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Maternal & Newborn Care > Week 2 - Preconception > Flashcards

Week 2 - Preconception Flashcards

1
Q

gravida

A

of pregnancies

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2
Q

multigravida

A

woman who has had previous pregnancy

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3
Q

para

A

live births

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4
Q

primipara

A

woman having her 1st birth

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5
Q

multipara

A

woman who has had previous birth

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6
Q

what does G4P2 mean?

A

4 pregnancies in total, 2 live births

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7
Q

who are primary care providers for pregnant women?

A

midwives
GPs
obstetricians

NOT NDs

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8
Q

why are NDs not primary care providers for pregnant women?

A

don’t have access to order ultrasound & other imaging

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9
Q

where can midwives attend births?

A

hospital, home, birthing centres (Ontario)

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10
Q

FHx questions?

A
  • down syndrome
  • NTDs
  • hemophilia
  • hemoglobinopathies & other birth defects
  • mental retardation
  • diabetes
  • HTN
  • TB
  • seizures
  • multiple pregnancies
  • mental illness
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11
Q

Personal MHx questions

A

esp:

  • CV
  • renal
  • metabolic
  • infectious
  • abdominal/pelvic trauma or operations
  • recent blood transfusions
  • hx current/past trauma/stressors
  • STIs
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12
Q

Menstrual hx

A
  • determine if woman is actually ovulating

- determine if fertile mucus present (when you should be having intercourse)

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13
Q

obstetric hx

A
  • prev. neonatal death, stillbirth, pre-term birth
  • if has been trying to conceive for some time, what procedures has she already been through? (diagnostics, labs, fertility treatments, etc)
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14
Q

hx methods of contraception

A

family planning & birth spacing

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15
Q

other hx questions

A

medications & supplements
occupation
diet & lifestyle
alcohol, smoking, illicit drugs

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16
Q

What are characteristics of a higher risk pregnancy?

A
  • extremes of age (teens & women >35yo)
  • genetic risk when father >55yo
  • African, Asian, Mediterranean descent - screen for heritable hemoglobinopathies (sickle cell ds & thalassemias)
  • Jewish/French Canadian heritage (Tay-Sachs ds, Canavan’s ds, CF)
  • lower socioeconomic status
  • drug & alcohol abuse
  • tobacco & caffeine use
  • experience of mental, emotional or physical abuse
  • occupational hazards (exposure to reproductive toxins, heavy physical exercise or stress)
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17
Q

Health promotion topics?

A
  • smoking, alcohol & drug cessation
  • avoidance of teratogenic meds & supplements (risks vs benefits; e.g. anti epileptics @ high doses = teratogens but seizures can also cause problems)
  • avoidance of environmental toxins
  • avoidance of occupational hazards (legal rights of pregnant workers; childcare options)
  • safe sexual practices & STD prevention
  • family planning & pregnancy prevention (contraception & birth spacing)
  • optimal management of medical problems
  • stress reduction & social support
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18
Q

Female P/E

A
  • height, weight
  • BP - every visit w/pregnant women!
  • blood type & Rh & other antibodies
  • CBC, ferritin (no gold standard for anemia), B12, Vit D (bacterial vaginosis)
  • thyroid panel 1.5-2.5 for pregnant women
  • fasting blood glucose - HbA1C in high risk groups
  • rubella immunity; parvo-virus B19 (Fifth’s ds)
  • VDRL (syphilis - veneral ds research lab), HIV, Hep B
  • genetic screen for Tay-Sachs, Canavan’s ds, CF as applicable to certain populations
  • TB in areas of prevalence
  • FSH day 3 & progesterone day 21 for >35 or who’ve been trying to conceive >1yr
  • urinalysis - protein, glucose, leukocytes, blood
  • cervical (pap) smear, vaginal swab, cultures for gonorrhea & chlamydia
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19
Q

Male P/E

A
  • semen analysis
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20
Q

Pre-conception physical exam

A
  • full screening physical
  • BP & cardiac
  • height & weight
  • breast exam
  • pelvic exam - estimate uterine size & palpate cervix for abnormalities; pap smear; culture for gonorrhoea & chlamydia; swab for bacterial vaginosis
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21
Q

DDx vaginal discharge

A
  • leukorrhea (normal) = whitish d/c of mucus & exfoliated vaginal epithelial cells - will increased w/pregnancy; odour can change too
  • bacterial vaginosis - predom. Gardnerella vaginalis. pH elevated (>4.5; fishy odour)
  • candida - thick white, curd-like d/c; causes pruritis & excoriation. Sour odour, esp. w/hormone increase in pregnancy
  • trichomonas vaginalis - thrives in alkaline environment; profuse & grey-green; frothy malodorous d/c
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22
Q

women of colour are how many times more likely to have BV than white women?

