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Womens Health > prenatal diagnosis and care > Flashcards

prenatal diagnosis and care Flashcards

1
Q

what is naegele’s rule?

A

1st day of LMP+7 days- 3mnths

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2
Q

what are some routine tests to get during prenatal visits?

A

TORCHS

TO: toxoplasmosis
R: rubella
C: CMV
H: HSV
S: syphillus

CBC, HepBsAg, GC/Chlam, UA (glucose and protein), BP, ABO and Rh, sickle cell, CF, papsmear

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3
Q

Goals of prenatal care?

A
  • reduce maternal and perinatal mortality
  • improve the physical and mental health of women and kids
  • prepare the woman for labor, lactation, and care of baby
  • early detection/tx of complicated conditions
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4
Q

how many visits are considered insufficeitn prenatal care?

A

<11

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5
Q

what is included in low risk prenatal care visits?

A

+/- preconceptual counseling

  • One extensive New Prenatal Visit
  • Every 4 weeks for first 24 to 28 weeks
  • Every 2 weeks, for 28-35 weeks
  • Every week from 36 to 40-41 weeks
  • 2x/wk 40+-42 6/7 (at the latest)
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6
Q

When does normal prenatal care begin?

A
  • before prego process!!
  • Folic acid (4mg/d)
  • Ca, Fe, prenatal vitamins
  • dietary concerns
  • management of chronic dz
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7
Q

sz tx for mom

A

Phenytoin: craniofacial and limb reduction
Valproic Acid: 1-2% risk of NTD
Carbamazepine: Elevated NTD risk
Phenobarbital: w/drawal, maternal/ fetal hemorrhage

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8
Q

what can happen in mom has dz during prego?

A

maternal/fetal trauma from falls or burns,↑risk of premature labor, miscarriage, fetal hypoxia, lowering of the fetal HR

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9
Q

what are some common teratogens?

A

Alcohol, smoking, illicit drugs, work exposures

SSRI (cat C)

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10
Q

what are meds that are cat X

A

Warfarin → Early SAB IUGR, craniofacial/CNS
Antineoplastic agents (chemo) –> Designed to kill rapidly-dividing cells
Retinoids, DES, AEDs

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11
Q

immunizations in pregnancy??

A

recombinant vaccines are ok and live vaccines are not

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12
Q

what are some live attenuated vaccines?

A

Rubella, MMR, Varicella

Must be >3 mo before/ after pregnancy

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13
Q

what is a blueberry muffin baby?

A

baby born w/ purpura due to congenital infxn; think rubella, also possible w/ coxsackie, toxo, hep B, CMV, EBV, and congenital syphilis

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14
Q

what are some recombinant vacccines?

A

Influenza, Tetanus, Hep B, Gardasil

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15
Q

what must happen at each routine visit, no matter the trimester?

A

weight
BP
U/A
fundal height starting at 20 wks (watch for FH >3 cm +/- gestational age)
listen to fetal heart (present after 12 wks)
edema
***Routine vaginal exams and cervical checks NOT advised

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16
Q

how common is first trimester bleeding?

A

20%-25% of pregnancies → Of those, pregnancy loss are ~25% -50%

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17
Q

when does risk of prego loos or non-viability increase?

A

Bleeding becomes heavy or occurs w/ cramps or pain

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18
Q

Risk of preg loss/non-viability ↓ (to 3-7%) if:

A
  • Intrauterine gestation w/ + FHR is detected

- BHCG values rise appropriately for gestational age

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19
Q

what is normal weight gain in prego?

A

Overall weight gain 25-35 lbs (for single gestation)

20
Q

weight gain for BMI <20?

A

should gain more, 35-45 lbs

21
Q

weight gain for BMI > 35?

A

15 lbs

22
Q

what is the typical weight gain?

A

10 lbs in first 20 wks, 1 lb/wk thereafter

23
Q

what are foods to avoid in early prego?

A

1) Coliform bacteria, toxoplasmosis, salmonella → Poorly cooked meat, raw eggs, cold cuts/hot dogs
2) Listeriosis → Soft, mold-ripened cheeses [brie, camembert, goat cheese], unpasteurized cheese/milk
3) Mercury → Sushi, king mackerel, tilefish, swordfish, shark
4) Restrict caffeine [< 200 mg/d or one 12 oz coffee]

24
Q

what are prego side effects that prego ppl should be advised on?

A

N/V, Constipation, Heartburn, Hemorrhoids, Varicose Veins, Leg cramps (relative hypokalemia), Backache, HA, Acne

25
Q

important labs changes to know during prego

A

1) Cholesterol will INCREASE and this is normal if elevated just repeat at the 6 week postpartum visit.
2) BUN and Creatinine will be DECREASED

26
Q

when is gestational dm screened for?

A

24-28 wks

27
Q

when do you repeat antibiody titers?

A

In unsensitized Rh negative mothers followed by RhoGAM @ 28 wks & within 72 hrs after childbirth

28
Q

when is GBS screened for?

A

32-37 wks (via vaginal-rectal cx)

29
Q

H/H screened?

A

35 wks

30
Q

biophysical profile of baby?

A

fetal breathing, fetal tones, amniotic fluid levels, NST & gross fetal movements → 2pts per criteria

31
Q

Non-stress testing?

A

reactive vs nonreactive; HR of a fetus that is neurologically intact will have a fetal heart rate accelerations with fetal movement

32
Q

reactive nst?

A

> 2 Accelerations in 20 mins
↑Fetal HR > 15 bpm from baseline lasting > 15 secs

prognosis: fetal well being
managment: repeat wk or biweekly

33
Q

non-reactive NST?

A

No fetal HR accelerations or <15 bmp lasting <15 secs

prognosis: Sleeping, immature or compromised fetus
management: Vibratory stimulation, May try contraction stress

34
Q

what is vibroacoustic stimulation?

A

useful for decreasing the number of nonreactive NSTs related to quiet fetal sleep cycles

35
Q

how is the vibroacoustic stimulation test preformed?

A

placeing an auditory source, such as an artifical larynx, on the partnal abdomen and delivering a short burst of sound to the fetus
-helps to stimulate the fetus to move and thus shortens the duration of time needed to produce an accelerations

36
Q

what are sx of prego?

A

amenorrhea, N/V, breast tenderness, quickening (fetal movement), easy fatigability, urinary frequency, nocturia, infection

37
Q

when can nullipara women detect quickening?

A

18-20wks

38
Q

when can multipara women detect quickening?

A

14-16 wks

39
Q

how can preg be dx based on b-hcg?

A

-Serum β-hCG → Serum quantitative can detect pregnancy as early as 5 days after conception
-Urine β-hCG → Can detect pregnancy 14 days after conception
↑Serum progesterone

40
Q

what are physical exam findings during uncomplicated prego?

A

Uterus changes, cervix changes, increased basal body temp, skin changes (melasma/cholasma, linea nigra)
palpation of fetus

41
Q

when can US detect fetus?

A

5-6 wks

42
Q

what are specific uterus changes?

A

1) Ladin’s Sign → Uterus softening after 6 weeks
2) Hegar’s Sign → Uterine isthmus softening after 6-8 weeks gestation
3) Piskacek’s Sign → Palpable lateral bulge or softening of uterus cornus 7-8 weeks gestation

43
Q

fundal height measurement: where should the FH be at 12 wks?

A

above the pubic symphysis

44
Q

fundal height at 16 wks?

A

midway btw the pubis and umbilicus

45
Q

fundal height at 20 wks?

A

at the umbilicus

46
Q

fundal height at 38 wks?

A

2-3 cm below xiphoid phrocess

Womens Health (24 decks)

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