Prenatal Assessment Flashcards
1
Q
gestation
A
of weeks from last menstrual period
2
Q
1st trimester
A
0-12 weeks
3
Q
2nd trimester
A
13-24 weeks
4
Q
3rd trimester
A
25-40 weeks
5
Q
term pregnancy
A
37-42 weeks
6
Q
Preterm
A
37 weeks
7
Q
post-dates
A
after 42 weeks
8
Q
gravida
A
total # of pregnancies regardless of whether they were carried to term
9
Q
para
A
# of viable (>20 wks) births multiples count as 1 birth
10
Q
nulligravida
A
never pregnant
11
Q
nullipara
A
never delivered
12
Q
primigravida
A
pregnant for the 1st time or has been pregnant 1 time
13
Q
multigravida
A
pregnant more than one time
14
Q
multipara
A
given birth 2 or more times
15
Q
Reason for preconception counseling
A
ID pts at increased risk of complications before pregnancy
Age >35 at increased risk
Diet: folic acid, MVI; avoid EtOH, tobacco/drugs, caffeine, meds
Vaccinations: varicella, rubella, hep B
PMH: DM, mental health, STI, etc
Wt: under/over weight discussed
16
Q
First 2 weeks of developing fetus
A
period of dividing zygote, implantation & bilaminar embryo
usually not susceptible to teratogens
prenatal death
17
Q
Embryonic period 3-8 weeks
A
major morphological abnormalities
18
Q
fetal period 9-40 weeks
A
physiological defects & minor morphological abnormalities
19
Q
Urine pregnancy test
A
accurate 95-98% of the time sensitive w/in 7 days of implantation pregnancy detected before 1st missed period inexpensive use 1st morning void when possible
20
Q
Serum hCG
A
gold std
qualitative results read as -/+
quantitative used for serial testing
level doubles q 48 hrs 1st 3-4 wks
leve peaks @ 60-70 days then level off
level should be 50-250 mlU/mL at the time of the first missed
period
21
Q
progesterone levels
A
remain constant thru 1st 9-10 wks non viable pregnancies have lower levels highly predictive of preg outcomes performed if freq SAB if level <20, progesterone vaginal suppository Prometrium 100-200 mg
22
Q
Risk factors for ectopic pregnancy
A
prior tubal preg tubal reversal surgery endometriosis IUD once IUP seen on sono, pt can be reassured
23
Q
Sx’s of pregnancy
A
n/v heartburn breast tenderness back pain abdominal pain/cramping quickening vaginal d/c or bleeding skin changes urinary frequency ptyalism HA absence of menses nosebleeds, gums bleed constipation fatigue
24
Q
ptyalism
A
excessive secretion of saliva
25
abdominal pain & cramping
assoc. w/ round ligament pain
26
MC problem associated with pregnancy
hyperemesis gravidum: freq. constant vomiting- dehydration, wt loss, electrolyte imbalance, poor appetite or food intake, ketonuria
27
Cervical & Vaginal tests on PE
pap
chlamydia
gonorrhea
as needed: BV, HSV, trichomonas
28
Pelvic exam
```
Hegar's sign
Chadwicks sign
cervical position & length
uterine size via bimanual
adnexal tenderness/enlarement
fetal heart tones
fetal mvnts after 18-20 weeks
fetal position after 28 weeks
```
29
Hegar's sign
softening of the cervix, about 4-6 weeks after conception
30
Chadwick's sign
bluish discoloration of the cervix from vascular congestion, after 6th week of pregnancy
31
FHT (fetal heart tones)
120-160 bpm
| heard at 10-12 weeks with Doppler
32
determining gestational age
+ signs
Fetal heart: fetoscope auscultation 17-20 weeks, ULS 5-8 wks
for cardiac activity
Mvnt: palpation of active fetal motion (quickening) at 18-20 wks
Visualization of fetus: ULS- fetal pole seen 5-6 wks
33
Dx of pregnancy
gestational sac appears at about 4 wks gestational age
grows at 1 mm a day thru the 9th week of pregnancy
gestational sac seen at the 4th-5th wk of gestation
serum hCG levels 1000-1500 mIU
34
gestational sac size
3-6 mm
35
dating the pregnancy
LMP- exact date? regular cycles?
