Prenatal care Flashcards
When is an ultrasound indicated in prenatal care?
- Evaluation of uncertain gestational age
- Size/date discrepancies
- Vaginal bleeding
- Multiple gestations
- Other high risk
What labs are recommended at the initial prenatal visit?
- CBC
- Hep B surface antigen
- HIV testing
- Syphillis screening (RPR)
- UA + culture
- Rubella antibody
- Blood type and Rh status with antibody screen
- Pap smear
- Cervical swab for gonorrhea and chlamydia
When is the optimal time to screen for trisomy?
- 16-18 weeks of gestation is optimal
* Trisomy screening may be performed between 15-20 weeks if necessary
At what time is the fetus most exposed to risks against development?
-3-8 weeks (organogenesis)
What level of radiation exposure could be harmful to the fetus?
> 5 rads (most x-rays provide a small fraction of this)
What drug/supplements are advised to be started in the pre-conception period?
- 400 micrograms of folic acid for one month prior to attempting to conceive
- 1mg for diabetic or epileptic women
- 4mg for women who have had children with neural tube defects
Which groups could be genetically screened for sickle cell trait?
- Africans and African Americans
Which groups could be genetically screened for Tay-Sachs trait?
French- Canadians or Ashkenazi Jews
Which groups could be genetically screened for thalassemia trait?
Middle Easterners and Southeast Asians
Which groups could be genetically screened for cystic fibrosis trait?
Ashkenazi Jews and Caucasians
At what age should women be educated about age related risk of pregnancy?
> 35
What conditions of the mother constitute high risk pregnancies?
- diabetes
- asthma
- thyroid disease
- hypertension
- lupus
- thromboembolism
- seizures
How is the delivery date calculated?
- Delivery date (Naegele’s rule) = first day of LMP - 3 months + 7 days
What history should be obtained in the initial prenatal visit?
- medical history
- prior pregnancies
- delivery outcomes
- pregnancy complications
- neonatal complications
- birth weights
- gynecologic history: mentruation, contraceptive use, STIs
- allergies
- current meds, vitamins, OTC drugs
- substance use
- social history: planned, unplanned, unintentional
What should be assessed in initial physical examination at the first prenatal visit?
- Height, weight, blood pressure
- Thyroid
- Breast, pelvic, and general physical
- Gestational age (uterine size or fundal height)
- Fetal heart tones by doppler (by 10 weeks)
What initial labs should be done during the first prenatal visit?
- blood type and Rh status antibody screen
- rubella status, HIV, hep B surface antigen, rapid plasma reagin
- Urinalysis, urine culture
- Papsmear, cervical swab for gonorrhea and chlamydia
- CBC
What is the typical schedule for prenatal visits?
- Every 4 weeks until 28 weeks
- Then, every 2 weeks from 28-36 weeks
- Then, every week until delivery
What are the ramifications of a hemoglobin less than 10.5?
- Preterm delivery
- Low fetal iron stores
- Thalassemia in the mother
What diagnostic test should be done if the mother has a hemoglobin less than 10.5?
- Mild: therapeutic trial of iron
- Moderate: ferritin and Hb electrophoresis
Are the ramifications of having negative titers to rubella?
- Mother is susceptible to rubella infection and vertical transmission if contracted
- Live attenuated vaccine should be given in the postpartum period
What are the ramifications of a positive RPR?
- Possible syphillis, test for specific antibody to confirm, then stage disease
- Penicillin should be administered to the mother if positive
What are the ramifications of gonorrhea during pregnancy?
- Preterm labor
- Blindness
What should be given to treat gonorrhea during pregnancy?
- IM ceftriaxone
What are the ramifications of chlamydia during pregnancy?
- neonatal blindness
- pneumonia
What should be given to treat chlamydia during pregnancy?
- Azithromycin
- Amoxicillin
- both po
What are the ramifications of a positive Hep B surface antigen?
- Mother is potentially infectious and the baby needs Heb B immunoglobins and hepatitis B vaccine
What is the ramification of a positive urine culture?
- Asymptomatic bacteriuria that may lead to pyelonephritis in up to 25% of patients
How should a positive urine culture be treated in pregnancy?
- Treat with Abx and recheck urine culture
- If the organism is GBS then give penicillin in labor
What might nuchal translucency indicate?
Nuchal translucency may indicate trisomy
What is the next step if nuchal translucency is seen (11-13wks)?
- karyotype and follow up ultrasounds
What is the next step with a positive trisomy screen (16-20 weeks)?
- Ultrasound
- Genetic amniocentesis
Which is more specific/sensitive, the triple or quad screening?
- Quad screening is 80% sensitive and 95% specific (triple screen is only 65-69% sensitive but just as specific)
What is the most common cause of false positives in aneuploidy screening?
Incorrect gestational age
When can amniocentesis be performed and what is the associated risk?
- Amniocentesis can be preformed at 15 weeks and is associated with a 0.5% risk of spontaneous abortion
When should women be tested for gestational diabetes?
- 24-28 weeks with a 1 hr 50mg glucose challenge test
When should a pregnant woman receive Rh-o (D) immune globulin if she is Rh-negative?
- 28 weeks
When should women receive a GBS screening?
- Vaginorectal culture at 35-37 weeks
When would a late term pregnancy be considered for inducing labor?
42 weeks
What vaccines should be given to pregnant women?
- Flu
- Tetanus toxoid
- Rubella after the child is born
