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Clin Med III > prenatal dx and care > Flashcards

prenatal dx and care Flashcards

1
Q

what is the most common cause of amenorrhea

A
  • pregnancy
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2
Q

gestational age

A
  • age in days or weeks from LMP
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3
Q

embryo

A
  • fertilization to 8 weeks
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4
Q

fetus

A
  • after 8 weeks to birth
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5
Q

infant

A
  • delivery to 1 year old
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6
Q

first trimester

A
  • first 14 weeks
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7
Q

second trimester

A
  • 14-28 weeks
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8
Q

third trimester

A
  • 28 weeks to birth
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9
Q

previable

A
  • infant delivered before 24 weeks
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10
Q

preterm

A
  • 24-37 weeks
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11
Q

term

A
  • 37-42 weeks
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12
Q

postterm

A
  • past 42 weeks
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13
Q

gravidity

A
  • number of times a woman has been pregnant
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14
Q

parity

A
  • number of pregnancies that led to birth after 20 weeks or > 500g infant
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15
Q

CV changes in pregnancy

A
  • CO increases
  • SV increases
  • pulse increases
  • systolic ejection murmur with S3
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16
Q

BP changes in pregnancy

A
  • peripheral vascular resistance decreases
  • BP falls in 2nd trimester
  • BP returns to normal in 3rd trimester
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17
Q

respiratory changes in pregnancy

A
  • decreased functional residual capacity, respiratory reserve volume, residual volume, total lung capacity
  • increased respiratory capacity and tidal volume
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18
Q

renal sys changes in pregnancy

A
  • increased size and weight of kidney
  • ureteral dilation
  • bladder becomes intraabdominal
  • GFR and CrCl increase
  • BUN and SCr decrease
  • increased Na reabsorption
  • increased renin and angiotensin but reduced vascular sensitivity
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19
Q

heme changes in pregnancy

A
  • plasma volume and RBC volume increases
  • WBC count increases
  • platelet count decreases
  • increased fibrinogen, factor VII-X
  • placenta produces plasminogen activator inhibitor
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20
Q

GI changes in pregnancy

A
  • decreased motility

- reduced gastric acid secretion

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21
Q

uterus changes in pregnancy

A
  • weight increases from 70 to 110 g

- BF increases to 750 cc/min

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22
Q

cervical changes in pregnancy

A
  • increased water content and vascularity

- increased cervical mucous secretion

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23
Q

dx of pregnancy

A
  • urine hcg as sensitive as serum

- if unsure of LMP get transvaginal US- can see gestational sac as early as 5 weeks

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24
Q

what is the leading cause of pregnancy associated death

A
  • homicide/ domestic voilence
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25
Q

chadwick sign

A
  • bluish discoloration of vagina and cervix

- sign of pregnancy

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26
Q

hegar’s sign

A
  • softening of uterine consistency
  • ability to palpate and compress connection between cervix and fundus
  • sign of pregnancy
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27
Q

goodell’s sign

A
  • softening and cyanosis of cervix at or after 4 weeks

- sign of pregnancy

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28
Q

Ladin’s sign

A
  • softening of uterus after 6 weeks

- sign of pregnancy

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29
Q

linea nigra

A
  • blue line from umbilicus to pubic bone

- sign of pregnancy

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30
Q

pregnancy sx

A
  • amenorrhea
  • N/V
  • breast pain
  • quickening- fetal mvmt
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31
Q

nagel’s rule

A
  • used to calculate the estimated date of confinement

- subtract 3 mo from LMP and add 7 days

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32
Q

dating the pregnacny

A
  • use nagel’s rule

- if uncertain of LMP then get US to determine crown- rump length

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33
Q

labs to order in first trimester

A
  • CBC
  • blood type and screen
  • +/- GLT
  • RPR, VRDL, gonorrhea, chlamyida
  • rubella ab screen
  • hep b surface antigen
  • VZV titer
  • PPD depending on population
  • pap smear depending on last one
  • UA and Cx
  • offer HIV test to all pts
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34
Q

why get blood type and screen?

