Prenatal Care Flashcards
What would elevated AFP levels in a pregnant mother indicate for the fetus?
High AFP levels often indicate neural tube defects in the fetus.
What would decreased AFP levels in a pregnant mother indicate for the fetus?
Low AFP levels often occur with trisomies 13, 18, and 21.
When should screening for vaginal and rectal GBS be performed in a pregnant woman?
Between 35 and 37 weeks gestation.
In a woman who has onset of labor at 35 weeks and GBS screening is negative, what GBS prophylaxis would be indicated?
None
What GBS prophylaxis regimen would be recommended in this scenario: A mother with onset of labor at 32 weeks gestation with positive GBS screen, labor is halted after 24 hours but resumes at 35 weeks and the mother delivers a healthy boy.
At 32 weeks, start PCN IV for 48 hours, during and after tocolysis to halt labor. Then, resume PCN when the mother goes into labor at 35 weeks and continue until delivery occurs.
In what (7) situations is intrapartum antibiotic prophylaxis recommended for GBS prevention?
- Women who delivered a previous infant with GBS disease, regardless of current colonization status
- Women with GBS bacteriuria during any trimester of the current pregnancy
- Women with a GBS positive screening result at 35-37 weeks of gestation in the current pregnancy
- Women at onset of labor who have unknown GBS status and any of the following: <37 weeks gestation, intrapartum temperature of ≥38.0 C, PROM, intrapartum nucleic acid amplification test positive for GBS.
Do you need to give antibiotic prophylaxis to a woman who delivered a previous infant with GBS disease, regardless of current colonization status?
Yes
Do you need to give antibiotic prophylaxis to a woman who had GBS bacteriuria during any trimester of the current pregnancy?
Yes
Do you need to give antibiotic prophylaxis to a woman who had a GBS positive screening result at 35-37 weeks of gestation in the current pregnancy?
Yes
Do you need to give antibiotic prophylaxis to a woman who has unknown GBS status at the start of labor at <37 weeks gestation?
Yes
Do you need to give antibiotic prophylaxis to a woman who has unknown GBS status at the start of labor and an intrapartum temperature of ≥38.0 C?
Yes
Do you need to give antibiotic prophylaxis to a woman who has unknown GBS status at the start of labor and prolonged rupture of membranes?
Yes
Do you need to give antibiotic prophylaxis to a woman who has unknown GBS status at the start of labor and intrapartum nucleic acid amplification test positive for GBS?
Yes
Do you need to give antibiotic prophylaxis to a woman who has a history of GBS colonization or bacteriuria during a previous pregnancy?
No
Do you need to give antibiotic prophylaxis to a GBS colonized woman who has intact membranes and is going for C-section?
No
Do you need to give antibiotic prophylaxis to a woman who had a negative vaginal and rectal GBS culture at 35-37 weeks gestation?
No
Do you need to give antibiotic prophylaxis to a pregnant woman who screens positive for asymptomatic GBS colonization prior to the onset of labor?
No
What is the recommended GBS antibiotic prophylaxis regimen?
PCN G 5 million units IV x 1, then 2.5-3 million units IV q4h until delivery. Ampicillin is also acceptable, with 2g x 1, then 1g q4h until delivery.
What drug regimen should be used for GBS prophylaxis in a PCN allergic mother at low risk of anaphylaxis?
Cefazolin 2g IV x 1, then 1g IV q8h until delivery.
How would a PCN-allergic woman be determined to be low-risk for anaphylaxis when deciding on an alternate treatment regimen?
She must have a negative history for anaphylaxis, angioedema, respiratory distress, or urticaria with PCN administration.
What antibiotics should be used for GBS prophylaxis in a PCN-allergic woman considered to be high-risk for anaphylaxis? What determines which drug to use?
