Prenatal Care Flashcards
What are things you should do preconception?
- assess woman’s medical and obstetrical risk
- modify risk and start education before pregnancy
- be away of LMP before any testing or new medication
- be on folate supplementation
- rubella/VZV vaccine
- smoking cessation
- decrease alcohol
- diabetes care
- consider epilepsy meds
What are the facial characteristics for FAS?
epicanthal folds flat nasal bridge small palpebral fissues railroad track ears upturned nose smooth philtrum thin upper lip
what are the risks that can come with smoking during pregnancy?
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%
How long is gestation typically
40 weeks plus or minus 2 weeks
Pre-terms is…
less than 37 weeks
Term is…
37-42 weeks
Post-term is…
over 42 weeks
First trimester goes from when to when
LMP to 12 weeks
Second trimester…
13 -27 weeks
third?
28-term
What is EDD?
estrimated date of delivery or estimated due date
What is Naegle’s rule for determining the EDD?
First day of LMP-3 months + 7 days + 1 year
(implied with a normal 28 day cycle) fairly accurate
Besides Naegle’s rule, what are some other ways we can determine EDD?
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)
Talk throguh gravity and parity….
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)
What would be the GPfpal in a new first pregnancy?
G1P000
What about after that baby is delivered?
G1P1001
In general, wha tare the drug classifications during pregnancy?
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
What is an example of a category A?
prenatal vitamin
WHat is an example of category B?
azithromycin, cephalosporins, erythromycin, penicillins, sulfonamides
What is an example of category C?
aminoglycosides, fluoroquinolones, trimethroprim, vancomycin
What are examples of category D?
streptomycin, tetracyclines
What is an example of category X?
acutane
methotrexate, warfarin, DES, thalidomide, ACE inhibitors
What is the typical prenatal visit scheudle?
every 4 weeks starting at 6
every 2 weeks from 28-36
weekly from 36 weeks til delivery
What are some typical first trimester symptoms?
Nausea and vomiting Ptyalism (increased salivation) Fatigue Increased urination Swollen breasts Dizziness Food aversions and cravings Heartburn and constipation
What are two pelvi signs that a woman is pregnant?
Chadwick’s (dark bluish coloration of the vulva, vagina and cervix)
Hegar’s sign (uterine and cervical consistency become softer)
Typical what should you do on the initial prenatal visit?
lab testing
prenatal education and answer questions
domestic violence screening
depression screening
WHat are some of the labs you would do on the initial visit?
CBC UA ABO and Rh with antibody screen Rubella titer RPR for syphilis HBsAg for hep B HIV antibody
WHat are the three diseases you shoul dideally vaccinate for before pregnancy?
rubella
varicella
influenza
During general prenatal visits, what should you do for exam?
ask symtoms check weight blood pressures fundal height fetal heart tones abdominal palpation evaluation for edema
About how many extra calories does a woman need to eat when pregnancy
about 150 kcal/day in first trimester and extra 35 kcal/day during the last two trimesters
What is the typical maternal weight gain during pregnancy?
25-35 pounds
Besides folic acid, what should you supplement?
prenatal iron if anemic - 25-30 mg/day
What are the typical reasons to get an ultrasound?
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
When should you push for genetic screening
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
What is the newer test that’s noninvasive to test for Trisomy 21?
frgament fetal DNA in maternal circulation - super expensive still
What are the other ways to do genetic testing/check for abnormalities?
chorionic villous sampling
early amniocentesis
ultrasound examination
maternal serum screening
When do you do the chorionic villus sampling? amnio?
10-12 weeks for villus
13-18 for amnio
What US sign do you look for to assess Down’s risk?
nuchal lucency increased in downs
What do you look for on the amniocentesis?
check amniotic fluid for alpha fetoprotein
also look at the amniotic fetal cells for chromosome abnormalities or biochemical disorders
What does the QUad screen look at?
maternal serum alpha fetoprotein
hCG
Unconjugated estriol
Pregnancy associated plasma protein
NTD
elevated alpha fetoprotein
Tirsomy 18
decreased AFP, decreased hCG, decreased UE3
Trisomy 21
Decreased AFP, increased hCG
decreased UE3
What are the second trimester symtposm?
skin changes larger breast nasal and gum swelling leg cramps leukorrhea braxton-hicks
When do you do gestational diabetes screening?
24-28 weeks
do the 1 hour test after 50 grams of glucose
confirm with a 3 hour glucose tolerance test if abnormal
WHen do you give rhogam to an Rh- woman?
at 28 weeks gestation
and again within 72 hours of delivery if the infant is RhD positive
What are typical third trimester symptoms?
back ache weight gain SOB heartburn swelling varicose veins hemorrhoids frequent urination vaginal discharge braxton hicks
When should you consider a Tdap in pregnancy?
between 27 and 36 weeks
When should you give a Tdap to others before the expected delivery?
2 weeks prior to expected delivery
When do we test for GBS?
35-37 weeks with vaginal, rectal swab
How can we determine baby’s position on exam?
Leopold’s maneuvers
