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Prenatal Care Flashcards

1
Q

Placental Hormones

A

Human chorionic gonadotropin (hCG) - maintains corpus leuteum (secretes progesterone) until week 13

Human placental lactogen (hPL) - increase the supply of glucose to the fetus; important in 24 weeks of pg, increases glucose levels to the fetus by making the mother more resistant, causes GDM

Progesterone - maintains the uterine lining and keeps the uterus in a relaxed state

Estrogen - stimulates uterine growth and mammary gland development for lactation

Glucocorticoids - organ development and maturation

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2
Q

When does an embryo become a fetus?

A

7 weeks

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3
Q

Four weeks gestation

A

Specialization of cells

  • inner layer: respiratory and digestive systems
  • middle layer: skeleton, muscles, circulatory system, kidneys, and sex organs
  • outer layer: nervous system, skin and hair

Home pg test now positive

Poppy seed

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4
Q

Six weeks gestation

A

Fetus is most susceptible to drugs, disease and other factors that interfere with normal growth

Cardiac motion can be detected by US

Sweet pea

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5
Q

Twelve weeks gestation

A

Organs now present; maturation occurs in 2nd and 3rd trimesters

Most critical development has occurred

Rates of miscarriage drop significantly after this week

Plum

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6
Q

Sixteen weeks gestation

A

Development of bones and muscles

External parts: face and ears

Most organs are developed and functioning

Avocado

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7
Q

Twenty weeks gestation

A

Nervous system starts to function

Sex genitalia fully developed

Patient should be able to feel fetal movement

Banana

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8
Q

Twenty-four weeks gestation

A

Fetus responds to sound by movement or increased HR

Considered viable at 23 weeks, and morbidity decreases considerably qweek after

Cantaloupe

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9
Q

Twenty-eight weeks gestation

A

Brain wave patterns appear like full term newborn

Lungs continue developing

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10
Q

Thirty-two weeks gestation

A

Layer of fat forming - homeostasis

Fetus will gain more than half of its weight between now and delivery

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11
Q

Thirty-six weeks gestation

A

Considered term

Brain developing rapidly

Lungs nearly developed

97% in vertex position

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12
Q

Supine hypotensive syndrome

A

When woman is supine, the uterus compresses the IVC and pt becomes pale and dizzy

Pt should tip hips slightly to the left to relieve pressure on IVC

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13
Q

Hematologic changes during pregnancy

A

Physiologic anemia: increased plasma volume is greater than the increase in RBC’s. Fetus steals iron from mom

Hypercoagulability - several changes in clotting factors to help with hemostasis during delivery

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14
Q

Rate of weight gain during pregnancy

A

First trimester 3-5lbs
Remainder 1-2lbs/week

If overweight, gain at 1/2 this rate

Total weight gain ~25-30lbs

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15
Q

How to calculate EDD

A

Add 7 days to the first day of LMP then subtract 3 months

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16
Q

G PTPAL

A

Gravida - # pg’s
Parity - # births
(term, preterm, abortions, living)

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17
Q

Chadwick’s sign

A

increased vasculature of the cervix, causing a blue appearance

18
Q

Initial Visit

A 
Labs: 
blood grp/rh
antibody screen 
Hgb/Hct 
Rubella antibody titer
Hep B virus surface antigen 
Syphilis, GC/CT, HIV screen 
UA - asymptomatic bacteriurea 
GDM screening (24-28 weeks unless high risk)
\+/- CF, sickle cell, thal, Tay Sachs, PKU, Fragile X screen 
Education
PNV with iron 
No activity restrictions unless cramping/bleeding
Tobacco (<10 cigs), alcohol, drugs
Sexual activity 
Travel ok until 36 weeks
19
Q

Medications safe during pg

A 
Acetaminophen 
Fiber 
Benadryl, chlorpheniramine 
Pseudoephedrine 
Guaifenesin

NO NSAIDS, except ASA for pre-eclampsia

Antibiotics: 
Penicillin 
Amoxicillin 
Ampicillin 
Cephalosporins
Clindamycin 
Erythromycin

AVOID: tetracyclines, nitrofurantoin, sulfonamides

20
Q

F/U Schedule

A

q4weeks until 28-32 weeks
q2weeks until 36weeks
qweek until delivery

21
Q

Fundal Height

A

Measured from pubic symphysis to fundus

Starting at 20 wks GA

  • 1cm fundal height growth per week
  • Nl is +/- 2-3cm of the weeks gestation

Red flags: no growth or huge jump

22
Q

Size > Dates

A

Macrosomia

  • fetus with estimated weight greater than 4500g
  • can be abnl genetics or maternal factors (weight, metabolic abnl, multiparous)

