Prenatal Care/Normal Pregnancy part 2 Flashcards
Monozygotic twins
Twins formed by the fertilization of one egg by one sperm
Dizygotic twins
Twins formed by the fertilization of two eggs by two sperm
Chorionicity
The number of placentas in a twin or higher order gestation; in monozygotic twins, can either be monochorionic or dichorionic. Dizygotic twins are always dichorionic
Amnionicity
The number of amniotic sacs in a twin or higher order gestation; monozygotic twins may be monoamniotic or diamniotic whereas dizygotic twins are always diamniotic
What is associated with an increased incidence of twinning?
Slowed tubal motility
OCPs can slow tubal motility, so ask a woman if she has used OCPs within 3 mos of becoming pregnant
When is there an increase of a twin pregnancy?
Rate increases with maternal age and peaks at 37 yrs
Also increased when the mother is a dizygotic twin
Fertility tx are also responsible for many twin gestations
Presentation in multiple gestation
Increased maternal serum alpha fetoprotein
Nausea and vomiting increased more than single gestation
Blood and stroke volume increased more than single gestation
Red cell mass increases proportionately less
Greater increase in size and wt of the uterus
Maternal complications in multiple gestation
Preeclampsia Gestational diabetes Anemia DVT Postpartum hemorrhage The need for caesarean delivery
Fetal complications in multiple gestation
Preterm delivery IUGR Polyhydramnios Stillbirth Fetal abnormalities Placenta previa Abruption Twin-twin transfusion syndrome
Apgar score: appearance
0: blue or pale
1: acrocyanotic
2: completely pink
Apgar score: pulse
0: absent
1: <100/minute
2: >100/minute
Apgar score: grimace
0: no response
1: grimace
2: cry or active withdrawal
Apgar score: activity
0: limp
1: some flexion
2: active motion
Apgar score: respirations
0: absent
1: weak cry, hypoventilation
2: good, crying
What is the most accurate means to date a pregnancy?
1st trimester transvaginal u/s
Initial labs of pregnancy
CBC Blood type Rh Antibody titer RPR or VDRL Hep B Rubella titer Varicella titer HIV HgbA1c if diabetic Hgb electrophoresis if possibility of sickle cell trait Offer CF screening
What should be done on any new OB pt?
Wet prep
Education for pregnant pt
Ok to keep doing almost anything she is USED to doing for physical activity, providing it doesn’t cause extreme temp. Sex OK unless told not to. Many times sex will cause some spotting
Use gloves with cat litter, no raw meat, good handwashing
Small frequent meals work best. Need about 300 extra calories/day in early pregnancy
Avoid unpasteurized milk products and cheeses
Limit tuna, shark, swordfish to 6 oz per wk
No safe amount of alcohol, no smoking
Avoid situations which can cause rise in the core temp
What does the triple screen measure?
AFP, beta-hCG, and unconjugated estriol
What does the quad screen measure?
Triple screen plus inhibin-A
What is one of the number one reasons for false pos triple or quad screen results?
Inaccurate dating of the pregnancy
What do high levels of alpha fetoprotein suggest?
The developing baby has a neural tube defect
What do low levels of AFP and abnormal levels of hCG and estriol suggest?
May indicate chromosomal abnormality
What does elevated inhibin A indicate?
Down syndrome but low with the other trisomies
When should an u/s be done to check for anomalies?
Around 20 wks
When is glucose screening done?
26-28 wks
When should a 3-hr GTT be done?
If >140 or if >130 plus risk factors
Normal values of GTT
Fasting: <95 mg/dL
1 hr: <180 mg/dL
2 hr: <155 mg/dL
3 hr: <140 mg/dL
Non stress test
Electronic fetal monitoring of fetal heart rate
Reactive: baby’s heart rate increases when it moves
Non-reactive needs prompt further workup
Contraction stress test
Evaluates fetal response to contractions
Biophysical profile
U/s evaluation of fetal well-being
Endocrine changes in pregnancy
Postprandial hyperglycemia ensures adequate glucose for fetus
Insulin resistance promotes hyperglycemia
Estrogen and progesterone may also have anti-insulin effects
Placental lactogen increases tissue resistance to insulin
Thyroid changes in pregnancy
Estrogen stimulates increase in thyroid binding globulin formation and increases its 1/2 life, peaking at 20 wks
Total T3 and T4 increased
TSH low to nl in early pregnancy, normal mid-pregnancy and reduced later
Genital tract changes in pregnancy
Increased vascularity Increased secretions Softening of the cervix (Goodell's sign) Violet color to vagina (Chadwick's sign) Size of the uterus can compress veins within the abdomen and impede venous return thereby decreasing CO
Gallbladder changes in pregnancy
Impaired contraction High residual volumes Bile of thicker consistency Promotion of stasis and increased likelihood of stone formation Retained bile salts can cause itching
