Prenatal Flashcards
Red flags in pregnancy?
Bleeding with cramping
Excessive swelling
HTN
Decreased fetal mvmt between 26-32wks (at least 6x in 2hrs)
Unstable mental health
How to diagnose pregnancy
Beta Hcg 12-14d after conception
Serum beta 11d after conception
Expected to double q2d x4 wks
How to date pregnancy
Naegels Rule: from the first day of the LMP, add 1 year, subtract 3m and add 7 days
Otherwise dating U/S - if it gives a different date from Naegels rule >5day difference Naegels Rule trumps
What should be done at every antenatal visit
BP, urine for protein, weight, FHR, ask about spotting and bleeding
What is the gold standard testing for genetic screening
IPS of eFTS
What is the IPS test?
Integrated Prenatal Screening (IPS)
Step 1: US looking at the fold of the back of the baby’s neck, assessing for nuchal translucency and BW @ 11-13 + 6wks (risk for down syndrome)
- Results will not come back to you
Step 2: Maternal Serum Screen @ 15-20wks (looking for probability of Trisomy 18 & 21, neural tube defects)
- Step 1 & 2 results will come back together as a probability factoring in the patient’s age
What is the eFTS?
Enhanced First Trimester Screen (eFTS)
- Essentially step #1 of IPS that is more enhanced and results are back by week 13-14 and has now replaced IPS for the most part
What is the NIPT?
Non-Invasive Prenatal Testing:
analyses maternal blood for circulating cell-free fetal DNA (ccffDNA) at 10 wk GA onwards. Requires
dating U/S for accuracy
*not OHIP covered unless you have screened + for the above or >40yrs of age
- Done after 9-10wks, it is a blood test done that measures circulating cell-free fetal DNA in maternal blood
- Cons: expensive
What if your patient presents to you after 15 weeks, what testing can you offer?
Maternal Serum Screen - essentially step #2 of IPS
& NIPT if they are willing to pay
If abnormalities are found on genetic screening what happens next?
Genetic testing through:
Chorionic Villus Sampling: done at 10-14wks, U/S guided catheter that takes a sample of the placenta, fetal loss risk of 1-2%
Amniocentesis: done at 15-20wks, U/S guided catheter that takes a sample of the amniotic fluid, fetal loss risk of 0.5-1%
What does GTPAL stand for?
Gravida
Term
Preterm
Abortions
Live
What are some contraindications to sex and exercise in pregnancy?
- Hx of incompetent cervix (no sex or exercise, typically on bed rest)
- PROM (risk of infection to baby
- Placenta Previa (no sex once diagnosed, no vigorous exercise at all but can do light >28wks)
- Vaginal Bleeding (No sex or exercise if consistence bleeding)
Who gets Rhogam and when is it given?
Rh - Mom
Given at 28wks and 72 hrs post delivery if babe is Rh +
What is placenta previa?
Completely overlying placenta over Os, Defined by U/S, special considerations for care. No internal checks until after 12wks confirming no previa
What are the risk factors for gestational diabetes?
Age >25yrs
Obesity
Ethnicity/Fhx of DM
Prev hx of GDM
Prev child with macrosomia BW >4.0kg
PCOS
Current use of glucocorticoids
Essential HTN or pregnancy-related HTN
What are some complications of GDM?
Increased risk of: stillbirth, shoulder dystocia, preeclampsia, c-section, LGA infant, later development for T2DM
When do we screen for GDM
24-28 wks with the OGTT
What screening tool can be used to screen for PPD?
Edinburgh PP Depression Scale
What are some differentials for spotting with pregnancy?
Ectopic Pregnancy
Post Sex
Pregnancy with normal spotting
Placental previa (painless bright red bleeding)
Placental Abruption
Miscarriage
STI
Screening tests for HTN in pregnancy
Symptomatic?
Take BP, weight
Urine for protein
Why are we concerned about HTN in pregnancy
Eclampsia
HELLP
For how long should the pregnant patient be seen primarily by PCP?
Up to 28 weeks and should have OB involved
What do each trimester translate into weeks?
the first trimester: from the first day of LMP-13 weeks the second trimester: from about 14-27 weeks
third trimester: from about 28 weeks until birth.
What are the first S/S of pregnancy?
Breast tenderness (4-6wks), nausea (starts at 6-8wks), perceived fetal movement (starts at 16-20wks), wt gain