Naegele's rule: add 7 days, subtract 3 months from LMP for EDD
avg length of gestation ~280 days
confirm with ULS, best in 1st trimester
36
determination of gestational age using CRL
```
crown rump length (CRL) up to ~14 wks: +/- 5-7 days accuracy
>16 wks, less accurate
biparietal diameter (BPD)
head circumference (HC)
abdominal circumference (AC)
femur length (FL)
```
37
Assessing fetal growth
10-12 wk: fundus at symphysis pubis
16 wk: fundus midway btw symphysis pubis & umbilicus
20-22 wk: fundus at umbilicus
measure from symphysis pubis to top of fundus
measure in cm: weeks gestation +/- 3 cm, most accurate btw 22-34 weks
38
topics of discussion: 1st visit
```
prenatal vitamins
lab tests
exercise
nutrition
sex
outline of care
handouts, books
grooming, dental hygiene, travel
```
39
General health & nutrition counseling
drink plenty of water/fluids
get plenty of rest
exercise: avoid overheating/ maintain adequate hydration
contraindications
40
Nutrition: assess risk factors
```
encourage approp. wt gain 25-30 lbs
pre-pregnant wt less than 90% or >135%
adolescent less than 15
2+ more pregnancies during 2 yrs
breast feeding
multiple gestation
food faddism, smoking, drugs, alcoholism
therapeutic diet for chronic systemic dz
```
41
Diet
2000-3000 cal/day
veg may be deficient in essential AAs, iron, complex lipids
food allergies
Ca2+ intake 1000-15000 mg/day 4 servings (lactose intolerance?)
protein 5-6 gm/day above non-pregnant, 8 servings/day
breads & cereals 6 servings
fruits & veggies 3 servings
42
Folic Acid
800 mcg start preconception
prevention of neural tube defects
neural tube closes 18-26 days post conception
43
Iron
15 mg/day over RDA of 30 mg/day
44
Vitamin A
>10,000 IU/ day is teratogenic
45
Vit C
vit C rich foods 3 servings
46
Common discomforts of pregnancy
n/v changes in libido
diarrhea angry/irritable
hemorrhoids constipation
heartburn loss of appetite
fatigue numbness of hands carpal tun
sciatica leg cramps
irregular heart beat abd. pain & cramping
47
schedule of future visits
once a month for 28-30 wks
every 2 wks until 36 wks
weekly until delivery
more frequent visits as indicated
48
evaluate at each visit
```
wt gain- eval fetal growth, nutritional intake
BP: screen for PIH
Fundal ht: eval fetal growth
Leopold's maneuver: det. fetal position
Fetal heart tones: eval fetal well being
edema: screen for PIH
UA: glucose & protein
sx's: ID problems, discomforts
```
49
prenatal revisit questions
HA exposure to dz
visual changes skin rashes/itching
swelling signs of labor
pain in chest, legs, abd, back accidents/falls
problems w/ urination changes in fetal motion
vaginal bleeding/abnl d/c vaginal lesions/sores
50
vaginal bleeding
miscarriage
SAD
ectopic
51
fluid leaking from vagina
PROM (premature rupture of membranes)
52
persistent HA, dizziness, edema, RUQ pain
PIH (pregnancy induced hypertension)
53
decreased fetal mvnt
fetal compromise
54
fever, chills
infection
55
recurrent vomiting
hyperemis gravidum
56
std OB panel
```
blood type, Rh & antibody screen
Hgb & Hct
pap smear & chlamydia screening
rubella immunity, Hept B sAG
urine cx
RPR, HIV
thyroid function
```
57
What causes less severe hemolytic anemia, jaundice in newborns
ABO incompatibility occurs in 1st pregnancies
| majority occurs in Type O mothers carrying type A or B fetus
58
Rhesus (Rh) factor
an inherited antigen on RBC surface
Dd, Cc, Ee are antigens
Rh-D presence is Rh +
Rh-D absence is Rh-
59
Rh negative pregnant women
pt produces IgG antibodies in response to Rh+ fetal RBC in maternal circulation- sensitization thru previous pregnancy, transfusion, trauma causing maternal/fetal blood to mix
IgG crosses placenta
coated erythrocytes destroyed in reticuloendothelial system causing fetal hemolytic anemia, hydrops & fetal death
