PRENATAL CARE Flashcards by Shiela Micah Gascon

Not reliable indication until 10 days or more after expected menses onset

Cessation of menses (Amenorrhea)

How well did you know this?

Not at all

Perfectly

Beaded pattern appears ______

after the 21st day

How well did you know this?

Not at all

Perfectly

Presence of sodium chloride crystallization in the mucus

FERNING PATTERN

How well did you know this?

Not at all

Perfectly

1st pregnancy only
- tenderness and paresthesia
- Appearance of veins
- Nipples become larger, deeply pigmented and more
erectile
- Areolae become broader and deeply pigmented
- (+) glands of Montgomery
- Gigantomastia

BREAST CHANGES

How well did you know this?

Not at all

Perfectly

bright bluish red pigmentation at the vaginal mucosa

CHADWICK SIGN

How well did you know this?

Not at all

Perfectly

CHANGES IN THE UTERUS
- Softening of the isthmus
- 6th to 8th week

Hegar sign

How well did you know this?

Not at all

Perfectly

CHANGES IN THE UTERUS
-shape by 12 weeks

GLOBULAR

How well did you know this?

Not at all

Perfectly

soft, blowing sound that is synchronous with maternal pulse

Uterine souffle

How well did you know this?

Not at all

Perfectly

sharp sound that is synchronous with fetal pulse
produced by the rush of blood into umbilical arteries
Usually not heard consistently

Funic souffle

How well did you know this?

Not at all

Perfectly

CERVIAL CHANGES

becomes patulous to admit a finger

EXTERNAL OS AND CERVICAL CANAL

How well did you know this?

Not at all

Perfectly

CERVICAL CHANGES

should remain closed

INTERNAL OS

How well did you know this?

Not at all

Perfectly

Perception of fetal movements
a. By the mother
- Primigravid ?
- Multigravid ?

Primigravid 18 to 20 weeks
-Multigravid 16 to 18 weeks

How well did you know this?

Not at all

Perfectly

Perception of fetal movements
b. By the examiner

b. By the examiner
- 20 weeks

How well did you know this?

Not at all

Perfectly

Detectable 8-9 days after ovulation
Peak at 60-70 days
Nadir at 16th weeks

Beta-HCG

How well did you know this?

Not at all

Perfectly

SONOGRAPHIC RECOGNITION OF PREGNANCY

4-5 weeks AOG

gestational sac

How well did you know this?

Not at all

Perfectly

SONOGRAPHIC RECOGNITION OF PREGNANCY

35 days / 6 Weeks AOG

HEART MOTION

How well did you know this?

Not at all

Perfectly

SONOGRAPHIC RECOGNITION OF PREGNANCY

predictive of gestational age
within 4 days

Up to 12 weeks
- CRL (Crown Rump Length)

How well did you know this?

Not at all

Perfectly

Define the health status of mother and fetus
Estimate the gestational age
Initiate a plan for continuing obstetrical care

GOAL OF INITIAL PRENATAL EVALUATION

How well did you know this?

Not at all

Perfectly

ROUTINE PRENATAL CARE

**BCU-HV-75 OG

Blood typing
CBC
urinalysis
HBsAg
VDRL
75 grams OGTT (24 to 28 weeks AOG)

How well did you know this?

Not at all

Perfectly

advanced maternal age patients (>/=35 years old)

routine prenatal care + neural tube defects screening

How well did you know this?

Not at all

Perfectly

request it at 24-28 weeks

Glucose tolerance test

How well did you know this?

Not at all

Perfectly

screened in the first trimester (15-20 weeks)
and repeated at the last trimester

Gonococcal screening

How well did you know this?

Not at all

Perfectly

last trimester (29-41 weeks)

Group B streptococcus culture

How well did you know this?

Not at all

Perfectly

NORMAL PREGNANCY DURATION

280 days
40 weeks

How well did you know this?

Not at all

Perfectly

Expected Date of Delivery = First day of the last normal menstrual period + 7 days – 3 months

NAEGELE’S RULE

● First trimester – thru completion of 14 weeks ● Second trimester – thru completion of 28 weeks ● Third trimester – 29th thru 42nd weeks

TRIMESTERS Each trimester = 14 weeks

Irregular menstruation: request for early transvaginal ultrasound (at least 12 weeks of gestation which is accurate at that time) if unsure with LMP to know the AOG.

Regular vs irregularly menstruating women

● Psychosocial Risk Factors – nonbiomedical factors that affect mental and physical well-being ● Advisable frequency is at least once each trimester

PSYCHOSOCIAL SCREENING

potent teratogen

ETHANOL

o Growth restriction o Facial abnormalities o Central nervous system dysfunction

FETAL ALCOHOL SYNDROME

Dilated, occluded cervical glands bulging beneath the ectocervical mucosa

Nabothian cysts

To identify cytological abnormalities, a Pap smear is performed, and specimens for identification

Chlamydia trachomatis and Neisseria gonorrhea

But if you have and asymptomatic bacteriuria (ASB) patient, what do you request?

URINE CULTURE

Prevalence of infection from____ is 2- 13% among pregnant women.

