Prenatal / Normal pregnancy 2 Flashcards
postterm infants
Infants born at > 42 weeks gestation
Risk factors for postterm birth
primigravidity, prior postterm pregnancy, maternal obesity, older maternal age, male fetal gender, and certain congenital conditions (e.g., adrenal gland hypoplasia, congenital adrenal hyperplasia, placental sulfatase deficiency)
Macrosomia
infant weight > 4,500 grams
common finding in post-term neonates
macrosomia
Complications associated with macrosomia
prolonged labor, clavicular fracture, brachial plexus palsy, cephalopelvic disproportion, and shoulder dystocia
physical findings in post term neonates
Physiological desquamation of the skin may be seen at 1 week of age
Meconium staining
Vernix caseosa and lanugo hair are typically decreased or absent
Dry and parchment-like peeling skin
Loose skin
Scalp hair is increased and the nails are usually long
Alert/Wide eyed appearance
Naegele rule
method of dating the pregnancy and helping to calculate the estimated due date
Naegele rule calculates the estimated due date by establishing the last menstrual period, subtracting 3 months, and adding 7 days
Limitations of Naegele rule
It assumes a 28-day menstrual cycle with ovulation on day 14
when can doppler US detect fetal heart tones
10 weeks
initial lab tests at first prenatal visit
A Pap smear should be taken at the initial visit if this has not been performed in the past year
ABO and Rh typing and antibody screen
immunoglobulin testing for varicella and rubella immunity if not otherwise documented
human immunodeficiency virus testing
RPR
Hep B
chlamydial testing for patients under 25 or those over 25 years with risk factors for sexually transmitted infection
when is a fetal US first performed
20 weeks
Pregnant uterus on PE
typically soft and globular
how long does the uterus remain in the pelvis during pregnancy
until about 12 weeks
where can the fundus be palpated at 12 weeks
pubic symphysis
where can the fundal height be palpated at 20 weeks
umbilicus
where can the fundus be palpated at 36 weeks
xiphoid process
What factors reduce the diagnostic accuracy of physical exam-based gestational age assessment?
Leiomyoma, obesity, and pregnancies of multiple gestation
lab findings in hyperemesis gravidarum
weight loss, dehydration, starvation ketosis, hypochloremic metabolic alkalosis, hypokalemia, and transient liver enzyme elevation
in what population is hyperemesis gravidarum MC
multiple fetuses
hydatidiform molar pregnancy
hyperthyroidism
tx hyperemesis gravidarum
Hydration and electrolytes should be maintained through parenteral fluids and vitamin supplementation (if hospitalized)
Administer antiemetics
After discharge - eat small meals
Common antiemetics for pregnancy
promethazine
metoclopramide
ondansetron
at what level can serum tests detect pregnancy
1–2 mIU/mL
at what level can urine tests detect pregnancy
20–50 mIU/mL
when do hCG values double
every 29–53 hours during the first 30 days following implantation of a normal intrauterine pregnancy
hCG levels that are rising slowly suggest
either an ectopic pregnancy or an early embryonic death
when are hCG levels useful in estimating fetal gestational age
the first 1 to 3 weeks postconception
The range of normal hCG at 8–10 weeks of gestation
5,000 to 150,000 mIU/mL
when do hCG levels decline
following 8–10 weeks
when do hCG levels plateau
20 weeks
hCG levels remain relatively constant between _______ from 20 weeks-term
2,000–50,000 mIU/mL
Fetal quickening
the perceived fetal motion by the mother
when is fetal quickening first noted - primiparity vs prior pregnancies
It is often first detected in primiparous women at 18–20 weeks gestation. In women with prior pregnancies, fetal quickening can be felt much earlier, as early as 14 weeks gestation
Unilateral lower abdominal pain that transpires early in pregnancy is often caused by
round ligament pain
leukorrhea
Clear or thick white vaginal secretions
when do Braxton hicks contractions usually occur
after 28 weeks
What is the Chadwick sign?
bluish discoloration of the vulva, vagina, and cervix that occurs as the result of increased blood flow around 8–12 weeks gestation
Hegar sign
characterized by a softening of the uterus
Osiander sign
Pulsations felt through the lateral vaginal fornices
Occur around 8 weeks
Associated w lateral implantation
Goodell sign
softening of the cervix
occurs around 4-6 weeks
Piskacek sign
Asymmetrical enlargement of uterus in case of lateral implantation
drugs that are C/I in pregnancy
angiotensin-converting enzyme inhibitors
androgens
carbamazepine
phenytoin
valproic acid
cyclophosphamide
diethylstilbestrol
methimazole
misoprostol
oral retinoids
tetracycline
thalidomide
warfarin
methotrexate
Ophthalmia neonatorum is also known as
neonatal conjunctivitis
when does neonatal conjunctivitis often occur
within 4 weeks of life
MC cause of neonatal conjunctivitis
Neisseria gonorrhoeae
what can neonatal conjunctivitis ultimately lead to
blindness
prevention neonatal conjunctivitis
erythromycin ointment to both eyes within 2 hours of birth
Routine procedures for newborns
erythromycin ointment on both eyes within 2 hours of birth
vitamin K1 to prevent vitamin K deficiency bleeding
hep B vaccine
umbilical cord care to prevent infection
monitoring for hyperbilirubinemia and hypoglycemia
When is ophthalmia neonatorum most likely to appear in a newborn?
