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REPRODUCTIVE SYSTEM > PRENATAL CARE (C5) > Flashcards

PRENATAL CARE (C5) Flashcards

1
Q

Most important parameter

A

Est of dates/AOG

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2
Q

1st trimester

A

LMP/Sexual contact
Uterine size - pelvic exam
Diagnostic tools: PT, ultrasonography

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3
Q

Subsequent prenatal care:

GOAL

A

To assess well-being of expectant mother & her fetus

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4
Q

Frequency of prenatal visits

A

Every 4 weeks until 28 weeks AOG
Every 2 weeks until 36 weeks
Weekly until 40 weeks

If problematic pregnancy: 1-2 weeks interval

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5
Q

Maternal evaluation

A 
Wt
Fundal ht
BP
Symptoms
Vaginal examination
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6
Q

Measured from the top of symphysis pubis to top of fundus

A

Fundal ht (Ht in cm of uterine fundus)

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7
Q

Between 20 & 34 wks, fundal ht in cm is

A

Gestational age in weeks

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8
Q

Pathologic BP

A

140 mmHg systolic or > and / or 90 mmHg diastolic or more

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9
Q

Maternal eval symptoms

A 
Headache
Altered vision
Abdominal pain
Nausea and vomiting
Bleeding
Vaginal fluid leakage
Dysuria
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10
Q

Vaginal examination - late in pregnancy to provide information regarding:

A

Confirmation of presenting part and station
Clinical estimation of pelvic capacity and its general configuration
Consistency, effacement and dilatation of cervix

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11
Q

Fetal heart tones

A

N 110-160/min

Doppler 10 weeks
Std nonamplified stet: 1st heard between 16-22 weeks
UTZ: 5 menstrual weeks; performed only when there is a valid medical condition

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12
Q

If initial results are normal, no need to repeat

SUBSEQUENT LAB TESTS

A 
Fetal aneuploidy screening
Neural tube defects
CBC
Sero for syphilis
HIV testing
D (Rh) negative
Rectovaginal culture for GBS
GTT
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13
Q

Fetal aneuploidy screening

A

11-14 weeks or 15-20 weeks

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14
Q

NTD

A

15-20 wks

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15
Q

CBC

A

Repeated at 28-32 wks

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16
Q

Sero test

A

Repeated at 28-32 weeks (in high risk pop)

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17
Q

HIV test

A

Repeat at 36 wks in high risk

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18
Q

D neg are unsensitized —

A

Repeat Ab screen at 28-29 wks

Give anti-D immune globulin if still unsensitized

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19
Q

Rectovaginal culture for Grp B Strep at

A

35-37 weeks (ACOG and CDC guidelines ‘13)

Intrapartum antimicrobial prophylaxis is given for those w (+) cultures

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20
Q

GTT

A

At 24-28 weeks for women at moderate risk for diabetes and for women at high risk if initial test is negative

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21
Q

Wt for ht category

A

Underwt: <18.5
Normal: 18.5-24.9
Overwt: 25-29
Obese: >30

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22
Q

Total wt gain range

A

Underwt: <18.5 —> 28-40 lbs —> 1 (1-1.3) lb/wk
Normal: 18.5-24.9 —> 25-35 lbs —> 1 (0.8-1) lb/wk
Overwt: 25-29 —> 15-25 lbs —> 0.6 (0.5-0.7) lb/wk
Obese: >30 —> 11-20 lbs —> 0.5 (0.4-0.6)

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23
Q

Obesity is ass w increased risk for

A 
Gestational hypertension
Preeclampsia
Gestational diabetes
Macrosomia
Cesarean delivery
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24
Q

Caloric requirements

A

Caloric increase of 100-300 kcal

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25
Q

Increase in CHON demand

A

5-6g/day

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26
Q

Needed for growth abd remodeling of fetus, placenta, uterus, breast and increased maternal volume

A

CHON

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27
Q

Shark, swordfish, king mackarel and tile fish contain potentially high lvls of

A

Methylmercury

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28
Q

Increased needs in 2nd-3rd trimester due to increased deposition of iron in fetal and placental tissues and increased in red cell mass wc proceed at higher rate

A

Iron

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29
Q

When is iron not necessary bcs it may aggravate GI rxns, nausea and vomiting

A

1st trimester

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30
Q

Sufficient amount for requirement for lactation

A

At least 27mg/day

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31
Q 
But if preggy is large 
Or has twin fetuses
Begins supplementation late in pregnancy
Takes iron irregularly
Has depressed Hb lvl

How much iron?

