Prenatal Care Flashcards
When is cessation of menses a reliable sign of pregnancy?
10 days after the expected time of menses
During pregnancy, there are changes inn cervical mucus, (1) what are the two patterns (2) what hormone causes each of the respective patterns (3) for each hormone, which day in the menstrual period do they occur.
- fern pattern due to estrogen and beaded patterns due to progesterone
- Fern pattern happens on the 7th to 18th day of the menstrual cycle while progesterone happens on the 21st. why?
fern pattern happens in the 7th to 18th day because in the menstrual cycle, the dominant follicle will produce estrogen, causing positive feedback leading to the recruitment of LH and LSH which stimulate the ovaries to produce more estrogen.
Progesterone or beaded pattern occurs in the 21st day and above for PREGNANT women because it is produced by the placenta once the corpus luteum involutes (produces progesterone before the placenta). Mostly found on pregnant women
What is the Chadwick sign? Is it a definitive sign of pregnancy? Why?
Bluish discoloration of the vaginal mucosa due to increased vascularization
It is NOT a definitive sign of pregnancy, this is because OCPs can bring about this change.
Name the changes in the cervix during pregnancy (1)
Softening
Name the changes in the skin during pregnancy (3)
Increased pigmentation (melasma, linea nigra, abdominal striae
Name the changes in the uterus
1, at the first few weeks
2. at 8 weeks
3. at 12 weeks
first few weeks -> increased uterine size
6-8 weeks -> hegar’s sign – softening of the isthmus (junction of the internal os and corpus of uterus)
- -non-pregnant patient isthmus is <1cm
- -pregnant patient – isthmus becomes lower uterine segment
12 weeks -> Uterus almost becomes globular and becomes an ABDOMINAL organ
What do you call the soft blowing sound synchronous with maternal pulse?
What is the sound synchronous with fetal pulse?
what causes it?
Uterine souffle for mother
Funic souffle for fetus
rush of blood through the uterine ARTERIES (constricted nga so malakas pressure)
What are the changes in the breasts? And do the changes revert back after pregnancy?
Increase in breast size, tenderness.
No these do not revert back, once it happens in the first pregnancy it will stay that way
What do you call the perception of fetal movements? And when do they happen for primigravida and multigravida
Quickening
for primigravida - 18-20th week
for multigravida - 16-18th week
When can you start hearing fetal heart tones with:
- Standard non-amplified stethoscope
- Doppler
- transvaginal ultrasound
What is the normal range?
- Standard non-amplified stethoscope -> 17-19 weks
- doppler -> 10 weeks
- Transabdominal US -> 8 weeks with MSD 25
- Transvaginal US -> 5 weeks (according ro doc magpale 6-6.5weeks aog) eith MSD 13-18
Normal range for fetal heartbeat is 110-160 ON AVERAGE
at 6 weeks -> normal is 100-115
at 8 weeks -> 144-170
at 9 weeks and above 137-144
What is the basis of pregnancy tests?
How many days after ovulation does this hormone appear?
What is its doubling time?
When is its peak?
What is its function?
Which hormones have similar subunits to this hormone?
Human Chorionic Gonadotropin
9 days after ovulation
1.4-2 days
60-70 days which is the 8th to 10th week AOG
Its function is to prevent the involution of the corpus luteum because CL only has a lifespan of 14 days. the placenta produces this to keep the CL “alive” to produce progesterone
LH, TSH, FSH
How many weeks does it take before the placenta takes over the corpus luteum in production of progesterone?
Approximately 6 weeks
What are possible causes of FALSE POSTIVE pregnancies via pregnancy test? (4)
Exogenous HCG injection for weight loss
Renal failure leading to impaired HCG clearance
Physiological pituitary HCG
HCG producing tumors
When is Gestational Sac seen in ultrasound?
Yolk sac?
Crown rump length? and what is its significance?
GS seen in US in 5 weeks
YS seen in 6 weeks
at 12 weeks, measuring CRL is accurate in predicting the AOG
Side note: this is the formula for calculating AOG with CRL: Weeks = 5.2876 + (0.1584 * Crown_Rump_Length) - (0.0007 * Crown_Rump_Length2)
What are the 3 goals in maternal prenatal care?
To define the health status of baby and mother
To estimate the age of gestation
To initiate the plan for continuing obstetrical care
What are the typical components of routine prenatal care? (3)
What are the divisions between the visits? (4)
- History, Physical Examination, Laboratory Tests
2. First Visit, 15-20 weeks, 24-28 weeks, 29-41 weeks
True or False, Only in the first visit is the complete prenatal check=up done with the rest of the checkups being updates
True
Which Tests should you perform in Physical Examination (5)?
- Blood Pressure
- Maternal Weight
- Pelvic/Internal exam
- . Fundic Height
- Fetal heart and position (leopolds)
How often is Psychosocial Screening performed?
once per trimester
In History Taking, Why is Obstetrical History Important?
What about menstrual history? (hint, something about AOG)
What about Contraceptive use?
- Because previous complications tend to recur
- Because AOG cannot be accurately determined if menses are irregular because ovulation is not easily predictable. need early ultrasound
- May lead to ectopic pregnancy for failed methods, Or, ovulation may not have resumed and may have been mistaken for cessation of menses.