Chlamydia trachomatis

they specialize in complicated pregnancies) - to whom you may want to refer

PERINATOLOGIST

subsequent prenatal visits have been scheduled at intervals of 4 weeks until 28 weeks, 2 weeks until 36 weeks, and weekly thereafter.

PRE NATAL VISITS

Measured as the distance over the abdominal wall from the top of the symphysis pubis to the top of the fundus

FUNDAL HEIGHT

o Heard between 16-19 weeks with standard stethoscope. a) 20 weeks – 80 percent b) 21 weeks – 95 percent c) 22 weeks – all

FETAL HEART SOUNDS

FETAL HEART SOUNDS Heard at ____ in Doppler heard at _____ in Transvaginal

10 weeks 5 weeks

● Aneuploidy Screening o 11- 14 weeks / 15-20 weeks ● Serum screening for NTD o 15- 20 weeks ● Repeat Hemoglobin/Hematocrit and Syphilis Screening o 28- 32 weeks

SUBSEQUENT LABORATORY TESTS

Special Screening for Genetic Diseases

1. Tay Sachs Disease 2. B Thalassemia 3. Sickle Cell anemia

recommendations for weight gain normal pre-pregnancy BMI

25-35 lb (11.5-16 kg )

recommendations for weight gain 1. twin pregnancy 2. young adolescents 3. Shorter women

1. twin pregnancy = 35 to 45 lb (16 to 20 kg) 2. young adolescents = strive for gains at the upper end of the range 3. Shorter women = (<62 in. or <157 cm) strive for gains at the lower end of the range

Birthweight can be influenced significantly by starvation -impaired brain development (animalfetuses) -no detectable effects (human)

SEVERE UNDERNUTRITION

concept of fetal programming by which adult morbidity and mortality are related to fetal health

BARKER HYPOTHESIS

Accruing weight with age - rather than parity - is considered the main factor affecting weight gain over time.

WEIGHT RETENTION AFTER PREGNANCY

excessive vitamin A may be teratogenic

more than 10,000 IU per day

PREGNANCY CALORIE requirement accumulated in the last 20 weeks

additional 80,000 kcal increase of 100 to 300 kcal per day

Protein requirement

1000 g of protein 5 to 6 g/day

most AA in maternal plasma fall

ornithine glycine taurine proline

AA rise in concentration

glutamic acid alanine

IRON Total = 1,000 mg INGESTION AT BEDTIME or EMPTY STOMACH

* 300 mg - fetus and placenta. * 200 mg - are lost through various normal routes of excretion, primarily the GIT * 500 mg - synthesis of erythrocytes. Iron requirement after mid-pregnancy 6 to 7 mg/day. * Recommended daily iron supplement is 27 mg, which is contained in most prenatal vitamins.

Overtly anemic women from iron deficiency responds well to oral supplementation with____

IRON SALTS

Supplemental iron is not necessary during the____

first 4 months of pregnancy

CALCIUM The pregnant woman retains approximately

30 g of calcium 2.5 percent of total maternal calcium, most of which is in bone

In cases of gestational hypertension, the patient is required to take calcium in order to prevent___

preeclampsia

-lead to poor appetite, suboptimal growth, and impaired wound healing -may cause dwarfism and hypogonadism, and a specific skin disorder, acrodermatitis enteropathica

ZINC DEFICIENCY REQUIREMENT 12 mg

Maternal plasma vitamin B12 levels decrease in normal pregnancy and result mostly from reduced plasma levels of ___

carrier proteins— transcobalamin

Excessive ingestion of ___ also can lead to a functional deficiency of vitamin B12.

vitamin C

VITAMIN B6 supplementation

daily 2 mg

VITAMIN C

80 to 85 mg/day —about 20 percent more than when nonpregnant.

In women suspected of having vit. D deficiency, serum levels of ____ can be obtained

25-hydoxyvitamin D

fivefold risk of preeclampsia

Women who work

PREGNANT WOMEN EXERCISE

30 minutes or more per day

excellent source of protein, are low in saturated fats, and contain omega-3 fatty acids

FISH except: shark, swordfish, king mackerel, and tile fish.

caffeine intake during pregnancy be limited to

less than 300 mg daily approximately three oz cups of coffee.

Nausea and vomiting of varying severity usually commence

first and second missed menstrual period and continue until 14 to 16 weeks.

The cravings of pregnant women for strange foods are termed

PICA

o ice (pagophagia), o starch (amylophagia), or o clay (geophagia) may predominate.

NON FOOD CRAVINGS triggered b SEVERE IRON DEFICIENCY

many women experience fatigue and need increased amounts of sleep

effect of progesterone

pregnant mothers REM sleep increased? decreased?

DECREASED

Pregnant women commonly develop increased vaginal discharge, which in many instances is not pathological. Increased mucus secretion by cervical glands in response to hyperestrogenemia is undoubtedly a contributing factor.

leukorrhea

treat hematopoietic cancers

umbilical cord blood transplantation

Perinatal mortality rates would be reduced by ___ if maternal smoking was eliminated.

patient have separate folic acid supplement during pregnancy in ____

FIRST TRIMESTER

FOLIC ACID SUPPLEMENTATION all neural tube defects can be prevented by

400 microgram of folic acid (peri conceptional period) 4 mg folic acid (month before conception)