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NNP Board Exam Review > Prenatal History > Flashcards

Prenatal History Flashcards

1
Q

Measurements in the 1st Trimester

A

Crown-to-Rump

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2
Q

Measurements in the 2nd & 3rd Trimester (note most accurate)

A

Head circumference (most accurate)
abdominal (2nd)
biparietal (3rd)
Femur (4th)

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3
Q

Assessment of the Anterior Vascular Capsule of the Lens

A

to estimate GA must be done in the first 24-48 hours of life

Hyaloid system & tunica vasculosa lentis - transient embryonic systems invade the developing eye to nourish during systems development

using opthalmascope set between +6 and +12

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4
Q

Ballard: posture

A

flexion increases with advancing gestational age, lower precedes upper flexion

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5
Q

Ballard: Square Window

A

angle between forearm and palm is measured

angle decreases with advancing GA

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6
Q

Ballard: Arm Recoil

A

supine, with arms flexed for 5 seconds then allowed to recoil, degree of flexion & strength of recoil measured

sluggish response w/ little to no flexion - low score

score of 4 requires fist to touch face

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7
Q

Ballard: popliteal angle

A

evals passive flexor tone in the knee (knee to ear)

angle decreases with advancing gestational age (resistance increases, flexibility decreases)

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8
Q

Hypoglycemia in SGA infants

A

hypoglycemia r/t decreased glycogen stores and decreased gluconeogenesis

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9
Q

Evaporation

A

heat loss when water evaporates from wet skin

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10
Q

Radiation

A

heat loss to surrounding surfaces not in direct contact with the infant

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11
Q

Convection

A

Heat is lost to air currents

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12
Q

conduction

A

heat lost to surfaces in direct contact with the neonate

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13
Q

Nonshivering thermogenesis

A

heat production through oxidation of brown fat

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14
Q

Maternal Medications: Aspirin

A

hemorrhage, premature closure of PDA

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15
Q

Maternal Medications: Ibuprofen

A

decreased amniotic fluid volume when used for tocolysis (to delay delivery), small risk of premature PDA closure

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16
Q

Maternal Medications: Codeine

A

NAS

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17
Q

Maternal Medications: Indomethacin

A

premature PDA closure, pulmonary artery hypertension

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18
Q

Maternal Medications: Meperidine

A

respiratory depression, peaks 2-3 hours after maternal dose

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19
Q

Maternal Medications: prophoxyphene

A

NAS, fetal anomalies

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20
Q

Maternal Medications: Phenobarbital

A

withdrawal symptoms, hemorrhagic disease

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21
Q

Maternal Medications: phenytoin (dilantin)

A

hemorrhagic disease, fetal hydantoin syndrome

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22
Q

fetal hydantoin syndrome

A

microcephaly, cleft lip/palate, hypoplastic digits

a characteristic facial appearance with midface hypoplasia, low nasal bridge, ocular hypertelorism, and an accentuated cupid’s bow of the upper lip

growth deficiencies

distal digital hypoplasia and of major malformations, particularly clefts of the lip and palate and cardiovascular anomalies,

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23
Q

Maternal Medications: Valproic acid

A

myelomeningocele, facial and cardiac anomalies

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24
Q

Maternal Medications: ribavirin

A

teratogenic, embyolethal in animals

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25
Q

Maternal Medications: zidovudine

A

potential fetal bone marrow suppression, decreases risk of perinatal HIV transmission

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26
Q

Maternal Medications: angiotensin converting enzyme inhibitors

A

neonatal bradycardia, hypoglycemia

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27
Q

Maternal Medications: beta blockers

A

hypoglycemia, bradycardia

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28
Q

Maternal Medications: calcium channel blockers

A

decreased maternal BP = decreased placental blood flow

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29
Q

Maternal Medications: diazoxide

A

hyperglycemia

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30
Q

Maternal Medications: digoxin

A

fetal toxicity with maternal OD

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31
Q

Maternal Medications: hydralazine

A

deceased placental blood flow

32
Q

Maternal Medications: methyldopa

A

clinical insignificant drop in neonatal BP

33
Q

Maternal Medications: mag sulfate

A

respiratory depression, hypotonia, hypermagnesemia, decreased bowel movement

34
Q

Maternal Medications: terbutaline

A

hypoglycemia

35
Q

Maternal Drug exposure: Alcohol

A

Fetal alcohol syndrome

36
Q

Fetal alcohol syndrome

A
  • At birth, infants with fetal alcohol syndrome (FAS) can be identified by:
  • small stature
  • microcephaly,
  • microphthalmia (small eyes)
  • short palpebral fissures
  • epicanthal folds
  • a small or flat midface
  • a flat elongated philtrum,
  • a thin upper lip,
  • a small chin
  • Abnormal palmar creases
  • cardiac defects
  • joint contractures may also be evident.
37
Q

Maternal drug exposure: Amphetamines

A

withdrawal, prematurity, fetal loss, infant death, low birth weight, SGA

38
Q

Maternal drug exposure: Cocaine

A

low birth weight, microcephaly, prematurity, abruption w/ possible asphyxia, shock, cerebral hemorrhage, stillbirth

39
Q

Maternal drug exposure: Heroine

A

low birth weight, SGA, withdrawal, impaired postnatal growth, behavior disturbances

40
Q

Maternal drug exposure: marijuana

A

decreased fetal growth, increased risk of nonlymphoblastic leukemia in childhood, ADHD

41
Q

Maternal drug exposure: Methadone

A

increased birth weight compared to heroine, drug withdrawal (worse than heroine alone)

42
Q

Maternal drug exposure: PCP

A

irritability, jitteriness, hypotonia, poor feeding

43
Q

Maternal drug exposure: tobacco

A

decreased birthweight by 175-250g, increased prematurity rate, increased rate of premature ROM, placental abruption, previa, increased fetal death, irritability

