Prenatal care Flashcards
What are the initial prenatal workup?
- CBC with DC/PC
- Blood typing
- Urinalysis, U/C
- FBS
- HBsAg
- Rubella IgG
- VDRL, RPR
- ICC ELISA
- Pap Smear
- 75 OGTT (24-28 weeks AOG)
- Biometry +/- BPP (24-28 weeks AOG)
Active hormone during 24-28 weeks AOG, in relation to OGTT administration?
Human Placental Lactogen (HPL)
What is Human Placental Lactogen (HPL)?
It has GH like action and causes insulin resistance, lipolysis and increased fatty acids.
In general, biophysical Profile can be tested during which AOG?
32-34 weeks
When patient has severe complications, biophysical Profile can be tested during which AOG?
24-28 weeks
Can you detect BPP components <24 weeks AOG?
No
10 Danger signs of Pregnancy with Rationale
Signs of Pre-eclampsia
- Headache
- Blurring of Vision
- Prolonged vomiting
- Epigastric/RUQ pain
- Nondependent edema
Signs of Infection
- Fever
- Dysuria
- Watery Vaginal Discharge
Signs of threatened pregnancy
- Bloody Vaginal Discharge
- Decreased fetal movement
What can cause Premature rupture of membranes (PROM)?
Infection
How do you compute EDC?
EDC = + 1 yr + 7 days - 3 months
Naegele Rule
Period of 1st trimester
Until 14 weeks (Spontaneous abortion)
Period of 2nd trimester
Until 28 weeks
Period of 3rd trimester
Until 42 weeks
Weeks of quickening in primigravid
18-20 weeks AOG
Weeks of quickening in multigravid
16-18 weeks AOG
Who are at high risk of pregnancy?
- Extremes of age ( <17 - >35 y/o)
- Medical Complications
- Poor OB Hx
- Placenta Previa
- Tumor
- Trophoblastic dse within last year
- Px with fetal aging/structure
- Polyhydramnios/Oligohydramnios
These are considered poor OB history
- 2 consecutive abortions
- 3 or more repeated abortions
- Hx of preterm delivery
- Hx of fetal death in utero
- Hx of neonatal death
- Previous baby with congenital anomaly
Maternal problems in terms of fetal structure and aging
1. AOG >41 wks 2 Fetal macrosomia/IUGR 3. Unsure fetal aging 4. Multiple gestation 5. Fetal congenital anomalies
What composes the Menstrual History?
Menarche Interval Duration Amount Symptoms
What risks are increased when a pregnant woman is smoking?
Placenta previa Abruptio placenta PROM Preterm delivery SGA neonate Spontaneous abortion Fetal death Fetal anomalies
What risks are increased when a pregnant woman has fetal alcohol syndrome?
Growth retardation
Facial anomalies
CNS dysfunction
What risks are increased when a pregnant woman is on illegal drugs?
IUGR
SGA Neonate
What risks are increased when a pregnant woman has experienced partner violence?
Preterm delivery
IUGR
Perinatal death
What are taken during PE of a pregnant woman
Fundal Height (cm)
Leopold’s
Estimated fetal weight (kg)
Fetal Heart tones
How do you obtain fundal height and its correlates
Measure from top of pubis symphysis to the top of the fundus
Correlation:
12 weeks = Uterus becomes an abdominal organ
16 weeks = Fundus is midway between pubis symphysis and umbilicus
20 weeks = Fundus at the level of umbilicus
20-34 weeks = AOG (-/+ 2)
How do you estimate fetal weight?
Cupping method
How do you check fetal heart tone?
Doppler 8 - 10 (100%) weeks
Stethoscope 16 - 20 (80%) - 22 (100%)
Leopold’s Maneuver?
L1 Fundal Grip = Fetal presentation
L2 Umbilical Grip = Fetal back
L3 Pawlick’s Grip = Fetal engagement
L4 Pelvic Grip = Fetal attitude
How would you know if its the head or feet you are palpalting in L1/L3?
