prenatal care Flashcards
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)
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)
Dx pregnancy: probable- more likely pregnant than something else… clinical signs? (3)
- pregnancy test ( HCG)
- enlarging abdomen,
- maternal feeling of movement
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
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
conception age
true fetal age and refers to the length of pregnancy from the time of conception
-full pregnancy 36 wks
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
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 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
what is “quickening” ?
first fetal movement felt (around 20 wks, later in first pregnancy)
- unreliable way to do clinical dating for pregnancy
what is the REAL way to do gestational dating?
US
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)
US dating: The correlation between fetal CRL and GA is excellent until approximately___ weeks’ amenorrhea
12 weeks
early in first trimester
If cardiac activity can be detected but the embryo is not measurable, the GA is about ___ - ____ wks
5-6 wks
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
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 does BP change in pregnancy?
progesterone decreases PVR = initial drop in BP.
normally, works it way back up to pre-pregnancy levels
how can venous return be affected by pregnancy?
woman laying flat on back, baby compresses IVC. Correct by laying on left side
blood flow to what three body areas increases in pregnancy?
kidneys, mucosa, skin
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
changes in CO, HR and stroke volume in pregnancy
all increase
what is dilutional anemia?
anemia caused by the inc. in blood volume.
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
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.
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?
- constipation (increased transit time for max nutrional absorption)
- reflux/heartburn : progesterone relaxes sphincter
- 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?
- Cervical exam
- FHR testing (NST or CST)- non-stress test
- 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
- accurately determines GA
- decr. need for labor induction after 41 weeks’
- 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?
- 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?
- 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
