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Women's Health > Prenatal Care, Normal Pregnancy, and Basic L&D > Flashcards

Prenatal Care, Normal Pregnancy, and Basic L&D Flashcards

1
Q

What are some routine tests conducted during prenatal visits?

A

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

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2
Q

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.

A
  • Every 4 weeks until 24-28 weeks
  • Every 2 weeks from 28-35 weeks
  • Every week from 36-40/41
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3
Q

What supplements are important during pregnancy?

A

Folic acid (4mg/day)
Ca++
Iron
Prenatal vitamins

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4
Q

Benefits of _____ (class of medication) must be weighed with potential harm when advising patient on continuation v. discontinuation.

A

Anti-sz meds

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5
Q

Some Category X drugs (teratogenic) include:

A
  • Warfarin
  • Chemo
  • Retinoids, DES, AEDs
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6
Q

SSRIs are Category ___ drugs.

A

C

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7
Q

____ vaccines are okay and _____ are not.

A

Recombinant vaccines are OKAY

Live vaccines are NOT okay

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8
Q

Examples of live vaccines to avoid during pregnancy are:

A

MMR and Varicella

*Must be >3 months before or after pregnancy

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9
Q

Examples of recombinant vaccines that are okay during pregnancy:

A

Influenza, Tetanus, Hep B, and Gardasil

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10
Q

Fundal height measurement is initiated at ___ weeks.

A

20

*Watch for FH measurement that is >3cm above or below gestational age

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11
Q

Fetal heart rate is normally in the range of ___ - ___.

A

120-160 bpm (present after 12 weeks)

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12
Q

1st Trimester bleeding occurs in 20-25% of pregnancies. Of those pregnancy losses are between ___ and ___ %.

A

25-50%

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13
Q

Overall weight gain in pregnancy is between ___ and ___ lbs (for single gestation).

A

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

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14
Q

Foods to avoid during pregnancy…

A
  1. Toxoplasmosis and Salmonella: poorly cooked meat, raw eggs, cold cuts/hot dogs
  2. Listeriosis: soft, mold-ripened cheeses (brie, camembert, goat chz), unpasteurized chz/milk
  3. Mercury: sushi, king mackerel, tilefish, swordfish, shark
  4. Restrict caffeine to <200 mg/d or one 12oz. a day
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15
Q

During pregnancy cholesterol will ____ (increase/decrease) and BUN/Cr will ____ (increase/decrease).

A

Cholesterol will INCREASE

BUN/Cr will DECREASE

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16
Q

A little about First Trimester Screening & Tests…(1-12 weeks)

A
  1. 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
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17
Q

Heartbeat is heard around ___ - ___ weeks via US of fetus.

A

5-6 weeks

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18
Q

Chorionic Villus Sampling (CVS) may be performed around 10-13 weeks. What patients is this often offered to?

A

Those with:

  • a prior child with chromosomal abnormality
  • maternal age > 35y
  • abnormal 1st or 2nd trimester maternal screening tests
  • abnormal US
  • prior pregnancy losses
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19
Q

If a-fetoprotein is low, b-hCG is high, and estradiol is low then a diagnosis of _____ is possible.

A

Down Syndrome (Trisomy 21)

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20
Q

Triple Screening, often performed at 15-20 weeks (during 2nd trimester) includes what measurements?

A
  1. a-fetoprotein
  2. b-hCG
  3. Estradiol
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21
Q

Amniocentesis may be offered to the same group of women that qualify for CVS. It is typically offered at what point during the pregnancy?

A

15-18 weeks gestation

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22
Q

Screening for gestational DM occurs between ___ and ___ weeks.

A

24-28

23
Q

Third trimester is classified as Weeks 28- Birth.

A

FYI

24
Q

Rhogam is given at ___ weeks and within ___ hours after childbirth in unsensitized Rh negative mothers.

