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Endo/Repro > Prenatal Care > Flashcards

Prenatal Care Flashcards

1
Q

Preconception

A

Goal - assess woman’s medical and obstetrical risks -> start education before pregnancy
- BE AWARE of LMP prior to any testing or new Rx

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2
Q

Gestation

A

40 week +/- 2 weeks

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3
Q

Pre-term

A

gestational age <37 weeks

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4
Q

Term

A

gestational age 37-42 weeks

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5
Q

Post-term

A

gestational age >42 weeks

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6
Q

1st Trimester

A

from LMP to 12 weeks

embryo develops all major organs and becomes fetus

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7
Q

2nd Trimester

A

13-27 weeks

fetus continues to develop

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8
Q

3rd Trimester

A

28-40 weeks

fetus finishes developing and prepares for delivery

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9
Q

Estimated Date of Delivery

A

Naegele’s Rules - First day of LMP - 3 months + 7 days + 1 year

  • first trimester ultrasound
  • fetal heart tones (doppler 10-12 weeks)
  • Quickening = fetal movements (16-19 weeks)
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10
Q

G(n)P(fpal)

A 
Gravidity = # of times patient has been pregnant (including current pregnancy)
Parity = results of previous pregnancy
- f = # of full-term births
- p = # of pre-term births
- a = # of abortions, ectopics
- l = # of living children
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11
Q

Drug Classes

A

Category A = studies in humans no risk
Category B = studies in animals no risks
Category C = no adequate studies
Category D = evidence of fetal risk but benefit may outweigh risk
Category X = fetal risks clearly outweigh benefit

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12
Q

Prenatal Visits

A

Every 4 weeks starting at 6-8 weeks
Every 2 weeks from 28-36 weeks
Weekly from 36 to delivery

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13
Q

Chadwick’s sign

A

purple coloration of cervix when pregnant

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14
Q

Hegar’s sign

A

cervix becomes softer when pregnant

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15
Q

Immunizations during pregnancy

A

CAN’T give rubella or varicella –> need to know if they have been previously immunized
CAN give influenza

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16
Q

Ultrasound

A

Dating, diagnosis of anomalies, evaluation of mass, size and date, suspected miscarriages, suspected multiple gestation, vaginal bleeding, diagnostic procedures, monitor health

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17
Q

Genetic Screening

A 
Age > 35 with singleton, >32 with twins
Family History
Thalassemia
Sickle Cell
Tay-Sachs
Cystic Fibrosis
Significant Meds/Street Drugs
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18
Q

Noninvasive prenatal screening

A

tests fragments of fetal DNA

  • tests for Down’s
  • not recommended for general screening
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19
Q

Chorionic Villus Sampling

A 
DNA analysis for single gene disorders
Metabolic disorders
Performed transvaginal/transabdominal
increases risk of miscarriage
10-12 weeks
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20
Q

Amniocentesis

A

fluid - alpha-fetoprotein for open neural tube defects
- amniotic fetal cells = chromosome abnormalities or biochemical disorders
14-16 weeks

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21
Q

Quad Screen

A

Maternal Serum Alpha Fetoprotein -> open neural tube defects
hCG, UE3, PAPP-A
16-18 weeks

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22
Q

Gestational Diabetes

A

24-28 weeks gestation
Risks = >35 y.o., high BMI, family hx, previous gestational diabetes, hispanic, asian, native
- 1 hour test after 50 gram glucose load
- confirmed with 3 hour glucose tolerance test
- maternal glucose crosses placenta -> fetus produces insulin -> fetal macrosomia

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23
Q

Rhogam

A

testing for ABO blood group and RhD antibodies - first trimester
- Rho(D) Ig 300 mcg for nonsensitized women at 28 weeks gestation and within 72 hours of delivery if infant has RhD positive blood

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24
Q

Tdap in Pregnancy

A

between 27-36 weeks

- protect mom and baby from pertussis

25
Q

Group B Strep

A

all pregnant women offered screening
35-37 weeks
- treat intrapartum antibiotic prophylaxis

26
Q

Leopold’s Maneuvers

A

determine presentation of baby

27
Q

Maternal Mortality Major Complications

A 
Severe bleeding - after birth
Infections - after birth
High BP - pre-eclampsia, eclampsia
Obstructed labor
Unsafe abortion
28
Q

Gestational Diabetes Treatment

A 
Diet
Glyburide
Glucophage (metformin)
insulin therapy
Treatment --> achieve glucose levels 130mg/dL one hour postprandially
29
Q

Fetal Surveillance during gestational diabetes

A

2x weekly non-stress testing, amniotic fluid determinations beginnining early in 3rd trimester (done less)
- may facilitate delivery but need to ensure lung maturity

30
Q

Postpartum maternal management after deliver of gestation diabetes

A

most don’t need insulin

  • approx 50% of women develop type 2 diabetes -> screen for later
  • promote post-partum weight loss and breast feeding, exercise, and diet
31
Q

