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OB > Prenatal Assessment > Flashcards

Prenatal Assessment Flashcards

1
Q

gestation

A

of weeks from last menstrual period

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2
Q

1st trimester

A

0-12 weeks

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3
Q

2nd trimester

A

13-24 weeks

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4
Q

3rd trimester

A

25-40 weeks

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5
Q

term pregnancy

A

37-42 weeks

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6
Q

Preterm

A

37 weeks

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7
Q

post-dates

A

after 42 weeks

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8
Q

gravida

A

total # of pregnancies regardless of whether they were carried to term

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9
Q

para

A 
# of viable (>20 wks) births
   multiples count as 1 birth
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10
Q

nulligravida

A

never pregnant

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11
Q

nullipara

A

never delivered

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12
Q

primigravida

A

pregnant for the 1st time or has been pregnant 1 time

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13
Q

multigravida

A

pregnant more than one time

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14
Q

multipara

A

given birth 2 or more times

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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

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16
Q

First 2 weeks of developing fetus

A

period of dividing zygote, implantation & bilaminar embryo
usually not susceptible to teratogens

prenatal death

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17
Q

Embryonic period 3-8 weeks

A

major morphological abnormalities

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18
Q

fetal period 9-40 weeks

A

physiological defects & minor morphological abnormalities

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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
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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

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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
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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
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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
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24
Q

ptyalism

A

excessive secretion of saliva

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25
Q

abdominal pain & cramping

A

assoc. w/ round ligament pain

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26
Q

MC problem associated with pregnancy

A

hyperemesis gravidum: freq. constant vomiting- dehydration, wt loss, electrolyte imbalance, poor appetite or food intake, ketonuria

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27
Q

Cervical & Vaginal tests on PE

A

pap
chlamydia
gonorrhea
as needed: BV, HSV, trichomonas

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28
Q

Pelvic exam

A 
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
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29
Q

Hegar’s sign

A

softening of the cervix, about 4-6 weeks after conception

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30
Q

Chadwick’s sign

A

bluish discoloration of the cervix from vascular congestion, after 6th week of pregnancy

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31
Q

FHT (fetal heart tones)

A

120-160 bpm

heard at 10-12 weeks with Doppler

32
Q

determining gestational age

A

+ 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
Q

Dx of pregnancy

A

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
Q

gestational sac size

A

3-6 mm

35
Q

dating the pregnancy

A

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
Q

determination of gestational age using CRL

A 
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
Q

Assessing fetal growth

A

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
Q

topics of discussion: 1st visit

A 
prenatal vitamins
lab tests
exercise
nutrition
sex
outline of care
handouts, books
grooming, dental hygiene, travel
39
Q

General health & nutrition counseling

A

drink plenty of water/fluids
get plenty of rest
exercise: avoid overheating/ maintain adequate hydration
contraindications

40
Q

Nutrition: assess risk factors

A 
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
Q

Diet

A

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
Q

Folic Acid

A

800 mcg start preconception
prevention of neural tube defects
neural tube closes 18-26 days post conception

43
Q

Iron

A

15 mg/day over RDA of 30 mg/day

44
Q

Vitamin A

A

> 10,000 IU/ day is teratogenic

45
Q

Vit C

A

vit C rich foods 3 servings

46
Q

Common discomforts of pregnancy

A

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
Q

schedule of future visits

A

once a month for 28-30 wks
every 2 wks until 36 wks
weekly until delivery

more frequent visits as indicated

48
Q

evaluate at each visit

A 
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
Q

prenatal revisit questions

A

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
Q

vaginal bleeding

A

miscarriage
SAD
ectopic

51
Q

fluid leaking from vagina

A

PROM (premature rupture of membranes)

52
Q

persistent HA, dizziness, edema, RUQ pain

A

PIH (pregnancy induced hypertension)

53
Q

decreased fetal mvnt

A

fetal compromise

54
Q

fever, chills

A

infection

55
Q

recurrent vomiting

A

hyperemis gravidum

56
Q

std OB panel

A 
blood type, Rh & antibody screen
Hgb & Hct
pap smear & chlamydia screening
rubella immunity, Hept B sAG
urine cx
RPR, HIV
thyroid function
57
Q

What causes less severe hemolytic anemia, jaundice in newborns

A

ABO incompatibility occurs in 1st pregnancies

majority occurs in Type O mothers carrying type A or B fetus

58
Q

Rhesus (Rh) factor

A

an inherited antigen on RBC surface
Dd, Cc, Ee are antigens
Rh-D presence is Rh +
Rh-D absence is Rh-

59
Q

Rh negative pregnant women

A

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
Q

fetal hydrops

A

accumulation of fluid or edema in at least 2 fetal compartments

61
Q

At risk mothers should also be screened for

A 
gonorrhea
TB
toxoplasmosis
Hep C Ab
varicella immunity
BV, Trichomonas, HSV
Chagas dz
lead level
62
Q

testing for genetic d/o

A 
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
Q

1st & 2nd trimester screening

A

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
Q

Integrated screening

A

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
Q

Nuchal Translucency

A

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
Q

blood work at 11-14 wks

A

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
Q

blood work at 15-18 wks

A

AFP
beta-hCG
E3
Inhibin A

68
Q

Integrated screen summary

A

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
Q

Indications for Amniocentesis

A 
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
Q

Amniocentesis

A

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
Q

indications for chorionic villus sampling

A

> 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
Q

CI of chorionic villus sampling

A

IUD
bleeding
cervical stenosis
PID, HSV, GC

73
Q

Chorionic Villus Sampling

A

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
Q

Advantages/Disadvantages of CVS over Amniocntesis

A

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
Q

3rd Trimester Testing

A

26-28 wks: GDM screening, Rhogam if Rh-

35-37 wks: vaginal rectal swab for GBS

76
Q

Milestone Visits

A

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

OB (13 decks)

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