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Women's Health Unit 2 > 3 Prenatal Care > Flashcards

3 Prenatal Care Flashcards

(71 cards)

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1
Q

What Hx questions do you need to ask during preconception evaluation?

A

Current health status:
• Regular menses?
• Chronic medical conditions? (high BMI, PCOS, DM, HTN, Thyroid, CKD, etc)
• Current meds? (Are they safe in pregnancy?)
• Age
• Substance use/abuse

Reproductive history

Family History

Nutrition and physical activity

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2
Q

What is considered advanced maternal age (AMA)?

A

> 35 🙄

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3
Q

What physical exams should you perform during preconception consultations?

A

BMI measurement
Check for dental caries
CV/Pulm
Pelvic exam

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4
Q

What labs must you run during a preconception consultation?

A

HIV TEST*****

If indicated - TSH/T4, HA1C

Ask if UpToDate on immunizations (MMR, Varicella, Hep B, Flu, Tdap)

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5
Q

Recommendations for women who for some unknown reason want to get pregnant

A

Obtain/maintain good control of medical illnesses**

Prenatal vitamin with folic acid and DHA beginning at least 1 month prior to trying to conceive

Abstain from substance use (alcohol, tobacco, illicit drugs)

Menstrual diary

OTC OPKs

Timed intercourse around ovulation day

Education - takes the average couple 1 year to conceive w/o intervention

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6
Q

What is the daily recommended dose of folic acid for those trying to conceive?

A

0.4 - 0.8 mg

4mg if history of NTD

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7
Q

When is the idea time for the first prenatal care visit?

A

Between 8-10 weeks

Most accurate U/S dating occurs in the first trimester

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8
Q

Pertinent hx items to include in first prenatal visit

A

GYN hx (last pap, hx of abnormal pap, hx of STI, hx of PID, pregnancy/delivery hx)

Intended vs unintended pregnancy

Domestic violence

Substance use

Inherited diseases

Barriers to routine visits

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9
Q

What is the G/P system for recording obstetrical hx?

A

G = Gravida = Total Number of Pregnancies (multiple gestation count as 1 pregnancy)

P = Para = TPAL
T= # full term births
P = # preterm births
A = # abortions (spontaneous, induced, ectopic)
L = # living children
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10
Q

Early term = _____ weeks

A

37.0 - 38.6 weeks

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11
Q

Full term = ______ weeks

A

39.0-40.6 weeks

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12
Q

Late term = _____ weeks

A

41.0 - 41.6 weeks

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13
Q

Post term = _____ weeks

A

42.0 weeks and beyond

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14
Q

What is LMP?

A

1st day of last menstrual period

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15
Q

What is EDC

A

Estimated date of confinement

= EDD (estimated date of delivery)

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16
Q

What is GA?

A

Gestational age

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17
Q

What is Naegele’s Rule?

A

Estimating EDD based on LMP

Add 7 days to LMP and subtract 3 months

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18
Q

What pelvic exam findings should you expect at the first prenatal visit?

A

Pay attention to uterus size, shape, and adnexa - is uterus larger/smaller than expected for GA?

CHADWICK’S SIGN - blue to purple tint of vaginal walls/cervix

HEGAR’S SIGN - palpable softening of the isthmus

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19
Q

Blue to purple tint of vaginal walls/cervix

A

Chadwick’s sign

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20
Q

Palpable softening of the isthmus

A

HEGAR’S sign

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21
Q

What breast changes occur in the early prenatal period?

A

Montgomery tubercles

Dilated veins

Enlarged breasts, expanding Arellano

Tenderness to palpation

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22
Q

What is the old timey way of determining if they baby will be able to be born vaginally?

A

Pelvimetry

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23
Q

Routine labs drawn at first prenatal visit

A

URINE HCG (make sure their preggo - duh)

Pap, GC/Chlamydia cultures

CBC

Blood type and Rh

Antibody screen

Rubella and varicella titers (even if vaccinated)

