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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
Group B Strep
all pregnant women offered screening 35-37 weeks - treat intrapartum antibiotic prophylaxis
26
Leopold's Maneuvers
determine presentation of baby
27
Maternal Mortality Major Complications
``` Severe bleeding - after birth Infections - after birth High BP - pre-eclampsia, eclampsia Obstructed labor Unsafe abortion ```
28
Gestational Diabetes Treatment
``` Diet Glyburide Glucophage (metformin) insulin therapy Treatment --> achieve glucose levels 130mg/dL one hour postprandially ```
29
Fetal Surveillance during gestational diabetes
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
Postpartum maternal management after deliver of gestation diabetes
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
Pre-term labor
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
Assessment for premature contractions
``` gestational age? membranes ruptured? in labor? infection? likelihood they will deliver? ```
33
Evaluation for premature contractions
speculum ultrasound digital exam -> dilation & effacement
34
Assessment Markers
biophysical - measurement of cervical length by ultrasound biochemical markers - fetal fibronection prior preterm deliver <35 weeks
35
Cervical length
<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
Fetal fibronectin Assay
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
Antenatal corticosteroids for lung maturation
betamethasone or dexamethasone -> benefit patients with PPROM and hypertensive syndromes
38
Infections during pregnancy
UTI Bacterial vaginosis Group B strep Chorioamnionitis
39
Infections that affect fetus
``` HSV, VZV, Parvo CMV, Rubella, HIV Neisseria Chlamydia Hepatitis B Syphilis Toxoplasmosis ```
40
Undiagnosed vaginal bleeding in pregnant woman
Ultrasound first if available Speculum exam if ultrasound not available DON'T DO BIMANUAL EXAM
41
Antepartrum bleeding
``` 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
Complete placenta previa
placenta completely covers internal cervical os
43
Partial placenta previa
placenta partially covers internal cervical os
44
Marginal placenta previa
placenta abuts against internal cervical os
45
Low lying placenta
edge of placenta is within 2.3 cm of internal cervical os
46
Placental abruption
premature separation of normally implanted placenta
47
Vasa previa
umbilical cord vessels insert in the membranes with the vessels overlying internal cervical os -> vulnerable to fetal exsanguination upon rupture of membranes
48
Placenta accreta
invasion of placenta into uterus -> more common with placenta previa
49
Cephalic Presentations
L-occiput anterior (2 sutures), L-occiput transverse, L-occiput posterior (3 sutures) R-occiput anterior, R-occiput transverse, R-occiput posterior
50
Fetal presentations
``` Face Brow Vertex Breech - complete, incomplete, frank - worry about hip dysplasia Shoulder ```
51
Hypertension
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
Pre-eclampsia
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
Eclampsia
pre-eclampsia with new-onset grand mal seizure | - magnesium sulfate - anticonvulsant
54
HELLP Syndrome
Hemolysis Elevated Liver enzymes Low Platelet count - obtain nonstress test 2x weekly, measure amniotic fluid, biophysical profile, perform ultrasound every 3-4 weeks
55
Bishop's Score for Induction
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
Cervical Ripening
mechanical ripening - balloon oxytocin PG - dinoprostone, misoprostol
57
Treating Postpartum Depression
treatment is essential (SSRI, counseling, support) | DSM-5 = major depressive episodes with post-partum onset within 4 weeks of birth
58
Antidepressants during pregnancy
Tricyclics - amitriptyline, nortriptyline SSRIs Burproprion

Endo/Repro (34 decks)

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