PRENATAL CARE (C5) Flashcards
1
Q
Most important parameter
A
Est of dates/AOG
2
Q
1st trimester
A
LMP/Sexual contact
Uterine size - pelvic exam
Diagnostic tools: PT, ultrasonography
3
Q
Subsequent prenatal care:
GOAL
A
To assess well-being of expectant mother & her fetus
4
Q
Frequency of prenatal visits
A
Every 4 weeks until 28 weeks AOG
Every 2 weeks until 36 weeks
Weekly until 40 weeks
If problematic pregnancy: 1-2 weeks interval
5
Q
Maternal evaluation
A
Wt Fundal ht BP Symptoms Vaginal examination
6
Q
Measured from the top of symphysis pubis to top of fundus
A
Fundal ht (Ht in cm of uterine fundus)
7
Q
Between 20 & 34 wks, fundal ht in cm is
A
Gestational age in weeks
8
Q
Pathologic BP
A
140 mmHg systolic or > and / or 90 mmHg diastolic or more
9
Q
Maternal eval symptoms
A
Headache Altered vision Abdominal pain Nausea and vomiting Bleeding Vaginal fluid leakage Dysuria
10
Q
Vaginal examination - late in pregnancy to provide information regarding:
A
Confirmation of presenting part and station
Clinical estimation of pelvic capacity and its general configuration
Consistency, effacement and dilatation of cervix
11
Q
Fetal heart tones
A
N 110-160/min
Doppler 10 weeks
Std nonamplified stet: 1st heard between 16-22 weeks
UTZ: 5 menstrual weeks; performed only when there is a valid medical condition
12
Q
If initial results are normal, no need to repeat
SUBSEQUENT LAB TESTS
A
Fetal aneuploidy screening Neural tube defects CBC Sero for syphilis HIV testing D (Rh) negative Rectovaginal culture for GBS GTT
13
Q
Fetal aneuploidy screening
A
11-14 weeks or 15-20 weeks
14
Q
NTD
A
15-20 wks
15
Q
CBC
A
Repeated at 28-32 wks
16
Q
Sero test
A
Repeated at 28-32 weeks (in high risk pop)
17
Q
HIV test
A
Repeat at 36 wks in high risk
18
Q
D neg are unsensitized —
A
Repeat Ab screen at 28-29 wks
Give anti-D immune globulin if still unsensitized
19
Q
Rectovaginal culture for Grp B Strep at
A
35-37 weeks (ACOG and CDC guidelines ‘13)
Intrapartum antimicrobial prophylaxis is given for those w (+) cultures
20
Q
GTT
A
At 24-28 weeks for women at moderate risk for diabetes and for women at high risk if initial test is negative
21
Q
Wt for ht category
A
Underwt: <18.5
Normal: 18.5-24.9
Overwt: 25-29
Obese: >30
22
Q
Total wt gain range
A
Underwt: <18.5 —> 28-40 lbs —> 1 (1-1.3) lb/wk
Normal: 18.5-24.9 —> 25-35 lbs —> 1 (0.8-1) lb/wk
Overwt: 25-29 —> 15-25 lbs —> 0.6 (0.5-0.7) lb/wk
Obese: >30 —> 11-20 lbs —> 0.5 (0.4-0.6)
23
Q
Obesity is ass w increased risk for
A
Gestational hypertension Preeclampsia Gestational diabetes Macrosomia Cesarean delivery
24
Q
Caloric requirements
A
Caloric increase of 100-300 kcal
25
Increase in CHON demand
5-6g/day
26
Needed for growth abd remodeling of fetus, placenta, uterus, breast and increased maternal volume
CHON
27
Shark, swordfish, king mackarel and tile fish contain potentially high lvls of
Methylmercury
28
Increased needs in 2nd-3rd trimester due to increased deposition of iron in fetal and placental tissues and increased in red cell mass wc proceed at higher rate
Iron
29
When is iron not necessary bcs it may aggravate GI rxns, nausea and vomiting
1st trimester
30
Sufficient amount for requirement for lactation
At least 27mg/day
31
```
But if preggy is large
Or has twin fetuses
Begins supplementation late in pregnancy
Takes iron irregularly
Has depressed Hb lvl
```
How much iron?
