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