A

3x

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23
Q

Why are women of colour more likely to have BV than white women?

A

darker skin pigmentation prevents adequate cutaneous synthesis of cholecalciferol from casual sunlight exposure

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24
Q

vitamin D dosing during pregnancy?

A

1000-4000 IU

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25
Q

BV is associated with negative pregnancy outcomes, especially?

A

preterm birth

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26
Q

body temperature peaks at which point during a woman’s cycle?

A

ovulation

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27
Q

How do you know when day 1 of your cycle is?

A
  • not quite spotting, not quite bleeding

- very light spotting is not day 1

28
Q

What are the phases (as correlated to day) of the cycle?

A

menstrual 1-7
follicular 4-14
ovulation 14-ish
luteal 14-28

29
Q

acupuncture principles for menstrual phase?

A

move Blood & Qi
smooth LV
remove obstruction/stagnation
stop pain

30
Q

acupuncture principles for follicular phase?

A

build Yin & Blood
tonify SP & KD
regulate water passages/resolve damp

31
Q

acupuncture principles for ovulation

A

promote smooth movement of Qi

32
Q

acupuncture principles for luteal phase

A 
Move Qi & Blood
tonify Yang
tonify SP
Smooth LV Qi
regulate water passages/resolve damp
33
Q

foods that decrease blood stagnation?

A 
eggplant
turmeric
chives
leeks & scallions
garlic & ginger
basil
rosemary
nutmeg 
spearmint
chesnut

avoid spicy, pungent, greasy foods to limit mucus burden prior to conception

34
Q

symptoms of too much estrogen?

A 
blood clots
impaired blood sugar
water retention
depression
anxiety 
headaches
breast tenderness
35
Q

conditions seen with too much estrogen?

A 
early puberty
uterine fibroids
uterine cancer
ovarian cysts
ovarian cancer
breast cysts
breast fibroadenoma
breast cancer
PMS
endometriosis
hypothyroidism
autoimmune diseases
increased risk of gallbladder disease
36
Q

where is estrogen metabolized?

A

liver - phase I & II

37
Q

what does B-glucoronidase do?

A

Cleaves glucoronic acid molecules attached to estrogen in the stool, allowing intestinal oestrogen to be re-absorbed into bloodstream

38
Q

what is B-glucoronidase produced by?

A

pathogenic gut bacteria

39
Q

why take probiotics for estrogen modulation?

A

probiotics will compete with b-glucoronidase and therefore LOWER circulating oestrogens

40
Q

what herb can increase progesterone?

A

vitex

41
Q

nutritional/supplemental interventions for hormonal regulation, day 1-14

A

2 tbsp ground flax & 2 tbsp pumpkin seeds/day

2 x 1000mg sutra-sea 3:1 fish oil capsule BID [EPA for phase 1 detox]

42
Q

nutritional/supplemental interventions for hormonal regulation, days 15-28

A

2 tbsp. sesame & 2 tbsp sunflower seeds/day

2 x 500mg Genestra evening primrose oil BID

43
Q

why take a multi B 1qd ?

A
  • help elim intermediary liver metabolites
  • replace depletion caused by OCP
  • increase energy
  • aid stress reduction
44
Q

what foods help eliminate excess estrogen?

A

cruciferous veggies (cauliflower, brussels sprouts, broccoli)
seaweeds - nori, wakame, kelp
fibre (whole grains, veg, brown rice, legumes, flax)
lean protein - tofu, beans, lentils, salm, turkey, chicken
filtered water/herbal tea 2L/day

45
Q

what foods to decrease/eliminate to eliminate excess estrogen?

A 
all animal products
sugar, caffeine, alcohol, chocolate
pesticides
additives
*avoid over-consumption of cold/raw foods esp in winter
46
Q

what medical conditions can have adverse effect on pregnancy outcomes & that have evidence that effect can be impacted by preconception care?

