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X Women's Health > Prenatal Care > Flashcards

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

A

q 4 wks

24
Q

Frequency of visits 28-36 wks

A

q 2 wks

25
Q

Frequency of visits from 36 wks on

A

Weekly

26
Q

Fetal movement based on wks

A

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
Q

When can you detect fetal heart tones?

A

Dopple at 10-12 wks (110-160 WNL)- probs not til 12

28
Q

Where should the fundal height be at 12 wks?

A

Pubic symphysis

29
Q

Where should the fundal height be at 20 wks?

A

Umbilicus

30
Q

What can happen to fundus at 36-28 wks?

A

Can drop due to fetus dropping into pelvis (LIGHTENING) and decreasing AFI

31
Q

Exams done at subsequent visits

A 
BP
FHT
Fundal height
Extremities
Urine sample always (protein and levels glucose)
32
Q

How to determine fetal gender

A

Determine with serum draw-NIPT as early as 9 wks gestation

Determine with u/s as early as 16 wks gestation

33
Q

When to do u/s in 2nd trimester?

A

18-22 wks GA- anatomy u/s and fetus can vary 10-14 days from EDD

34
Q

What to educate about in 2nd trimester?

A

Abnormal lab values, pediatricion, flu vaccine, preterm labor precautions, gestational diabetes testing, Tdap, cord blood banking

35
Q

When to do lab draw in 3rd trimester?

A

24-28 (28!!!!!!) wk lab draw

36
Q

1 hr glucose challenge in 3rd trimester

A

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
Q

3 hr glucose tolerance test in third trimester

A

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
Q

When do lab rhogram and they are RhD negative

A

Need Rh immune globulin 300 ug given between 28-30 wks

39
Q

What is done in visit in third trimester

A

U/s: evaluate fetal growth, fetal position, state of placenta and AFI (between 32-34 wks of GA)
Leopold maneuvers-feel baby positioning

40
Q

What should be done at 35-40 wks?

A

Cervical exams (dilation, effacement, station, position, presenting part)

41
Q

When to do group b strep culture

A

Swab lower vagina and rectum between 35-37 wks GA

42
Q

What to do if group b strep culture is +

A

Intrapartum abx prophylaxis to prevent neonatal GBS

43
Q

Asymptomatic group B strep in mother

A

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
Q

Early onset neonatal GBS

A

Sx onset <24 hrs from birth (sepsis, pneumonia, meningitis)

45
Q

Late onset neonatal GBS

A

Sx onset in 4-5 wks from birth (bacteremia, meningitis, focal infections)

46
Q

What is Bishop scoring used for?

A

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
Q

What to do with high risk pregnancy in third trimester?

A

NST and biophysical profile (BPP)

48
Q

What is NST?

A

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
Q

What is a BPP?

A

Fetal u/s monitoring: movement, muscle tone, breathing movements, amniotic fluid level and HR

50
Q

Pt education third trimester

A

Anesthesia, fetal kick counts, preterm labor precautions, breast feeding, postpartum contraception, FMLA, GBS, counseling

51
Q

NT scan

A

b/w 11 wks GA and 13.6 wks GA
Determination of nuchal translucency
Thickened NT is soft marker for down syndrome

52
Q

First trimester screening

A

Serum draw that coincides with NT scan
Measure PAPP-A and Beta HCG
If elevated soft markers for Down syndrome and Edwards

53
Q

Non-invasive perinatal screening

A

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
Q

AFP only

A

Maternal serum marker AFP
Performed b/w 15-21.6 wk GA
Elevated can indicate NTD

55
Q

Maternal serum screen

A

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
Q

Common complaints

A

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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