prenatal care Flashcards
if a preggo is underweight w/ a BMI of less than 18.5, how many pounds is it recommended that she gain during pregnancy
28-40
how much exercise should a preggo be getting per week
150 min
2nd trimester is considered week ___ to ___
13 to 26 6/7
when do fetal kick counts begin?
what are you wanting?
at the third trimester
want
10 kicks/rolls/flutters within 2 hours
Naegeles rule
how to estimate when baby will be born
add 7 days to LMP
add 9 months
LMP means
1st day of last menstrual cycle
if a preggo is obese w/ a BMI over 30, how many pounds is it recommended that she gain during pregnancy
11-20
what bloodwork are you getting at the 1st trimester visit
CBC (anemia?
blood type and RH
antibody screen
rubella and varicella titers
RPR (syphilis testing)
Hep B antigen
HIV
what is NIPT
Non-Invasive Prenatal Test
serum draw that tests DNA
coincides with a Nuchal Translucency scan that can be done instead of First Trimester Screening to indicate trisomies
done as early as 9 weeks
earlier detection than FTS but more expensive
(optional)
when is the 2nd trimester visit?
what diagnostic tests are done
18-22 weeks
ultrasound
look for abnormalities, fetal position, location and status of placenta, Amniotic Fluid Index, cervical length, estimate fetal weight
what vaccinations does a woman trying to become pregnant need to be up to date on
MMR
varicella
Hep B
Flu
Tdap
which weeks are you doing US and Leopold Maneuvers
(3rd trimester)
weeks 32 to 34
what is Non Stress Test (NST)
traces the fetal HR and uterine activity for 20 minutes
need minimum of 2 acclerations that increase by 15 bpm and last for 15 seconds
at 20 weeks, the fundal heigh is measured to
the umbilicus
leopolds maneuvers
how you check the positioning of the fetus
done at 32 to 34 weeks
(3rd trimester)
if a preggo is of normal weight w/ a BMI of 18.5 to 24.9, how many pounds is it recommended that she gain during pregnancy
25-35
how is the success rate of induction estimated?
Bishop score
8 to 13 = high chance of success
0 to 4 = high chance of failure
what is the quickening and when does it occur
first fetal movements
1st pregnancy = 18 to 20 weeks
2+ pregnancies = 16 to 18 weeks
how often should a patient be seeing the OBGYN during pregnancy
first 28 weeks = every 4 weeks
weeks 28-36 = every 2 weeks
weeks 36 onwards = weekly
when should the 1st trimester visit be
between 8-10 weeks
antenatal
means prenatal
what is the lightening and when does it occur
when the fetus drops into the pelvis
at 36 to 38 weeks
decreases Amniotic Fluid Index
what are some social things you need to talk about with a newly pregnant patient
intentional pregnancy?
domestic violence?
substance abuse?
inherited diseases?
barriers to routine visits
what is an NT scan
sonogram that determines if Nuchal Translucency (NT) is thickened which can indicate Down Syndrome and cardiac abnormalities
done between 11 and 14 weeks
(optional but often covered and available)
what urine lab tests are you doing at the 1st trimester visit
UA
urine cx
when do you do a Quad Screen
if NT and FTS were not performed
(if they were, only do the AFP
If you have a high risk pregnancy, what tests might you do in the 3rd trimester
NST
Biophysical Profile
what is early term pregnancy
37 weeks to 38 6/7 weeks
if you have a RhD negative mom, when are you giving Rh Immune Globulin and how much
at 28 to 30 weeks
300 ug
what is the most accurate screen for Downs
NIPT
(Non-Invasive Prenatal Testing)
what labs do you get at every visit
urine
(check glucose and protein)
which weeks are you doing cervical exams to determine dilation, effacement, station, position, and presenting part
weeks 35 to 40
(3rd trimester)
which prenatal visit is all about the US
(looks at anatomy, fetal position, location and status of placenta, Amniotic Fluid Index, cervical length, fetal weight estimates)