Antimicrobial susceptibility testing should be ordered from antenatal GBS cultures in these women. If the GBS isolate is susceptable to both clindamycin and erythromycin, they should receive Clindamycin 900 mg IV q8h. If the GBS isolate is resistant to clindamycin, demonstrates inducible resistance to clindamycin, or if susceptability is unknown, the mother should receive vancomycin 1g IV q8h.
T/F: Women with GBS bacteriuria at any time during the current pregnancy, or who previously gave birth to an infant with GBS disease, should receive intrapartum antimicrobial prophylaxis, whether currently colonized or not.
TRUE
Draw the flowchart for GBS prophylaxis in the setting of threatened preterm delivery (***Figure 1-2)
*** Figure 1-2
Draw the flowchart for GBS prophylaxis in the setting of preterm premature rupture of membranes (***Figure 1-3)
*** Figure 1-3
Draw the flowchart for management of a baby born to a mom who was given GBS prophylaxis. (Figure 1-4***)
*** Figure 1-4
Define preterm labor.
The onset of regular uterine contractions, producing changes in the cervix, at <37 weeks gestation.
What is “incompetent cervix” and how is it treated?
This is the onset of premature labor due to cervical tissue that has matured too early. If identified, a cerclage (placement of sutures around the incompetent cervix) offers a potential solution.
Define PROM.
Premature rupture of membranes refers to membrane rupture prior to the onset of uterine contractions.
Define PPROM.
Preterm premature rupture of membranes refers to membrane rupture prior to the onset of uterine contractions at a gestational age <37 weeks.
How would one confirm PROM if physical exam is nondiagnostic?
Test the pH of the vaginal fluid with nitrazine paper. Amniotic fluid has a pH of 7.0-7.3 compared to the normally acidic vaginal pH of 3.8-4.2. A second confirmatory test, called ferning, is performed by swabbing vaginal fluid onto a slide and allowing it to dry. After drying, a delicate fern-like pattern (from increased salt) forms if amniotic fluid is present due to rupture of membranes.
If a mother goes into labor, at what gestational ages should one consider performing fetal pulmonary maturity testing?
If the mother is thought to be at 32-39 weeks gestation. If gestational age is <32 weeks the lungs are definitely immature. If gestational age is ≥39 weeks the lungs are mature.
What tests are included in fetal pulmonary maturity testing?
Lecithin/sphingomyelin ratio, phosphatidylglycerol level, and lamellar body count.
Under what conditions is delivery recommended in pregnant women with PROM?
If fetal lung maturity is confirmed and gestational age is ≥34 weeks, then delivery is recommended.
Under what conditions is expectant management recommended for pregnant women with PROM?
If fetal lung maturity is confirmed but gestational age is <34 weeks, then expectant management until 34 weeks, followed by delivery, is recommended. Alternatively, if an immature fetal lung profile is discerned, expectant management should be continued until 36 weeks of gestation prior to delivery.
What is the recommended management for a pregnant woman with PROM and signs of infection?
The baby should be delivered as quickly as possible, since the risk of serious fetal infection is directly proportional to the length of time between rupture of membranes and delivery.
What is included in “expectant management” for mothers with PROM who meet the required criteria?
Prophylactic antibiotics when indicated, corticosteroids in infants with documented pulmonary immaturity, tocolytics to delay progression of labor, and surveillance for maternal infection and fetal compromise.
What is preeclampsia?
A progressive multisystem disorder caused by vascular dysfunction of both the mother and placenta. It occurs in 3-7% of pregnancies and the etiology is unknown.
How is most preeclampsia identified in the prenatal period?
Early signs of preeclampsia are identified by monitoring blood pressure and urine protein during the late 2nd and 3rd trimesters.
What signs indicate the presence of severe preeclampsia?
SBP ≥160 mmHg or DBP ≥110 mmHg; Proteinuria >5g in 24h or ≥3+ on a dipstick; oliguria < 500 ml in 24 hours; visual or mental status changes; cyanosis, signs of respiratory distress, or pulmonary edema; epigastric or upper abdominal pain; liver function abnormalities; thrombocytopenia (<100 platelets).
