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ENRP > Normal Pregnancy > Flashcards

Normal Pregnancy Flashcards

1
Q

What is the goal of a preconception visit?

A

Decrease risk of adverse effects by optimizing WOMAN’s health before conception

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2
Q

What are some examples of things to do a a preconception office visit?

A

Start folic acid supplementation
Glucose control for a diabetic patient
= Optimizing woman’s health before conception

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3
Q

Gravidity (G)

A

Number of pregnancies

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4
Q

Parity (P)

A

FPAL

  • Full term pregnancies
  • Preterm pregnancies
  • Aborted pregnancies
  • Living children
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5
Q

Parity components

A

FPAL

  • Full term pregnancies
  • Preterm pregnancies
  • Aborted pregnancies (loss < 20 weeks)
  • Living children
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6
Q

A woman has had 1 term child, 1 set of preterm twins, 1 miscarriage, 1 ectopic pregnancy and has 3 living children. Document with Gravidity and Parity.

A

G4 P1123

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7
Q

What are some things to do at a Prenatal office visit?

A
  • History/physical
  • Labs are drawn
  • Estimate gestational age and due date
  • Possible genetic counseling, teratology and pregnancy symptom discussion
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8
Q

Gestational age

A

of weeks between 1st day of last missed period and due date

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9
Q

What does a Pregnancy test detect?

A

hCG in serum/urine

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10
Q

For a pregnancy test to be positive, what level must the hCG be above?

A

> 25

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11
Q

In the first 30 days of pregnancy, what occurs with the hCG?

A

DOUBLES every 2 days!

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12
Q

What doubles every 2 days in the first 30 days of pregnancy?

A

hCG

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13
Q

With a Transvaginal US, what can be seen at 5, 6, and 7 weeks respectively?

A

5 weeks = gestational sac
6 weeks = fetal pole
7 weeks = cardiac activity

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14
Q

How do you calculate due date with a patient that has about 28 day menstrual cycles?

A

Last menstrual period - 3 months + 7 days

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15
Q

When is an US the most accurate for estimating the due date and what does it measure?

A

1st trimester

– measures crown rump length

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16
Q

In what patients should genetic counseling be recommended?

A

Advanced maternal age (>35)
Multiple fetal losses
Previous children with abnormalities

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17
Q

With advanced maternal age and other conditions that require genetic counseling, what are they at risk for with the next pregnancy?

A

Aneuploidy

  • trisomies
  • sex chromosome abnormalities
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18
Q

What are 1st trimester screening options for fetal aneuploidy? (3)

A
  • Fetal Nuchal Translucency
  • Maternal b-hCG
  • PAPP-A
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19
Q

What is fetal nuchal translucency and what may it indicate?

A

Thickness/translucency at the back of the fetal neck

–> aneuploidy

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20
Q

What levels of maternal b-hCG and PAPP-A could indicate aneuploidy?

A

Increased maternal b-hCG

Decreased PAPP-A

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21
Q

What are 2nd trimester screens for aneuploidy?

A

Triple or Quadruple screens

- b-hCG, estriol, AFP +/- Inhibin

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22
Q

What is a NON-invasive screening option for HIGH risk patients for aneuploidy?

A

Cell-Free Fetal DNA

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23
Q

Cell - Free Fetal DNA test can be done at any time after 9-10 weeks. What does it measure?

A

Tests cell-free fetal DNA from apoptosis of trophoblastic cells that are in maternal circulation

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24
Q

When should you order a Cell-Free Fetal DNA test?

A

HIGH risk patients for aneuploidy

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25
Q

What does the Cell-Free Fetal DNA test NOT test for and what should you get for that?

A

Does NOT test for Neural Tube defects

– Need AFP

26
Q

If the Cell-Free Fetal DNA test is (+), what should you get next?

A

Amniocentesis or CVS (chorionic villi sampling)

– INVASIVE

27
Q

What risk does the Amniocentesis and CVS tests carry?

A

Risk of miscarriage

28
Q

What is a Teratogen and are they commonly identified?

A

Any agent that causes abnormalities in the fetus

– NOT usually ID’ed

29
Q

Thalidomide is a Teratogen. What does it cause in the fetus?