Syphilis, Hep B, HIV testing

UA and culture

+/- TSH, CF screening, TB testing, Ha1C

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24
Q

During the first prenatal visit, fetus size can vary +/- _____ days from EDD

A

5-7 days

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25
Common food items to avoid during pregnancy
Tuna, shark, swordfish, etc - high mercury Raw meats/eggs Hot dogs, deli meats, raw milk - listeriosis More than 200 mg caffeine daily (~1 12-oz cup of coffee) No ceviche
26
Exercise recommendations for prenatal visits
150 min of exercise weekly for pregnant/postpartum women Start slow and encourage daily exercise
27
BMI of ________ is considered underweight Expected range of total weight gain during pregnancy = _______
<18.5 28-40lbs
28
BMI of ________ is considered normal weight Expected range of total weight gain during pregnancy = _______
18.5-24.9 25-35lbs
29
BMI of ________ is considered overweight Expected range of total weight gain during pregnancy = _______
25-29.9 15-25lbs
30
BMI of ________ is considered obese Expected range of total weight gain during pregnancy = _______
≥30 11-20lbs
31
GA for the 1st trimester
Week 1 - 12w6d
32
GA for the 2nd trimester
Week 13 - 26w6d
33
GA for 3rd trimester
Week 27 - end of pregnancy
34
What should be the frequency of prenatal visits?
First 28 weeks - q4 weeks Weeks 28-36 - q2 weeks Week 36 and beyond - weekly
35
What is quickening?
First fetal movements
36
In a woman’s first pregnancy, quickening occurs...
At 18-20 weeks
37
In subsequent pregnancies after the first, quickening occurs...
At week 16-18
38
When should a pregnant woman do fetal kick counts?
Beginning in 3rd trimester If <10 kicks/rolls/flutters within 2 hours, go to ER
39
When can fetal heart tones be detected?
Doppler might pick them up by 10-12 weeks but be careful doing it too early - it sucks if you can’t hear them b/c you’re trying too soon
40
_____bpm is WNL for fetal heart rate
110-160bpm
41
Fundal height is measured from ______ to ______
Pubic bone to uterine fundus
42
Fundal height at 12 weeks should be ....
At the pubic symphysis
43
Fundal height at 20 weeks should be...
At the umbilicus
44
Why does fundal height typically drop after 36-38 weeks?
Due to fetus dropping into pelvis (Lightening) and decreasing amniotic fluid index (AFI)
45
What PE findings should you always look out for during prenatal visits, other than FHT and Fundal height?
BP Edema Urine sample at every visit!
46
Why do we do urine samples at every prenatal visit?
Checking for protein levels and glucose
47
When can fetal sex be determined?
With NIPT (non-invasive perinatal Testing) as early as 9 weeks but $$$$ By U/S as early as 16 weeks GA
48
Which U/S is the most important one?
2nd trimester, between 18-22 weeks This is the anatomy U/S that evaluates for anatomical abnormalities, fetal position, location/status of placenta AFI, cervical length Fetus can vary +/- 10-14 days from EDD at this point (but doesn’t change the due date)
49
What important counseling occurs during the 2nd trimester?
Address abnormal lab values Pick a pediatrician FLU VACCINE Preterm labor precautions Gestational DM testing TDAP VACCINE Cord blood banking
50
Which blood draw is the most important
During the 3rd trimester, at 24-28 weeks ABO and Rh CBC RPR for Syphilis 1hr glucose challenge —> 3 hr if failed +/- Rhogam if Rh (-)
51
What is a passing result for the 1 hour glucose challenge?
<140 mg/dL
52
What if you get a result of >140mg/dL on 1 hour glucose challenge?
Abnormal —> proceed with 3 hour challenge Unless >200mg/dL = automatic fail, congrats, you now have gestational diabetes!
53
How is the 3 hr glucose tolerance test different from the 1 hr challenge?
100g vs 50g ``` 4 total blood draws: • Fasting <95 • 1 hour <180 • 2 hours <155 • 3 hours <140 ``` Two abnormal values = fail One value exceeding 200 = fail
54
What needs to happen if an expectant mother is Rh negative?
Rh immune globulin 300µg given between 28-30 weeks
55
What are you evaluating for on U/S during the 3rd trimester?
Fetal growth, fetal position, state of placenta, and AFI Should be done between 32-34 weeks
56
What manual thing can you do to determine the baby’s position?
Leopoldo maneuvers
57
What should occur during prenatal visits at 35-40 weeks?
``` Cervical exams to determine: • Dilation • Effacement • Station • Position • Presenting part ```
58
What is Effacement?
Thinning of the cervix
59
What is dilation?
It’s exactly like it sounds
60
What is station?
How far down the baby’s head is in the pelvis
61
When is Group B strep culture performed?
Swab of both lower vagina and rectum between 35-37 weeks GA If (+), intrapartum abx prophylaxis is indicated to prevent neonatal GBS (normally penicillin)
62
Early onset neonatal GBS
Symptom onset <24 hours from birth Most common Sx: Sepsis, PNA, meningitis
63
Late onset neonatal GBS
Sx onset within 4-5 weeks of birth Most common Sx: Bacteremia, meningitis, focal infections
64
What scoring system is used to determine if a pregnant woman can safely be induced?
Modified Bishop ``` Scores based on: • Dilation (0-3) • Effacement (0-3) • Station (0-3) • Cervical consistency (0-2) • Position of cervix (0-2) ``` 8-13 points = highest chance of successful induction 0-4 points = highest chance of failed induction
65
What testing is done for high risk pregnancies in the 3rd trimester?
NST - tracing of fetal HR and uterine activity x 20 min • Must have min of 2 accelerations by 15 bpm lasting at least 15 sec Biophysical profile • Fetal U/S measuring (movement, muscle tone, breathing, AFI) - perfect score is 8/8 • Fetal HR also measured and scored —> perfect score 10/10
66
What things should you discuss with the patient during the 3rd trimester?
``` Anesthesia plans Fetal kick counts Preterm labor/labor precautions Breastfeeding Postpartum contraception FMLA or disability forms GBS Post-erm/induction counseling ```
67
What is an NT scan and when is it performed
Nuchal Translucency Performed between 11-13.6 weeks Thickened NT is soft marker for Down Syndrome
68
What is FTS and when is it performed
First Trimester Screening Serum draw that coincides with NT scan Measures PAPP-A and ßHCG If elevated, soft markers for Down Syndrome and Edwards Syndrome
69
What is NIPT and when is it performed?
Non-invasive Perinatal Screening Serum draw as early as 9 weeks Fetal fraction of 8% needed It’s expensive though - so offer but not many will do it
70
How is AFP testing used in prenatal screening?
Maternal serum measured between 15-21.6 weeks GA If elevated, can indicated possible NTD (screening only, not diagnostic)
71
What is the Maternal Serum Screen and when is it performed?
Aka Quad screen Drawn if NT/FTS was not performed. If NT/FTS already done, do AFP only Performed at 15-21.6 weeks but most accurate at 16-18 weeks Screens for NTDs, Downs, and Edwards Syndrome

Women's Health Unit 2 (4 decks)

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