Prenatal care part 1 Flashcards
Risk factors for fetal abnormalities
- Advanced maternal age
- previous pregnancy affected by chromosomal abnormalities
*recurrent history of early pregnancy loss
Screenings performed at a preconception visit
HIV, STD, TB, the antibody for Rh factor, any genetic disorder influenced by race or ethnicity
How long do you wait for pregnancy after receiving a live vaccine
1 month
what is the recommended dose of folic acid a pregnant lady should take
> 0.4-0.8
when does antepartum surveillance begins
1st prenatal visit
what is hyperemesis gravidarum
extreme nausea and vomiting, top reason to cause the pregnant women to go to the hospital
What are some of the symptoms present in the 1st trimester
amenorrhea, breast tenderness, fatigue, edema, weight gain, morning sickness
When does hyperemesis gravidarum begin?
1st trimester
2nd and 3rd trimester signs and symptoms
back pain, leg cramps, round ligament pain, varicose veins
treatment for round ligament pain
yoga/stretching/change positions GRADUALLY
quickening
begins 16-18 weeks at times until 20 weeks
when can examiners feel quickening
24 weeks
Striae gravidarum
pigmented line down the midline of a pregnant women
what causes the striae in the middle of the abdomen
increase in progesterone
when is the 1st trimester
0-13 weeks and 6 days
when is the 2nd trimester
14 weeks - 27 and 6 days
when is the 3rd trimester
28-40 and 6 days
what is considered preterm
born before 37 weeks
what is considered full term
39- 40 weeks and 6 days
components of 1st prenatal visit
medical/obstetric history, psychosocial history, calculated EDD, US, lab test, selective screenings
What does the HPI always have to include
maternal age, gravity/parity status, LMP, estimated gestational age, CC
GTPAL
G- total number of pregnancies
T - full term babies (37-40 weeks)
P - preterm babies (20-37 weeks)
A- abortion and miscarriages
L- living children
Gravida
a woman who is or has been pregnant
primigravida
a woman who is in or who has experienced her 1st pregnancy
multigravida
a woman who has been pregnant more than once
null gravida
a woman who has never been pregnant
primipara
a woman who has given birth to only 1 child
multipara
a woman who has given birth 2 or more times
nullipara
a woman who has never given birth or who has never had a pregnancy progress beyond the gestational age of abortion
how to calculate EDD
1st LMP - 3months + 7 days
What is the most accurate in calculating gestational age?
US
how much should a pregnant woman gain?
25-35lbs
what is the total weight an obese woman should gain when they are pregnant
11-20lbs
when does BP typically decrease
at the end of the 1st trimester
what is considered gestational HTN
after 20 weeks, persistent systolic of >140 or diastolic of >90 WITHOUT proteinuria
what does the 1st prenatal visit obstetric exam include
pelvic exam, cervical assessment, fetal HR
when can you use Doppler US to detect FHR
8-10 weeks
Narrowest fixed distance through which the fetal head must pass during vaginal delivery
obstetric conjugate
which pelvic type is the most common
round/gynaecoid
which is pelvis shape is the second most common
anthropoid
which pelvic shape requires C-section or is the most difficult
platypelloid
what is chadwick sign
bluish discoloration of the vaginal mucosa
when is the chadwich sign seen
8-12 weeks
what is Goodell sign
softening and cyanosis of the cervix
when is goodell sign seen
6-8 weeks
what is hegar sign
softening of the uterus at the junction with the cervix (cervical isthmus)
when is hegar sign felt
6-12 weeks
what is the normal fetal HR
110-160
what is the FHR in 1st weeks
150-170
where can you feel the fundus when the gestational age is 20 weeks
umbilicus
From where do you measure the fundal height
top of the uterine fundus to the pubis symphysis
when is the fundal height in cm roughly equal to the weeks of gestational age
16-36 weeks
what is the goal fetal presentation
occiput anterior
when can you feel lightening
about 36 weeks
What is lie
long axis of fetus relative to longitudinal axis of uterus
what is presentation
the fetal part that directly overlies the pelvic inlet
- cephalic/breech
position
relationship of the fetus’s head in comparison to the maternal pelvis
- occipital anterior
Sunny side up
cephalic posterior (back of the head is on the back of the mom’s pelvis)
What is Leopod’s maneuvers
series of 4 palpitations to determine fetal lie, presentation and position
when can you use the Leopold maneuvers
20 weeks
when can you conduct an external cephalic version
36-38 weeks if breeched
Transabdominal can visualize pregnancy at what weeks
5-6 weeks
when do you use transvaginal US
if transabdominal US is inconclusive, can detect at 4-5 weeks
what is the most accurate method of estimating gestational age
US assessment of crown to rump length
how long should you exercise if the patients does not have any medical or obstetric complications
30 minutes per day of the week
pica
inclination for non-nutritional substances such as ice, food, starch, clay
what should a pregnant woman avoid eating
unpasteurized/raw food, thoroughly wash fresh fruits, avoid fish high in mercury, avoid soft cheese
how much folic acid should a pregnant woman take a day
400ug/day for low risk and 4mg/day for high risk
which med is the pain reliever of choice in pregnant woman
acetaminophen
what is the antihistamine of choice in a pregnant woman
chlorpheniramine
which antidiarrheal med is the TOC for pregnant woman
kaopectate
what are the first choice antidepressant for pregnant woman
SSRI and SNRI
fetal alcohol syndrome
growth restriction, facial abnormalities, CNS dysfunction
what is the most common developmental delay that is preventable
alcohol
what are considered teratogens to a pregnant woman
ionizing radiation, methyl mercury, herbal remedies
Sexual activity in pregnant woman
no restrictions during pregnancy
when is sexual activity restricted in a pregnant woman
placenta previa, vaginal bleeding, premature rupture of the membrane, history of preterm labor
Most airline permit travel for up to how many weeks
36 weeks
travel is avoided in which types of pregnant women
HTN, poorly controlled DM, sickle cell disease
how long is the leave of absence
4-6 weeks
benefits of breastfeeding
nutrition, passive immunity, decrease rates of DM, HTN and heart disease
CI to breastfeeding
maternal infection, medication, if an infant has galactosemia
what vitamin need to be supplemented for infants who are breast feeding in the 1st year
vitamin D 400IU
vaccines not recommended
HPV, MMR, live flu, varicella, travel vaccines
when is circumcision performed
2 days of life
primigravida
a woman who is in or who has experienced her 1st pregnancy
