Prenatal Diagnosis and Care Flashcards
What is the leading cause of secondary amenorrhea?
Pregnancy
Define gestational age (GA).
Age in days or weeks from the last menstrual period
Define embryo.
From time of fertilization-8 weeks (GA= 10 weeks)
Define fetus.
After 8 weeks to time of birth
Define infant.
Time between delivery-1 year old
Define 1st trimester.
1st 14 weeks GA
Define 2nd trimester.
14-28 weeks GA
Define 3rd trimester.
28 wks until delivery
Define previable.
Infant delivered before 24 weeks
Define preterm.
24-37 weeks
Define term.
37-42 weeks
Define post-term.
Past 42 weeks
Define gravidity.
Number of times a woman has been pregnant
Define parity.
Number of pregnancies that led to birth after 20 weeks or >500g infant (how it is written: term, preterm, abortions, living children)
What does G2P1011 mean?
2 pregnancies, 1 term, 0 preterm, 1 abortion, 1 living child
What does G4P3104 mean?
4 pregnancies, 3 term, 1 preterm, 0 abortions, 4 living children
What are 4 common cardiac changes for pregnant women?
(1) CO inc about 30-50%
(2) SV inc about 10-15%
(3) pulse inc about 15-20 bpm
(4) systolic ejection murmur and S3 gallop common
What are 2 changes in BP for pregnant women?
(1) peripheral vascular resistance falls
(2) fall in BP in 2nd trimester, return to normal during 3rd trimester
How early can a pregnancy test be positive?
1 week after fertilization
What is Chadwick’s sign?
Bluish discoloration of vagina and cervix
What is Hegar’s sign?
Softening of uterine consistency and ability to palpate or compress the connection between the cervix and the fundus
What is Goodell’s sign?
Softening and cyanosis of cervix at or after 4 weeks
What is Ladin’s sign?
Softening of uterus after 6 weeks
What are 4 additional pregnancy signs?
(1) breast swelling and tenderness
(2) linea nigra
(3) telangiectasis
(4) palmar erythema
What is Naegele’s Rule?
Calculate EDC by subtracting 3 months from the LMP and adding 7 days (if uncertain LMP, use ultrasound to determine EDC)
Why should you be concerned if an Rh antibody screen is positive?
Rh antibodies can destroy fetal RBCs causing hemolytic anemia (RBCs destroyed faster than the body can replace them→ fatal to fetus)
What age is considered advanced maternal age?
35 or older at time of delivery
What are the 4 tests in a quad screen?
(1) MSAFP (alpha-fetoprotein)
(2) hCG
(3) estriol
(4) inhibin-A
What does it mean if MSAFP is elevated during the second trimester?
Inc risk of neural tube defects
What does it mean if MSAFP is decreased during the second trimester?
Aneuploidies including Downs Syndrome
What 4 things do you look at in a second trimester ultrasound (at 18-20 weeks)?
(1) fetal survey
(2) amniotic fluid volume
(3) placental location
(4) gestational age
What does cell-free fetal DNA (cffDNA) analysis test for?
Fetal trisomies (21, 18, 13) in maternal blood
When are 5 times an ultrasound is used during pregnancy?
(1) at initial visit to measure crown-rump length if uncertain LMP
(2) 1st trimester bleeding
(3) anatomy survey b/w 18-20 weeks
(4) any time fundal height is >3cm discrepant from GA
(5) confirm presentation at or after 37 weeks
What are 3 ways of fetal karyotyping?
(1) amniocentesis
(2) chorionic villus sampling (CVS)
(3) cordocentesis
When is amniocentesis usually performed and why is it done?
Between 15-20 weeks to obtain fetal karyotype
What is chorionic villus sampling and when is it done?
Catheter placed into intrauterine cavity and small amount of chorionic villi aspirated from placenta; can obtain fetal karyotype b/w 10-13 weeks
What is cordocentesis/PUBS?
Puncturing the umbilical vein under direct ultrasound guidance; karyotype analysis of fetal blood usually w/in 24-48 hrs
When do you screen all pts for Group B Strep?
36 weeks
What are 5 routine prenatal visit components?
(1) BP
(2) weight
(3) urine dipstick-for protein and glucose
(4) fundal height, estimated fetal weight, and fetal position
(5) auscultation of the fetal heart tones
What is the frequency of visits when <28 weeks?
Every 4 weeks
What is the frequency of visits when 28-36 weeks?
Every 2 weeks
What is the frequency of visits when >36 weeks?
Every week
What supplement do you want pregnant pts taking?
Prenatal vitamins containing 800mcg of folic acid
What are 4 fat soluble vitamins to avoid excessive amounts of during pregnancy?
D, A, K, E
Why do you want to avoid/limit fish in pregnancy?
Mercury risk
What are 4 things you want to inc/supplement during pregnancy?
(1) calories: inc 15%/day
(2) protein: additional 10-30g/day
(3) iron: supplement 30-60mg/day
(4) calcium: 1200mg needed/day
What are 4 2nd trimester counseling points for pregnancy?
(1) attend birthing classes
(2) preterm labor risks after viability
(3) breastfeeding
(4) Rhogam at 28 weeks if Rh negative
What 8 things should be discussed during 3rd trimester?
(1) analgesia/anesthesia in labor
(2) operative vaginal delivery or c-section
(3) travel
(4) fetal kick counts (10 kicks/hr)
(5) labor and delivery tour-things to bring to hospital
(6) pediatrician-if boy: circumcision
(7) Group B strep
(8) postpartum contraception
What are the 5 techniques of antepartum fetal surveillance?
(1) fetal movement assessment
(2) Non-stress test
(3) contraction stress test
(4) fetal biophysical profile
(5) amniotic fluid index
What is the indication and technique for fetal movement assessment?
Indication: maternal perception of dec or absent fetal movement
Technique: mother counts # of kicks during a specified amt of time-have mom eat or drink something and sit or lay still
What is a non-stress test and what are reactive and nonreactive results?
Measurement of fetal heart rate w/movement
Reactive (normal): 2+ fetal heart rate accelerations w/in 20 min period
Nonreactive: insufficient fetal heart rate accelerations over a 40 min period
What is a contraction stress test and 2 decel findings on it?
Looking for presence or absence of late fetal heart rate decelerations in response to uterine contractions
Late decels: decels that reach their nadir after the peak of the contractions and usually persist beyond the end of the contraction
Variable decels: cord compression
What are the 5 components to a biophysical profile and what is the scoring system of it?
Components: NST, fetal breathing movements, fetal movement, fetal tone, AFI
Scoring: each is 2 or 0→ normal is 8 or 10, abnormal is 4 or less
What is amniotic fluid index (AFI) and how does it vary for oligohydramnios and polyhydramnios?
Summation of the largest cord-free vertical pockets in each of the 4 quadrants of an equally divided uterus
Oligohydramnios (dec amniotic fluid): no US measured pocket of fluid >2 cm or AFI of 5cm or less→ bad
Polyhydramnios: usually AFI >/= 24cm; can be normal, or cause PROM or malpresentation
When is the postpartum follow up after a vaginal delivery and what do you check?
6 weeks: lochia, voiding, bowel movements, breastfeeding, depression, contraception
When is the postpartum follow up after a c-section and what do you check?
2 and 6 weeks: incision check