A

60-100mg/day

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32
Q

Essential component of thyroid hormone

A

Iodine

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33
Q

Essential component of thyroid hormone

A

Iodine

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34
Q

Predisposes to have offspring with cretinism (mental retardation, neurologic deficits)

A

Subclinical maternal hypothyroidism

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35
Q

Adequate iodine intake

A

Use of iodized salt
Iodine tablets
Iodized oil injections
Addition of iodine to municipal water supplies

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36
Q

Supplementation not recommended for routine use during preggy

A

Ca

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37
Q

Zinc recommended daily intake for preggy

A

12mg

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38
Q

Severe zinc deficiency

A

Leads to poor appetite, suboptimal growth and impaired wound healing

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39
Q

Folate or folic acid deficiency

A

Megaloblastic anemia

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40
Q

Folate requirements

A

0.4-0.8mg/day

41
Q

Folate increased requirements in

A

Protracted vomiting
Hemolytic anemia
Multiple fetuses

42
Q

Recommended dose of folate for prevention of NTDs

A

400ug/day

43
Q

Recommended dose of folate for a month prior to conception and in first trimester (70% redxn of 2-5% occurrence)

A

4mg/day

44
Q

Associated w congenital malformations when taken in higher doses during pregnancy (>10,000 IU daily)

A

Vit A

45
Q

Routine supplementation also not reco

A

Vit A

46
Q

Occurs naturally in food of animal origin

A

Vit B12

47
Q

They may give birth to infants with low vitamin B12 stores

A

Strict vegetarians 😱

48
Q

May contribute to vit B12 deficiency

A

Excess vit C

49
Q

Vit B12 deficiency may increase risk of

A

NTD

50
Q

Vit B6 (Pyridoxine) recommended for women at high risk for deficiency:
Substance abusers
Adolescents
Multifetal gestation

A

2mg/day

51
Q

Used in combination w antihistamine doxylamine in management of nausea and vomiting of pregnancy

A

Vit B6 (Pyridoxine)

52
Q

Daily req w a reasonable diet

RDA = 80-85mg/day

A

Vit C

53
Q

Wt gain goal approx.

A

25-35 lbs in women w normal BMI

54
Q

At least hm mg iron daily

A

27mg

55
Q

Detect Hb conc at

A

28-32 wks for any significant decrease

56
Q

Absolute contraindications to aerobic exercise during pregnancy

A
  • hemodynamically significant ❤️ dse
  • restrictive lung dse
  • incompetent cervix/cerclage
  • multiple gestation at risk for preterm labor
  • persistent second or third trimester bleeding
  • placenta previa after 26 wks of gestation
  • preterm labor during current pregnancy
  • ruptured membranes
  • preeclampsia/PIH
57
Q

During flights

A

Hourly ambulation to lower venous thromboembolism risk

58
Q

Preg in aircraft

A

Safely fly (naol) up to 36 weeks

59
Q

When is coitus during pregnancy avoided?

A

When abortion, placenta previa or preterm labor threatens

60
Q

Steroid induced suppression of bowel activity, compression of bowels by enlarging uterus or prolonged transit time

A

Constipation

Enemas and strong cathartics should be avoided

61
Q

Potent teratogen

A

Alcohol

62
Q

Fetal alcohol syndrome

A

Growth restriction
Facial abn
CNS dysfxn

63
Q

Heavy intake (5-6 glasses/day)

A

Obstetric complications

Fetal alcohol syndrome

64
Q

Moderate intake (3-4 glasses/day)

A

Slight inc risk for abortion

65
Q

Caffeine no harm w mod use hm?

A

2 cups daily

200mg of caffeine

66
Q

Associated w abortion caffeine hm?

A

> 5 cups per day (500mg caffeine)

67
Q

Recommended caffeine intake

A

<300mg daily or approx.

Three 5oz cups of percolated coffee

68
Q

Contraindicated during pregnancy: live attenuated

A

MMR
Varicella
Smallpox
HPV

69
Q

Susceptible to rubella must receive

A

MMR vax postpartum

70
Q

Vaccines that may be given to women at risk of exposure

A

Poliomyelitis
Hepa B
Hepa A
Typhoid

71
Q

Vaccines routinely given

A

Influenza

Tdap

72
Q

Given to all preg regardless of trimester during flu season

A

Influenza

73
Q

Recommended in every pregnancy preferably between 27-36 weeks to maximize passive antibody transfer

A

Tdap

74
Q

Vaccines whose indication for prophylaxis is not altered by pregnancy

A

Rabies
Pneumococcus
Meningococcus

75
Q

Relation of the long axis of fetus to that of mother

A

Lie:

