Prenatal Care, Normal Pregnancy, and Basic L&D Flashcards
What are some routine tests conducted during prenatal visits?
BP, Blood type & Rh, CBC, UA (glucose and protein), Random Glucose, HBsAg, HIV, Syphilis, Rubella Titer, Screening for Sickle Cell and CF, and Pap Smear
Timeline for frequency of prenatal visits entails seeing doctor every ___ week/s for first 24-28 weeks and every ___ week/s for 28-35 weeks. Then every ___ week/s from 36-40/41.
- Every 4 weeks until 24-28 weeks
- Every 2 weeks from 28-35 weeks
- Every week from 36-40/41
What supplements are important during pregnancy?
Folic acid (4mg/day)
Ca++
Iron
Prenatal vitamins
Benefits of _____ (class of medication) must be weighed with potential harm when advising patient on continuation v. discontinuation.
Anti-sz meds
Some Category X drugs (teratogenic) include:
- Warfarin
- Chemo
- Retinoids, DES, AEDs
SSRIs are Category ___ drugs.
C
____ vaccines are okay and _____ are not.
Recombinant vaccines are OKAY
Live vaccines are NOT okay
Examples of live vaccines to avoid during pregnancy are:
MMR and Varicella
*Must be >3 months before or after pregnancy
Examples of recombinant vaccines that are okay during pregnancy:
Influenza, Tetanus, Hep B, and Gardasil
Fundal height measurement is initiated at ___ weeks.
20
*Watch for FH measurement that is >3cm above or below gestational age
Fetal heart rate is normally in the range of ___ - ___.
120-160 bpm (present after 12 weeks)
1st Trimester bleeding occurs in 20-25% of pregnancies. Of those pregnancy losses are between ___ and ___ %.
25-50%
Overall weight gain in pregnancy is between ___ and ___ lbs (for single gestation).
25-35 lbs (usually 10lbs in 1st 20 weeks and then 1lb a week thereafter)
*If initial BMI < 20 then weight gain should be between 35-45 lbs
**If initial BMI > 35 then weight gain should be about 15 lbs
Foods to avoid during pregnancy…
- Toxoplasmosis and Salmonella: poorly cooked meat, raw eggs, cold cuts/hot dogs
- Listeriosis: soft, mold-ripened cheeses (brie, camembert, goat chz), unpasteurized chz/milk
- Mercury: sushi, king mackerel, tilefish, swordfish, shark
- Restrict caffeine to <200 mg/d or one 12oz. a day
During pregnancy cholesterol will ____ (increase/decrease) and BUN/Cr will ____ (increase/decrease).
Cholesterol will INCREASE
BUN/Cr will DECREASE
A little about First Trimester Screening & Tests…(1-12 weeks)
- Down Syndrome screening can be performed
- if b-hCG is abnormally high or low this could indicate abnormalities
- PAPP-A: usually LOW with fetal Down Syndrome
- If there is INCREASED THICKNESS of nuchal fluid on US @ 10-13 weeks then there could be a problem
Heartbeat is heard around ___ - ___ weeks via US of fetus.
5-6 weeks
Chorionic Villus Sampling (CVS) may be performed around 10-13 weeks. What patients is this often offered to?
Those with:
- a prior child with chromosomal abnormality
- maternal age > 35y
- abnormal 1st or 2nd trimester maternal screening tests
- abnormal US
- prior pregnancy losses
If a-fetoprotein is low, b-hCG is high, and estradiol is low then a diagnosis of _____ is possible.
Down Syndrome (Trisomy 21)
Triple Screening, often performed at 15-20 weeks (during 2nd trimester) includes what measurements?
- a-fetoprotein
- b-hCG
- Estradiol
Amniocentesis may be offered to the same group of women that qualify for CVS. It is typically offered at what point during the pregnancy?
15-18 weeks gestation
Screening for gestational DM occurs between ___ and ___ weeks.
24-28
Third trimester is classified as Weeks 28- Birth.
FYI
Rhogam is given at ___ weeks and within ___ hours after childbirth in unsensitized Rh negative mothers.
28 weeks and within 72 hours of childbirth
Group B Strep screening occurs between ___ and ___ weeks (via vaginal-rectal cx).
32-37 weeks
*Treated during labor if positive with Penicillin or cefazolin if there is a mild penicillin sensitivity.
