20 - Perinatal Care Flashcards
(85 cards)
1
Q
Nutritional recommendations in pregnancy:
Calcium
A
1000 mg daily for those 19-50 yrs old (plus vitamin D 600 IU)
1300 mg daily for those < 19 years old (plus vitamin D 600 IU)
2
Q
Nutritional recommendations in pregnancy:
Folic Acid
A
0.4 mg daily
3
Q
Nutritional recommendations in pregnancy:
Iodine
A
220-250 micrograms daily
4
Q
Nutritional recommendations in pregnancy:
Iron
A
27 mg daily
5
Q
Why is folic acid supplementation important in pregnancy?
A
To prevent neural tube defects
6
Q
What is the recommended caffeine intake during pregnancy?
A
< 300 mg/day
7
Q
Does pregnancy increase or decrease the immune system?
A
decreases it
8
Q
What is listeria present in?
A
unpasteurized milk, soft-ripened cheeses, deli meat
9
Q
How do we prevent getting listeria?
A
Avoid unpasteurized milk, soft-ripened cheeses, deli meat, reheat until steaming hot, wash raw fruit/veggies well
10
Q
What is salmonella present in?
A
raw seafood, raw eggs, sushi that hasn’t been properly handled/prepared
11
Q
How do we prevent getting salmonella?
A
avoid raw or soft-cooked eggs, raw cookie dough, avoid sushi that hasn’t been prepared properly
12
Q
What is methylmercury present in?
A
Fish (shark, swordfish, mackerel, albacore tuna)
13
Q
How much fish is safe in pregnancy?
A
2 servings/week
14
Q
How do we prevent methylmercury poisoning in pregnancy?
A
- Only 2 servings of fish/week
- Choose fish lower in mercury (shrimp, salmon, canned light tuna)
15
Q
What is toxoplasma?
A
A parasite in raw meat, soil & dirty cat litter
16
Q
How do we prevent toxoplasma in pregnancy?
A
Wear gloves if gardening, have someone else change the litter box, cook meat thoroughly
17
Q
When is travel safe in pregnancy?
A
Generally safe up to 4 weeks before expected due date
18
Q
What are the risks of air travel when pregnant?
A
Immobilization and pregnancy both increase the risk of venous thromboembolism:
-Maintain hydration, frequent walking, stretching & isometric leg exercises, compression stockings
Cabin hypoxemia:
-Concern in those with CV disease & compromised uterine blood flow (preeclampsia, growth restricted)
Cosmic radiation:
-ICRP recommends max exposure of 1 mSv over 40 week pregnancy (longest internal flight is <15% of this)
19
Q
What things need to be considered before air travel?
A
- Increased risk of VT
- Comorbid conditions: respiratory & cardiac disease, pregnancy complications
- Air line policies
- Medical resources & insurance at destination
- Exposure to infectious diseases at destination (vaccination, malarial prophylaxis)
20
Q
Are hot tubs/saunas safe in pregnancy?
A
- Avoid in 1st trimester
- Heat exposure in early pregnancy is associated with neural tube defects & miscarriage
21
Q
Are hair treatments safe in pregnancy?
A
- Human studies showed very limited systemic absorption, quantities unlikely to reach fetus
- Personal use by pregnant women 3-4 times throughout pregnancy is not considered to be of concern
- Should be avoided if there are burns or open wounds on the area to be treated
- Occupational use (hairdresser): wear gloves, ensure adequate ventilation in workplace
22
Q
What are some prenatal discomforts?
A
- Nausea & vomiting, heartburn, constipation, hemorrhoids
- Leukorrhea (increased vaginal discharge)
- Gingivitis
- Edema
- Varicose Veins
- Cutaneous changes: spider angioma’s, melasma, striae gravidarum
23
Q
What is physiologic edema caused by?
A
- Hormone-induced Na retention (Increased plasma volume)
- Uterine compression of the interior vena cava
24
Q
What are some differential diagnosis for edema in pregnancy?
A
- Preeclampsia
- DVT
- cellulitis
25
_____ ______ = symmetric, bilateral leg edema that lessens with recumbency (laying down)
physiologic edema
26
_____ = tender unilateral swelling of a leg or calf, erythema & warmth
DVT
27
_____ = hypertension and proteinuria
preeclampsia
28
_____ = tender unilateral swelling in a leg or calf, erythema (asymmetric), warmth and sometimes fever
Cellulitis
29
What are some symptoms that suggest preeclampsia?
- bilateral
- accompanied by HTN
- edema involves the hands, face & sacram
- blurry vision
- dyspnea
- nausea, vomiting, jaundice
- decreased urine output
- confusion, headache
- weight gain that is sudden and dramatic
- rash
30
What are some key questions that need to be asked when a pregnant patients comes to the pharmacy wondering about getting rid of swelling?
- Does the swelling get relieved when laying down/elevating them
- When did it start?
- Is it in both ankles?
- Any redness or warm to touch?
- Any fever?
