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Prenatal Care Flashcards

1
Q

What to evaluate preconception

A 
Regular menstrual cycles
Chronic medical conditions
Current meds (pregnancy safe??)
Age (AMA >35 YO)
Substance use
Reproductive and family history
Nutrition and physical activity
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2
Q

Important immunizations for preconception care

A 
MMR
Varicella
Hep B
Flu
Tdap (even while pregnant most are for before)
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3
Q

1 recommendation for preconception care

A

Good control of medical illnesses

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4
Q

Prenatal vitamins?

A

Folic acid and DHA (this may help ward off postpartum depression)
Folic acid .4-.8 mg (4 mg if NTD)
Begin 1 mo before concieving b/c neural tube closes by 4th week of pregnancy

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5
Q

Why have prenatal care?

A

Ensure birth of healthy baby while monitoring risk of mom
Pt education and establish trust
Early u/s, ID risks, ongoing evaluations, anticipate probs

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6
Q

What to check for on preconception exam?

A

BMI
Dental caries!!
Cardiac/pulm
Pelvic exam

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7
Q

When is the first visit recommended

A

First trimester (ideal b/w 8-10 wks)- most accurate u/s dating occurs in first trimester

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8
Q

Routine labs before conception

A

HIV (if indicated TSH and HbA1c)

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9
Q

Pertinent items of history

A 
GYN history
Intended or unintended pregnancy
Domestic violence
Substance use
Inherited diseases
Barriers to routine visits
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10
Q

Important components to obstetrical history at first visit

A

Gravida: v, para w, x, y, z, (TPAL)

v: # of pregnancies
w: # of full term births (after 37 wks)
x: # of preterm births
y: # of abortions
z: # of living kids

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11
Q

3 living children born full term, 1 ectopic pregnancy, currently pregnant

A

G5, P3013

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12
Q

Definition of termed pregnancy

A

Early: 37 0/7 wks- 38 6/7 wks
Full term: 39 0/7 wks-40 6/7 wks
Late term: 41 0/7 wks-41 6/7 wks
Post term: 42 0/7 wks and beyond

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13
Q

What is Naegele’s rule?

A

Add 7 days to LMP and subtract 3 months to get estimated date of delivery

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14
Q

Physical exam done at first visit

A 
General (constitutional, skin, thyroid, pulm etc, BMI)
Breast exam (montgomery tubercles, dilated veins, enlarged breasts, expanding areola, TTP)
Pelvic exam (uterus size, shape and adnexa, Chadwicks sign, Hegars sign, specimen)
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15
Q

Chadwick’s sign

A

Blue to purple tint of vaginal wallks/cervix

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16
Q

Hegar’s sign

A

Palpable softening of isthmus

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17
Q

First step lab at first prenatal visit

A

Urine HCG

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18
Q

Other labs at first prenatal visit

A

Specimen collection from pelvic (pap, G&C), CBC, blood type and Rh, antibodies, rubella and varicella titers, syph, hep B antigen test, HIV, UA and urine culture (maybe TSH, cystic fibrosis, TB, Ha1c)

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19
Q

Why is u/s done on first prenatal visit?

A

Confirm EDD is crucial (fetus can vary 5-7 days from EDD)
Transvaginal u/s can see cardiac activity as early as 5.5-6.5 wks
R/o ectopic

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20
Q

Common items to avoid in pregnancy

A

Tuna, shark, swordfish, mackerall, tile fish (mercury)
Raw meat and eggs
Hot dogs, deli meat, unpasteurized deli prodcuts
More than 200 mg caffeine daily (1 cup)
No ceviche

