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Prenatal Care - PRIN WK1 Flashcards

0
Q

What is the recommendation for folic acid supplementation?

A

1mg per day, taken 3 months preconception until 12 weeks along. 5mg is recommended in populations at increased risk for spina bifida

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1
Q

What are the guidelines for the routine maternal and fetal assessment follow up visits?

A

Every 4 weeks until 28 weeks.
Every 2 weeks from 28-36 weeks.
Every 1 week until delivery.

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2
Q

What immunizations are recommended preconception if they haven’t already been received?

A

Rubella, varicella and Hepatitis B. Influenza vaccinations are also recommended.

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3
Q

What STDs need to be screened for?

A

HIV, Hep B (and C if at risk) and syphilis by blood tests. Screen by cervical swabs for gonorrhea/chlamydia.

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4
Q

What type of lifestyle characteristics should be educated about?

A

Weight management, smoking cessation, alcohol and substance abuse.

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5
Q

What does GTPAL stand for?

A 
G = Gravida; the # of times pregnant
T = Term; the # of pregnancies carried to term
P = Preterm; # of pregnancies delivered preterm
A = Abortion; # of pregnancies delivered <20 weeks GA
L = Living; # of living children
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6
Q

What is the human gestational length?

A

40 weeks / 280 days

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7
Q

What is considered a term pregnancy?

A

37-42 weeks

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8
Q

What is the gestational age? How is it expressed?

A

The time since the last menstrual period (LMP). The LMP is the 1st day of the last period. Expressed in # of week + days,

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9
Q

What is the assumption made by gestational age calculations?

A

Assumes a regular 28 day menstrual cycle where ovulation occurs at day 14.

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10
Q

How is gestational age calculated?

A

Embryonic age + 2 weeks.

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11
Q

What are the four pregnancy dating methods?

A
  1. Last menstrual period (LMP)
  2. Ultrasound measurements.
  3. Blood/urine pregnancy test.
  4. Physical examination.
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12
Q

How is physical examination used to date pregnancy?

A

Fruit Size of Uterus
6-8 weeks = small pear
8-10 weeks = orange
10-12 weeks = grapefruit

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13
Q

Why is pregnancy dating so important?

A
  1. Timing obstetrical intervention.
  2. Monitoring fetal growth.
  3. Assessing impact regarding teratogenic exposure.
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14
Q

What are the components of an initial pregnancy assessment?

A
  1. Demographics
  2. Maternal Health
  3. Family History
  4. Complete Physical Examination
  5. Standard Lab Investigations
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15
Q

What are the three important components of a pregnant woman’s demographic assessment?

A
  1. Increased risk of complications.
  2. Ethnic origins.
  3. Potential exposure to teratogens.
16
Q

What two things may increase the risk complications in a pregnancy?

A
  1. Maternal Age (Especially >40 Yrs)

2. Low Socio-economic Status

17
Q

Why is ethnic origin important in an assessment of demographics?

A

Some ethnicities are at increased risk for genetic diseases or specific pregnancy complications.

18
Q

What are 4 potential areas for teratogenic exposure?

A
  1. Occupational
  2. Environmental
  3. Medication/Herbal Remedies
  4. Infectious
19
Q

What are the 4 important areas of maternal health that need to be assessed during the initial pregnancy visit?

A
  1. Obstetrical History
  2. Current Pregnancy
  3. Medical History
  4. Lifestyle/Social History
20
Q

Why is an obstetrical history important?

A

Past obstetrical history helps identify potential risk factors for the current pregnancy (ie. previous preterm delivery and previous Cesarean sections).

21
Q

What is the most accurate means of pregnancy dating?

A

Early pregnancy ultrasound at 8-14 weeks.

22
Q

What are 2 different ways the due date for a pregnancy is determined?

A
  1. Estimated date of delivery (EDD) using Nagele’s rule.

2. Pregnancy wheel/calculator.

23
Q

What is Nagele’s rule?

A

EDD = 1st day of LMP - 3 months + 7 days + 1 year

24
What 6 things are important to go over in medical history during an assessment of maternal health?
1. Medical illness that may impact the pregnancy/fetus. 2. Infections/Vaccinations 3. Surgical History 4. Blood Transfusions 5. Medications 6. Allergies
25
What are is the general timeline for trimesters of pregnancy?
1st Trimester - <14 wks since LMP 2nd Trimester - 15-28 wks 3rd Trimester - 28-40 wks
26
What 7 things should be looked for in regards to the family history of a pregnant woman?
1. Genetic Disorders 2. Birth Defects 3. Developmental Delay 4. Medical Illness 5. Multiple Births 6. Alcohol Abuse 7. Depression
27
What is done to assess physical status during the initial visit?
Complete physical examination with a pelvic exam and a Pap test.
28
What is done for a focused examination during a follow up visit to assess physical status?
Blood pressure, abdomen examination and measurement of uterus (to determine the symphysis fundal height).
29
What is the symphysis fundal height?
The height of the fundus of the uterus, measured in centimeters from the top of the symphysis pubis to the highest point in the midline at the top of the uterus.
30
What does the bloodwork look for in lab investigations from the initial visit?
1. Blood group/rhesus type. 2. Blood count - hemoglobin. 3. Rubella/varicella immunity status. 4. Syphylis serology. 5. Heb B status. 6. HIV status. 7. As per risk: Hep C, parvoviruses, etc.
31
What is a 1st trimester ultrasound used for?
1. Dating of pregnancy. 2. Documentation of viability and location of the pregnancy. 3. Number of fetuses. 4. Prenatal diagnosis (nuchal translucency measurements).
32
What are topics for discussion with the pregnant woman in the first trimester?
Prenatal diagnosis, diet, prenatal classes and call coverage arrangements.
33
What are the seven common symptoms/findings of a first trimester pregnancy?
1. Fatigue 2. Bloating 3. Breast Tenderness 4. 1-2kg Weight Gain 5. Frequent Urination 6. At 12 Weeks: Fetal heart beat detectable by Doptone 7. 16-20 Weeks: Mom starts feeling fetal movements.
34
What does the risk, nature and severity of congenital defect resulting from antenatal exposure to a teratogen depend on?
1. The teratogenic agent itself (drug, maternal condition/disease, infection, chemical). 2. Does and amount of exposure. 3. Developmental stage at time of exposure. 4. Drug/drug interaction. 5. Individual's genetic susceptibility to exposure.
35
What types of screening are offered to all pregnant women (and when)?
Screening for Trisomy 18, Trisomy 21 and Spina bifida, as well as screening for fetal structural abnormalities.
36
What are the two invasive prenatal diagnosis tests offered to high risk patients?
Amniocentesis and chorionic villi sampling.
37
When is a pregnancy considered high risk?
For advanced maternal age, abnormal screening tests, or when there is a high risk for a specific genetic disease.

Pregnancy (1 decks)

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