Prenatal care 1 & 2 Flashcards
When is fetal movement felt usually?
Multiparous: 16-18 weeks
Nulliparous: 20-22 weeks
When can HCG be detected in the serum?
8 - 9 days after ovulation
its doubles in 1.4 - 2 days
What is the function of HCG?
prevents involution of the corpus luteum which produces progesterone
What are the causes of false positive pregnancy tests?
- renal impairment -> defective clearance of HCG
- exogenous HCG for weight loss
- HCG producing tumors
When can a gestational sac be seen on ultrasound?
at 4-5 weeks by transvaginal ultrasound
double shadow shows decidua capsularis & parietalis
What are the trimesters in a pregnancy?
First trimester: till the end of week 14
Second trimester: till the end of week 28
Third trimester: 42 weeks
When should a baby be delivered?
- preterm < 37 weeks
- term 37 - 40 weeks
- post date 40 - 42 weeks
- post term > 42 weeks
How is gestational age calculated using LMP?
+ 7 days
- 3 months
What is the most accurate method to confirm gestational age?
first trimester ultrasound using
- crown rump length = 45 - 84mm
What should be preformed for a pregnant lady on her first visit?
by 10 weeks max
1- detailed history & physical: nausea, vomiting, abdominal pain, blurred vision, headache, leakage of fluid
2- blood pressure
3- weight & height
4- fundal height (if late presentation): starting at 20 weeks
5- fetal heart rate: detectable at 10 weeks by doppler and by stethoscope at 20 weeks
6- cervical & pelvic examination
What are the lab tests that should be done in the first trimester?
1- hemoglobin level (repeat at 28 weeks)
2- blood group & Rh
3- Syphilis & Rubella & Chlamydia screening
4- HIV & Hepatitis B serology
5- Red cell antibodies
6- Urine protein assessment
7- urine culture
How much folic acid should be taken in prenatal vitamins?
- 400-800 micrograms for low risk
- 4 mg for Sickler’s with previous NTD, epileptic patients, & diabetics
How frequent should prenatal visits be?
- every 4 weeks until 28 weeks
- every 2 weeks until 36 weeks
- every week after 36 weeks
10 for primigravida & 7 for multiparous usually
When should testing for B streptococci be done?
at 35 - 36 weeks through vaginal & rectal specimen
- if positive -> intrapartum IV penicillin
Who should receive intrapartum iv penicillin prophylaxis?
- positive group b streptococci results
- bacteriuria
- preterm labour
- previous infants with GBS
When should screening of gestational diabetes be done?
at booking & at 24-28 weeks for all ladies
by 50gm oral glucose load test
when is genetic screening offered?
Fetal aneuploidy
- 10-14 weeks in first trimester
- 15-20 weeks in second trimester
- cell free DNA anytime after 10 weeks
- maternal serum alpha fetal protein -> increase in second trimester indicates neural tube defects
When should anti D prophylaxis be offered?
for Rh -ive women at 28 & 34 weeks
Is exercise allowed in pregnancy?
only moderate intensity physical exercise
150 minutes each week if there are no contradictions such as CVD or risk of preterm labor
Can a pregnant woman travel?
up to 36 weeks with ambulation & lower extremity movement
What is fetal alcohol spectrum disorders?
- growth restriction
- facial abnormalities
- CNS disorders
What are the effects of smoking on pregnancy?
- subfertility
- miscarriage
- stillbirth
- low birthweight
- preterm delivery
What vaccinations are taken during pregnancy?
- TDAP at 27-36 weeks: tetanus toxoid, reduced diptheria toxoid, acellular pertussis
- influenza vaccine in flu season
- hepatitis vaccine according to exposure
no live attenuated vaccines
What are the common symptoms in pregnancy?
nausea & vomiting
- disappear after 16-18 weeks
- eating small frequent meals, & ginger herbs can help
Heart Burn
- small meals & antacids can help
