Prenatal care Flashcards
Low risk pregnancy, dr office visit schedule
- Extensive prenatal visit
- Every 4 weeks for first 24-28 weeks
- Every 2 weeks for 28-35 weeks
- Every week for 36-40 weeks
- Twice/week for 40-42 weeks
Minimum number of visits = 11
If LMP is unknown, what measurement can be used to determined gestational age between 6-11 weeks?
Fetal C-R or crown rump length between 6-11 weeks can define gestational age to +/- 7 days**
If LMP is unkown, what measurement can be used to determined gestational age 12-20 weeks?
U/S (c-r length) should define gestational age to +/- 10 days
GP count w TPAL
Term deliveries (G) Preterm deliveries (G) Abortions/losses (P) Living children (P)
Why do RPR) rapid plasma reagin in prenatal testing?
Screen for syphilis
What serology needs to be done to determine immunity in prenatal testing?
Rubella
List of infections to “worry about” during pregnancy
Toxoplasmosis-cat feces; blindness, mental retardation
Varicella
CMV– retinitis
HIV– high risk of vertical transmission in vaginal delivery; C/S mandatory
Parvovirus B 19 – hydrops (heart failure of the fetus)
HSV– encephalopathy, blindness
Group B strep– pneumonia, sepsis– (see third trimester
4 Autosomal recessive traits to screen for
Sickle cell
Thalassemia
Cystic fibrosis
Tay-sachs
Teratogenic medications
Warfarin
Chemo
Retinoids
DES
FAS
CNS involvement: can be structural (e.g., small brain size, alterations in specific brain regions) or functional (e.g., cognitive and behavioral deficits, sensory processing deficits, motor and coordination problems).
Small eye openings
Smooth philtrum
Thin upper lip
Seizure meds w pregnancy
Phenytoin: craniofacial and limb reduction
Valproic Acid: 1-2% risk of NTD
Carbamezapine: Elevated NTD risk
Phenobarbital: withdrawal, maternal/ fetal hemorrhage
Seizure during Pregnancy: maternal/fetal trauma from falls or burns, increased risk of premature labor, miscarriage, fetal hypoxia, and lowering of the fetal heart rate.
The benefits of anti seizure medication have to be weighed with the potential harm
First trimester bleeding : losses, percentages
First trimester bleeding occurs in 20% to 25% of pregnancies.
Of those pregnancies, estimates of pregnancy loss are ~ 25% -50%.
First trimester bleeding:
Risk of pregnancy loss or non-viability increases if:
Bleeding becomes heavy
Bleeding is accompanied with cramping or pain
First trimester bleeding:
Risk of preg loss/nonviability decreases significantly (to 3-7%) if:
Intrauterine gestation with + FHR is detected
BHCG values rise appropriately for gestational age (more on this later)
Normal overall weight gain in pregnancy
25-35lbs, single gestation
Initial BMI <20: should gain more
35-45 lbs
Initial BMI >35: should gain
up to 15 lbs
Vaccines which are live/attenuated and must be given > 3 months before or after pregnancy
Rubella
MMR
Varicella
Routine checkup, every trimester
Weight (watch for inappropriate weight gain)
Blood pressure (remember the normal pattern)
U/A (protein, glucose, ketones)
Fundal height measurement starting at 20 weeks
# cm’s from pubic symphysis to top of fundus
Watch for FH that is > 3 cm above or below gestational age
Listening to fetal heart tones (normal is from 120-160; should be present after 12 weeks)
Assess for edema
NOTE: routine vaginal exams and cervical checks not advised
How pregnancy causes varicose veins
Progesterone relaxes venous smooth muscle, causing slow venous return
valves become insufficient
Screening at second trimester
Trisomy/NTD
Fetal anatomic assessment
Fundal height measurement starts at
20 weeks
Fundal height measures from what to what
top of pubic symphysis to top of uterus
cms = # weeks gestation +/- 3 cm
Fetal movement first noted
18-22 weeks
“advanced maternal age” diagnosed when
patient will be >35 at due date
Subcutaneous fluid-filled space located between back of fetal neck and skin
Nuchal translucency
when is nuchal translucency measured
1st trimester, 11 weeks -13 weeks 6 days
possible indications of increased nuchal translucency
Cardiac failure
Abnormal development of the lymphatic system
Altered composition of the connective tissue under the nuchal skin
Venous congestion
Infection diseases12
Integrated prenatal screening (IPS), steps
1st trimetser: 11-13 weeks) nuchal translucency + maternal serum marker PAPP-A
2nd trimester: (15-20 weeks) maternal serum markers AFP, uE3, hCG
Serum Integrated prenatal screening (SIPS), steps
1st trimester: PAPP-A
2nd trimester: AFP, uE3, hCG, Inhibin-A
best option when NT not available
when to screen for gestational diabetes
24-28 weeks
earlier, then again at 28 weeks, if risk factors exist
If an infant delivers through a Group B Strep POsitive canal…
assocaited with sepsis, pneumonia, death
when to screen for group b strep
vaginal swab at 36 weeks
if present, Abx at labor
“favorable cervix”?
bishop’s score: dilation, length of cervix, station consistency, position
favorable = > 7 unfavorable = < 5
