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Womens health exam 2 > Prenatal Care > Flashcards

Prenatal Care Flashcards

1
Q

Why have prenatal care?

A

● 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

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2
Q

According to WHO, leading causes of infant morbidity/mortality include

A

● premature birth
● birth complications (birth asphyxia/trauma)
● neonatal infections
● congenital anomalies

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3
Q

Quantitative 𝛃-hCG

A

● Measures amount present in blood (different
from qualitative!)
● Doubles every 2 days for the first 4 weeks of
normal pregnancy

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4
Q

Best imaging in 1st trimester

A

Ultrasound

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5
Q

Baby can move, but mom can’t feel it yet during____

A

1st trimester

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6
Q

Weight of the fetus more than doubles in this time period

A

third trimester

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7
Q

Morning sickness

A

● 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

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8
Q

Morning sickness treatment

A

○ Small frequent meals
○ Ginger
○ B6+doxylamine (diclegis)
○ Antiemetics

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9
Q

Fetal Heart Activity

A

● Begins beating by 18-25 days
● Can be heard via Doppler by 10 weeks

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10
Q

Quickening

A

● Maternal perception of fetal movement
○ 18-20 weeks in primiparous women
○ 14-18 weeks in multigravida women

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11
Q

Fundal Height

A

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

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12
Q

How to measure fundal height

A
  1. Make sure the patient has emptied her bladder.
  2. Have the patient lie down on her back, semi-recumbent.
  3. Expose the patient’s belly and locate the uterine fundus.
  4. Use a measuring tape (always cm) to measure straight from the fundus to the pubic symphysis.
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13
Q

Folic acid

A

● 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

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14
Q

MTHFR gene

A

○ 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

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15
Q

Iron need in pregnancy

A

● 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

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16
Q

Calcium need in pregnancy

A

● 1000 mg daily from all sources
● Most prenatal vitamins contain 200-300 mg
● Used to build baby’s bones and teeth

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17
Q

Vitamin D in pregnancy

A

● 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

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18
Q

DHA need during pregnancy

A

● 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

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19
Q

Choline need during pregnancy

A

● 450 mg daily
● Supports nervous system development
● Eggs, meats, fish, dairy, navy beans, brussels sprouts, broccoli, spinach

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20
Q

Iodine need during pregnancy

A

● 220 mcg daily
● Supports healthy brain development, but excess can cause abnormalities
● Not included in most prenatal vitamins
● Iodized salt helpful

21
Q

Zinc and B12

A

● Evidence suggests supplementation during pregnancy does not have any benefit

22
Q

Medical/Obstetric history

A

● 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

23
Q

Psychosocial screening during pregnancy

A

● Done at least once per trimester
○ Barriers to care
○ Housing and food security
○ Mental health
○ Safety concerns (intimate partner violence, depression, stress,
substance use)

24
Q

Pelvic exam in pregnancy

A

○ Chadwick’s sign = bluish-red hyperemia of cervix and
vagina (6-8 weeks)
○ Goodell’s sign = cervical softening (5 weeks)

25
bluish-red hyperemia of cervix and vagina
Chadwicks sign
26
Goodell’s sign =
cervical softening (5 weeks)
27
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
28
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
29
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
30
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
31
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
32
Immunizations recommendations during pregnancy
● Live vaccines are contraindicated (MMR, Varicella) ● Inactivated vaccines okay ○ Influenza (recommended for all pregnant women) ○ Tdap and RSV commonly given
33
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
34
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
35
Vaginal bleeding is a warning sign for
○ Mild spotting is normal ○ Heavy bleeding (especially w/ cramping) could be sign of miscarriage
36
Excessive nausea and vomiting is:
Can’t keep liquids down for more than 12 hours
37
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
38
Pica
● Craving of pregnant women for strange foods or non-foods (ice, clay) ● Tied to severe iron deficiency
39
Cord blood banking
● Remote chance that child or family member may use (1 in 2700 individuals)
40
Leukorrhea
● Increased vaginal discharge, not usually pathological ● Due to response of cervical glands to elevated estrogen
41
Risk factors for post partum depression
○ Previous hx of depression ○ Stressful life events ○ Poor social/financial support ○ Obstetric complications
42
Treatment for post partum depression
○ Exercise, social support ○ Cognitive-behavioral therapy ○ SSRIs (sertraline 1st line)
43
“Anatomy Scan” at 18-22 weeks
Checks physical development, screens for congenital anomalies, estimates gestational age, location of placenta, amount of amniotic fluid
44
Group B streptococcal cultures (vaginal/rectal)
○ Recommended for all pregnant women at 35-37 weeks ○ Prophylactic antibiotics give to women w/ positive cultures
45
Screen for gestational diabetes
Oral glucose tolerance test at 24-28 weeks
46
_____ ALWAYS treated in pregnant women
Asymptomatic bacteriuria
47
Rhogam is only needed for mothers with RhD ____ blood types
negative
48
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

Womens health exam 2 (5 decks)

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