prenatal care Flashcards by Jacqui Joseph

5 most important things before becoming pregnant (maybe weeds)

400-800mcg folic acid daily for 3 months
stop alcohol and smoking
control any med conditions, vaccines up to date
discuss Rx and OTC drugs with doc
avoid toxic substances (i.e. cat feces)

How well did you know this?

Not at all

Perfectly

Dx of pregnancy,: presumptive- equally likely pregnant or something else… clinical signs?

Amenorrhea , N&V, breast tenderness, fatigue, pelvic discomfort ,
Chadwick’s sign (cervix looks blueish)

How well did you know this?

Not at all

Perfectly

Dx pregnancy: probable- more likely pregnant than something else… clinical signs? (3)

- pregnancy test ( HCG)
enlarging abdomen,
maternal feeling of movement

How well did you know this?

Not at all

Perfectly

Dx pregnancy: positive- they are DEFINITELY pregnant…. clinical signs? (3)

fetal heart sounds by a Doppler in the doctor’s office,
ultrasound detection of the fetus,
movement of the fetus felt by a doctor

How well did you know this?

Not at all

Perfectly

gestational age/ menstrual age

length of pregnancy after the first day of the last menstrual period (LMP). assumes conception at day 14 menstrual cycle
-full pregnancy: 40 wks

How well did you know this?

Not at all

Perfectly

conception age

true fetal age and refers to the length of pregnancy from the time of conception
-full pregnancy 36 wks

How well did you know this?

Not at all

Perfectly

what is the “fallacy” with gestational age? (what does it assume?)

This estimation assumes that conception occurs on day 14 of the cycle
-time of ovulation varies greatly in relation to the menstrual cycle, both from cycle to cycle and individual to individual

How well did you know this?

Not at all

Perfectly

what is Naegele’s rule?

standard way of calculating the due date for a pregnancy (EDD or EDC)
calc: first day LMP plus one year - three months + 7

How well did you know this?

Not at all

Perfectly

how do you do clinical dating via uterine size? what should it be around 20 weeks?

tape measure pubic symphysis to fundus.

20wks=20cm- at the umbilicus

How well did you know this?

Not at all

Perfectly

what is “quickening” ?

first fetal movement felt (around 20 wks, later in first pregnancy)
- unreliable way to do clinical dating for pregnancy

How well did you know this?

Not at all

Perfectly

what is the REAL way to do gestational dating?

How well did you know this?

Not at all

Perfectly

how do you do gestational dating with US? (early in first trimester)

GA may be estimated from the sac diameter

-usually calculated from the fetal crown-rump length (CRL)

How well did you know this?

Not at all

Perfectly

US dating: The correlation between fetal CRL and GA is excellent until approximately___ weeks’ amenorrhea

12 weeks

early in first trimester

How well did you know this?

Not at all

Perfectly

If cardiac activity can be detected but the embryo is not measurable, the GA is about ___ - ____ wks

5-6 wks

How well did you know this?

Not at all

Perfectly

US dating: Fetal biometry in the second trimester can yield acceptably accurate estimates of GA from ___ to approximately ___ weeks of amenorrhea plus or minus __ -____days

12-22 weeks , plus or minus 5-7 days

How well did you know this?

Not at all

Perfectly

is fetal biometry by US dating useful in the third trimester?

not really, its accuracy is for gestational age (GA) is reduced considerably compared to during the seond semester.

How well did you know this?

Not at all

Perfectly

how does BP change in pregnancy?

progesterone decreases PVR = initial drop in BP.

normally, works it way back up to pre-pregnancy levels

How well did you know this?

Not at all

Perfectly

how can venous return be affected by pregnancy?

woman laying flat on back, baby compresses IVC. Correct by laying on left side

How well did you know this?

Not at all

Perfectly

blood flow to what three body areas increases in pregnancy?

kidneys, mucosa, skin

How well did you know this?

Not at all

Perfectly

how are blood volumes changed in pregnancy? what does this allow for?

increased angiotensin II = more blood volume.

enables blood loss with delivery to be met without compensation

How well did you know this?

Not at all

Perfectly

changes in CO, HR and stroke volume in pregnancy

all increase

How well did you know this?

Not at all

Perfectly

what is dilutional anemia?

anemia caused by the inc. in blood volume.

How well did you know this?

Not at all

Perfectly

how does clotting change in pregnancy? what is a pro and con to this?

clotting factors and fibrinogen increase and fibrolytic activity decreases. AKA pregnancy is a hypercoag state.

pro: protects from hemorrhage at delivery
con: increased risk of thromboembolism

How well did you know this?

Not at all

Perfectly

what is a common respiratory complaint in pregnancy?

SOB- we dont know why this occurs b/c tidal volume actually increases, and residual vol decreases.

How well did you know this?

Not at all

Perfectly

normal pregnancy is a state of respiratory ______

alkalosis arterial pCO2- drops, pO2- unchanged HCO3- drops (to prevent pH change) overall: lower maternal pCO2

Rising ____ levels often lead to Nausea and Vomiting

HCG

what 3 GI complaints (other than N/V) are common in pregnancy? why?