A
  • if Rh neg then pt gets Rhogam at 28 weeks

- if ab screen is pos then contact perinatologist due to risk of hemolytic anemia and fetal death

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35
Q

when is GDM screening recommended in first trimester

A
  • BMI > 30
  • prior pregnancy with GDM or previous infant > 9 lbs
  • AA, latino, native american, asian american, pacific islander
  • HcbA1C > 5.7%
  • physical inactivity
  • first degree relative with DM
  • HTN
  • HDL < 35 or TG > 250
  • hx of CVD
36
Q

steps of GDM

A
  • if pass GLT then repeat at 24-28 weeks
  • if fail then get GTT
  • if pass 3 hour GTT then repeat at 26-28 weeks
  • if fail 3 hour GTT then dx made
  • if first trimester diabetic screening > 200 then dx GDM
37
Q

when should all pts get GDM testing

A
  • 24-28 weeks if not indicated in first trimester
38
Q

glucose loading test (GLT)

A
  • 1 hour test
  • 50 g PO glucose
  • check serum glucose lev 1 hour later
  • if > 130 then get GTT
39
Q

glucose tolerance test (GTT)

A
  • 3 hour test
  • 100 g PO glucose loading dose
  • serum glucose lev at 1, 2 and 3 hours
  • elevation of 2 or more levels= GDM
40
Q

levels of GTT that qualify as elevated

A
  • fasting > 95
  • 1 hour > 180
  • 2 hours > 155
  • 3 hours > 140
41
Q

when is US indicated in pregnancy

A
  • initial visit to measure crown rump length if uncertain LMP
  • first trimester bleeding
  • anatomy survey 18-20 weeks
  • any time fundal height is > 3 cm discrepancy from GA
  • confirm presentation at or after 37 weeks
42
Q

cystic fibrosis screening

A
  • offered at pre-conceptual or new OB visit
  • increased chance of being a carrier if close relative affected
  • if both parents are carriers risk of baby being affected is 1 in 4
43
Q

screening for fetal chromosomal abnormalities

A
  • all women offered aneuploidy screening before 20 weeks
  • discuss risks and desires
  • consult genetic counselor for high risk pts
44
Q

maternal serum screenings for chromosomal abnorm

A
  • offer to all pts but more important for AMA
  • quad screening
  • sequential screen
  • NIPT testing
45
Q

sequential screening

A
  • part 1 is blood testat 11-13 weeks
  • part 2 is blood test at 15-18 weeks
  • detects down syndrome, trisomy 18, and NTD
  • can detect down syndrome in twins
46
Q

who is sequential screening not recommended for

A
  • triplets +

- fetal anomaly or reduction of fetus

47
Q

what blood tests are included in sequential screening

A
  • PAPP-A
  • free b-hcg
  • MS-AFP
  • estriol
  • inhibin
48
Q

what is included in quad screen

A
  • MS-AFP
  • hcg
  • estriol
  • inhibin A
49
Q

quad screening use

A
  • 15-18 weeks, up to 20 weeks
  • cant be used for multiple gestations
  • screening only
  • detects trisomy 21, trisomy 18, open NTD
50
Q

non-invasive paternal testing (NIPT)

A
  • collect moms blood and look at fetal DNA
  • detects fetal trisomies 21. 18, 13
  • can detect abnormal numbers of sex chromosomes
  • if pos then get confirmatory test
51
Q

when is NIPT less reliable

A
  • fetal fraction under 4%

- obesity > 200 lbs

52
Q

who should get NIPT

A
  • AMA
  • fetal US findings indicating increased risk aneuploidy
  • hx of prior pregnancy with aneuploidy
  • pos test result for aneuploidy
53
Q

advanced maternal age (AMA)

A
  • women 35+ at time of delivery
  • offer maternal serum screening
  • offer genetic counseling with possible dx test
54
Q

what are definitive dx tools for aneuploidy

A
  • amniocentesis

- chorionic villus sampling (CVS)

55
Q

amniocentesis

A
  • used to obtain fetal karyotype
  • done 15-20 weeks
  • US guided to aspirate amniotic fluid
  • highly dependent on provider experience
56
Q

chorionic villus sampling

A
  • done to obtain fetal karyotype
  • done between weeks 10-13
  • catheter placed into intrauterine cavity and sm amount chorionic villi aspirated from placenta
  • highly dependent on provider experience
57
Q

cordocentesis

A
  • aka percutaneous umbilical blood sampling (PUBS)
  • puncture of umbilical vein under US guidance
  • karyotype analysis of fetal blood
  • rarely needed
58
Q

diagnostics done in 3rd trimester

A
  • CBC
  • GLT
  • RPR/VRDL depending on pt
  • if high risk repeat gonorrhea, chlamydia, HSV
  • CXR if PPD was pos
  • group b strep culture at 36 week
59
Q

culture for group b strep

A
  • screen all pts at 36 weeks
  • culture from lower vagina and anus, must go through sphincter
  • if PCN allergic ask for sensitivities or send for allergy testing
60
Q

what is measured at routine prenatal visits

A
  • BP
  • weight
  • urine dip for protein and glucose
  • fundal ht, estimated fetal wt, fetal position
  • auscultation of heart tones
61
Q