Irregular & Nodular = Feet
Hard, round, ballotable, mobile = Head
How would you know if its the back or extremities you are palpalting in L2?
Linear, convex, bony ridge = Back
Nodulations = Extremities
How would you know the side of the cephalic prominence ?
Opposite side as the back = Head flexed
Same side as the back = Head extended
What is the order of speculum exam?
Inspect and Palpate Speculum Exam Pap Smear Bimanual Examination Rectovaginal Examination
How do you report inspection in a normal speculum exam during inspection and palpation?
Normal external genitalia (labia, clitoris, and perineum). No lesions, masses and pigmentation
How do you report inspection in a normal speculum exam?
The vagina and cervix is pink/violaceous. There is also no apparent masses or discharge
How do you report inspection in a normal bimanual exam?
Normal external genitalia. Vagina is smooth and/or parous. The cervix is smooth, 3x3, closed and non-tender. The uterus is small/enlarged to AOG, non-tender. No adnexal masses or tenderness.
How do you report inspection in a normal rectovaginal exam?
Good sphincter tone. Intact rectal vault. No intraluminal mass. Rectovaginal septum is intact. Parametria is soft, thin, smooth, pliable, with no masses. There is no fullness n the cul-de-sac. No blood per examining finger.
Basis of AOG
- LMP (if regular)
- Early UTZ
- Late UTZ
- Quickening
- Fundal height
Frequency of Prenatal check-up if <28 weeks (first 2 months)
Monthly
Frequency of Prenatal check-up if 28-36 weeks
Every 2 weeks
Frequency of Prenatal check-up if >36 weeks or close to term
Every week
BMI of Underweight
<18.5
BMI of Normal Weight
18.5-24.9
BMI of Overweight
25-29.9
BMI of Obese
> /= 30
Total weight gain for underweight woman with singleton
28-40 lbs
Total weight gain for normal weight woman with singleton
25-35 lbs
Total weight gain for overweight woman with singleton
15-25 lbs
Total weight gain for obese woman with singleton
11-20 lbs
Total weight gain for normal weight woman with twins
37-54 lbs
Total weight gain for overweight woman with twins
31-50 lbs
Total weight gain for obese woman with twins
25-42
Average weight gain in pregnancy
28.6 lbs (4.8kg)
Weight loss at delivery
12 lbs (5.5 kg)
Weight loss 2 weeks PP
9 lbs (4 kg)
Weight loss between 2nd-6th week PP
5.5 lbs (2.5 kg)
Average retained weight
3 lbs (1.4 kg)
Is more than 10,000 IU teratogenic?
Yes
RDA in calories
Increase 100-300 kcal/day
RDA in protein
5-6g/day
RDA in Iron
27 mg elemental Fe/day
When do you start giving iron?
2nd trimester due to peak of vomiting during 1st trimester
RDA in Folic Acid
400 mcg
RDA in iron if large, twin, started late, irregular/decreased Hgb
60-100 mg
RDA in Folic Acid if px has hx of neural tube defect; and when should it be given?
4mg, start giving preconception until 1st trimester
Is coitus safe while pregnant?
Yes, except those cases with placenta previa, preterm labor and abortion
How much caffeine intake is allowed?
Max: 3 cups of 5 oz percolated coffee
Until when can a pregnant woman travel?
Safe until 36 weeks AOG
Gestational sac is detected in what age of gestation
a. 2-3 weeks AOG
b. 5-6 weeks AOG
c. 3-4 weeks AOG
d. 4-5 weeks AOG
D
Patient came in on her 3rd pregnancy. Her 1st pregnancy is an ectopic pregnancy and her 2nd pregnancy is a twin pregnancy (both are delivered preterm and alive). What is her GP score? *
a. G3P2 (0112)
b. G3P3 (0212)
c. G3P3 (0112)
d. G3P2 (0212)
A
Vaccine CONTRAINDICATED to pregnant patients *
a. HPV
b. Vaccinia
c. COVID-19
d. Hepatitis B
B
