Prenatal Care Flashcards
during a first prenatal visit, what sort of information do you want to gather on history? (8)
- information on current pregnancy - side effects - N/V, bleeding
- obstetric hx - GTPAL, prev complications, method of delivery, preterm/poster
- gynecologic hx
- medical hx - personal dx - HTN, DM, CVD, genetic conditions, autoimmune
- family hx - genetic, consanguinity, multiple gestations, birth defects, race/ethnicity, CVD, DM, HTN
- social hx - support, desire for pregnancy, smoking and alcohol, safety concerns
- medications and supplements - screen for teratogenic agents and get on vit D, calcium and folic acid
- infectious hx - vaccinations (rubella, varicella), STI (chlamydia, gonorrhea, syphilis), hepatitis B, HIV, TB, CMV, parvovirus
during the initial prenatal visit, what physical exams do you wanna do?
- vitals - BP
- maternal weight/BMI ➔ get baseline and also risk stratification for potential gestational DM, CVD, preeclampsia
- pelvic - complete Pap smear if indicated ➔ can also do swabs for STI testing
during the initial prenatal visit what ix do you wanna order?
- Bloodwork ➔ beta-hCG, CBC, calcium (Ext lytes), vit D, ferritin, TSH, A1c, ABO screen, Rh factor, antibodies
- Urine analysis ➔ dipstick, microscopy, C & C ➔ asymp bacteremia
- Infectious workup ➔ gonorrhea swab, chlamydia swab, serum VDLP (syphilis), HBsAg, HIV, TB, immunity for rubella/varicella
- Imaging ➔ dating U/S
why and when to give RhoGAM before delivery?
ONLY FOR RH- MOMS W/O ANTIBODIES
give at 28wks
to prevent antibody creation that may endanger future pregnancies for mom as the baby may be Rh+ to a Rh- mom
can give anytime there is chance of baby and mom’s blood mixing – s/s of bleeding, miscarriage, ectopic, CVS/amnio, 48 hours after delivery if baby is +Rh
why and when give TDAP vaccine to mom?
at 28-30wks
vertical transfer of immunity to baby, to prevent whooping cough in fetus
what is the timing of prenatal visits for the normal pregnancy?
initial - 28wks - q4wks
28-35 wks - q2wks
35-delivery - q1wk
what is a part of follow-up prenatal visits?
- conversation ➔ ask about fetal movements, side effects, uterine bleeding/leaking, maternal concerns/questions
- physical ➔ fetal doppler u/s for FHR, fundal height when >20wks, can palpate for fetal lie, position, and presentation and do leopold’s maneuvers to move the fetus around
- bloodwork - do whatever makes sense with current maternal health
- urine - dipstick - protein and sugars
- vitals - BP and weight
walk me through the timing of gestation-specific ix
> 10 weeks - NIPT - T21, T18, T13, chromosomal abnormalities
10-12 wks - chorionic villus sampling - T21, T18, T13, sex chromosome abnormalities
11-14 wk
- eFTS - T21, T18, ONTD
- bloodwork: PAPPA, AFP, free b-hCG, placental growth factor
- NT U/S
15-20 wks - STS - T21, T18, ONTD
- bloodwork: AFP, b-hCG, unconjugated estradiol, inhibin A
> 15wks - amniocentesis
18-20wks - anatomy scan
24-28 wks - OGTT
28 weeks - repeat CBC and blood type, Rh factor, and antibodies
closer to delivery (35wk+)- group B strep screen
What are some nutrition facts we should council prenatally?
- calcium intake + vit D supplements
- folic acid supplementation
- iron supplementation
- caffeine ➔ reduce; some herbal teas have a toxic effect so be cautious (raspberry tea)
- food safety ➔ avoid deli meats, raw seafood, unpasteurized milk/eggs ➔ risk of Toxoplasmas/parasites
- essential fatty acids
should pregnant people exercise? what do the guidelines say?
yes
at least 150 minutes of moderate-intensity physical activity each week (spread to at least 3 days) to achieve clinically meaningful health benefits and reductions in pregnancy complications
aerobic and resistance exercises + pelvic floor exercises (kegel exercises)
Do not put patient on bed rest even with contraindications (because they can still walk and do stuff or else they can get DVTs and stuff)