  • longitudinal
  • transverse
76
Q

Refers to the part of fetus lying over the inlet

A

Presentation:

  • cephalic
  • breech
  • shoulder
77
Q

Relation of an arbitrary chosen portion of the fetal presenting part to the right or left side of the maternal birth canal

A

Position

  • vertex
  • face
  • breech
  • shoulder
78
Q

VERTEX

A

Right occiput anterior
Right occiput posterior

Left occiput anterior
Left occiput posterior

Right occiput transverse
Left occiput transverse

Direct occiput anterior
Direct occiput posterior

79
Q

FACE

A

Right mento anterior

Right mento posterior

80
Q

BREECH

A

Right sacro anterior

Right sacro posterior

81
Q

SHOULDER

A

Right acromiodorso anterior

Right acromiodorso posterior

82
Q

Relation of fetal parts to one another

A

Attitude

83
Q

First 3 maneuvers, the examiner faces the

A

Torso and head of pt

84
Q

Last maneuver

A

Faces the feet

85
Q

The examiner palpates the fundus w the tips of the fingers of both hands in order to define which fetal pole ia present in the fundus

A

First maneuver

86
Q

The palms of the examiner’s hands are placed on either side of the abdomen to determine on wc maternal side lie the fetal back and the fetal small parts and next noting if fetal bacc is directly anteriorly, transversely or posteriorly

A

Second maneuver

87
Q

1) Using thumb and fingers of one hand, the examiner grasps the lower portion of maternal abdomen (just above symphysis pubis in order to determine the fetal part that’s presenting)
2) If presenting part is NOT engaged, a movable body will be felt usually the fetal head and the attitude of the head is defined
3) If the presenting part is deeply engaged, findings are simply indicative of the fact that lower pole of fetus is fixed in the pelvis

A

Third maneuver

88
Q

The examiner faces the mother’s feet and with the tip of the first 3 fingers of each hand, exerts deep pressure in the direction of the axis of the pelvic inlet

If head presents, one hand is arrested sooner than the other by a rounded body, the cephalic prominence, while other hand descends more deeply into the pelvis

In vertex presentations, on the same side as the small parts and the face presentations, on the same side as the fetal back

A

Fourth maneuver

89
Q

Not reliable for fetal position

A

Auscultation

90
Q

Transmitted through the convex portion of the fetus, therefore best heard thru the fetal back in vertex and breech presentation and thru the fetal thorax in face presentations

A

Fetal heart sounds

91
Q

In cephalic, fetal heart sounds are best heard

A

Midway between the maternal umbilicus and the anterior superior iliac spine

92
Q

In breech presentations, fetal heart tones are usually heard

A

at or slightly above umbilicus

93
Q

In occipito-anterior positions, heart sounds are usually heard best a

A

Short distance from midline, in transverse position, more laterally and in the posterior positions,

best heard: back in the mom’s flank

94
Q

Fetal position is determined by identifying the location of the anterior (lozenge-shaped) fontanel and the posterior (triangular-shaped) fontanel in

A

In vertex presentation

95
Q

ID fetal position esp in obese or women w rigid abdominal walls

A

Ultrasonography

96
Q

Safety- ALARA principle (As Low As Reasonably Achievable)

A
  • sonography should be performed only w valid medical indication using lowest possible exposure setting to obtain necessary info
  • professionals, trained
  • keepsake fetal imaging
97
Q

Components of standard UTZ exam by FIRST TRIMESTER

A
  • Gestational sac size, loc and number
  • Embryo and/or yolk sac ID
  • Crown-rump length: most accurate biometric predictor of gestational age
  • Fetal number, including amniocity and chorionicity of multifetal gestations
  • Embryonic cardiac activity
  • Assessment of embryobic/fetal anomaly appropriate for first tri
  • Eval of uterus, adnexa and cul-de-sac
  • Eval of fetal nuchal region (transparency assessment is considered)
98
Q

Components of standard UTZ exam by 2nd and 3rd trimester

A
  • fetal number (amniocity and chorionicity of multi)
  • fetal cardiac activity
  • fetal presentation
  • placental loc, appearance and relationship to the internal cervical os
  • amniotic fluid vol
  • gestational age assessment
  • fetal wt estimation
  • fetal anatomical survey
  • eval of maternal uterus, adnexa and cervix
99
Q

Gestational age assessment

A

Second tri, biparietal diameter (BPD) - most accurately reflects gestational age

Femur length correlates well w both BPD and gestational age

Abdominal circumference has the greatest variation of gestational age (2-3 wks)

REPRODUCTIVE SYSTEM (8 decks)

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