A

28 weeks and within 72 hours of childbirth

25
Q

Group B Strep screening occurs between ___ and ___ weeks (via vaginal-rectal cx).

A

32-37 weeks

*Treated during labor if positive with Penicillin or cefazolin if there is a mild penicillin sensitivity.

26
Q

Other tests performed during the 3rd trimester…

A
  1. Hg and Hct: 35 weeks
  2. 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)
  3. Non-Stress Testing
27
Q

A Reactive NST indicates fetal ____ (wellbeing/complications).

A

Wellbeing

28
Q

If there is a non-reactive NST then the next step may be a Contraction Stress Test (CST).

A

Interpretation:

  • a Negative CST (no late decelerations)= Fetal well being
  • a Positive CST (repetitive late decelerations)= Worrisome- need PROMPT DELIVERY
29
Q

Serum b-hCG can detect pregnancy as early as ___ days after conception. Urine b-hCG can detect pregnancy ___ days after conception.

A
  • Serum= 5 days after conception

- Urine= 14 days after conception

30
Q

Uterus and Cervix changes during pregnancy…

A

Uterus:
1. Ladin’s sign: uterus softening after 6 wks

  1. Hegar’s sign: Uterine isthmus softening after 6-8 wks
  2. 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

  1. Chadwick’s sign: bluish colorization of cervix and vulva around 8-12 wks
31
Q

Fetal movement usually occurs when?

A

16-20 weeks

32
Q

Fundal height measurement…

A

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

33
Q

_____ contractions are NOT associated with cervical dilation.

A

Braxton-Hicks

34
Q

“Bloody show” refers to cervical thinning and effacement

A

FYI

35
Q

Stage 1 of Labor…

A

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)
36
Q

Stage 2 of Labor…

A

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 :)
37
Q

Stage 3 of Labor…

A

Postpartum until delivery of PLACENTA

-Lasts 0-30 min (avg 5)

38
Q

Stage 4 of Labor…

A

Period 1-2 hours after delivery where mother is assessed for complications

39
Q

Cardinal movements of labor…

A

See study guide

40
Q

Fetal monitoring during an uncomplicated pregnancy occurs how often?

A
  • 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

41
Q

During active phase of labor the cervix should be assessed every ___ (time frame).

A

2 hours

*Vaginal exam should be done sparingly during latent phase (esp if membranes have ruptured) to decrease risk of intrauterine infxns

42
Q

APGAR score is usually done when?

A

At 1 and 5 mins after birth (repeat at 10 min if abnormal)

43
Q

How is APGAR scored?

A

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)

44
Q

Postpartum–>Puerperium (6 week period after delivery)…

A

-Uterus returns to normal size and placement around 6 weeks postpartum

45
Q

What is Lochia Serosa?

A

Pinkish/brown vaginal bleeding that occurs 4-10 days postpartum (usually resolves in 3-4 weeks)

46
Q

If not breastfeeding menses may return __ - __ weeks postpartum.

A

6-8

47
Q

How long do the stages of labor last typically?

A

Stage 1: 6-20 hours (first child)

Stage 2: 30min-3hrs

Stage 3: 0-30mins

48
Q

If maternal AFP is increased this suggests possible ____ in fetus. If maternal AFP is decreased this suggests ___.

A

Increased AFP= NTD

Decreased AFP= Trisomy

49
Q

Anatomy scan and gender reveal are done by US around week ____.

A

20

50
Q

Full term is ___ weeks.

A

37

51
Q

____ and ____ vaccines are given at 28 weeks.

A

Tdap and Rhogam at 28 weeks

52
Q

Biophysical profile is composed of which 5 components?

A 
NST
Amniotic fluid level 
Fetal movements 
Fetal tone 
Fetal breathing
53
Q

Late decelerations is when FHR drops at the end of contractions. It is usually due to uteroplacental insufficiency. And it is ALWAYS worrisome!

A

FYI

Women's Health (8 decks)

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