Prenatal Care Flashcards
3 Categories of Pregnancy Signs
1) Presumptive
2) Probable
3) Positive
Presumptive Signs
- 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
Skin changes associated w/pregnancy
- Cholasma ~16+wk
- Linea nigra
- Stretch marks (Stiae)
- Spider telangiectases
Probable signs of pregnancy
- 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
Positive signs of pregnancy
- FHT
- Palpable outline of the fetus/movement
- Ultrasound of fetus
- hCG: Urine (99.5% sensitive); Serum (98%)
Fetal Heart Tones
- Audible at 10wk gestation by doppler
- 12wk from LMP
When Fetal Heart Tones Can Be Felt by Examiner
- 17-19wk
Ultrasound confirmation of Pregnancy Dx
- Gestational sac and cardiac activity @ 5-6wk
- Fetal pole with movement/heart 7-8wk
- Limb buds at 7-8wk
- Finger/Limb movement @ 9-10wk
Pregnancy Test Overview
- 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
Accuracy of UPT
- Menstrual day 20-26: 60%
- Menstrual day 28: 90%
- 7 Days late: 97%
When to check if periods are irregular
- Wait the number of days of the longest cycle in last 6mo. If negative, repeat test.
Prenatal Care Facts
- 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
Frequency/Type or PNC
- 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
Initial PNC Visit
- Prior to 12wk gestation
- Written information: pregnancy care services, proposed schedule of visits; screening offered; Lifestyle issues
1st Antepartum Visit
- Dx & Dating of pregnancy
- Contraceptive/gynecologic/med/surg Hx
- Thorough H&P
Prenatal Care record
- Document:
1) Risk assessment
2) health promotion
3) Interventions
After Dx: Pregnancy
- Gestational age is crucial
- HPI r/t possibility of pregnancy
- Menstrual Hx (EGA/EDC most important fact)
- Hx of other Pregnancies
Establishing EGA/EDC
- Nagele’s Rule: date of 1st day of LMP - 3mo + 7d
- Fundal Height
- Ultrasound crown-to-rump
G-TPAL
- Gravida: Total # pregnancies
- Para (Parity): Total # of births (Preterm, term)
- Abortions
- Live births
G_P_ _ _ _
- G = Total
- P = Term; Preterm; Abortions; Living Children
Gyn Hx: Red Flags
- Genetic abnormalities (NTD, Down’s)
- Family Hx: Medical/hereditary illness, twins
- Work Hx
Teratogens/illnesses to be aware of during pregnancy
- 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)
Prescriptions that can be teratogens (A-M)
- 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)
Prescriptions that can be teratogens (N-Z)
- 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+)
STIs/Dz that may be teratogen
- Rubella (0-16wk)
- CMV (0-27wk)
- Parvovirus (10-25wk)
- Syphillis (10wk+)
- Toxoplasmosis (10-24wk)
- Varicella zoster (0-20wk)
Breast Changes During Pregnancy
- Tingling
- Swelling
- Sensitivity/Tenderness
EGA by Fundal Size
- 6wk: Globular (handball, tangerine)
- 8wk: 2x normal size, globular (baseball)
- 10wk: 3x Normal, globular (softball)
- 12wk: 4x Normal (at pelvic brim, grapefruit)
Ballottement
- Method of palpation of floating object in abdomen
- Felt at 16-20wk
Listening for FHT
- Doppler: 8-11wk
- Fetascope: 18-20wk
Bimanual exam findings
- Uterus smaller than expected: later fertilization; ectopic preg.; incomplete/missed SAB; error in UPT
- Uterus larger: Earlier fertilization, fibroids, twins+, uterine anomaly, molar preg.
US confirmation of EGA
- +/- 7d by crown-to-rump meas. @ 6-11wk
* +/- 10d by multiple meas. @ 12-20wk
US Gestage Age
- 4.5-5.5wk: Gestational sac
- 6-12wk: C-R length
- 15-22wk: BPD, Femur length, cerebellar transverse diameter
