WH- Prenatal, Abortion Flashcards
A few meds that ARENT pregnancy safe
ACE-I/ARB
Triptans
Statins
Tetracyclines
Advanced maternal age
> 35YO
UTD on immunizatoins?
MMR and Varicella especially bc these are LIVE and cannot be given during pregnancy
Start Folic acid + DHA 1 month before trying to get pregant
neural tube closes by 4th week
DHA
help ward off post partum depression
Folic acid
0.4-0.8 mg
4 mg if hx of NTD
Exam for Preconception care
BMI
Dental caries (can put mom at risk of preterm delivery)
Cardiopulm
Pelvic exam
when to use OTC Ovulation predictor kits
days 10-20 of cycle
Timed intercourse
Day 11,13,15,17 of cycle
day 14 is ovulation
1st visit
between 8-10 wks of pregnancy
best for 1st Ultrasound
Obstetric history
Gravida= # of pregnancies Para=TPAL T: births after 37 wks P: births prior to 37 wks A: abortion L: # of living children
G2P2002
G2= 2 pregnancies P2002 "TPAL" 2: births after 37 wks 0: preterm 0: abortions L: 2 living children
LMP
1st day of last menses
Naegele’s Rule
add 7 days to LMP and subtract 3 mo
to predict Estimated Delivery Date (EDD)
EDC
Est date of confinement
confinement- concluding phase of pregnancy, onset of contractions to the birth of baby
Breast exam
Montg tubercles
Dilated veins
Enlarged breast, expanding areola
TTP
normal
Chadwick’s sign
Blue to purple tint of vaginal walls/cervix
Hegar’s sign
Palpable softening of isthmus
Montgomery tubercles on breast of pregnant women
oil glands on pregnant women’s breasts to keep breast tissue supple as it expands in growing breasts
to keep from cracking
prep for breastfeeding also
Prenatal care first visit
Hcg: pregnancy test! Specimen from pelvic: Pap, Gonn, Chlam CBC Blood type/ Rh Rubella/Varicella Syphilis (RPR) Hep B HIV UA and culture
+/- TSH, Cystic fibrosis, TB, HA1C
Transvaginal US can visualize cardiac activity as early as 5.5-6.5 wks BUT
best to wait until 8-10 weeks
1st US
R/o Ectopic!!!
Common items to avoid:
Tuna, shark, swordfish, king mackerall, Tillefish (high mercury)
Raw meet/eggs
Hot dogs, deli meat
Civiche
No More than 200 mg caffeine daily (one 12 oz cup coffee)
What sports to avoid
contact sports
hot yoga
How much weight should you gain?
25-35 lbs
Prof recommends no more than 30 lbs
2nd trimester
weeks 13-26
3rd trimester
weeks 27- end
1st trimester
weeks 1-12
Frequency of visit during first 28 wks
7 mo
every month
Frequency of visit during 28-36 wks
7-9 mo
every 2 weeks
Frequency of visit after 36 wks
after 9 mo
WEEKLY
Fetal movement
1st pregnancy
18-20 weeks
Fetal movement
2nd pregnancies and so forth (bc mom knows what to expect)
16-18 weeks
Fetal kicks, start to count at 3rd trimester
10 movements within 2 hours
Fundal height
Measuring from pubic bone –> Uterine fundus (the top part)
12 weeks
uterine fundus should be at
Pubic symphysis
cm
20 weeks
uterine fundus should be at
Umbilicus
cm
Doppler is able to detect between
10-12 weeks
110-160 bpm is normal
Fundal height can drop after 36-38 wks d/t to
baby dropping into pelvis
“lightening”
mom can feel like she can breathe again
Urine sample every visit
Protein levels
Glucose
Gender
US at 16 weeks
NIPT blood draw can tell gestation as early as
9 weeks
1st trimester US
dating purposes
2nd trimester US
Anatomy ultrasound
b/w 18-22 weeks GA
3rd trimester visit
Lab draw
(cbc, rpr, abo and rh, antibody screen)
1 hour glucose challenge
3 hour glucose tolerance
1 hour glucose challenge
50 g oral glucose
draw serum 1 hr later
<140= normal
>140: proceed to 3 hr
>200: AUTOMATIC FAIL, GDm diagnosed
3 hour glucose test
100 g oral glucose load
4 draws total
fasting <95
1 hr: <180
2 hr: <155
3 hr: <140
TWO ABN VALUES= fail
ONE VALUE > 200= fail
3rd trimester US
growth US
fetal position
state of placenta
Leopold maneuver
place hands on belly to find position of baby
3rd trimester- start to perform cervical exams
Determine:
dilation effacement station position presenting part
Group B strep
3rd trimester
Can live in woman’s vagina and rectum
transmitted to baby during delivery
35-37 wks
if positive, will get Abx before labor
Bishop score
based on dilation, effacement, station, cervical consistency, position of cervix
0-4: failed induction
8-13: highest chance of successful induction
Antenatal screening
Trace fetal HR and uterine activity x 20 minutes
Mimimum of 2 accelerations (increase in FHR by 15 bpm and last for 15 seconds)
THIS IS GOOD!!!
BPP
Fetal US
fetal mov
fetal musc tone
fetal breathing movement
amniotic fluid
perfect score is 8/8
Optional testing
NT scan
FTS
NIPT Non invasive perinatal screening
NT scan
nuchal translucency
b/w 11-13.6 weeks
SOFT marker for down syndrome, requires FURTHER TESTING to confirm dx
FTS first trimester screen
with NT scan
SOFT markers again (screening)
For Down and Edwards
NIPT
can be as early as 9 wks
drawn in place of FTS if performed w NT scan
very expensive
Confirmatory test if first NT scan was abnormal (to confirm aneuploidy- Down syndrome or Edwards)
NIPT
9 weeks
confirmatory screen for Down syndrome
Maternal serum screen
Quad screen
only draw this if NT/FTS were not done
b/w 15-21 wks
Screen for NTD, down, edwards
For advanced maternal age >35YO
folic acid up to 4mg
daily ASA 81 mg
AMA other considerations
Offer NIPT at 9 wks
Involve Maternal fetal medicine- perform level 1 US
Antenatal testing for AMA
NST and BPP twice weekly starting at 36 wks
Delivery of AMA
Induction vs C section recommended at 39 wks if haven’t delivered already
