‣ hCG is found in urine or blood about 10 to 11 days after conception
◦ Recommended to test for pregnancy using a strip test 1 week after a missed menses
Prenatal Visits Frequency
4 to 28 weeks - once a month
28 to 36 - every 2 weeks
36 to 41 weeks - once a week
Test Momma for Gestational Diabetes
Gestation Diabetes at 24 to 28 weeks, but not after birth
Test Momma for Group B Strep
Group B Strep at 36 and 38 weeks
* IV penicillin if mom has it during labor
What does Group B Strep cause?
- inflammation of the covering of the brain or spinal cord (meningitis) - both late and early onset
- infection of the lungs (pneumonia)
- infection in the blood (sepsis)
s/s
Lack of energy
Irritability
Poor feeding
High fever
Naegele’s Rule
Date of the last menstrual period
Subtract 3 months
Add 7 days
Fundal Height
12 weeks
20 weeks
Distance in centimeters from the pubic bone to the top of the fundus used to measure fetal growth & gestational age
◦ 12 weeks: level of pubic symphysis
◦ 20 weeks: level of umbilicus
‣ Measure is started at 20 weeks & should be close to fetus’s gestational age
First Prenatal Visit tests
Chlamydia
Gonorrhea
Syphilis
HIV
Hepatitis B & C
Monitoring Fetal Movement in the Third Trimester
“Kick counts”
Count the number of fetal movements in an hour with a goal of ten movements (kicks, flutters, or rolls) in an hour or less
Fetal Movement Stimulation
◦ If less than 10 kicks an hour, patient should
‣ Eat or drink something
‣ Take a brief walk
* If two hours pass without 10 movements, seek additional evaluation from their healthcare provide
Aneuploidy Condition with an Extra or Missing Chromosome
Primary risk is advanced maternal age
Trisomy: extra chromosome
Down Syndrome: Associated with an extra copy of chromosome 21 = most common type
Trisomy 16: Leads to fetal death in the first trimester
Trisomy 18 (Edwards Syndrome): genetic disorder caused by the presence of an extra copy of chromosome 18
- Most fetuses die before or soon after birth
Tay-Sachs Disease
Genetic disorder caused by the absence of the Hexosaminidase-A (Hex-A) enzyme due to a chromosomal defect in Chromosome 15. Lack of Hex-A leads to an abnormal accumulation of GM2 gangliosides
- Defects cause progressive deterioration of the neurologic system
- Symptoms
◦ Infants generally appear normal at birth
◦ Developmental regression usually occurs by 6 months of age
◦ Fatal, typically by the age of five
Genetic Screening Indications - offer screening to pregnant couples or those considering pregnancy if
◦ Either member is of Ashkenazi Jewish, French Canadian, or Canadian descent
◦ Family history of Tay-Sachs disease
Preggers Standard Screening - Genetics
Spinal muscular atrophy
Cystic fibrosis
Additional Screening Based on Risks
◦ Hemoglobinopathies: African, Middle Eastern, and Mediterranean descent
◦ Fragile X Syndrome: Family history
◦ Tay-Sachs Disease: Ashkenazi Jewish, French Canadian descent