how frequently do pts have appts < 28 weeks

A
  • appt every 4 weeks
62
Q

how frequently do pts have appts 28- 36 weeks

A
  • appt every 2 weeks
63
Q

how frequently do pts have appts > 36 weeks

A
  • appt every week
64
Q

questions to ask about in the first trimester

A
  • cramping or bleeding

- n/v

65
Q

questions to ask in the second trimester

A
  • cramping or bleeding

- fetal movement

66
Q

questions to ask in the third trimester

A
  • contractions
  • leaking of fluid, bleeding
  • fetal movement
67
Q

treatment of vomiting in pregnancy

A
  • det if n/v due to pregnancy
  • start with dietary changes and emotional support
  • vit B6, unisom, acupressure, ginger
  • check ketones and electrolytes
  • consider phenergan and reglan
68
Q

what foods can folic acid be found in

A
  • green leafy veggies
  • oranges
  • cantaloupe
  • bananas
  • milk
  • grains and organ meats
69
Q

prenatal nutrition

A
  • limit caffeine to 500 mg/day
  • limit fish due to mercury
  • nutrition referral if inadequate wt gain, PICA, or eating disorder
  • increase calories and protein
  • iron supplement
  • calcium
70
Q

weight gain in pregnancy

A
  • avg 25-35 lbs
  • 15 ls if obese
  • 40 lbs if underweight
71
Q

safe meds in pregnancy

A
  • prenatal vitamins
  • tylenol
  • benadryl
  • sudafed
  • tums
  • FeSO2
  • colase
72
Q

meds commonly used in pregnancy

A
  • macrobid
  • bactrim except 3rd trimester
  • metrogel and monistat in first trimester
  • flagyl and diflucan after 1st trimester
  • anti-emetics
  • vistaril
  • prozac and other SSRIs
  • acyclovir
73
Q

exercise in pregnancy

A
  • continue normal activity level
  • 70% HRmax
  • limit new exercise to low impact like walking and swimming
  • avoid overheating- teratogenic
  • avoid contact sports after 1st trimester
74
Q

2nd trimester counseling

A
  • birthing classes
  • preterm labor risks and viability
  • breastfeeding
  • rhogam at 28 weeks if Rh neg
75
Q

3rd trimester counseling

A
  • analgesia/ anesthesia in labor
  • operative vaginal delivery or c section
  • travel
  • fetal kick counts
  • labor and delivery tour, things to bring to hosp
  • pediatrician, if boy circumcision
  • group B strep testing
  • post-partum contraception
  • if planning tubal ligation have pt sign consent
76
Q

things to consider if pt has had a prior c section

A
  • document uterine scar
  • have discuss risk/ benefit of VBAC vs repeat c section
  • have pt sign consent
  • sched repeat c section 29 weeks
77
Q

vaccines during pregnancy

A
  • flu

- Tdap 27-36 weeks

78
Q

vaccines c/i in pregnancy

A
  • live vaccines
  • MMR
  • varicella
79
Q

ways to do fetal surveillance

A
  • fetal movement assessment
  • non-stress test (NST)
  • contraction stress test
  • fetal biophysical profile
  • amniotic fluid index
  • initiate testing 32-34 weeks for most, if reassuring then repeat weekly or biweekly
80
Q

fetal movement assessment

A
  • used if maternal perception of decreased kicks or absent mvmt
  • mother counts number of kicks during specific time- usu 10 kicks/hr
81
Q

non-stress test

A
  • measure of fetal HR with movement (should accelerate)
  • reactive/normal= 2 or more accel in 20 min
  • nonreactive= insufficient accel over 40 min
82
Q

contraction stress test

A
  • look for presence or absence of late decel in response to contractions
  • late decel- nadir occurs after peak of contraction, persists beyond contraction
  • variable decel- cord compression
83
Q

amniotic fluid index

A
  • sum of largest cord free vertical pockets in each of 4 quadrants of uterus
84
Q

oligohydramnios

A
  • too little fluid
  • no US measured pocket of fluid > 2 cm or AFI of 5 cm or less
  • requires close maternal fetal surveillance
85
Q

polyhydramnios

A
  • excess fluid
  • usu AFI > 24 cm
  • can be normal, cause PROM, or malpresentation
86
Q

components of biophysical profile

A
  • +/- nonstress test
  • fetal breathing movements
  • fetal movement
  • fetal tone
  • AFI
87
Q

post partum visits

A
  • vaginal delivery 6 weeks
  • c section 2-6 weeks depending
  • consider sooner f/u if complications

Clin Med III (26 decks)

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