A 
HTN
diabetes
SLE
epilepsy
anemia
thyroid disease
47
Q

what is the m/c pre-existing medical condition in pregnancy? Why is it important to control this?

A

diabetes

glycemic control should be achieved b/c teratogenic effects of hyperglycaemia occur during organogenesis (1st trimester)

48
Q

what is macrosomia?

A

birth weight >8 lbs, 13oz (4000 gm) regardless of gestational age (~9% babies born worldwide)

risks increase greatly when birth weight is >9 lbs, 15 oz (4500 gm)

associated fetal complications:

  • abnormalities of spine & skeleton
  • CV system (4X greater)
  • renal system
49
Q

folic acid supplementation reduces the risk of?

A 
heart defects
urinary tract abnormalities
oral facial clefts
pyloric stenosis
limb defects
50
Q

what minerals are altered with OCP use?

A

copper levels raised

zinc levels reduced

51
Q

what vitamin levels are altered with OCP use?

A 
def:
folate (B9)
B complex
vitamin c
increase: vitamin A
52
Q

Dose of folic acid for a woman at low risk of having a baby with NTD w/healthy diet incl. leafy greens & whole grains

A

0.4mg (400 mcg) - 1mg / day

should be taken after several months preconception, until about 4-6 weeks after breastfeeding stops

53
Q

dose of folic acid for a woman w/poor supplementation, poor dietary habits, &/or previous child w/NTD

A

5mg/day

54
Q

risk factors for bearing children with NTDs? = need for 5mg/d

A 
insulin dependent diabetes
epilepsy
obesity
prev child born w/NTD
fam hx of NTD
sikh or celtic ethnicity
born in northern china
55
Q

when & for how long should a woman supplement with folic acid?

A

at least 3 months pre-conception & continue until 12 weeks post-conception

after that, regular recommended dosage can be continued

56
Q

preconception supplements?

A
  • prenatal vitamin w/low or no iron
  • vit D 1000-4000IU/d; depending on serum status & risk factors
  • folic acid, 1-5mg/d depending on risk factors
  • CoQ10, 200-600mg/day (women at risk of HTN & infertility)
  • fish oil 1-3gm/day
  • cortisol regulation
57
Q

which vitamin to AVOID?

A

high dose vit A: retinol form

as low as 3000IU/d has been shown to be teratogenic

58
Q

why should you not consume caffeine when pregnant?

A
  • caffeine metabolism slows during 2 + 3 trimesters
  • immature liver systems = half life of 80-100 hours
  • heavy intake of caffeine >400mg assoc. w increase SIDS & increased risk of spontaneous abortion
  • ACOG (American Congress of Obstetricians and Gynecologists) concludes moderate caffeine consumption (<200 mg/d) does not appear to be a major contributing factor is miscarriage or preterm birth
59
Q

what is the mechanism of action of FAS?

A

unknown

60
Q

how much is risk of still birth in pregnant women increased with alcohol consumption 5 drinks/wk from <1 drink/wk?

A

1 drink = 1.37/1000

5 drinks = 8.83/1000

61
Q

what is the harm of cannabis during pregnancy?

A
  • no evidence of increased risk premature birth,miscarriage, major physical abnormalities
  • prenatal exposure has subtle adverse effects beginning at approx 3 yo on cognitive function, behaviour, mental health & subsequent substance use in offspring
62
Q

risks of cocaine use during pregnancy?

A
  • increased risk placental abruption
  • decreased birth weight, length & head circumference
  • in newborn: jittery tremor, high pitched cry, hyper-alert state, irritability & excessive sucking reflex
63
Q

what is Canavan disease?

A
  • affects myelin
64
Q

what is Tay Sachs disease?

A
  • affects neuron
65
Q

what is a “low risk pregnancy”?

A

none of the social or demographic risks exist

66
Q

which labs would you do for a woman w 3rd pregnancy, feeling exhausted?
Went vegetarian between 2nd & 3rd pregnancy.

A

Ferritin (CBC)
b12
vit D

67
Q

what is the best TCM action for luteal phase?

A

tonify yang

Maternal & Newborn Care (6 decks)

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