A

Phocomelia

30
Q

What is the current method of assessing meds and their teratology risk?

A

PLLR

= pregnancy lactation labeling rule

31
Q

What does the PLLR do?

A

(pregnancy lactation labeling rule)

- assess benefit vs risk in pregnant women who need the medication

32
Q

What subsections does the PLLR have?

A
  • pregnancy
  • lactation
  • reproductive potential
33
Q

What is the most vulnerable time when teratogens can impact fetal development?

A

Organogenesis stage = 17-56 days post conception

34
Q

After the Organogenesis stage (17-56 days post conception), what usually occurs to the fetus if a teratogen is exposed?

A

Delayed growth

35
Q

What is the most common drug that is a teratogen?

A

Alcohol

36
Q

What are the signs of a Fetal Alcohol baby?

A 
Growth restriction
Low set ears
Thin upper lip
Smooth philtrum 
Flat face and small head
Behavioral issues
37
Q

What are the signs of a Fetal Alcohol baby?

A 
Growth restriction
Low set ears
Thin upper lip
Smooth philtrum
Flat midface and small head
Behavioral problems
38
Q

Radiation exposure is also a teratogen. If exposure occurs before 2 weeks postconception, what are the options of what can occur?

A

NO effect

Lethal

39
Q

What level of radiation carries NO risk of being a teratogen for the fetus?

A

< 5 rads of radiation is no risk

40
Q

Are most diagnostic tests with radiation safe to order for pregnant ladies?

A

YES

– < 5 rads is acceptable

41
Q

List some unpleasant symptoms of pregnancy

A 
N/V
Heartburn
Constipation and Hemorrhoids
Leg cramps
Backache
42
Q

List some unpleasant symptoms of pregnancy and ways to treat them

A

N/V - small/frequent meals, avoid greasy foods, meds, acupuncture
Heartburn - elevate head of bed, avoid greasy foods, antacids
Constipation and Hemorrhoids - diet changes, stool softener
Leg cramps - stretch/massage
Backache - stretch, pillows, heat, etc.

43
Q

Leg cramps and backaches occur when in pregnancy?

A

Later in pregnancy

44
Q

Describe how often prenatal office visits should occur?

A
  • Every 4 weeks until 28 weeks
  • Every 2 weeks from then until 36 weeks
  • Every week from then until delivery
45
Q

What is quickening and around when does it occur?

A

First sensation of fetal movement

– 20 weeks

46
Q

What are 4 Antepartum tests?

A
  • Kick counting
  • NONstress test
  • Contraction stress test
  • BPP (biophysical profile)
47
Q

What are 4 Antepartum tests?

A
  • Kick counting
  • NONstress test
  • Contraction stress test
  • Biophysical Profile (BPP)
48
Q

What is Kick Counting?

A

Monitoring fetal movement

49
Q

What is a normal result for Kick Counting?

A

10 movements within 2 hours

50
Q

What is the expected result of a NONstress test?

A

Reactive = 2 accelerations of more than 15 beats above baseline lasting at least 15 seconds during a 20 minute period

51
Q

If a Nonstress test is Reactive, what does that mean?

A

2 accelerations of more than 15 beats above baseline lasting for at least 15 seconds in a 20 minute period

52
Q

If the Nonstress test is NONREACTIVE what is indicated?

A

Contraction Stress test

53
Q

How do you perform the Contraction Stress Test?

A

Give oxytocin to establish at least 3 contractions in a 10 minute period

54
Q

How do you perform the Contraction Stress Test?

A

Give oxytocin to establish at least 3 contractions in a 10 minute period

55
Q

What is a (+) result of a Contraction Stress Test?

A

Late decelerations with majority of contractions

56
Q

What is a (+) result of a Contraction Stress Test and what is then warranted?

A

Late decelerations with a majority of the contractions

–> Delivery is warranted

57
Q

What does the Biophysical Profile (BPP) take into account?

A

Nonstress test
Fetal attributes
Amniotic fluid volume

58
Q

A Biophysical Profile score of 8-10

A

Reassuring

59
Q

A Biophysical Profile score of 6

A

Equivocal

– consider delivery if at term

60
Q

A Biophysical Profile score less than 4

A

NON-reassuring

– Delivery warranted usually

ENRP (45 decks)

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