Prenatal Care Flashcards
What was the original purpose of prenatal care
To be used as a preventative measure against preeclampsia
What are the goals of overall prenatal care?
Early, accurate estimation of gestational age
Identification of pregnancies at increased risk for maternal or fetal morbidity and mortality
Ongoing evaluation of maternal and fetal health status
Anticipation fo problems and intervention when applicable
Promote health, education, support and shared decision making
1st trimester prenatal care
Start at around 8-10 weeks
Complete H&P and paying close attention to
- obstetrical
- medications
Get estimated dating and ages
- also get last menstrual period and last ultrasound date
Do an initial prenatal care panel
- CBC
- blood type and antibody screen
- RPR
- varicella, rubella, toxoplasmosis,, etc. (TORCH)
- HIV
- Urine cultures (asymptomatic bacteriuria = risk of pyelonephritis and increased risk for preterm birth. NEED TO TREAT)
- patient specifics as needed (TSH and glucose/A1C)
- papsmears
Get genetic history and test if suspecting
Get vaccines as needed
- especially influenza
check for cervicitis even if asymptomatic
Gravity vs parity
Gravity = # of pregnancies regardless of outcome
Parity = # of pregnancies based on outcomes
- if not using subsections = just live pregnancies
- if using subsections = “TPAL”
- T = term
- P = preterm
- A = abortions
- L = Living
**example G4P3003 = 4 total pregnancies, 3 term and living births
Term based on weeks
Early term = 37-38.6 weeks
Term birth = 39-41.6 weeks
Post term = > 42 weeks
Preterm = 34-36.6 weeks
- makes up 12% of births
Dating ultrasound
Used to determine viable pregnancy, gestational age and umber of embryos
Genetic history and testing examples
Amnocentesis
-1/200 risk of complications with use = not used as much anymore
Cell free fetal DNA
- more used since its not invasive
First trimester = blood work and ultrasound
Second trimester = blood work and ultrasound
- often shows “soft markers” for genetic abnormalities (example = “double bubble sign” for Down syndrome)
Blood work = quad screen always
Carrier screening
- especially for CF, spinal muscular atrophy and fragile X syndrome
Nutrition differences in pregnancy
Caloric intake goes up
Protein increases from 0.8g/kg/day -> 1.1g/kg/day
Carbohydrates = 175g/day
Micronutrients needed**
- iron = 27mg
- calcium = 250mg minimum/day
- folate = at least 0.4mg 1st trimester (0.6 mg in 2nd/3rd trimester)
- iodine = 250 mcg
- vitamin D = 200-600 IU
Cervicitis guidelines
All pregnant patients under 25 yrs old and those at increased risk
Need retesting at 1 month and 3 months
Considering retesting in the 3rd trimester
Specific things to do at 2nd trimester
*give RhoGAM (300 mcg) at 28 weeks if Rh- doing any intervention that could cause bleeding
Screen for gestational diabetes between 24-28 weeks
- 1hr GCT test
- 130-140 is the threshold
- also get a CBC
Get ultrasound as needed
Start planning for pregnancy
- pediatrician
- pain control
- pain control methods
- hospital length of stay
Criteria for screening presentational diabetes
- *BMI is > 25 kg (>23 in Asian women) + one or more of the following**
- previous gestational DM history
- 1st degree relative with diabetes
- high risk race/ethnicity
- history of CVD
- HTN or on therapy for HTN
- HDL <35 or TAG >250
- history of PCOS
- other clinical conditions or symptoms associated with insulin resistance
- previous birth of an infant weighing >4000 g
Routine at 28 weeks with 1 step approach = 75g 2 hr GTT w/ overnight fast
Can do a two step instead = 1 hr GCT 50g to screen; 3 hr GTT 100g to diagnosis
Vaccines
2nd trimester= influenza and whooping cough MUST be done
COVID is unknown at this point (at risk usually gets it but other than that usually hold back)
3rd trimester screening
Growth restrictions of any kind
Screen and treat for any Group B step or cervicitis
- also an infectious disorders need to be treated if in the womb
Education and planning
- both before birth
- also after birth (breastfeeding, circumcision, car/safety care, vaccines, vitamin K shots, postpartum depression)
Presentation of the baby in the womb
GBS
Rectovaginal pathogen that is always screened at 35-36 weeks old or with any case of bacteriuria
**must identify penicillin allergies (cant use penicillin G as 1st Line )
if bacteriuria with this at any point = treat it
