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)