- Maybe ask her to take BP reading
- Any swelling anywhere else in the body?
- Pitting edema? (leaves an impression in the leg which goes back to normal with time)
31
Are varicose veins itchy?
Yes - can be
32
Edema and varicose veins can cause such symptoms as ?
- numbness
- mild pain
- aching
- heavy feeling
- itching, throbbing, irritation around vein
33
Describe the etiology of varicose veins (same to edema)
- In addition hormones (progesterone) relax muscular walls of blood vessels
- Blood vessel valve weakens & blood stagnates in vein causing distension and ballooning
34
What are some self-management strategies for deem & varicose veins?
- Compression stockings
- Sleep in left side-laying position (allows IVC to open and more draining to happen over night)
- Maintain adequate fluid intake
- Avoid prolonged standing
- Rest with legs elevated often
- Do not sit with legs crossed
- Maintain physical activity
35
What is melasma/chloasma?
"Mask of Pregnancy"
- Dark skin discolouration occurs on sun exposed areas
- Generally affects the face, often symmetrical
- Caused by excess melanin in the skin
36
Why does melasma/chloasma happen in pregnancy?
Elevations in E and P levels in epidermal & dermal cells and melanocyte-stimulating hormone upon sun exposure may potentiate tyrosinase activity and thus stimulate melanogenesis
**Requires exposure to UV rays - SPF sunscreen is very important
37
Melasma/chloasma:
| Risk factors
- genetic predisposition
| - darker skin tones
38
Melasma/chloasma:
| Does it stay after pregnancy is over?
Usually fades after delivery (within 1 year)
10-30% of cases persist
39
Describe spider angioma's
- Central red pundit with radiating branches
- Usually appears in 2nd to 5th month of pregnancy
- Most common around eyes & areas drained by SVC (neck, face, upper chest, arms & hands)
- Vascular distention & proliferation of blood vessels during pregnancy increase risk
40
Who does spider angioma's affect more?
Caucasians
41
Are spider angioma's present after pregnancy?
90% regress by 3 months post partum
42
Striae gravidarum = ____ _____
stretch marks
43
Describe Striae gravidarum (stretch marks)
- Red or purple lines or streaks, fade to pale lines. Can be itchy.
- Commonly affect breasts, abdomen and thighs
44
```
Striae gravidarum (stretch marks):
Risk factors
```
- degree of abdominal distension
- maternal weight gain
- genetic predisposition
- younger maternal age
45
```
Striae gravidarum (stretch marks):
Mechanism ?
```
not well understood
-E, adrenocorticol hormone & relaxin: influence connective tissue formation (promotes separation of the collagen fibrils) leading to formation of striae when skin stretched
46
```
Striae gravidarum (stretch marks):
Present after birth?
```
Usually persist postpartum, may fade over months to 1-2 years
47
Melasma:
| _______ = key
prevention (broad-spectrum sunscreen)
48
Melasma:
| Describe the pharmacological treatment options
- hydroquinone
- azelaic acid
- trentinoin (this is toxic during pregnancy so i'm assuming treatment is after birth)
49
Melasma:
| Camouflage techniques?
mineral makeup containing titanium dioxide/zinc oxide
50
Do we treat angioma's?
Treatment not required (resolve in 3 months)
Could treat with IPLS (intense pulsed light source)
51
List some common agents to treat striae gravidarum
- cocoa butter
- hyaluronic acid
- vitamin E
- cantella asiatica extract
- bitter almond oil
52
MOA of the agents to treat striae gravidarum?
- stimulation of fibroblastic activity leading to increased production of collagen
- increased blood perfusion through massaging of the area and potential anti-inflammatory
- increased skin hydration
53
_____ = only used post arum (toxic to babe)
tretinoin
54
What would you do if a person wants a skin lightening cream that is safe in pregnancy?
- Recommend broad-spectrum sunscreen
- Tell them that it will most likely go away after pregnancy
- Could recommend make up with titanium dioxide/zinc oxide
55
Prenatal Signs of Potential complications (prob signs for referral)
- Severe vomiting (risk of dehydration)
- Signs of infection (fever, diarrhea, pain on urination)
- Abdominal cramping
- Vaginal bleeding
- Sudden loss of fluid from vagina or continued leakage of fluid from the vagina (LOL THIS IS YOUR WATER BREAKING LMAO)
- decreased fetal activity
- signs of preterm labor (ex. low, dull backache, increased uterine activity compared to previous patterns; menstrual-like cramps; diarrhea, etc)
56
Describe normal nipple pain
- pain subsides within 30-60 seconds of initiation of feeding
- often peaks around 3-6 days postpartum
- usually resolves in about a week
57
Describe trauma nipple pain
- pain persists or increases throughout feeding
- lasts > 1 week
- cracks, fissures, bleeding
58
Describe bleb nipple pain
- shiny white bump at tip of nipple (blocked nipple pore)
| - pinpoint pain on feeding
59
Describe eczema nipple pain
- bilateral
- Hx of eczema, assess for exposure to new irritant
- Red scaly rash usually not entered around nipple
60
Describe raynaud's or vasospasm nipple pain
- Triphasic color change (red, white and blue)
- Intense pain, burning, numbness, prickling, stinging
- Pain on exposure to cold (may be during, following or b/w feedings)
61
Possible infections that can cause nipple pain?
mastitis
| candidiasis
62
How can we manage nipple trauma?
