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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
chadwick sign
- bluish discoloration of vagina and cervix | - sign of pregnancy
26
hegar's sign
- softening of uterine consistency - ability to palpate and compress connection between cervix and fundus - sign of pregnancy
27
goodell's sign
- softening and cyanosis of cervix at or after 4 weeks | - sign of pregnancy
28
Ladin's sign
- softening of uterus after 6 weeks | - sign of pregnancy
29
linea nigra
- blue line from umbilicus to pubic bone | - sign of pregnancy
30
pregnancy sx
- amenorrhea - N/V - breast pain - quickening- fetal mvmt
31
nagel's rule
- used to calculate the estimated date of confinement | - subtract 3 mo from LMP and add 7 days
32
dating the pregnacny
- use nagel's rule | - if uncertain of LMP then get US to determine crown- rump length
33
labs to order in first trimester
- 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
34
why get blood type and screen?
- 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
35
when is GDM screening recommended in first trimester
- 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
steps of GDM
- 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
when should all pts get GDM testing
- 24-28 weeks if not indicated in first trimester
38
glucose loading test (GLT)
- 1 hour test - 50 g PO glucose - check serum glucose lev 1 hour later - if > 130 then get GTT
39
glucose tolerance test (GTT)
- 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
levels of GTT that qualify as elevated
- fasting > 95 - 1 hour > 180 - 2 hours > 155 - 3 hours > 140
41
when is US indicated in pregnancy
- 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
cystic fibrosis screening
- 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
screening for fetal chromosomal abnormalities
- all women offered aneuploidy screening before 20 weeks - discuss risks and desires - consult genetic counselor for high risk pts
44
maternal serum screenings for chromosomal abnorm
- offer to all pts but more important for AMA - quad screening - sequential screen - NIPT testing
45
sequential screening
- 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
who is sequential screening not recommended for
- triplets + | - fetal anomaly or reduction of fetus
47
what blood tests are included in sequential screening
- PAPP-A - free b-hcg - MS-AFP - estriol - inhibin
48
what is included in quad screen
- MS-AFP - hcg - estriol - inhibin A
49
quad screening use
- 15-18 weeks, up to 20 weeks - cant be used for multiple gestations - screening only - detects trisomy 21, trisomy 18, open NTD
50
non-invasive paternal testing (NIPT)
- 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
when is NIPT less reliable
- fetal fraction under 4% | - obesity > 200 lbs
52
who should get NIPT
- AMA - fetal US findings indicating increased risk aneuploidy - hx of prior pregnancy with aneuploidy - pos test result for aneuploidy
53
advanced maternal age (AMA)
- women 35+ at time of delivery - offer maternal serum screening - offer genetic counseling with possible dx test
54
what are definitive dx tools for aneuploidy
- amniocentesis | - chorionic villus sampling (CVS)
55
amniocentesis
- used to obtain fetal karyotype - done 15-20 weeks - US guided to aspirate amniotic fluid - highly dependent on provider experience
56
chorionic villus sampling
- 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
cordocentesis
- aka percutaneous umbilical blood sampling (PUBS) - puncture of umbilical vein under US guidance - karyotype analysis of fetal blood - rarely needed
58
diagnostics done in 3rd trimester
- 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
culture for group b strep
- 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
what is measured at routine prenatal visits
- BP - weight - urine dip for protein and glucose - fundal ht, estimated fetal wt, fetal position - auscultation of heart tones
61
how frequently do pts have appts < 28 weeks
- appt every 4 weeks
62
how frequently do pts have appts 28- 36 weeks
- appt every 2 weeks
63
how frequently do pts have appts > 36 weeks
- appt every week
64
questions to ask about in the first trimester
- cramping or bleeding | - n/v
65
questions to ask in the second trimester
- cramping or bleeding | - fetal movement
66
questions to ask in the third trimester
- contractions - leaking of fluid, bleeding - fetal movement
67
treatment of vomiting in pregnancy
- 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
what foods can folic acid be found in
- green leafy veggies - oranges - cantaloupe - bananas - milk - grains and organ meats
69
prenatal nutrition
- 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
weight gain in pregnancy
- avg 25-35 lbs - 15 ls if obese - 40 lbs if underweight
71
safe meds in pregnancy
- prenatal vitamins - tylenol - benadryl - sudafed - tums - FeSO2 - colase
72
meds commonly used in pregnancy
- 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
exercise in pregnancy
- 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
2nd trimester counseling
- birthing classes - preterm labor risks and viability - breastfeeding - rhogam at 28 weeks if Rh neg
75
3rd trimester counseling
- 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
things to consider if pt has had a prior c section
- document uterine scar - have discuss risk/ benefit of VBAC vs repeat c section - have pt sign consent - sched repeat c section 29 weeks
77
vaccines during pregnancy
- flu | - Tdap 27-36 weeks
78
vaccines c/i in pregnancy
- live vaccines - MMR - varicella
79
ways to do fetal surveillance
- 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
fetal movement assessment
- used if maternal perception of decreased kicks or absent mvmt - mother counts number of kicks during specific time- usu 10 kicks/hr
81
non-stress test
- measure of fetal HR with movement (should accelerate) - reactive/normal= 2 or more accel in 20 min - nonreactive= insufficient accel over 40 min
82
contraction stress test
- 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
amniotic fluid index
- sum of largest cord free vertical pockets in each of 4 quadrants of uterus
84
oligohydramnios
- too little fluid - no US measured pocket of fluid > 2 cm or AFI of 5 cm or less - requires close maternal fetal surveillance
85
polyhydramnios
- excess fluid - usu AFI > 24 cm - can be normal, cause PROM, or malpresentation
86
components of biophysical profile
- +/- nonstress test - fetal breathing movements - fetal movement - fetal tone - AFI
87
post partum visits
- 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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