2-5 days after birth
untreated infections in pregnancy increase the risk of
neonatal infection (e.g., conjunctivitis, pneumonia), preterm birth, low birth weight, and congenital defects
should you screen for chlamydia and gonorrhea in pregnancy
Screening for chlamydia and gonorrhea with nucleic acid amplification testing is recommended in all pregnant women < 25 years of age and pregnant women ≥ 25 years of age at increased risk for sexually transmitted infections
antibiotic treatment for chlamydia in pregnancy
zithromycin 1 g PO in a single dose
antibiotic tx for gonorrhea or both chlamydia and gonorrhea in pregnancy
azithromycin 1 g PO in a single dose and ceftriaxone 500 mg IM in a single dose
Patients who weigh ≥ 150 kg should receive ceftriaxone 1 g IM in a single dose
should you do a test of cure or repeat testing for chlamydia or gonorrhea
a test of cure is indicated in all pregnant women 3–4 weeks after treatment is completed
repeat testing for chlamydia and gonorrhea is recommended 3 months after the test of cure
Routine vaccinations during pregnancy
tetanus, diphtheria, acellular pertussis (Tdap) vaccine, and the influenza vaccine
when should pregnant person get the flu vaccine
should be given in the first trimester if the patient is pregnant during the flu season,
when should pregnant person get Tdap
between 27–36 weeks gestation
what additional vaccines can be given in pregnancy but are not given routinely
Pneumococcal pneumonia, meningococcal meningitis, and hepatitis A vaccines may be given as indicated during pregnancy. Patients at high risk for hepatitis B may be given the hepatitis B vaccine during pregnancy
what types of vaccines should be avoided in pregnancy
live vaccines
examples of live vaccines that should be avoided in pregnancy
measles, mumps, rubella, varicella, yellow fever, smallpox, Bacillus Calmette-Guéerin, the live attenuated influenza vaccine, and the live zoster vaccine
pregnancy weight gain: BMI of 18.5–24.9 kg/m2
25–35 lbs over the course of the entire pregnancy
pregnancy weight gain: BMI < 18.5 kg/m2
should gain 28–40 lbs during pregnancy
pregnancy weight gain: BMI of 25.0–29.9 kg/m2
should gain 15–25 lbs during pregnancy
pregnancy weight gain: BMI ≥ 30.0 kg/m2
should gain 11–20 lbs during pregnancy
caloric need in second and third trimester
The caloric need of the mother increases by approximately 340 kcal/day in the second trimester and 450 kcal/day in the third trimester
protein recs in pregnancy
1.1 g/kg/day
carb recs in pregnancy
175 g/day
fiber recs in pregnancy
28 g/day
micronutrient recommendations during pregnancy
iron 27 mg
calcium 1,000 mg
vitamin D 600 IU
folate 600 mcg
iodine 220 mcg
adequate intake of what micronutrient can decrease the risk of HTN in pregnancy
calcium
folate intake recs for women who have had a previous neural tube defect-affected pregnancy
4,000 mcg of folic acid daily
which US is preferred in pregnancy
TVUS
when is the gestational sac visible on TVUS
4.5–5 weeks
when can the yolk sac be visualized on TVUS
5–6 weeks
when is fetal pole with cardiac activity visualized on TVUS
5.5–6 weeks
what is the smallest gestational sac size that can be visualized on TVUS
2–3 mm
what is the first structure to appear within the gestational sac
yolk sac
what confirms intrauterine pregnancy
visualization of the yolk sac
when does the yolk sac degrade
between 10-12 weeks
In patients with a gestational sac but no yolk sac, what signs increase the likelihood of an intrauterine pregnancy
double decidual sac sign or intradecidual sign
Absence of these signs does not exclude intrauterine pregnancy
The double decidual sac sign
intrauterine fluid collection surrounded by two concentric echogenic rings, with the inner ring representing the decidua capsularis and the outer ring representing the decidua parietalis
The intradecidual sign
intrauterine fluid collection with an echogenic rim located inside a thickened decidua on one side of the uterine cavity and deviation of the central endometrial echo
Most accurate assessment of gestational age
measuring the crown-rump length of an embryo with cardiac activity