prenatal diagnosis and care Flashcards
what is naegele’s rule?
1st day of LMP+7 days- 3mnths
what are some routine tests to get during prenatal visits?
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
Goals of prenatal care?
- 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
how many visits are considered insufficeitn prenatal care?
<11
what is included in low risk prenatal care visits?
+/- 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)
When does normal prenatal care begin?
- before prego process!!
- Folic acid (4mg/d)
- Ca, Fe, prenatal vitamins
- dietary concerns
- management of chronic dz
sz tx for mom
Phenytoin: craniofacial and limb reduction
Valproic Acid: 1-2% risk of NTD
Carbamazepine: Elevated NTD risk
Phenobarbital: w/drawal, maternal/ fetal hemorrhage
what can happen in mom has dz during prego?
maternal/fetal trauma from falls or burns,↑risk of premature labor, miscarriage, fetal hypoxia, lowering of the fetal HR
what are some common teratogens?
Alcohol, smoking, illicit drugs, work exposures
SSRI (cat C)
what are meds that are cat X
Warfarin → Early SAB IUGR, craniofacial/CNS
Antineoplastic agents (chemo) –> Designed to kill rapidly-dividing cells
Retinoids, DES, AEDs
immunizations in pregnancy??
recombinant vaccines are ok and live vaccines are not
what are some live attenuated vaccines?
Rubella, MMR, Varicella
Must be >3 mo before/ after pregnancy
what is a blueberry muffin baby?
baby born w/ purpura due to congenital infxn; think rubella, also possible w/ coxsackie, toxo, hep B, CMV, EBV, and congenital syphilis
what are some recombinant vacccines?
Influenza, Tetanus, Hep B, Gardasil
what must happen at each routine visit, no matter the trimester?
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
how common is first trimester bleeding?
20%-25% of pregnancies → Of those, pregnancy loss are ~25% -50%
when does risk of prego loos or non-viability increase?
Bleeding becomes heavy or occurs w/ cramps or pain
Risk of preg loss/non-viability ↓ (to 3-7%) if:
- Intrauterine gestation w/ + FHR is detected
- BHCG values rise appropriately for gestational age
what is normal weight gain in prego?
Overall weight gain 25-35 lbs (for single gestation)
weight gain for BMI <20?
should gain more, 35-45 lbs
weight gain for BMI > 35?
15 lbs
what is the typical weight gain?
10 lbs in first 20 wks, 1 lb/wk thereafter
what are foods to avoid in early prego?
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]
what are prego side effects that prego ppl should be advised on?
N/V, Constipation, Heartburn, Hemorrhoids, Varicose Veins, Leg cramps (relative hypokalemia), Backache, HA, Acne
important labs changes to know during prego
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
when is gestational dm screened for?
24-28 wks
when do you repeat antibiody titers?
In unsensitized Rh negative mothers followed by RhoGAM @ 28 wks & within 72 hrs after childbirth
when is GBS screened for?
32-37 wks (via vaginal-rectal cx)
H/H screened?
35 wks
biophysical profile of baby?
fetal breathing, fetal tones, amniotic fluid levels, NST & gross fetal movements → 2pts per criteria
Non-stress testing?
reactive vs nonreactive; HR of a fetus that is neurologically intact will have a fetal heart rate accelerations with fetal movement
reactive nst?
> 2 Accelerations in 20 mins
↑Fetal HR > 15 bpm from baseline lasting > 15 secs
prognosis: fetal well being
managment: repeat wk or biweekly
non-reactive NST?
No fetal HR accelerations or <15 bmp lasting <15 secs
prognosis: Sleeping, immature or compromised fetus
management: Vibratory stimulation, May try contraction stress
what is vibroacoustic stimulation?
useful for decreasing the number of nonreactive NSTs related to quiet fetal sleep cycles
how is the vibroacoustic stimulation test preformed?
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
what are sx of prego?
amenorrhea, N/V, breast tenderness, quickening (fetal movement), easy fatigability, urinary frequency, nocturia, infection
when can nullipara women detect quickening?
18-20wks
when can multipara women detect quickening?
14-16 wks
how can preg be dx based on b-hcg?
-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
what are physical exam findings during uncomplicated prego?
Uterus changes, cervix changes, increased basal body temp, skin changes (melasma/cholasma, linea nigra)
palpation of fetus
when can US detect fetus?
5-6 wks
what are specific uterus changes?
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
fundal height measurement: where should the FH be at 12 wks?
above the pubic symphysis
fundal height at 16 wks?
midway btw the pubis and umbilicus
fundal height at 20 wks?
at the umbilicus
fundal height at 38 wks?
2-3 cm below xiphoid phrocess
