Prenatal Diagnosis/Care Flashcards
recommended prenatal care schedule
- 4-28 weeks: monthly
- 28-36 weeks: biweekly
- after 36 weeks: weekly
- 38-40 weeks: delivery
2 supplements all prenatal women should take
folic acid
prenatal vitamin
folic acid recs prior to conception vs for secondary prevention
prior to conception: 0.4 - 0.8 mcg
secondary prevention: 4 mg
indications for prenatal Ca supplementation (2)
-high risk for gestional HTN
-low Ca intake
1,200-1,300 mg/day
vitamin A should be limited to _ during prenatal period
< 5,000 IU/day
full PE should be performed at the first prenatal visit
what should be done at each subsequent prenatal visit (7)
weight
BP
UA
fundal height
fetal heart rate
fetal position
+/- cervical exam
pregnancy weight gain recs for obese women
< 15 lb
gs (but impractical) test for proteinuria in pregnancy
24 hour protein excretion
fetal HR is usually audible by
12 weeks
fetal position by palpation can usually be determined at _ weeks
36
advanced maternal age
35 yo
consideration for advanced maternal age
offer genetic testing
expectant date of confinement (EDC) - due date can be calculated using
naegele’s rule:
1st day of LMP + 7 days - 3 mo + 1 year
initial prenatal visit should take place _ weeks after LMP
6
ACOG defines HTN as
SBP > 140
OR
DBP > 90
triple screen
AFP
HCG
estriol
quad screen
AFP
HCG
estriol
inhibin A
when should corionic villus sampling occur
10-12 weeks (end of 1st trimester)
when should amniocentesis occur
15-18 weeks (beginning of 2nd trimester)
when should 75 g 2 hour glucose tolerance test be done
26-28 weeks
when should group B strep test be done
35-37 weeks
estimated gestational age by uterine size schedule
-12 weeks: pubic symphysis
-16 weeks: midway from symphysis to umbilics
-20 weeks: at umbilicus
-20-36 weeks: height in cm above pubic symphysis = weeks gestation
prenatal screening tests: first trimester
11-14 weeks:
-US for nuchal transucency
-PAPP-A and hCG
-chronic villus sampling (CVS)
elevated levels of PAPP-A and hCG are seen with
chromosomal abnormalities
low levels of PAPP-A can be associated w.
Down’s syndrome
prenatal screening test: 10 weeks
cell free fetal DNA (fetal DNA in maternal blood)
what does cell free DNA test for
-trisomies of 13, 18, 21
-if positive -> amniocentesis
what does chronic villus sampling test
placental tissue for chromosomal/genetic abnormalities
prenatal screening test: 16-18 weeks
quadruple screen
elevated AFP indicates
neural tube or abdominal wall defects
quad screen indicative of down syndrome
elevated hcg and inhibin
PLUS
decreased AFP and estradiol
quad screen indicative of edwards syndrome
elevated AFP, Hcg, and estradiol
prenatal screening test: 15-20 weeks
amniocentesis
prenatal screening test: 24-28 weeks
- 1 hr glucose challenge test
- if abnormal: glucose tolerance test
prenatal screening test: 35-37 weeks
lower genital swab for GBS
6 symptoms of pregnancy
amenorrhea
increased urinary frequency
breast engorgement
nausea
hyperpigmentation
cervical softening
urine pregnancy test detects _ (2)
and is sensitive starting at _ weeks pregnancy
hCG OR beta subunit
1-2 weeks
most accurate method to detect fetal size
US
US detection can detect the following at what gestational ages:
gestational sac:
fetal image:
cardiac activity:
gestational sac: 5 weeks
fetal image: 6-7 weeks
cardiac activity: 8 weeks
procedure where small samples of placenta are acquired to perform prenatal genetic analysis
chronic villus sampling
5 indications for chronic villus sampling
-maternal age > 35 yo
-prior child w. genetic d.o
-parents are carriers of genetic d.o
-1st trimester US suggestive of congenital anomaly
-abnormal aneuploidy screening result
2 risks of chronic villus sampling
-maternal alloimmunization
-vertical transmission of infxn (ex HIV)
2 complications associated w. chronic villus sampling
miscarriage
amniotic fluid leakage
2 routine 3rd trimester tests
UA
BG
when should RhoGAM be given if indicated
28-30 weeks
mothers w. pre gestational DM should undergo twice weekly non stress testing until delivery between _ weeks
28-32
when should cervical chlamydia and gonorrhea cultures be done if indicated
36-40 weeks