Nipple care:
- Wash with warm water and mild soap when bathing
- Avoid excessive moisture
Cool or warm compresses
Acetaminophen or ibuprofen
Could use lanolin or hydro-gel dressings (avoid vitamin E oils or creams)
63
How do you manage a nipple bleb?
warm soaks
| frequent feedings
64
How do you manage engorgement and plugged ducts?
- Optimize feeding technique & encourage frequent feeding
- Avoid tight or restrictive clothes (impede milk flow)
- Warm compress or shower may enhance letdown and facilitate milk removal (by expression or by baby)
- Cool compresses between feeding to decrease swelling/discomfort (ice 15 min on & 45 min off)
- Plugged ducts - massage breast from affected area toward nipple
65
List some risk factors for breast pain caused by mastitis (infection of breast tissue)
- previous mastitis
- engorgement
- poor milk drainage
- nipple damage
66
Mastitis:
| Most common pathogen?
S. aureus
67
Mastitis:
| Management?
- Supportive measures as for engorgement
- Antibiotics indicated if fever is present or if symptoms do not improve within 12-24 hours with supportive measures
- Cloxacillin or cephalexin 500 mg PO QID
- Clindamycin 300 mg QID if MRSA suspected or beta lactic allergy
- Treatment duration 10-14 days
*Symptoms should resolve within 48-72 hours of initiating antibiotics
68
Nipple Candidiasis:
| Diagnosis?
- Pain out of proportion to physical finding (often sharp, shooting pain)
- Affected nipple appears pink/red & shiny or the skin may be flaky
- Exclusion of other causes of breast pain
69
Nipple Candidiasis:
| Predisposing factors?
- history of infant oral or diaper candid infection
- history of maternal VVC
- previous antibiotic use
- nipple damage
70
Nipple Candidiasis:
| Management?
- Non-pharms to prevent reinfection and cross contamination of candida
- Mother and child should be treated simultaneously
71
Nipple Candidiasis:
| Treatment duration?
As with other fungal infections, continue 1 week AFTER patient is symptom free
72
Nipple Candidiasis:
| What are the pharmacological treatment options?
- Topcial antifungals - miconazole or clotrimazole preferred over nystatin
* Applied after each feeding
-If fissures present, topical antibiotic often added
APNO = all purpose nipple ointment: 2% miconazole in mupirocin 2% ointment; betamethasone ointment 0.1% aa
- Possible add on therapy: Gentian violet 1% once daily for 3-4 days (used for a max of 1 week, should never be used alone)
* THIS STUFF IS SHIT - WHY IS IT IN OUR NOTES
-If treatment failure: consider Fluconazole 400 mg STAT then 200 mg daily for at least 2 weeks
73
What are common reasons to use a breast pump?
- To stimulate milk production
- To maintain milk supply
- To provide infant with breast milk
74
Tips for breast pumping
- Wash hands with soap and water before pumping
- Ensure that the pump pieces and milk collection containers are clean (wash with hot soapy water & rinse)
- Ensure flanges are the approbate size
* WTF is the flange man
75
How can you manage the difficulty with let-down (milk coming out?)
OMG USE NORMAL WORDS
- Gently massage the breasts before pumping
- Apply a warm wet cloth to breasts before pumping
- Pump in a quiet, darkened room to avoid distractions
- Look at a picture of the baby or smell of the baby's blanket
76
List 3 ways to care for the vaginal area (perineum) after child birth
CTMA pg 1114
- Prevent constipation by drinking water and eating fibre
- Kegel exercises to strengthen the area
- Use a pillow when sitting
77
Signs for referral?
If you have severe pain, a foul-smelling discharge or a high fever
78
Lochia
uterine discharge after birth
79
Days 2-3 PP:
| What type of Lochia?
Lochia = bright red, small clots
80
Days 3-10 PP:
| What type of Lochia?
Lochia serosa = brown or pink
81
Days 10-up to 6 weeks PP:
| What type of Lochia?
Lochia alba = white or pale yellow
82
Bleeding beyond 6 weeks, increasing bleeding or clots larger than a ____- size should be reffered
quarter/loonie
83
When does the period usually return?
within 1-6 months
84
List 3 post partum mood disorders
1) Postpartum "Blues" (max 2 weeks)
2) Postpartum Depression
3) Postpartum Psychosis
85
What are some postnatal red flags? (list 4)
- Abnormal vaginal bleeding
- Fever/chills
- Painful, difficult or frequent urination
- Breasts have signs of infection
