Prenatal Care Flashcards
Why have prenatal care?
● Women who do not receive prenatal care are three to four times more likely to die from pregnancy-related complications
● An estimated 60% of maternal deaths are preventable
According to WHO, leading causes of infant morbidity/mortality include
● premature birth
● birth complications (birth asphyxia/trauma)
● neonatal infections
● congenital anomalies
Quantitative 𝛃-hCG
● Measures amount present in blood (different
from qualitative!)
● Doubles every 2 days for the first 4 weeks of
normal pregnancy
Best imaging in 1st trimester
Ultrasound
Baby can move, but mom can’t feel it yet during____
1st trimester
Weight of the fetus more than doubles in this time period
third trimester
Morning sickness
● Usually starts between 4-8 weeks and continues until 14-16 weeks
○ Can occur anytime during the day
○ 75% of pregnant women
○ Average duration 35 days
○ 90% resolved by 22 weeks
Morning sickness treatment
○ Small frequent meals
○ Ginger
○ B6+doxylamine (diclegis)
○ Antiemetics
Fetal Heart Activity
● Begins beating by 18-25 days
● Can be heard via Doppler by 10 weeks
Quickening
● Maternal perception of fetal movement
○ 18-20 weeks in primiparous women
○ 14-18 weeks in multigravida women
Fundal Height
Uterine size can correlate closely with
gestational age in a singleton pregnancy
● 8 weeks = palpable at pubic symphysis
● 12 weeks = becomes an abdominal organ
● 16 weeks = midway between pubic
symphysis and umbilicus
● 20 weeks = at umbilicus
● Between 18-34 weeks measurement (cm)
from pubic symphysis to uterine fundus
correlates well with # of weeks of gestation.
○ ex: 25 cm = 25 weeks
How to measure fundal height
- Make sure the patient has emptied her bladder.
- Have the patient lie down on her back, semi-recumbent.
- Expose the patient’s belly and locate the uterine fundus.
- Use a measuring tape (always cm) to measure straight from the fundus to the pubic symphysis.
Folic acid
● Prenatal vitamin should contain 400 mcg
○ Total of 600 mcg daily from all sources (some recommend 800 mcg)
● Reduces risk of neural tube defects
● Prior hx of child with neural tube defect
○ 4 mg the month before conception and during first trimester
MTHFR gene
○ Adds methyl group to folic acid in order for the body to be able to use it.
○ 1 mutated copy = 55-70% efficacy
○ 2 mutated copies = 10% efficacy
○ Can get prenatal vitamin with methylfolate
Iron need in pregnancy
● 27 mg daily
● Increased absorption if taken w/ vitamin C
● During pregnancy, double the amount of iron is needed
○ Blood volume increases by almost 50%
○ More red blood cells produced to supply oxygen to the baby
Calcium need in pregnancy
● 1000 mg daily from all sources
● Most prenatal vitamins contain 200-300 mg
● Used to build baby’s bones and teeth
Vitamin D in pregnancy
● 600 IU daily from all sources
● Vitamin D deficiency is common during pregnancy (and also in
general)
○ Deficiency can cause disordered skeletal homeostasis, congenital
rickets, and fractures in the newborn
DHA need during pregnancy
● 200 mg daily
● Essential for appropriate development of fetal nervous system
● Can take in supplement or 8-12 oz of fish weekly
○ Mercury: avoid shark, swordfish, king mackerel, tilefish
Choline need during pregnancy
● 450 mg daily
● Supports nervous system development
● Eggs, meats, fish, dairy, navy beans, brussels sprouts, broccoli, spinach
Iodine need during pregnancy
● 220 mcg daily
● Supports healthy brain development, but excess can cause abnormalities
● Not included in most prenatal vitamins
● Iodized salt helpful
Zinc and B12
● Evidence suggests supplementation during pregnancy does not have any benefit
Medical/Obstetric history
● Demographic information
○ age, education/health literacy, occupation, race/ethnicity, religious
concerns regarding blood transfusion and information about the patient’s
partner
● Past obstetric history
○ Types and number of pregnancies, complications, delivery outcomes
● Past medical history
○ Signs/symptoms or risk factors for heart disease?