60-100mg/day
32
Essential component of thyroid hormone
Iodine
33
Essential component of thyroid hormone
Iodine
34
Predisposes to have offspring with cretinism (mental retardation, neurologic deficits)
Subclinical maternal hypothyroidism
35
Adequate iodine intake
Use of iodized salt
Iodine tablets
Iodized oil injections
Addition of iodine to municipal water supplies
36
Supplementation not recommended for routine use during preggy
Ca
37
Zinc recommended daily intake for preggy
12mg
38
Severe zinc deficiency
Leads to poor appetite, suboptimal growth and impaired wound healing
39
Folate or folic acid deficiency
Megaloblastic anemia
40
Folate requirements
0.4-0.8mg/day
41
Folate increased requirements in
Protracted vomiting
Hemolytic anemia
Multiple fetuses
42
Recommended dose of folate for prevention of NTDs
400ug/day
43
Recommended dose of folate for a month prior to conception and in first trimester (70% redxn of 2-5% occurrence)
4mg/day
44
Associated w congenital malformations when taken in higher doses during pregnancy (>10,000 IU daily)
Vit A
45
Routine supplementation also not reco
Vit A
46
Occurs naturally in food of animal origin
Vit B12
47
They may give birth to infants with low vitamin B12 stores
Strict vegetarians 😱
48
May contribute to vit B12 deficiency
Excess vit C
49
Vit B12 deficiency may increase risk of
NTD
50
Vit B6 (Pyridoxine) recommended for women at high risk for deficiency:
Substance abusers
Adolescents
Multifetal gestation
2mg/day
51
Used in combination w antihistamine doxylamine in management of nausea and vomiting of pregnancy
Vit B6 (Pyridoxine)
52
Daily req w a reasonable diet
| RDA = 80-85mg/day
Vit C
53
Wt gain goal approx.
25-35 lbs in women w normal BMI
54
At least hm mg iron daily
27mg
55
Detect Hb conc at
28-32 wks for any significant decrease
56
Absolute contraindications to aerobic exercise during pregnancy
- hemodynamically significant ❤️ dse
- restrictive lung dse
- incompetent cervix/cerclage
- multiple gestation at risk for preterm labor
- persistent second or third trimester bleeding
- placenta previa after 26 wks of gestation
- preterm labor during current pregnancy
- ruptured membranes
- preeclampsia/PIH
57
During flights
Hourly ambulation to lower venous thromboembolism risk
58
Preg in aircraft
Safely fly (naol) up to 36 weeks
59
When is coitus during pregnancy avoided?
When abortion, placenta previa or preterm labor threatens
60
Steroid induced suppression of bowel activity, compression of bowels by enlarging uterus or prolonged transit time
Constipation
Enemas and strong cathartics should be avoided
61
Potent teratogen
Alcohol
62
Fetal alcohol syndrome
Growth restriction
Facial abn
CNS dysfxn
63
Heavy intake (5-6 glasses/day)
Obstetric complications
| Fetal alcohol syndrome
64
Moderate intake (3-4 glasses/day)
Slight inc risk for abortion
65
Caffeine no harm w mod use hm?
2 cups daily
| 200mg of caffeine
66
Associated w abortion caffeine hm?
>5 cups per day (500mg caffeine)
67
Recommended caffeine intake
<300mg daily or approx.