Other tests performed during the 3rd trimester…
- Hg and Hct: 35 weeks
- Biophysical profile: Looking at 5 variables- fetal breathing, heart tones, amniotic fluid levels, NST & gross fetal movements (2pts each for a maximum score of 10)
- Non-Stress Testing
A Reactive NST indicates fetal ____ (wellbeing/complications).
Wellbeing
If there is a non-reactive NST then the next step may be a Contraction Stress Test (CST).
Interpretation:
- a Negative CST (no late decelerations)= Fetal well being
- a Positive CST (repetitive late decelerations)= Worrisome- need PROMPT DELIVERY
Serum b-hCG can detect pregnancy as early as ___ days after conception. Urine b-hCG can detect pregnancy ___ days after conception.
- Serum= 5 days after conception
- Urine= 14 days after conception
Uterus and Cervix changes during pregnancy…
Uterus:
1. Ladin’s sign: uterus softening after 6 wks
- Hegar’s sign: Uterine isthmus softening after 6-8 wks
- Piskacek’s sign: lateral bulge or softening of uterus cornus 7-8 weeks gestation
Cervix:
1. Goodell’s sign: cervical softening due to increased vascularization around 4-5 wks gestation
- Chadwick’s sign: bluish colorization of cervix and vulva around 8-12 wks
Fetal movement usually occurs when?
16-20 weeks
Fundal height measurement…
12 Weeks: Above pubic symphysis
16 Weeks: Midway between the pubis and umbilicus
20 Weeks: At the UMBILICUS
38 Weeks: 2-3cm below the xiphoid process
_____ contractions are NOT associated with cervical dilation.
Braxton-Hicks
“Bloody show” refers to cervical thinning and effacement
FYI
Stage 1 of Labor…
Onset of labor (true, regular contractions) to full dilation of cervix @ 10cm
- Latent phase: 1-6 hours–> cervix effacement with gradual cervical dilation
- *Active phase: 4-6 hours–> rapid cervical dilation (usually beginning at 3-4cm)
Stage 2 of Labor…
Lasts 1-2 hours. Time from full cervical dilation to delivery of fetus :)
- Passive phase: complete cervical dilation to active maternal expulsive efforts
- *Active phase: from active maternal expulsive efforts to delivery :)
Stage 3 of Labor…
Postpartum until delivery of PLACENTA
-Lasts 0-30 min (avg 5)
Stage 4 of Labor…
Period 1-2 hours after delivery where mother is assessed for complications
Cardinal movements of labor…
See study guide
Fetal monitoring during an uncomplicated pregnancy occurs how often?
- At least every 30 minutes in the active phase of 1st stage of labor
- At least every 15 minutes in the second stage of labor
- Uterine contractions are assessed every 30 min (includes frequency, duration, and intensity)
**Pulse and BP at least every 2-4 hours in normal labor
During active phase of labor the cervix should be assessed every ___ (time frame).
2 hours
*Vaginal exam should be done sparingly during latent phase (esp if membranes have ruptured) to decrease risk of intrauterine infxns
APGAR score is usually done when?
At 1 and 5 mins after birth (repeat at 10 min if abnormal)
How is APGAR scored?
1-10
≥7–> Normal
4-6 –> Fairly Low
≤3–> Critically Low
*APGAR of 4 necessitates resuscitation!!
A: Appearance P: Pulse G: Grimace A: Activity R: Respiration
(See study guide for more info)
Postpartum–>Puerperium (6 week period after delivery)…
-Uterus returns to normal size and placement around 6 weeks postpartum
What is Lochia Serosa?
Pinkish/brown vaginal bleeding that occurs 4-10 days postpartum (usually resolves in 3-4 weeks)
If not breastfeeding menses may return __ - __ weeks postpartum.
6-8
How long do the stages of labor last typically?
Stage 1: 6-20 hours (first child)
Stage 2: 30min-3hrs
Stage 3: 0-30mins
If maternal AFP is increased this suggests possible ____ in fetus. If maternal AFP is decreased this suggests ___.
Increased AFP= NTD
Decreased AFP= Trisomy
Anatomy scan and gender reveal are done by US around week ____.
20
Full term is ___ weeks.
37
____ and ____ vaccines are given at 28 weeks.
Tdap and Rhogam at 28 weeks
Biophysical profile is composed of which 5 components?
NST Amniotic fluid level Fetal movements Fetal tone Fetal breathing
Late decelerations is when FHR drops at the end of contractions. It is usually due to uteroplacental insufficiency. And it is ALWAYS worrisome!
FYI