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21
Q

Recommendation for exercise in pregnancy

A

150 min weekly during and after pregnancy

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22
Q

Trimester dates

A

1: week 1-12w6 days
2: week 13-26 wk 6 days
3: week 27- end of pregnancy

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23
Q

Frequency of visits first 28 wks

24
Q

Frequency of visits 28-36 wks

25
Frequency of visits from 36 wks on
Weekly
26
Fetal movement based on wks
1st pregnancy 18-20 wks (quickening) 2+ pregnancies 16-18 wks Fetal kick counts begin at 3rd trimesters (10 kicks/rolls/flutters within 2 hrs)
27
When can you detect fetal heart tones?
Dopple at 10-12 wks (110-160 WNL)- probs not til 12
28
Where should the fundal height be at 12 wks?
Pubic symphysis
29
Where should the fundal height be at 20 wks?
Umbilicus
30
What can happen to fundus at 36-28 wks?
Can drop due to fetus dropping into pelvis (LIGHTENING) and decreasing AFI
31
Exams done at subsequent visits
``` BP FHT Fundal height Extremities Urine sample always (protein and levels glucose) ```
32
How to determine fetal gender
Determine with serum draw-NIPT as early as 9 wks gestation | Determine with u/s as early as 16 wks gestation
33
When to do u/s in 2nd trimester?
18-22 wks GA- anatomy u/s and fetus can vary 10-14 days from EDD
34
What to educate about in 2nd trimester?
Abnormal lab values, pediatricion, flu vaccine, preterm labor precautions, gestational diabetes testing, Tdap, cord blood banking
35
When to do lab draw in 3rd trimester?
24-28 (28!!!!!!) wk lab draw
36
1 hr glucose challenge in 3rd trimester
50 gram oral glucose load <140 mg/dl is pass >140 abnormal (proceed to 3 hr glucose tolerance) >200 (automatic fail and gestational DM)
37
3 hr glucose tolerance test in third trimester
100 g oral glucose load and 4 total blood draws: Fasting <95 1 hr <180 2 hr <155 3 hr<140 2 abnormal values is fail and one value exceeding 200 is automatic fail and gestational DM
38
When do lab rhogram and they are RhD negative
Need Rh immune globulin 300 ug given between 28-30 wks
39
What is done in visit in third trimester
U/s: evaluate fetal growth, fetal position, state of placenta and AFI (between 32-34 wks of GA) Leopold maneuvers-feel baby positioning
40
What should be done at 35-40 wks?
Cervical exams (dilation, effacement, station, position, presenting part)
41
When to do group b strep culture
Swab lower vagina and rectum between 35-37 wks GA
42
What to do if group b strep culture is +
Intrapartum abx prophylaxis to prevent neonatal GBS
43
Asymptomatic group B strep in mother
Not treated unless colony forming units EXCEED 10 to the 4 (intrapartum abx regardless of count) Can get intra amniotic infection, postpartum endometritis and bacteremia
44
Early onset neonatal GBS
Sx onset <24 hrs from birth (sepsis, pneumonia, meningitis)
45
Late onset neonatal GBS
Sx onset in 4-5 wks from birth (bacteremia, meningitis, focal infections)
46
What is Bishop scoring used for?
Induction 8-13 pts: highest change of successful induction 0-4 pts: highest change of failed induction *measure dilation, effacement, station, cervical consistency, position of cervix
47
What to do with high risk pregnancy in third trimester?
NST and biophysical profile (BPP)
48
What is NST?
Tracing of fetal HA and uterine activity x 20 min | Minimum of 2 accelerations (accelerations must increase in FHR by 15 bpm and lasts for 15 seconds)
49
What is a BPP?
Fetal u/s monitoring: movement, muscle tone, breathing movements, amniotic fluid level and HR
50
Pt education third trimester
Anesthesia, fetal kick counts, preterm labor precautions, breast feeding, postpartum contraception, FMLA, GBS, counseling
51
NT scan
b/w 11 wks GA and 13.6 wks GA Determination of nuchal translucency Thickened NT is soft marker for down syndrome
52
First trimester screening
Serum draw that coincides with NT scan Measure PAPP-A and Beta HCG If elevated soft markers for Down syndrome and Edwards
53
Non-invasive perinatal screening
Serum draw can be as early as 9 wks GA Fetal fraction of 8% needed for best performance Drawn in place of FTS if done with NT scan Expensive so pts might prefer FTS
54
AFP only
Maternal serum marker AFP Performed b/w 15-21.6 wk GA Elevated can indicate NTD
55
Maternal serum screen
Quad screen! Draw if NT/FTS not performed (only AFP id they were done) B/w 15-21.6 wk Ga (best between 16-18 wk) Measure AFP, uE3, hCG, inhibin A Screen for neural tube defects, downs and edwards syndrome
56
Common complaints
N/v, fatigue, back pain, HA/dizzy, hemorrhoids/constipation, GERD, vaginal discharge, round ligament pain, urinary frequency, bleeding, cramping, sciatica, swelling

X Women's Health (4 decks)

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