2nd trimester
18 to 22 weeks
what is a Biophysical Profile (BPP)
fetal US that measures fetal:
- movement
- muscle tone
- breathing (motion of diaphragm)
- amniotic fluid level
each is worth 2 points w/ 8/8 being perfect
- sometimes fetal HR is measured (so 10/10)
when does the most accurate US dating occur
1st trimester
what is AFP
Alpha FetoProtein
elevated levels could indicate neural tube defects
performed between 15 and 22 weeks, possibly with Quad Screen
optional test
how do you do the 3 hour glucose tolerance test
load her up with 100 grams of oral glucose
4 blood draws
- fasting should be less than 95
- 1 hour should be less than 180
- 2 hour should be less than 155
- 3 hour should be less than 140
2 abnormal OR 1 value > 200 = FAIL = GDM
EDC means
estimated date of confinement
same thing as estimated date of delivery
hegars sign
palpable softening of the isthmus that is a sign of pregnancy
what serum markers are measured during the Quad Screen
alpha fetoprotein
uE3
hCG
inhibin A
what is full term pregnancy
39 weeks to 40 6/7 weeks
GA means
gestational age
at 12 weeks, the fundal height is measured to the
pubic symphysis
what is a Quad Screen
aka Maternal Serum Screen
done between 15 and 22 weeks (most accurate between 16 and 18) along with AFP
screens for neural tube defects and trisomies
when doing the Group B Strep Culture, what are you swabbing
the lower vagina and the rectum
what is late term pregnancy
41 weeks to 41 6/7 weeks
3rd trimester is considered week ___ to ___
week 27 to the end
during the 1st trimester visit, you should instruct the preggo to avoid what foods
fish w/ high mercury content (tuna, swordfish, etc.)
raw meat/ eggs
hot dogs/ deli meat
unpasteurized dairy
more than 200 mg of caffeine/ day
EDD means
estimated date of delivery
how and when can you determine fetal gender
in the blood at 9 weeks
US at 16 weeks
the Bishop score gives points based on what 5 things
C-PEDS
- Cervical consistency
- Position of cervix
- Effacement Percent
- Dilation (cm)
- Station
when is everyone tested for Gestational DM
between weeks 24 and 28
(3rd trimester visit)
could be sooner if reason to suspect GDM
chadwicks sign
blueish purple tint of vaginal walls/ cervix indicating pregnancy
(due to increased blood flow; occurs around 6-8 weeks)
if a preggo is overweight w/ a BMI of less than 25 to 29.9 how many pounds is it recommended that she gain during pregnancy
15 to 25
how do you do 1 hour glucose challenge
load her up with 50 grams of oral glucose
1 hour later…
- BS < 140 = pass
- BS 141 to 199 = abnormal ⇒ 3 hour glucose tolerance test
- BS > 200 = automatic fail = GDM
what is the earliest that a transvag US can visualize cardiac activity of the fetus
5.5 weeks
1st trimester is considered week __ to ___
week 1 to 12 6/7
which tests screen for neural tube defects
NT scan
AFP
Quad screen
what is FTS
First Trimester Screening
serum draw that coincides with a Nuchal Translucency scan that determines if PAPP-A and beta HCG are elevated which can indicate trisomies
done between 11 and 14 weeks
(optional)
what is post term pregnancy
42+ weeks
in addition to bloodwork and urine testing, what other testing are you doing at the 1st trimester visit
cytology (Pap smear, gonorrhea, and chlamydia cx)
US (confirm EDD and r/o ectopic pregnancy)
maybe
TSH, CF screening, TB, HbA1C
what labs are you drawing up at 24 to 28 week visits?
(3rd trimester)
CBC
RPR (syphillis)
ABO and Rh
antibody screen
blood glucose
if someone comes in for prenatal care counseling, what supplements should you suggest
folic acid (0.4 to 0.8 mg/ day beginning 1 month prior to conception)
DHA (wards off postpartum depression)
what are you giving someone with GDM
insulin
which weeks are you doing the Group B Strep Culture
weeks 35 to 37
(3rd trimester)
which tests screen for trisomies
NT scan
FTS
NIPT
Quad screen
