prenatal care

Question 1

placenta functions

Answer 1

interface between the mother and feuts. prevents rejection of fetal allograft. metabolic, endocrine, produces hormones. nutrition, oxygen, and protection

Question 2

placental hormones

Answer 2

hCG:maintains corpus luteum (secretes prgesterone
insulin like growth factors: fetal growth regulation
progesterone: maintains endometrial lining keeps uterus relaxed.
estrogen: stimulates uterine growth and mammry gland dev.
glucocorticoids: organ dev and maturation

Question 3

four weeks gestation

Answer 3

home pregnancy tests are now positive.

Question 4

six weeks gestation

Answer 4

cardiac motion can be detected; fetus is most susceptible to drugs, disease, and other factors that interfere with nl growth

Question 5

twelve weeks gestation

Answer 5

rates of miscarriage drops after this week

Question 6

sixteen weeks gestation

Answer 6

bones, muscles and organs developed and functioning.

Question 7

twenty weeks gestation

Answer 7

nervous system starts to function and sex is fully developed

Question 8

24 wks gestation

Answer 8

responds to sounds considered viable after 23 weeks

Question 9

28 wks gestation

Answer 9

brain wave pattern

Question 10

32 wks gestation

Answer 10

layer of fat forming. fetus will gain more than half its weight between now and delivery

Question 11

36 wks

Answer 11

considered term

Question 12

GI maternal changes

Answer 12

decrease in motility. N/V

Question 13

pulmonary changes maternal

Answer 13

increased oxygen demands, dyspnea of pregnancy perceived sob, no sig changes in actual lung volumes

Question 14

cardiovascular changes maternal

Answer 14

increased CO.

Question 15

Heme changes maternal

Answer 15

physiologic anemia of pg. hypercoagulability

Question 16

renal and irnary tract changes

Answer 16

frequency and nocturia, urgency, increased renal plasma blood flow

Question 17

G PTPAL

Answer 17

G=gravida (number of pregnancies)
P=para (number of completed pregnancies)
T=term
P=preterm
A= abortion
L= living

Question 18

common sxs with pg

Answer 18

n/v, heartburn, constipation, urinary frequency, round ligament pain, backache

Question 19

follow up frequency

Answer 19

every 4 wks until 28-32
every 2 weeks until 36 wks
every week until delivery

Question 20

macrosomia

Answer 20

feuts with an estimated weight greater than 4500 gm. risk with fetal factors or maternal factors. increased maternal and fetal risk especially during delivery

Question 21

polyhydramnios

Answer 21

excessive accumulation of amniotic fluid, indication of fetal anomalies, risk for maternal complications during delivery (size> dates)

Question 22

Intrauterine growth restriction

Answer 22

main pre req for determining is precise dating. symmetrc is equally poor growth and assymetric is head and long bones are spared compared with the abs and viscera

Question 23

Intrauterine fetal growth

Answer 23

maternal wt gain, symphisis fundal height, US exam

Question 24

doppler velocimetry

Answer 24

in cases of placental insufficiency, the low resistance of the placental blood vessels increase, yielding a detectable decrease in diastolic flow in the umbilical artery. In setting of IUGR doppler US be used to assess fetal status

Question 25

risk factors for IUGR

Answer 25

HTN, DM, smoking/substance use and abuse

Question 26

IUGR prevention

Answer 26

nutrition, supplementation, maternal health, infection

Question 27

tobacco and pg

Answer 27

most preventable cause of IUGR. reduction of fetal weight related to number of cigs smoked per day.

Question 28

pg screening

Answer 28

all get hep b, hiv, syph test and at risk get chlamydia and gon

Question 29

safe abx vs unsafe in pg

Answer 29

safe: amoxicillin, ampicillin, clindamycin, erythromycin, pen, cephs unsafe: tetracyclines, nitrofurantoin, sulfonamides

Question 30

screening US

Answer 30

looks for fetal number, presentation, biometry, assessment of amniotic fluid, survery of anatomy for gross malformation

Question 31

intrapartum prophylaxis for GBS

Answer 31

pen G, ampicillin, or cefazolin.

Question 32

antenatal testing

Answer 32

testss of fetal wellbeing in circumstances where is convern to prevent adverse outcomes. fetal kick counts, non stress test, biophysical profiles, amniotic fluid index

Question 33

indications for antenatal testing

Answer 33

``` abnormal fetal hr fundus size different than dates decreased fetal mvmts fetal growth restriction amniotic fluid abnormalities postterm pg multiple gestation diabetes hypertensive disorders history of prior stillbirth ```

Question 34

non stress test

Answer 34

used after 34 wks. reactive is 2 or more accelerations in a 20 min period: > 15 bpm increases in hr for > 15 seconds.

Question 35

biophysical profile

Answer 35

obtained after a non-reactive NST. presence or absence of 5 components in 30 min: reactive NST, 1 episode of fetal breathing mvts lasting 30 sec, 3 discrete body or limb mvmts, 1 episode of extremity extension with return to flexion or opeing or closing of hand, max vertical AF pocket > 2 cm, or AFI > 5cm. 6/10 repeat in 24 hours. 4/10 is abnormal.

Question 36

amniotic fluid volume (AFI)

Answer 36

sum of 4 pockets = 8.1-24 cm is normal

Question 37

modified BPP

Answer 37

NSTand and AFI. as reliable as a full BPP.