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ER Week 5 > Prenatal Care > Flashcards

Prenatal Care Flashcards

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1
Q

What are things you should do preconception?

A
  1. assess woman’s medical and obstetrical risk
  2. modify risk and start education before pregnancy
  3. be away of LMP before any testing or new medication
  4. be on folate supplementation
  5. rubella/VZV vaccine
  6. smoking cessation
  7. decrease alcohol
  8. diabetes care
  9. consider epilepsy meds
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2
Q

What are the facial characteristics for FAS?

A 
epicanthal folds
flat nasal bridge
small palpebral fissues
railroad track ears
upturned nose
smooth philtrum
thin upper lip
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3
Q

what are the risks that can come with smoking during pregnancy?

A

SMOKING-Increased risk of placenta previa, placenta abruption, ectopic pregnancy and preterm premature rupture of membranes. Maternal smoking increases the risk of stillbirth, intrauterine growth retardation and sudden infant death syndrome (SIDS). Estimated that smoking cessation would reduce all infant deaths by 10%

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4
Q

How long is gestation typically

A

40 weeks plus or minus 2 weeks

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5
Q

Pre-terms is…

A

less than 37 weeks

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6
Q

Term is…

A

37-42 weeks

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7
Q

Post-term is…

A

over 42 weeks

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8
Q

First trimester goes from when to when

A

LMP to 12 weeks

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9
Q

Second trimester…

A

13 -27 weeks

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10
Q

third?

A

28-term

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11
Q

What is EDD?

A

estrimated date of delivery or estimated due date

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12
Q

What is Naegle’s rule for determining the EDD?

A

First day of LMP-3 months + 7 days + 1 year

(implied with a normal 28 day cycle) fairly accurate

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13
Q

Besides Naegle’s rule, what are some other ways we can determine EDD?

A

An ultrasound during the first trimester

you can also use clinical judgement based on when you can ear heart tones (10-12 weeks) or when the woman feels quickening (18-19 weeks if primigravida, 16-17 if multigravida)

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14
Q

Talk throguh gravity and parity….

A

Gravity = how many times patient has been pregnancy including current pregnancy

Parity - results of previous pregnancies
F - # of full term
P = # of pre-term births
A = # abortions - elected or spontaneous, ectopics included
L - # of living children

(Florida Power and Light)

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15
Q

What would be the GPfpal in a new first pregnancy?

A

G1P000

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16
Q

What about after that baby is delivered?

A

G1P1001

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17
Q

In general, wha tare the drug classifications during pregnancy?

A

category A - studies in humans show no risk
B - studies in animals show no risk
C - no adequate studies
D - evidence of fetal risk, but benefit may outweigh the risk
X - fetal risk clearly outweight benefit

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18
Q

What is an example of a category A?

A

prenatal vitamin

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19
Q

WHat is an example of category B?

A

azithromycin, cephalosporins, erythromycin, penicillins, sulfonamides

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20
Q

What is an example of category C?

A

aminoglycosides, fluoroquinolones, trimethroprim, vancomycin

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21
Q

What are examples of category D?

A

streptomycin, tetracyclines

22
Q

What is an example of category X?

A

acutane

methotrexate, warfarin, DES, thalidomide, ACE inhibitors

23
Q

What is the typical prenatal visit scheudle?

A

every 4 weeks starting at 6
every 2 weeks from 28-36
weekly from 36 weeks til delivery

24
Q

What are some typical first trimester symptoms?

A 
Nausea and vomiting
Ptyalism (increased salivation)
Fatigue
Increased urination
Swollen breasts
Dizziness
Food aversions and cravings
Heartburn and constipation
25
Q

What are two pelvi signs that a woman is pregnant?

A

Chadwick’s (dark bluish coloration of the vulva, vagina and cervix)

Hegar’s sign (uterine and cervical consistency become softer)

26
Q

Typical what should you do on the initial prenatal visit?

A

lab testing
prenatal education and answer questions
domestic violence screening
depression screening

27
Q

WHat are some of the labs you would do on the initial visit?

A 
CBC
UA
ABO and Rh with antibody screen
Rubella titer
RPR for syphilis
HBsAg for hep B
HIV antibody
28
Q

WHat are the three diseases you shoul dideally vaccinate for before pregnancy?

A

rubella
varicella
influenza

29
Q

During general prenatal visits, what should you do for exam?

A 
ask symtoms
check weight
blood pressures
fundal height
fetal heart tones
abdominal palpation
evaluation for edema
30
Q

About how many extra calories does a woman need to eat when pregnancy

A

about 150 kcal/day in first trimester and extra 35 kcal/day during the last two trimesters

31
Q

What is the typical maternal weight gain during pregnancy?

A

25-35 pounds

32
Q

Besides folic acid, what should you supplement?

A

prenatal iron if anemic - 25-30 mg/day

33
Q

What are the typical reasons to get an ultrasound?

A 
dating
dx uterine anomaly
evaluation of pelvic mass
size and date discrepancies
suspected miscarriage
suspected multiple gestation
vaginal bleeding
prenatal diagnostic procedure for major fetal abnormalities
monitor fetal health for breathing, body  movements, fetal tone and umbilical blood flow
34
Q

When should you push for genetic screening

A

age over 35 with singleton
age over 32 with twins
family history of thalassemia, sickle cells, tay-sachs, cystic fibrosis
significant meds or street drug use

35
Q

What is the newer test that’s noninvasive to test for Trisomy 21?

A

frgament fetal DNA in maternal circulation - super expensive still

36
Q

What are the other ways to do genetic testing/check for abnormalities?

A

chorionic villous sampling
early amniocentesis
ultrasound examination
maternal serum screening

37
Q

When do you do the chorionic villus sampling? amnio?

A

10-12 weeks for villus

13-18 for amnio

38
Q

What US sign do you look for to assess Down’s risk?

A

nuchal lucency increased in downs

39
Q

What do you look for on the amniocentesis?

A

check amniotic fluid for alpha fetoprotein

also look at the amniotic fetal cells for chromosome abnormalities or biochemical disorders

40
Q

What does the QUad screen look at?

A

maternal serum alpha fetoprotein
hCG
Unconjugated estriol
Pregnancy associated plasma protein

41
Q

NTD

A

elevated alpha fetoprotein

42
Q

Tirsomy 18

A

decreased AFP, decreased hCG, decreased UE3

43
Q

Trisomy 21

A

Decreased AFP, increased hCG

decreased UE3

44
Q

What are the second trimester symtposm?

A 
skin changes
larger breast
nasal and gum swelling
leg cramps
leukorrhea
braxton-hicks
45
Q

When do you do gestational diabetes screening?

A

24-28 weeks

do the 1 hour test after 50 grams of glucose

confirm with a 3 hour glucose tolerance test if abnormal

46
Q

WHen do you give rhogam to an Rh- woman?

A

at 28 weeks gestation

and again within 72 hours of delivery if the infant is RhD positive

47
Q

What are typical third trimester symptoms?

A 
back ache
weight gain
SOB
heartburn
swelling
varicose veins
hemorrhoids
frequent urination
vaginal discharge
braxton hicks
48
Q

When should you consider a Tdap in pregnancy?

A

between 27 and 36 weeks

49
Q

When should you give a Tdap to others before the expected delivery?

A

2 weeks prior to expected delivery

50
Q

When do we test for GBS?

A

35-37 weeks with vaginal, rectal swab

51
Q

How can we determine baby’s position on exam?

A

Leopold’s maneuvers

ER Week 5 (6 decks)

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