1. constipation (increased transit time for max nutrional absorption) 2. reflux/heartburn : progesterone relaxes sphincter 3. cholesterol gallstones: estrogen

what happens to the gums in pregnancy?

become soft, spongy, friable- prone to bleeding.

what do hormonal changes do to the skin? | what are the two specific vocab words for these

pigmented areas get darks | Hyperpigmentation of the umbilicus, nipples, abdominal midline (linea nigra) and face (chloasma/melasma)

Hyperdynamic circulation and high levels of estrogen may cause what two skin changes?

spider nevi and palmar erythema.

what happens to fat storage and insulin resistance in pregnancy? what can result from insulin changes?

both increase | insulin: can cause low blood glucose levels or lead to gestational DM

what causes increased fat storage in pregnancy?

increased cortisol levels

what changes in the urinary tract occur in pregnancy? what can this lead to?

increased urine volume, increased GFR (increased excretion of substances) - increased risk for UTI and pyelonephritis

what enviornmental exposure must pregnant women avoid? why?

cat feces- toxoplasmosis

how often do you see the doctor in the different stages of pregnancy? what age will you need to see a doctor more often?

1 per month: weeks 4 - 28 2 per month: weeks 28 - 36 1 per week: weeks 36 - birth **older than 35 or your pregnancy is high risk, you'll probably see your doctor more often.

what 4 things must you ask about for each pregnancy visit?

Fetal movement (not likely to be felt before week 19/20) Contractions Bleeding Leaking fluid

when are fetal heart tones discernable?

after about 12-14wks

what 2 lab tests will you do at weeks 13-27?

gestational DM and fetal heart ultrasound

what lab test will you do at 28-35 wks?

Rh , administer Rh immunoglobin as needed

what is PROM?

premature rupture of uterine membrane

what 3 signs must you counsel a pregnant woman on? wks 28-35 visit..

Signs/symptoms preterm labor signs/symptoms of preeclampsia PROM

what 2 tests will you do at wks 35-40?

Group B Beta Hemolytic Streptococcus culture | Leopold maneuver to determine fetal position

what is the leopold maneuver?

4 steps to do in order to determine fetal position

what is included in assessment wks 40-42 (post-due date) ? what are the two options here?

1. Cervical exam 2. FHR testing (NST or CST)- non-stress test 3. Ultrasound for biophysical profile (see if baby is too big) and/or amniotic fluid volume Expectant management (just wait) vs. induction

what is uterine involution?

uterus shrinking back to the appropriate size after birth

what 4 things will you check at post-partum 4-6wks assessment? (of mother)

- episiotomy repair - check uterine involution (correct size and muscular contractions intact?) - rubella vaccine - check emotional status

is gestational DM screening standard in the US? which test does the US use?

yes! ACOG test

ADA vs ACOG gestational DM screening test. which is more sensitive? what does the US use?

ADA prefers 75 g one-step fasting test ACOG prefers 50 g --> 100 g two-step glucose tolerance test ADA more sensitive, but US uses ACOG

Rh and ABO blood typing should be performed at which pre-natal visit?

the first one

RhοD immune globulin (Rhogam) is recommended who? when do they get it?

for all nonsensitized Rh-negative women at 28 weeks’ gestation

Ultrasonography at 10 to 14 weeks’ gestation can measure nuchal translucency, what is this?

screening test for Down syndrome.

when do you US for structural aanomalies?

18-20 wks

when is US considered "early" ? | what are the three benefits of doing US within this time period?

before 14 weeks 1. accurately determines GA 2. decr. need for labor induction after 41 weeks’ 3. detects twins/triplets/ etc.

when do you screen for neural tube defects?

16–18 weeks | **results are GA- dependent so correct dating is important

what is aneuploidy screening? what women are offered this?

tests for genetic variations- trisomy 18 or 21 | - women of ALL ages should be offered

what two things indicate high risk for women having aneuploidy (poor pregnancy outcomes)?

isolated nuchal thickening | isolated maternal serum AFP (with normal ultrasonography and normal karyotype)

what is "combined testing" for aneuploidy? when is this done?

nuchal translucency and serum screening | - 1st trimester screening

who tends to gain more weight in pregnancy?

women under or overweight prior to pregnancy

if a woman's serum sampling shows high risk for aneuploidy what two things must you then provide?

1. Genetics counseling | 2. chorionic villus sampling or amniocentesis

Calcium supplementation has been shown to decrease _______ and ______, but not _____ _______

decrease: blood pressure and preeclampsia | perinatal mortality.

what are the guidelines for folic acid supplementation? why is it important?

0. 4 to 0.8 mg of folic acid (4 mg for secondary prevention) should begin at least one month before conception. - prevent neural tube defects

what 4 vitamins supplements are recommended for pregnant women? which do they need to lower?

calcium, vit D, iron, folic acid | lower: vit A

why do pregnant women need iron?

Iron-deficiency anemia = preterm delivery and low birth weight.

why do women need to limit vitamin A?

High dietary intake of vitamin A (i.e., more than 10,000 IU per day) = cranial-neural crest defects.

what is the reccomendation for pregnant women in industrial countries for vitamin A? limit to ____ / day (weeds)

less than 5,000 IU per day.

Vitamin D deficiency is rare but lower levels has been linked to _______ and ________. what about high levels of it?

neonatal hypocalcemia and maternal osteomalacia. | High doses of vitamin D can be toxic.

what are the vitamin D reccomendations for pregnant women? (maybe weeds)

DA (daily allowance) is 5 mcg per day (200 IU per day).- but need 800-1000 units supplement if not getting enough sun.

hot tubs and saunas during pregnancy?

avoided during the first trimester

opiate addicted pregnant women (and babies)?

opiates actually arent very harmful to babies… the worry is having them go through withdrawal, so give opiate baby (and mom) methadone and taper down

All pregnant women should be screened for_____ misuse.

alcohol.

what amount of alcohol is "safe" for pregnancy?

none!

abstain from sex during pregnancy if one of what 4 things are occuring?

Vaginal bleeding Placenta previa Preterm labor Ruptured membranes

how long to wait for post-partum sex?

Usually wait 4-6 wk, longer if episiotomy