60
fetal hydrops
accumulation of fluid or edema in at least 2 fetal compartments
61
At risk mothers should also be screened for
```
gonorrhea
TB
toxoplasmosis
Hep C Ab
varicella immunity
BV, Trichomonas, HSV
Chagas dz
lead level
```
62
testing for genetic d/o
```
advanced maternal age >34 yo
thalassemia (Asian, Mediterranean background)
Hemoglobinopathies (African Americans)
Tay-sachs (Ashkenazi Jews)
cystic fibrosis (carriers)
Serum phenylalanine level (PKU)
fragile X (developmental delay)
```
63
1st & 2nd trimester screening
all women should be offered screening for Down syndrome & other genetic abnormalities, especially those at higher risk
integrated screening w/ blood tests & nuchal translucency (ULS)
CVS sampling
Amniocentesis
ULS
64
Integrated screening
Screening test, NOT diagnostic
Nuchal translucency @ 11-14 wks
maternal serum PAPP-A (preg. assoc. plasma protein A) & beta
hCG at 11-14 weeks
maternal serum E3 (unconjugated estriol), AFP, beta hCG at 15-
16 wks
detection of ~90-95% of Trisomy 21
65
Nuchal Translucency
use ULS to measure amt of fluid accumulation behind baby's neck
non-invasive test
ID increased risk for Down syndrome
offered to women ages 11-14 wks
90% of fetuses with NT of 3 mm at 12 wks gestation are nl at birth
10% have major abnormalities
66
blood work at 11-14 wks
performed on mother's blood at 10w 3d to 13w 6d
measures the levels of a protein found in the blood of all pregnant women, PAPP-A (pregnancy associated plasma protein-A)
also measure quantitative serum beta-hCG
67
blood work at 15-18 wks
AFP
beta-hCG
E3
Inhibin A
68
Integrated screen summary
will detect up to 92% of babies affected w/ Down Syndrome & up to 90% w/ Trisomy 18
will also detect up to 80% of babies that have open neural tube defects such as Spina Bifida
1st & 2nd trimester results are combined, so risk assessment available when 2nd trimester blood work is completed
69
Indications for Amniocentesis
```
assessment of:
presence of bilirubin
L/S ratio
genetic d/o's
fetal sex chromosomes
advanced maternal age
+ AFP or 1st trimester screen
X-linked dz (hemophilia)
carriers of autosomal recessive d/o's
```
70
Amniocentesis
under ULS guidance, small amt of amniotic fluid removed thru the abdomen- 20 cc anmiotic fluid- cultured- kayotyped
detects most chromosomal d/o's w/ high degree of accuracy: Down syndrome, Tay-Sachs, Neural tube defects, spina bifida, etc
risk of miscarriage as a result of amniocentesis 1 in 400 or less
71
indications for chorionic villus sampling
> 35 yo
previous infant w/ chromosome abnormality
mother carrier for x-linked dz
parents known carriers of autosomal recessive inherited d/o's (Tay-sachs, CF, inborn errors of metabolism)
72
CI of chorionic villus sampling
IUD
bleeding
cervical stenosis
PID, HSV, GC
73
Chorionic Villus Sampling
10-12 wks gestation
provides earlier detection of DS, CF, TS, SCD
Procedure: removal of tiny piece of tissue from the placenta
needle inserted thru abdomen/catheter thru cervix w/ ULS
visualization
cultured for karyotype analysis
74
Advantages/Disadvantages of CVS over Amniocntesis
Advantage: performed earlier in preg- 10-12 wks rather than 15-20 wks. Results are avail. by end of 3rd month
Disadvantage: spinal cord defects cannot be detected. ULS performed later in pregnancy to screen for spinal cord defects
75
3rd Trimester Testing
26-28 wks: GDM screening, Rhogam if Rh-
| 35-37 wks: vaginal rectal swab for GBS
76
Milestone Visits
6-12 wks: confirm preg, discuss CVS, initial labs, complete Hx, PE
10-12 wks: determine fetal age by ULS; CVS
11-14 wks: 1st trimester screen
15-20 wks: quad screen, ULS, Amnio if high risk
24-28 wks: GTT for GDM, Ab screen if Rh-, Hgb/Hct
35-37 wks: GBS screen
