Prenatal Care Flashcards
Physiologic changes in pregnancy – respiratory?
- Tidal volume increased
- Increase in TV increases minute ventilation
- Respiratory rate unchanged
Physiologic changes in pregnancy – cardiovascular?
- 50% increase in Cardiac output and plasma volume
- Decrease in Systemic vascular resistance
- Normal/low mean arterial pressure
Physiologic changes in pregnancy – ABG?
- PH 7.45 (increased)
- PCO2 28 (decreased)
- HCO3 18 (decreased)
primary respiratory alkalosis with partial metabolic compensation
Physiologic changes in pregnancy – renal?
- 50% increase in GFR
- Decreased serum creatinine (Increased creatinine clearance)
- Dilated ureters
- Glucosuria
Physiologic changes in pregnancy – hematologic?
- Decreased hemoglobin
- Decreased platelets
- Slightly increased leukocytes
Physiologic changes in pregnancy – gastrointestinal?
- Decreased LES tone
- Delayed stomach emptying
- Decreased gut motility
Isoimmunization?
Development of antibodies due to stimulation from another’s RBCs
Asymptomatic bacteriuria?
Urine culture of 100,000+ in mid stream specimen
antenatal testing – goal?
Determine risk for uteroplacental insufficiency and perinatal death (NST and BPP)
PCO2 of 40 in the pregnant patient indicates?
Significant CO2 retention and possible impending respiratory
Dating via LMP and fundal height – discrepancy if?
3 cm or more difference in fundal height as what would be expected based on LMP
Anemia in pregnancy? Complication if untreated? Next steps?
Hemoglobin <10.5
Preterm delivery
Trial of iron, ferritin studies, hemoglobin electrophoresis
Patient nonimmune to rubella – when to vaccine?
Postpartum
If Rh antibody screen is negative?
If negative but baby is Rh positive?
Rhogam at 28 weeks
Rhogam at 28 weeks and also after delivery
Positive antibody screen suggests?
Lewis lives, Kell kills, Duffy dies
Lewis antibodies are IgM and do not cross placenta
Pregnant patient with positive HIV ELISA?
Western blot or PCR – if positive:
- anti-HIV medicines
- offer C-section or give IV ZDV is labor
Pregnant patient positive for syphilis – tx?
If less than one year – penicillin x1
If unknown/over one year – IM penicillin x3
Pregnant Patient positive for gonorrhea – complications? Next step?
Preterm labor, blindness
Ceftriaxone IM
Pregnant Patient positive for chlamydia – complications? Next step
Neonatal blindness, pneumonia
Azithromycin or amoxicillin orally
Pregnant Patient positive for Hepatitis B surface antigen – complications? Next step
Check LFTs and hepatitis serology to determine if chronic carrier or active hepatitis
Baby needs HB IG and hepatitis B vaccine
Pregnant Patient positive for urine culture but asymptomatic – complications? Next step
Asymptomatic bacteriuria leads to Pyelonephritis 25%
treat and recheck; if positive for GBS, give penicillin in labor
Pregnant Patient with abnormal Pap smear – Next steps?
Alter management only if invasive cancer
If ASC-US – re-PAP postpartum
If LGSIL or HGSIL – Colposcopy
Pregnant Patient positive for nuchal translucency – complications? Next step
May indicated trisomy
Offer karyotype and follow-up ultrasounds
Pregnant Patient positive for trisomy screen – complications? Next step
At risk for trisomy or neural tube defect
Ultrasound for dates. If confirmed, offer genetic amniocentesis
Glucose tolerance test positive it?
2 normal values
Pregnant patients with previous placental abruption – management?
Induction slightly before time of last abruption
