Prenatal Care Flashcards
What are complications with adolescent pregnancy?
Poor compliance Poor nutrition Pre-eclampsia Preterm delivery STDs Increased perinatal morbidity and mortality
What are complications of an advanced maternal age?
increased frequency of medical illnesses (gestational diabetes and chronic HTN)
Increased frequency of karyotype abnormalities
What is the age specific risk of a karyotype abnormality of a 45 year old mother?
trisomy- 1:30
all abnormalities: 1:15
What are several prenatal care effects of race?
Access to care Medical conditions (sickle cell, thalassemia, CF)
What are several prenatal care effects of religion?
Genetics disorders (Tay-Sachs in Jews)
Transfusion (Jehovah’s Witnesses)
Abortion (Catholics and Evangelical Christians)
Gravidity
number of pregnancies
Parity
number of birth events
What goes into an prenatal abortion history?
Type of abortion
Trimester
Complications
In the assessment of menstrual pattern in prenatal care we need to look at:
LMP
Regularity
OC use
Timing of intercourse
What are common prenatal care childhood illnesses?
CHD
Viral illnesses
What is the most common type of connective tissue disease in the prenatal setting?
SLE- lupus
What previous surgeries should we be aware of in prenatal care?
Tubal surgery- possible risk of ectopic pregnancy
Uterine surgery- possible risk of uterine rupture
What can valproic acid cause?
Spina bifida
What can carbamazepine cause?
Spina bifida, facial malformations
What can antineoplastic agents cause?
Varied defest
What can warfarin cause?
facial deformity, intracranial bleeding
What can lithium cause?
cardiac malformation
What can tetracycline cause?
straining of teeth
What can quinolones cause?
cartilage injury
What can ace inhibitors and ARBs cause?
Renal injury
What can beta blockers cause?
growth restriction
What can isotretinoin cause?
brain, face, thymus, heart defects
What can topiramate cause?
facial cleft
What can NSAIDs cause?
premature stricture of the ductus arteriosus and oligohydramnios
What can excess heat cause?
Neural tube defects
What can excess radiation cause?
Neural tube defects
When taking a family history in prenatal care we have to look into these 3 big topics.
Mental retardation
Genetic disorders
Birth defects
What factors determine if a particle can cross the barrier to the fetus?
charge
size
soluability
What effects does smoking have on the fetus?
low birth weight
greater chance of a pre term birth
placental abortion
inhibited growth
What aspects of social history impact the fetus and its development?
smoking
occupation
drug use
What special laboratory studies do we need to look at during the prenatal care?
HBsAG
PPD
CXR
HIV serology
What tests screen for aneuploidy?
Nucal translucent screening (US and blood test)- checks for trisomy 18 and 21
Quadscreen- NTD, trisomy 18 and 21
US- NTD, trisomy 13, 18, 21
Cell free fetal DNA- trisomy 13, 18, 21 and sex chromosomes
What are two specialized laboratory tests for aneuploidy?
CVS (chronic villus sampling, biopsy of placenta)- 10-12 weeks - karyotype abnormalities
Amniocentesis - 15-16 weeks, chromosome abnormalities and genetic disorders (sickle cell and CF)
low risks of loss
When do you look at the hematocrit and hemeglobin?
3rd trimester
what does the glucose screen test for?
gestational DM
What encompasses the prenatal focused examination?
BP
Wt gain
Uterine size
What is the average total weight gain during pregnancy?
22lbs
What is the recommended wt gain of an underweight patient?
28-40
What is the recommended wt gain of an normal patient?
25-30
What is the recommended wt gain of an overweight patient?
15-25
What is the recommended wt gain of an obese patient?
11-20
What are the perinatal care nutritional considerations?
approx 30-35 cal/kg of ideal body weight
avoid alcohol
avoid tobacco
well balanced diet, including dairy
What is the distrinbution of calories?
50%- CHO
25%- Fat
25%- Protein
Determination of gestational age by examination?
weeks = cm +/- 2
What test can help determine size vs date discrepancy?
US
What are the landmarks for the determination of gestational age?
FHT- doptone: 10-12 weeks
Fetal motion: 16-20
FHT- fetoscope: 18-20 weeks
What is the frequency of routine apts for perinatal care?
monthly until 36 weeks and then every week from 36 weeks to delivery
What is the single most important intervention in improving maternal and perinatal outcome?
early and consistent perinatal care
What are the most common medical diseases that complicate pregnancy?
HTN DM Connective tissue disease Acquire heart disease STD
When testing for HBsAG if it comes back that the mom is sero + what do you do?
start vaccine at birth and have them come back for follow up
What is the purpose of a quad screen test?
2nd trimester test
look for NTD, trisomy 18, 21