Pre-term labor

A

cervical change associated with uterine contractions prior to 37 weeks
- nulliparous woman = uterine contractions with 2 cm dilation and >80% effacement
- incidence in US is 11% —> A LOT
Risk Factors = premature rupture of membranes, multiple gestation, previous, hydramnios, uterine anomaly, cocaine

32
Q

Assessment for premature contractions

A 
gestational age?
membranes ruptured?
in labor?
infection?
likelihood they will deliver?
33
Q

Evaluation for premature contractions

A

speculum
ultrasound
digital exam -> dilation & effacement

34
Q

Assessment Markers

A

biophysical - measurement of cervical length by ultrasound
biochemical markers - fetal fibronection
prior preterm deliver <35 weeks

35
Q

Cervical length

A

<16 mm consider cerclage - stitch to prevent cervix from dilating
16-20 mm = best rest and re-measure in 1 week
21-25 mm = reduce activity and re-measure in 2 weeks

36
Q

Fetal fibronectin Assay

A

large glycoprotein thought to act as adhesive of fetal membranes to decidua
- better predictive value than cervical dilation or uterine activity in predicting imminent delivery
HIGH NEGATIVE PREDICTIVE VALUE

37
Q

Antenatal corticosteroids for lung maturation

A

betamethasone or dexamethasone -> benefit patients with PPROM and hypertensive syndromes

38
Q

Infections during pregnancy

A

UTI
Bacterial vaginosis
Group B strep
Chorioamnionitis

39
Q

Infections that affect fetus

A 
HSV, VZV, Parvo
CMV, Rubella, HIV
Neisseria
Chlamydia
Hepatitis B
Syphilis
Toxoplasmosis
40
Q

Undiagnosed vaginal bleeding in pregnant woman

A

Ultrasound first if available
Speculum exam if ultrasound not available
DON’T DO BIMANUAL EXAM

41
Q

Antepartrum bleeding

A 
placenta previa (painless bleeding) -> history of postcoital spotting
placenta abruption (painful contractions) -> stabilize patient, prepare for possible hemorrhage, prepare for delivery
Risk Factors - grand multiparity, prior c-section, prior uterine curettage, previous placenta previa, multiple gestation
- deliver by c-section
42
Q

Complete placenta previa

A

placenta completely covers internal cervical os

43
Q

Partial placenta previa

A

placenta partially covers internal cervical os

44
Q

Marginal placenta previa

A

placenta abuts against internal cervical os

45
Q

Low lying placenta

A

edge of placenta is within 2.3 cm of internal cervical os

46
Q

Placental abruption

A

premature separation of normally implanted placenta

47
Q

Vasa previa

A

umbilical cord vessels insert in the membranes with the vessels overlying internal cervical os -> vulnerable to fetal exsanguination upon rupture of membranes

48
Q

Placenta accreta

A

invasion of placenta into uterus -> more common with placenta previa

49
Q

Cephalic Presentations

A

L-occiput anterior (2 sutures), L-occiput transverse, L-occiput posterior (3 sutures)
R-occiput anterior, R-occiput transverse, R-occiput posterior

50
Q

Fetal presentations

A 
Face
Brow
Vertex
Breech - complete, incomplete, frank
- worry about hip dysplasia
Shoulder
51
Q

Hypertension

A

BP > 140/90 mmHg
chronic (before pregnancy), pregnancy induce hypertension (>20 weeks, no proteinuria), pre-eclampsia, eclampsia, HELLP
don’t use ACE-inhibitors –> associated with oligohydramnios and neonatal renal failure

52
Q

Pre-eclampsia

A

systolic BP >140/90 occurring after 20 weeks but has proteinuria (> 300mcg/24hrs)
- non-dependent edema usually present but not a criterion
- increased risk in subsequent pregnancies, chronic HTN, low dietary Ca
- reduce risk = Ca supplementation, low-dose aspririn
Tx = delivery (definitive), can use hydralazine or labetolol
- magnesium sulfate to prevent seizure

53
Q

Eclampsia

A

pre-eclampsia with new-onset grand mal seizure

- magnesium sulfate - anticonvulsant

54
Q

HELLP Syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelet count
- obtain nonstress test 2x weekly, measure amniotic fluid, biophysical profile, perform ultrasound every 3-4 weeks

55
Q

Bishop’s Score for Induction

A

0, 1, 2, 3
Higher the score, better results with an induction
Position - posteior, intermediate, anterior
Consistency - firm, intermediate, soft
Effacement- 0-30%, 40-50%, 60-70%, 80%
Dilation - 0, 1-2, 3-4, >5 cm
Fetal Station - -3, -2, -1-0, +1-2

56
Q

Cervical Ripening

A

mechanical ripening - balloon
oxytocin
PG - dinoprostone, misoprostol

57
Q

Treating Postpartum Depression

A

treatment is essential (SSRI, counseling, support)

DSM-5 = major depressive episodes with post-partum onset within 4 weeks of birth

58
Q

Antidepressants during pregnancy

A

Tricyclics - amitriptyline, nortriptyline
SSRIs
Burproprion

Endo/Repro (34 decks)

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