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N825 > Prenatal Care > Flashcards

Prenatal Care Flashcards

1
Q

3 Categories of Pregnancy Signs

A

1) Presumptive
2) Probable
3) Positive

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2
Q

Presumptive Signs

A
  • Amenorrhea
  • N/V: ~50%
  • Breast tenderness (mastodynia)
  • Urinary Sx
  • Fatigue
  • Quickening (Can be confused with peristalsis)
  • 18wk w/primapara
  • 14-16 w/multipara
  • Skin Changes
  • Increased basal body temperature
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3
Q

Skin changes associated w/pregnancy

A
  • Cholasma ~16+wk
  • Linea nigra
  • Stretch marks (Stiae)
  • Spider telangiectases
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4
Q

Probable signs of pregnancy

A
  • Enlarged ABD
  • Ballottement
  • Change in uterine shape, size, consistency
  • Softening of cervix (Goodell’s sign: 6-8wk)
  • Blueish discoloration of cervix (Chadwick’s sign)
  • Softening and palpability of Uterine Isthmus (Hegar’s Sign)
  • Uterine contractions (28wk)
  • Leukorrhea
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5
Q

Positive signs of pregnancy

A
  • FHT
  • Palpable outline of the fetus/movement
  • Ultrasound of fetus
  • hCG: Urine (99.5% sensitive); Serum (98%)
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6
Q

Fetal Heart Tones

A
  • Audible at 10wk gestation by doppler

- 12wk from LMP

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7
Q

When Fetal Heart Tones Can Be Felt by Examiner

A
  • 17-19wk
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8
Q

Ultrasound confirmation of Pregnancy Dx

A
  • Gestational sac and cardiac activity @ 5-6wk
  • Fetal pole with movement/heart 7-8wk
  • Limb buds at 7-8wk
  • Finger/Limb movement @ 9-10wk
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9
Q

Pregnancy Test Overview

A
  • hCG first detectable in urine/serum @ 7-8d after ovulation/conception
    • test by 3wk after conception or 5wk after LMP
  • Peak levels at 60-90d post-conception
  • Blood levels parallel urine
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10
Q

Accuracy of UPT

A
  • Menstrual day 20-26: 60%
  • Menstrual day 28: 90%
  • 7 Days late: 97%
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11
Q

When to check if periods are irregular

A
  • Wait the number of days of the longest cycle in last 6mo. If negative, repeat test.
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12
Q

Prenatal Care Facts

A
  • Somewhat controversial
  • Insufficient data to recommend for or against
  • Probably beneficial to high risk pt’s
  • Ongoing assessment of mother’s physical/emotional health; fetal health and development
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13
Q

Frequency/Type or PNC

A
  • Preconception
  • Regular visits (7-11x/pregnancy)
  • Initial visit -> q4-6wk until 28wk -> q2-3 34-36wk -> weekly after 36wk
  • Usual Practice: routine visits for prenatal education and reassure; Provision of screening tests; Problem-oriented; Condition-specific visits
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14
Q

Initial PNC Visit

A
  • Prior to 12wk gestation

- Written information: pregnancy care services, proposed schedule of visits; screening offered; Lifestyle issues

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15
Q

1st Antepartum Visit

A
  • Dx & Dating of pregnancy
  • Contraceptive/gynecologic/med/surg Hx
  • Thorough H&P
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16
Q

Prenatal Care record

A
  • Document:
    1) Risk assessment
    2) health promotion
    3) Interventions
17
Q

After Dx: Pregnancy

A
  • Gestational age is crucial
  • HPI r/t possibility of pregnancy
  • Menstrual Hx (EGA/EDC most important fact)
  • Hx of other Pregnancies
18
Q

Establishing EGA/EDC

A
  • Nagele’s Rule: date of 1st day of LMP - 3mo + 7d
  • Fundal Height
  • Ultrasound crown-to-rump
19
Q

G-TPAL

A
  • Gravida: Total # pregnancies
  • Para (Parity): Total # of births (Preterm, term)
  • Abortions
  • Live births
20
Q

G_P_ _ _ _

A
  • G = Total

- P = Term; Preterm; Abortions; Living Children

21
Q

Gyn Hx: Red Flags

A
  • Genetic abnormalities (NTD, Down’s)
  • Family Hx: Medical/hereditary illness, twins
  • Work Hx
22
Q

Teratogens/illnesses to be aware of during pregnancy

A
  • DM (1st tri, many anomalies)
  • Hypothyroid (all trimesters)
  • PKU (2-4wk)
  • Hyperthermia (2-4wk)
  • SLE (2-4wk)
  • ETOH (All, FAS)
  • Tobacco (unknown, LBW)
  • Toluene (Unkown, IUGR, microenceph)
23
Q

Prescriptions that can be teratogens (A-M)

A
  • Methotrexate (14-60d; CNS, limb)
  • ACE-I (2-3rd tri; thyroid dys)
  • Carbamazepine (2-3rd; IUGR, SpinaBif)
  • Fluconazole (14-60d; cardiac, cleft palate)
  • Indomethacin (14-60d; NEC, oligo, PDA)
  • Lithium (1st; cardiac)
  • Methylene blue (2nd; jejunal atresia)
  • Misoprostol (14-60d; limbs)
24
Q

Prescriptions that can be teratogens (N-Z)

A
  • Penicillamine (14-60d)
  • Phenytoin (14-60d)
  • Retinoids (Unk)
  • SSRIs (3rd)
  • Tetracycline (2nd-3rd)
  • Thalidomide (27-40d)
  • Trimethoprim (1st)
  • Trimethidione (14-60d)
  • Valproic Acid (14-60d)
  • Warfarin (6wk+)
25
Q

STIs/Dz that may be teratogen

A
  • Rubella (0-16wk)
  • CMV (0-27wk)
  • Parvovirus (10-25wk)
  • Syphillis (10wk+)
  • Toxoplasmosis (10-24wk)
  • Varicella zoster (0-20wk)
26
Q

Breast Changes During Pregnancy

A
  • Tingling
  • Swelling
  • Sensitivity/Tenderness
27
Q

EGA by Fundal Size

A
  • 6wk: Globular (handball, tangerine)
  • 8wk: 2x normal size, globular (baseball)
  • 10wk: 3x Normal, globular (softball)
  • 12wk: 4x Normal (at pelvic brim, grapefruit)
28
Q

Ballottement

A
  • Method of palpation of floating object in abdomen

- Felt at 16-20wk

29
Q

Listening for FHT

A
  • Doppler: 8-11wk

- Fetascope: 18-20wk

30
Q

Bimanual exam findings

A
  • Uterus smaller than expected: later fertilization; ectopic preg.; incomplete/missed SAB; error in UPT
  • Uterus larger: Earlier fertilization, fibroids, twins+, uterine anomaly, molar preg.
31
Q

US confirmation of EGA

A
  • +/- 7d by crown-to-rump meas. @ 6-11wk

* +/- 10d by multiple meas. @ 12-20wk

32
Q

US Gestage Age

A
  • 4.5-5.5wk: Gestational sac
  • 6-12wk: C-R length
  • 15-22wk: BPD, Femur length, cerebellar transverse diameter

N825 (16 decks)

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