What do you call the syndrome when a mother drinks too much alcohol?
What are its effects?
Fetal alcohol syndrome:
- Growth restriction
- Facial Abnormalities
- CNS dysfunction
(Small body, small head, small brain)
What are the effects of illicit drug use?
differentiate from consumption of alcohol (the effects)
- Fetal Growth restriction (same)
- Low birthweight (different)
- Drug withdrawal soon after birth (Different)
What are possible outcomes of intimate partner violence?
- Preterm birth
- Fetal Growth Restriction (same)
- Perinatal death
What are the 5 components of the physical exam and which of those must only be done on the first visit if there are no complications?
- Maternal Blood Pressure
- Fetal Heart and Position
- Maternal Weight
- Fundic Height
- Pelvic/Cervical Internal Examination
Of the five, only pelvic and cervical internal examination must be done once (on first visit)
What do you perform in a pelvic exam? Describe each one.
- Speculum exam
- Bimanual exam
- Measuring the Fundic Height
- Fetal Position
- Fetal Heart tone
At what weeks is the height of the fundus (in cm) approximately the gestational age?
20-34 weeks AOG
For laboratory tests in the prenatal examination, what does: 1. a 2. b 3. A 4. B 5. C 6. D 7. E mean in terms of visits?
a = first trimester aneuploidy screening may be offered at 11-14 weeks b = Screening with mantoux test at any visit if indicated A = Performed a 28 weeks if indicated B = Test can be offered C = High risk women should be RETESTED beginning of third trimester D = High risk woman should be screened at initial visit and re-screened at third trimester E = rectovaginal culture obtained between 35-37 weeks
List down all 18 laboratories before prenatal checkup.
Hint: 3 blood test, 1 cervical test, 1 screen for DM, 3 congenital screening tests, 1 test for preeclampsia, and 8 tests for infection.
Blood tests: Hematocrit + hemoglobin, Rh factor and blood type, Antibody screening test
1 pap smear test
Glucose tolerance test
Aneuploidy screening, neural tube defect, cystic fibrosis screening
Urine protein assessment
Urine culture, rubella serology, syphilis serology, gonococcal culture, chlamydial culture, Hepatitis B serology, HIV serology, Group B streptococci culture (rectovaginal at 35-37 weeks)
Give 10 risk factors that may classify a pregnant woman as high-risk
Cardiac disease Uncontrolled DM Family or Personal History of genetic abnormalities hemoglobinopathy Chronic hypertension Renal insufficiency (with proteinuria >500mg/24h and serum creatinine >1.5) Pulmonary disease HIV DVT Epilepsy Cancer RH alloimmunization Prior fetal abnormality Periconceptional exposure to teratogens Exposure to infections Severe amniotic fluid disorders Higher order multifetal pregnancies
Give the time of subsequent visits for low risk, high-risk, and during the pandemic visits
Low risk: every 4 weeks till 28, every 2 weeks till 36, then weekly thereafter
Highrisk: every 1-2 weeks intervals
Covid: face to face is rare, so first visit is at 11-13 weeks, then 20 or 22 or 24 weeks for fetal anomaly scans, then 32 weeks, 36 weeks, then weekly thereafter.
When pregnant can a woman eat whatever she wants to eat? what are the conditions?
Yes, but has to be a well balanced diet
Give IRON tablets, FOLATE supplementation, and IODINE supplementation in endemic areas.
Give the expected weight gains per weight category
Underweight 28-40
Normal weight 25-35
Overweight 15-25
Obese 11-20
Hoe much additional k/cal per day should a woman consume?
100-300 kcal/day
How much additional protein (in grams) should a woman take if she is pregnant?
5-6 grams in the second half of pregnancy
What is the iron requirement per day for pregnant women? what is the RDA?
7mg daily is needed
27 is the recommended dietary allowance
When should you increase the Iron intake to 60-100mg?
Large woman Late supplementation Anemia Multiple Fetus Irregular intake
What is the RDA of Iodine in pregnant women?
220mcg/day
For Zinc, what is the RDA? What happens if you don’t fulfill the requirements?
12mg
consequences are: Poor appetite, suboptimal growth, impaired healing (obviously)
What is the only vitamin that needs supplementation?
what is the RDA?
Folic acid
RDA is 400mcg during PERICONCEPTIONAL period
during PREGNANCY, increased to 4mg/day
What are the contraindicated vaccines in pregnant women? Which vaccine should the women take?
Contraindicated: MMR, Varicella, Smallpox
Must take: Flu shots
How would you address nausea in pregnant women?
Small frequent meals at frequent intervals
Vit B6 if with mild symptoms
Excessive intake of caffeine (500mg) may cause what?
ABORTION.
take 200-300mg daily
What triggers PICA in babies?
Severe Iron deficiency.
needless to say the above condition also leads to anemia and preterm birth
How would you treat:
- Headache
- Heartburn
- Backache
- Varicosities
- Hemorrhoids
- Sleeping and Fatigue
For Headache -> acetaminophen
For Heartburn -> frequent meals + antacids
For backache -> positioning + analgesics
For Varicosities -> elevated leg position
For hemorrhoids -> warm sitz bath
For Sleeping and fatigue -> mild sedatives such as diphenhydramine