44
Q

Alpha Fetoprotein

A

measured at ~`16-20 weeks

made in liver of developing fetus

increased AFP can indicate neural tube defects or other congenital chromosomal defects

45
Q

Prophylactic Rho (D) Immune globulin (Rhogam) adminstration timing

A

28 weeks

46
Q

GBS screening (timing)

A

35-37 weeks

47
Q

Maternal Conditions: asthma

A

increased rates of prematurity, toxemia, perinatal loss

48
Q

Maternal drug exposure: cystic fibrosis

A

prematurity, IUGR, fetal loss

mothers have trouble absorbing nutrients, at higher risk of GDM, decreased lung function (fetal hypoxia)

49
Q

maternal conditions: hypertension, preE

A

uteroplacental insufficiency, abruption, fetal loss, IUGR, thrombocytopenia, neutropenia (theory that insufficiency causes bone marrow suppression)

50
Q

Maternal conditions: diabetes

A
  • hypoglycemia,
  • hypocalcemia
  • macrosomia
  • polycythemia
  • hyperbilirubinemia
  • birth trauma
  • heart defects
  • small left colon syndrome
  • RDS
51
Q

Maternal conditions: hypoparathyroidism

A

fetal hypocalcemia, neonatal HYPERparathyroidism. - check this one

52
Q

Maternal conditions: hyperparathyroidism

A

neonatal hypocalcemia, neonatal hypoparathyroidism

elevated maternal calcium → transplacental transport of calcium → fetal hypercalcemia → suppresses fetal PTH levels → leads to neonatal hypoparathyroidism

53
Q

Maternal conditions: hyperthyroidism (graves)

A

fetal and neonatal hyperthyroidism, IUGR, prematurity, CHF, tachycardia

54
Q

Maternal conditions: PKU

A

mental retardation, microcephaly, congenital heart defects

55
Q

Maternal conditions: fetal platelet antigen sensitization

A

thrombocytopenia, CNS hemorrhage

56
Q

Maternal conditions: Rh or ABO incompatability

A

jaundice, anemia, hydrops fetalis

57
Q

Maternal conditions: Chlamydia

A

conjunctivitis, pneumonia

58
Q

TORCH infections: CMV

A
  • IUGR
  • microcephaly
  • hepatosplenomegaly
  • hydrocephalus
  • periventricular brain calcifications
  • jaundice
  • blueberry muffin rash
  • sensorineural hearing loss
  • chorioretinitis
59
Q

TORCH: Toxoplasmosis

A
  • hepatosplenomegaly
  • hydrocephalus
  • diffuse brain calcifications
  • bony abnormalities
  • skin rash, petechiae
  • jaundice
  • sensorineural hearing loss
  • cataracts
    • lymphadenopathy
    • anemia
    • thrombocytopeia
    • pneumonitis
60
Q

TORCH: Rubella

A
  • cardiac: PDA, Pulmonary Stenosis
  • mental retardation
  • bony abnormalities (radiolucent bone disease)
  • cardiac abnormalities
  • blueberry muffin rash (dermal erythropoiesis)
  • jaundice
  • SN hearing loss
  • cataracts, glaucoma, micropthalmos
    • maternal skin rash
      • thrombocytopenia
61
Q

TORCH: HSV

A
  • cataracts
  • optic atrophy
  • chorioretinitis
  • keratoconjunctivitis
  • liver dysfunction
  • vesicles
  • bullae
  • ulcers
62
Q

TORCH: Syphillis

A
  • leptomeningitis
  • osteochondritis
  • psuedoparalysis
  • periostitis
  • edema
  • desquamation rash
  • snuffles
  • lymphadenopathy
  • hemolytic anemia
  • thrombocytopenia
  • snuffles
    *
63
Q

TORCH: VZV

A
  • hydrocephalus
  • calcifications
  • microphalmos
  • cataracts
  • chorioretinitis
  • optic atrophy
  • anisocoria
  • limb hypoplasia
  • absent DTR
  • cicatricial skin lesion
    • hypopigmentation
64
Q

TORCH: ZIKA

A

lissencephaly, chorioretinal atrophy, SN hearing loss, congenital contractures

65
Q

TORCH: Toxo workup

A

toxo IgM, IgG, IgA, CSF/Urine PCR, blood PCR

66
Q

TORCH: Rubella workup

A

Rubella IgM

67
Q

TORCH: CMV Workup

A

CSF/Urine PCR, Saliva PCR within 2-3 weeks

68
Q

TORCH: HSV Workup

A

Surface Cultures, Serum PCR, CSF PCR

69
Q

TORCH: Syphillis workup

A

Serum VDRL, CSF VDRL

70
Q

TORCH: VZV workup

A

VZV IgG, IgM, CSF PCR

71
Q

TORCH Treatment: Toxo

A

pyrimethamine, sulfadiazine, folinic acid x 1 year

72
Q

TORCH Treatment: Rubella

A

Supportive

73
Q

TORCH Treatment: CMV

A

ganciclovir or

valganciclovir

x 6 months

74
Q

TORCH Treatment: HSV

A

Acyclovir x 14 days (SEM) or 21 days (dissem) then oral x 6 months (suppressive)

75
Q

TORCH Treatment: Syphillis

A

Penicillin G x 10 days

76
Q

TORCH Treatment: VZV

A

VZIG within 72 hours of birth, acyclovir x 10 days

77
Q

Maternal Conditions: SLE (Lupus)

A

fetal death, SAB, heart block, neonatal lupus, thrombocytopenia, neutropenia, hemolytic anemia, endocardial fibrosis

NNP Board Exam Review (19 decks)

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