| Three 5oz cups of percolated coffee
68
Contraindicated during pregnancy: live attenuated
MMR
Varicella
Smallpox
HPV
69
Susceptible to rubella must receive
MMR vax postpartum
70
Vaccines that may be given to women at risk of exposure
Poliomyelitis
Hepa B
Hepa A
Typhoid
71
Vaccines routinely given
Influenza
| Tdap
72
Given to all preg regardless of trimester during flu season
Influenza
73
Recommended in every pregnancy preferably between 27-36 weeks to maximize passive antibody transfer
Tdap
74
Vaccines whose indication for prophylaxis is not altered by pregnancy
Rabies
Pneumococcus
Meningococcus
75
Relation of the long axis of fetus to that of mother
Lie:
- longitudinal
- transverse
76
Refers to the part of fetus lying over the inlet
Presentation:
- cephalic
- breech
- shoulder
77
Relation of an arbitrary chosen portion of the fetal presenting part to the right or left side of the maternal birth canal
Position
- vertex
- face
- breech
- shoulder
78
VERTEX
Right occiput anterior
Right occiput posterior
Left occiput anterior
Left occiput posterior
Right occiput transverse
Left occiput transverse
Direct occiput anterior
Direct occiput posterior
79
FACE
Right mento anterior
| Right mento posterior
80
BREECH
Right sacro anterior
| Right sacro posterior
81
SHOULDER
Right acromiodorso anterior
| Right acromiodorso posterior
82
Relation of fetal parts to one another
Attitude
83
First 3 maneuvers, the examiner faces the
Torso and head of pt
84
Last maneuver
Faces the feet
85
The examiner palpates the fundus w the tips of the fingers of both hands in order to define which fetal pole ia present in the fundus
First maneuver
86
The palms of the examiner's hands are placed on either side of the abdomen to determine on wc maternal side lie the fetal back and the fetal small parts and next noting if fetal bacc is directly anteriorly, transversely or posteriorly
Second maneuver
87
1) Using thumb and fingers of one hand, the examiner grasps the lower portion of maternal abdomen (just above symphysis pubis in order to determine the fetal part that's presenting)
2) If presenting part is NOT engaged, a movable body will be felt usually the fetal head and the attitude of the head is defined
3) If the presenting part is deeply engaged, findings are simply indicative of the fact that lower pole of fetus is fixed in the pelvis
Third maneuver
88
The examiner faces the mother's feet and with the tip of the first 3 fingers of each hand, exerts deep pressure in the direction of the axis of the pelvic inlet
If head presents, one hand is arrested sooner than the other by a rounded body, the cephalic prominence, while other hand descends more deeply into the pelvis
In vertex presentations, on the same side as the small parts and the face presentations, on the same side as the fetal back
Fourth maneuver
89
Not reliable for fetal position
Auscultation
90
Transmitted through the convex portion of the fetus, therefore best heard thru the fetal back in vertex and breech presentation and thru the fetal thorax in face presentations
Fetal heart sounds
91
In cephalic, fetal heart sounds are best heard
Midway between the maternal umbilicus and the anterior superior iliac spine
92
In breech presentations, fetal heart tones are usually heard
at or slightly above umbilicus
93
In occipito-anterior positions, heart sounds are usually heard best a
Short distance from midline, in transverse position, more laterally and in the posterior positions,
best heard: back in the mom's flank
94
Fetal position is determined by identifying the location of the anterior (lozenge-shaped) fontanel and the posterior (triangular-shaped) fontanel in
In vertex presentation
95
ID fetal position esp in obese or women w rigid abdominal walls
Ultrasonography
96
Safety- ALARA principle (As Low As Reasonably Achievable)
- sonography should be performed only w valid medical indication using lowest possible exposure setting to obtain necessary info
- professionals, trained
- keepsake fetal imaging
97
Components of standard UTZ exam by FIRST TRIMESTER
- Gestational sac size, loc and number
- Embryo and/or yolk sac ID
- Crown-rump length: most accurate biometric predictor of gestational age
- Fetal number, including amniocity and chorionicity of multifetal gestations
- Embryonic cardiac activity
- Assessment of embryobic/fetal anomaly appropriate for first tri
- Eval of uterus, adnexa and cul-de-sac
- Eval of fetal nuchal region (transparency assessment is considered)
98
Components of standard UTZ exam by 2nd and 3rd trimester
- fetal number (amniocity and chorionicity of multi)
- fetal cardiac activity
- fetal presentation
- placental loc, appearance and relationship to the internal cervical os
- amniotic fluid vol
- gestational age assessment
- fetal wt estimation
- fetal anatomical survey
- eval of maternal uterus, adnexa and cervix
99
Gestational age assessment
Second tri, biparietal diameter (BPD) - most accurately reflects gestational age
Femur length correlates well w both BPD and gestational age
Abdominal circumference has the greatest variation of gestational age (2-3 wks)