● Family hx
● Social hx
Psychosocial screening during pregnancy
● Done at least once per trimester
○ Barriers to care
○ Housing and food security
○ Mental health
○ Safety concerns (intimate partner violence, depression, stress,
substance use)
Pelvic exam in pregnancy
○ Chadwick’s sign = bluish-red hyperemia of cervix and
vagina (6-8 weeks)
○ Goodell’s sign = cervical softening (5 weeks)
bluish-red hyperemia of cervix and
vagina
Chadwicks sign
Goodell’s sign =
cervical softening (5 weeks)
Routine Labs for initial prenatal care
● Blood type w/ Rh status and antibody screen
● CBC, ferritin
● Documentation of rubella and varicella
immunization or antibody titers
● Urine protein
● Urine culture
○ Asymptomatic bacteriuria is always treated
during pregnancy
● Pap smear (w/ or w/o HPV testing)
● STI screening (HIV, syphilis, hepatitis B &C,
gonorrhea/chlamydia
Exercise recommendations during pregnancy
● 30+ min of moderate exercise daily
● Avoid activities w/ high risk of falling or
abdominal trauma
● Avoid supine position during exercise
● If hx of preterm delivery or IUGR, reduce
activity in 2nd and 3rd trimesters
Cigarette Smoking risks during pregnancy
● High risk of placenta previa, placental
abruption, and premature membrane
rupture
● Associated w/ preterm delivery, low birth
weight, spontaneous abortion, SIDS
● Nicotine replacement also associated w/
negative outcomes
● Vaping is not safe during pregnancy
Alcohol use during pregnancy
● Potent teratogen
● Alters psychomotor development, contributes to cognitive defects, causes emotional and behavioral problems in children
● Fetal alcohol syndrome (FAS)
○ Growth restriction
○ Facial abnormalities
○ CNS dysfunction
Illicit Drugs risk during pregnancy
● Should be avoided completely
● Some states legally require positive drug test results in pregnant women or newborns to be reported
○ Considered child abuse
Immunizations recommendations during pregnancy
● Live vaccines are contraindicated (MMR,
Varicella)
● Inactivated vaccines okay
○ Influenza (recommended for all
pregnant women)
○ Tdap and RSV commonly given
Breastfeeding benefits
● Supports optimal growth and
development
● Provides immune benefits
● Reduces risk of SIDS
● Lowers risk of maternal
breast and ovarian cancers
● Not an option for everybody,
good time to discuss a plan
Genetic counseling
● Based on family history and ethnicity
● Pretest counseling
○ Screening or diagnostic?
○ What is being checked?
○ Possibility of false positives/negatives
● All patients should be offered the option for
screening and diagnostic testing for
aneuploidy
Vaginal bleeding is a warning sign for
○ Mild spotting is normal
○ Heavy bleeding (especially w/ cramping)
could be sign of miscarriage
Excessive nausea and vomiting is:
Can’t keep liquids down for more than 12
hours
Warning signs for issues during pregnancy
● Vaginal bleeding
● Excessive nausea and vomiting
● Fever ≥ 101 degrees F
● Vaginal discharge or itching
● Pain or burning w/ urination
● Leg or calf pain w/ swelling in 1 leg, chest
pain/cough/SOB, severe headache
Pica
● Craving of pregnant women for strange
foods or non-foods (ice, clay)
● Tied to severe iron deficiency
Cord blood banking
● Remote chance that child or family
member may use (1 in 2700 individuals)
Leukorrhea
● Increased vaginal discharge, not usually
pathological
● Due to response of cervical glands to
elevated estrogen
Risk factors for post partum depression
○ Previous hx of depression
○ Stressful life events
○ Poor social/financial support
○ Obstetric complications
Treatment for post partum depression
○ Exercise, social support
○ Cognitive-behavioral
therapy
○ SSRIs (sertraline 1st line)
“Anatomy Scan” at 18-22 weeks
Checks physical development,
screens for congenital
anomalies, estimates
gestational age, location of
placenta, amount of amniotic
fluid
Group B streptococcal cultures (vaginal/rectal)
○ Recommended for all pregnant women at 35-37 weeks
○ Prophylactic antibiotics give to women w/ positive cultures
Screen for gestational diabetes
Oral glucose tolerance test at 24-28 weeks
_____ ALWAYS treated in pregnant
women
Asymptomatic bacteriuria
Rhogam is only needed for mothers with RhD ____ blood types
negative
RhoGAM prescription amount
● RhoGAM 300 ug IM at 28 weeks
○ Also after chorionic villus sampling,
amniocentesis, miscarriage, ectopic
pregnancy, uterine bleeding, any
trauma
○ Again within 72 hrs after delivery
