Prenatal Care Flashcards
Presumptive signs
Changes in breast Cessation of menses Chadwick sign Changes in mucus Thermal signs Inc skin pigmentation
Changes related to hormones
Not uterus and fetus
Presumptive
Presumptive sx
NV
Breast tenderness
Urinary disturbance
Fatigue
Changes related to uterus or placenta
Probable
Enlargement of abdomen Ballottement Physical outlining Braxton Hick's Hegar's sign Goodell's sign Changes in cervix Positive pregnancy test
Changes related to fetus
Definitive
Fetal heart tones
Fetal movement
Utz
Fetal heart
Ultrasound
Doppler
Stethoscope
5 w
10 w
17-19 w
Naegele’s rule
Add 7 days
Subtract 3 mos
Asx bacteriura tx
Nitrofurantoin
Amoxicillin
First gen ceohalosporin
X 7d
Follow up
Every 4 weeks until 28
2 until 36
Weekly
Weight gain for BMI 19.8-26
25-35 lbs
Iron supplement
27-30 mg
Zinc
12 mg/day
Iodine
220 mcg/day pregnant
290 lactating
Safe immunization
Hepa A and B pre and post exposure
Pneumococcus HR
Meningococcus outbreaks
Influenza
Pathologic causes of leukorrhea
BV metro
Trichinoniasis metro
Candidiasis mico clotri nystatin
Discrepancy of fundal size
+/- 3 cm
Obstetrical milestones
16-18 wks
Maternal screening for NTDs and chromosomal abnormalities
Obstetrical milestones
24-28 wks
GDM screening
Rhogam administration
Fetal counting at 28: 8-10/2 h
Obstetrical milestones
28-32 wks
Repeat Hgb and Hct
Obstetrical milestones
35-37 wks
GBS infection screening
Obstetrical milestones
>41 wks
Non stress test
Indications for GBS prophylaxis
Previous infant
GBS bacteriuria
Positive GBS screening
Unknown GBS + delivery of 18h/ intrapartum temp >38
Intrapartum prophylaxis
PenG alt: Ampicillin
Allergy: LR Cefazolin HR Erythromycin or Clindamycin
Fetal Assessment
Kick count
NST
CST
BPP
Reactive NST
2 or more FHR accelerations in 20 mins that peak at least 15 bpm above baseline lasting for 15 sec
Rpt weekly
Negative CST
3 contractions in 10 minutes
No late decelerations
Positive CST
Repetitive late decelerations in 3UCs in 10 mins
Deliver
Equivocal suspicious
Int late decel
Significant variable decel
Equivocal hyperstimulatory
UCs more freq than every 2 min or lasting longer than 90 s
5 BPP components
FHR acceleration reactive NST Fetal breathing 1/30s Fetal movements 3/30m Fetal tone 1/30m AFV >2 cm
BPP 10 to 8 normal AFV 8 abnormal AFV 4-6 0-2
Norm rpt test wkly and twice wkly for DM and post term
Chronic asphyxiated >37 deliver 36 or AFV ABNORMAL deliver 6 observe
Almost certain fetal asphyxia deliver
Single most important indicator of an adequately oxygenated fetus
Baseline or beat to beat variability
6-25
Causes of deceleration
Early mirror image
Variable
Late
Head compression
UC compression
Uteroplacental insufficiency
Candidates for Prenatal Diagnosis
Primigravid >35 Twin gestation >31 Autosomal trisomy Triple X or Klinefelter Chromosomal abnormalities Spontaneous abortions Major structural defect
Most common isolated structural defects
Congenital Heart Defects
Second most common
NT defects
RF: FH
Major serum protein in the embryo-fetus
Maternal Serum AFP screening
14-22 wks
Multiple of median
Five cranial signs of NTD
Small BPD
Ventriculomegaly
Frontal bone scalloping “Lemon sign”
Elongation and downward displacement of the cerebellum “Banana sign”
Effacement or obliteration of Cisterna Magnus
Down syndrome
Low AFP
Low estriol
High HCG
High Inhibin
