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clin med > prenatal care > Flashcards

prenatal care Flashcards

1
Q

5 most important things before becoming pregnant (maybe weeds)

A
  1. 400-800mcg folic acid daily for 3 months
  2. stop alcohol and smoking
  3. control any med conditions, vaccines up to date
  4. discuss Rx and OTC drugs with doc
  5. avoid toxic substances (i.e. cat feces)
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2
Q

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

A

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

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3
Q

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

A
    • pregnancy test ( HCG)
  2. enlarging abdomen,
  3. maternal feeling of movement
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4
Q

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

A
  1. fetal heart sounds by a Doppler in the doctor’s office,
  2. ultrasound detection of the fetus,
  3. movement of the fetus felt by a doctor
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5
Q

gestational age/ menstrual age

A

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

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6
Q

conception age

A

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

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7
Q

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

A

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

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8
Q

what is Naegele’s rule?

A

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

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9
Q

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

A

tape measure pubic symphysis to fundus.

20wks=20cm- at the umbilicus

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10
Q

what is “quickening” ?

A

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

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11
Q

what is the REAL way to do gestational dating?

A

US

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12
Q

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

A

GA may be estimated from the sac diameter

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

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13
Q

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

A

12 weeks

early in first trimester

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14
Q

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

A

5-6 wks

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15
Q

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

A

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

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16
Q

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

A

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

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17
Q

how does BP change in pregnancy?

A

progesterone decreases PVR = initial drop in BP.

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

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18
Q

how can venous return be affected by pregnancy?

A

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

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19
Q

blood flow to what three body areas increases in pregnancy?

A

kidneys, mucosa, skin

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20
Q

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

A

increased angiotensin II = more blood volume.

enables blood loss with delivery to be met without compensation

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21
Q

changes in CO, HR and stroke volume in pregnancy

A

all increase

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22
Q

what is dilutional anemia?

A

anemia caused by the inc. in blood volume.

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23
Q

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

A

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

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24
Q

what is a common respiratory complaint in pregnancy?

A

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

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25
Q

normal pregnancy is a state of respiratory ______

A

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

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26
Q

Rising ____ levels often lead to Nausea and Vomiting

A

HCG

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27
Q

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

A
  1. constipation (increased transit time for max nutrional absorption)
  2. reflux/heartburn : progesterone relaxes sphincter
  3. cholesterol gallstones: estrogen
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28
Q

what happens to the gums in pregnancy?

A

become soft, spongy, friable- prone to bleeding.

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29
Q

what do hormonal changes do to the skin?

what are the two specific vocab words for these

A

pigmented areas get darks

Hyperpigmentation of the umbilicus, nipples, abdominal midline (linea nigra) and face (chloasma/melasma)

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30
Q

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

A

spider nevi and palmar erythema.

31
Q

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

A

both increase

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

32
Q

what causes increased fat storage in pregnancy?

A

increased cortisol levels

33
Q

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

A

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

34
Q

what enviornmental exposure must pregnant women avoid? why?

A

cat feces- toxoplasmosis

35
Q

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

A

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.

36
Q

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

A

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

37
Q

when are fetal heart tones discernable?

A

after about 12-14wks

38
Q

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

A

gestational DM and fetal heart ultrasound

39
Q

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

A

Rh , administer Rh immunoglobin as needed

40
Q

what is PROM?

A

premature rupture of uterine membrane

41
Q

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

A

Signs/symptoms preterm labor
signs/symptoms of preeclampsia
PROM

42
Q

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

A

Group B Beta Hemolytic Streptococcus culture

Leopold maneuver to determine fetal position

43
Q

what is the leopold maneuver?

A

4 steps to do in order to determine fetal position

44
Q

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

A
  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

45
Q

what is uterine involution?

A

uterus shrinking back to the appropriate size after birth

46
Q

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

A
  • episiotomy repair
  • check uterine involution (correct size and muscular contractions intact?)
  • rubella vaccine
  • check emotional status
47
Q

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

A

yes! ACOG test

48
Q

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

A

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

49
Q

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

A

the first one

50
Q

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

A

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

51
Q

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

A

screening test for Down syndrome.

52
Q

when do you US for structural aanomalies?

A

18-20 wks

53
Q

when is US considered “early” ?

what are the three benefits of doing US within this time period?

A

before 14 weeks

  1. accurately determines GA
  2. decr. need for labor induction after 41 weeks’
  3. detects twins/triplets/ etc.
54
Q

when do you screen for neural tube defects?

A

16–18 weeks

**results are GA- dependent so correct dating is important

55
Q

what is aneuploidy screening? what women are offered this?

A

tests for genetic variations- trisomy 18 or 21

- women of ALL ages should be offered

56
Q

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

A

isolated nuchal thickening

isolated maternal serum AFP (with normal ultrasonography and normal karyotype)

57
Q

what is “combined testing” for aneuploidy? when is this done?

A

nuchal translucency and serum screening

- 1st trimester screening

58
Q

who tends to gain more weight in pregnancy?

A

women under or overweight prior to pregnancy

59
Q

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

A
  1. Genetics counseling

2. chorionic villus sampling or amniocentesis

60
Q

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

A

decrease: blood pressure and preeclampsia

perinatal mortality.

61
Q

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

A
  1. 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
62
Q

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

A

calcium, vit D, iron, folic acid

lower: vit A

63
Q

why do pregnant women need iron?

A

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

64
Q

why do women need to limit vitamin A?

A

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

65
Q

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

A

less than 5,000 IU per day.

66
Q

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

A

neonatal hypocalcemia and maternal osteomalacia.

High doses of vitamin D can be toxic.

67
Q

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

A

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

68
Q

hot tubs and saunas during pregnancy?

A

avoided during the first trimester

69
Q

opiate addicted pregnant women (and babies)?

A

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

70
Q

All pregnant women should be screened for_____ misuse.

A

alcohol.

71
Q

what amount of alcohol is “safe” for pregnancy?

A

none!

72
Q

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

A

Vaginal bleeding
Placenta previa
Preterm labor
Ruptured membranes

73
Q

how long to wait for post-partum sex?

A

Usually wait 4-6 wk, longer if episiotomy

clin med (88 decks)

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