Polyhydramnios

  • excessive accumulation of amniotic fluid
  • indication of fetal anomalies

Multiple gestation - fundal height greater because more babies

Error in dates

23
Q

Size < Dates

A

IUGR
- Symmetric: equally poor growth velocity of head, abd, and long bones
MC causes: chromosomal abnlties, SMOKING, infx
- Asymmetric: head and long bones are spared compared to abd and viscera
MC causes: chronic HTN (MC cause overall)
- Other causes: maternal health conditions, extremes of age, teratogens, low SES, low pg weight, placental dz, malnutrition

Oligohydramnios

Congenital anomoly

Error in dates

24
Q

Screening recommendations

A

All pg women: Hep B, syphilis, HIV, UA/UC

If <25 AND engaging in high risk sexual behaviors also screened for GC/CT

25
Asymptomatic bactiuria
E. coli MC High rate of PPROM Tx: Cephalexin, 250mg po qid X 7days Test for cure
26
HIV screening
offer to everyone at initial visit If they decline at initial visit, do a rapid HIV screen at L&D
27
Varicella
If US born before 1980 or have had 2 documented vaccination, ok If unsure of status, get titers and can vaccinate AFTER delivery
28
CF screening
Offer to all women of reproductive age Most efficacious in non-Hispanic white and Ashkenazi Jewish ancestry
29
Parvovirus B-19
Slapped cheek disease or Fifth's Disease Embryotoxic, not teratogenic During 1st trimester --> miscarriage 2nd and 3rd trimesters --> hydrops fetalis and stillbirth
30
Gestational Diabetes
Generally do universal screening in practice but make sure to screen high risk patients earlier (first prenatal visit, otherwise wait until 24weeks) Individuals who are low risk theoretically do not need to be screened Two step approach to screening - initial screening: 50g OGTT; if >130 abnl - second step is any 3 hr OGTT with 2 or more abnl values (track over 3 hrs so fasting >95; 1h >180; 2h >155; 3h >140) OR can check plasma glucose: fasting >126 casual >200
31
High risk GDM
- marked obesity - PMHx of DMII - Glycosuria - Dx of PCOS - Strong FHx of DMII
32
Low risk GDM
Must meet ALL of the following: - ethnicity with low incidence of DM - no first degree relatives with DM - no past OB complications - no hx of abnl glucose tolerance - healthy, nl BMI before pg
33
MAFSP and Quad screening
Maternal serum alpha-fetoprotein (MSAFP) - neural tube defects Quad screening - aneuploidy, including Down's Screen between 16 - 18 weeks
34
Folic acid supplementation
All women of childbearing age - 0.4mg/day Hx of neural tube defects or have epilepsy - 4g/day
35
Screening US
Generally use to do a fetal anatomy survey at 20 weeks ``` Check for: fetal number fetal presentation documentation of fetal life placental location fetal biometry assessment of amniotic fluid voume ``` Accuracy of GA 1st: 3-7 days 2nd: 10-14 days 3rd: 2-3 weeks
36
Anemia in pg
all women should be screened for IDA because can lead to LBW, preterm delivery and perinatal mortality Give Fe supplementation
37
GBS screening
Universal screening at 35-37weeks Swab over vagina and rectum with same swab Tx with Pen G
38
When to give rhogam
Rh (-) mom, unsensitized who has: - ectopic pg - abortion (threatened, spontaneous, induced >12 wks gestation) - procedure w/ possible bleeding including CVS, amnio - delivers at 28 weeks - delivers a D+ baby *Note: if father is Rh- do not have to do any testing or give rhogam because there is no risk for the fetus of being positive Testing can be done with antibody testing - Coombs Risks: fetus gets hemolytic anemia
39
Antenatal testing when concern for fetal wellbeing
Fetal kick counts - 10 kicks over 2 hrs after 28 weeks Non stress test - Cardiotocographic method used after 34 weeks - Should be reactive: 2 or more accelerations in 20 minute period (>15bpm inc for >15 sec) - best predictor of fetal well being ``` Biophysical profile - usually obtained after NST - 5 different tests that are scored on a scale out of 10 Modified Biophysical Profile (MBP) - NST and AFI - equally reliable as full BPP ``` Amniotic fluid index - measures amount of amniotic fluid present as the sum of 4 pockets - measures polyhydramnios, oligohydramnios
40
When to go to the hospital - signs of labor
ROM - sudden gush of water, or constant dribble Ctxs q3-5 minutes for at least 1hr or increase in intensity Bleeding like a period (nl with cervical changes) Decreased fetal movement
41
Breastfeeding
Do q1-3hrs to best stimulate milk production Start within 1 hr of delivery Proper latching
42
Post Term Pg
>42 weeks Greatest concern is that placenta has finite lifetime, can get fetal dysmaturity Best to induce around 41 weeks

Women's Health (9 decks)

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