Prenatal Care Flashcards
When is genetic testing done during prenatal care
before conception
What is a screening
identification of an asymptomatic disease, harmful condition or risk factor
What is the difference between a prenatal screening and a diagnostic test
Screenings give a probability
Diagnostic gives a definitive
What are some fetal diagnostic tests
chorionic villus sampling
amniocentesis
What do fetal diagnostic tests show us
detects all trisomies, chromosomal abnormalities, several hundred mendelian abnormalities
When is chorionic villus sampling preformed and what is it
between 10-13 weeks gestation
Bx of placental tissue
How is a chorionic villus sampling preformed
transabdominal approach preferred (less risk and higher yield)
When can an amniocentesis be preformed
> 15weeks gestation
Who should be offered an amniocentesis
All pregnant women but especially those >35 due to higher risk for abnormalities
What is percutaneous umbilical blood sampling
Fetal blood samples via percutaneous puncture of umbilical cord vein under US guidance
*generally in 3rd trimester if new abnormality is found
What is preimplantation genetic testing (PGT)
Prior to IVF implantation, polar bodies for oocytes, blastomeres from 6-8 embryos or trophectoderm sample from blastocytes are sampled
How many types of PGT are there and what do they test for
PGT-M: Risk of certain mendelian disorders
PGT-A / PGT-SR: Chromosomal abnormalities
PGT-A: primarily for embryos from older women
What is aneuploidy testing
Tests for additions or deletions from chromosomes (trisomy 21)
What are the genetic screening catagories
Carrier screening
Aneuploidy screening
Neural tube defects
What is the main risk factor for genetic disease
Advanced maternal age >35y/o
What is commonly screened for in pregnancy
CF
Hemoglobinopathies
neural tube defects
Trisomy 13,18, 21
Spinal muscle atrophy
Tay-sachs
Which ethnicity is at greatest risk for tay-sachs disease
Ashkenazi Jews
What is trisomy 18
Edwards syndrome
What is trisomy 13
Patau syndrome
What genetic mutations causes CF
CFTR mutation
What is a common hemoglobinopathy
thalassemia and sickle cell
When is father tested for genetic abnormalities
Only if the mother is positive
What tests are used for checking for neural tube defects
Maternal serum alpha fetoprotein
*elevated at 16-18 weeks
Transvaginal ultrasound (TVUS)
What is the test of choice with increased risk of neural tube defects
Transvaginal ultrasound
*screening & diagnostic
Which women should have aneuploidy testing
all women regardless of age
What is spinal muscular atrophy
Degeneration of anterior horn cells in spinal cord and motor nuclei in lower brainstem
When is genetic screening done in pregnancy
First and second trimester via maternal serum markers or cfDNA and US
What is tested via maternal serum markers
Alpha fetoprotein
Uncongugated Estriol
Human chorionic gonadotropin
Inhibin A
What are the non-invasive screening strategies during pregnancy
Integrated screening
Sequential screening
non-invasive prenatal test (for trisomies ONLY)
When is an US recommended for all pregnant women
at 18-22 weeks
What is looked for on 18-22 week ultrasound
Confirm gestational age
determine fetal viability
detect multi-fetal pregnancy
When are targeted prenatal ultrasounds utilized
couples with families with a history of congenital malformations
What is detected on targeted US
Renal malformations
Achondrogenesis
Gut malformations
Diaphragmatic hernia
microcephaly
hydrocephalus
What finding on US mark genetic disorders
Increased nuchal translucency
Echogenic cardiac focus
Echogenic bowel
single umbilical artery
short femur length
choroid plexus cyst
absent nasal bone
what are presumptive signs of pregnancy
missed period
N/V
Breast changes
Increased urine frequency
What are probable signs of pregnancy
-Enlargement of uterus
-Hegars sign (Softening of isthmus)
-Chadwicks sign (Cyanotic cervix)
-Goodells (Softening of cervix from increased vascularity)
-Piskaceks sign (Asymmetric bulge from placenta)
-Positive HCG
-Melasma
What are positive signs of pregnancy
Fetus seen on US
Fetal heartbeat
Delivery of baby
How early can hCG and urine detect pregnancy
hCG detectable 8 days post conception
Urine detectable 10days after conception
What is the most accurate method of determining gestational age
first trimester US
What is the EDC calculated with
Naegeles rule
*LMp -3 months + 1year + 7days
What trimester is a mother is if she’s is 14-27 weeks gestation
2nd
When is the fetal heartbeat detectable
10 weeks
When is the uterus palpable in the abdomen
12 weeks
When is quickening noticed
between 18-20 weeks
When does the fundus reach the umbilicus
20 weeks
When can fetal movement be observed by partner
24 weeks
When does the fundus meet the max height and what is the max heigh
Xiphoid process around 36 weeks
How many prenatal visits are recommended
14 visits
*W/ AT LEAST 1 US
What is FHT
Fetal heart tracing
What is CRL
Crown to rump length
What is SLIUP
Single Live intrauterine pregnancy
When is the first prenatal visit done and what does the appointment confirm
8-10 weeks
comprehensive visit
-confirm pregnancy
- Estimated delivery date
-prescriptions
OB-GYN hx
When is the first prenatal visit done and what does the appointment confirm
What is the most important vital to check throughout pregnancy
blood pressure
What is the schedule for prenatal visits
first visit at 8-10 weeks
every 4 weeks until 28 weeks
every 2-3 weeks until 36 weeks
every week until delivery
What infectious disease testing is done at the first prenatal visit
Hep B
Rubella
Varicella
Chlamydia
syphillis
HIV
If high risk = gonorrhea
Who is at risk for gestational diabetes
women with BMI >25 and meet 1 other risk factor
-first degree reletive
-prior gestational diabetes
-advanced maternal age
-weight gain > 11lbs since 18th bday
What is a normal caloric requirement during pregnancy
2200-2900 cals/day
How many extra calories a day are required during breast feeding
500
What does a new onset elevated blood pressure after 20 weeks indicate
gestational HTN or preeclampsia
When is gestational diabetes screened for
24 week prenatal visit
When is Rhogam used prenatal and what is it
Rh immunoglobulin to prevent antepartum auto immunization to possible fetal Rh-positive cells
When does the mother receive Tdap to protect the baby from pertussis
between 27-36 weeks
How do you determine fetal position
Leopolds Maneuvers
Who gets prenatal group B strep testing
all mothers
When is labor induction offered
> 41 weeks
