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RGU 2 > Prenatal Care > Flashcards

Prenatal Care Flashcards

1
Q

What is prenatal care (PNC)?

A

care of the baby before delivery

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2
Q

What is the goal of PNC?

A

ensure a healthy baby and mother:

  • evaluate health status of mother and baby
  • complete H&P of mother
  • obtain accurate estimated gestational age of fetus (should be done in first trimester).
  • anticipate problems
  • patient education is key!
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3
Q

How do we diagnose pregnancy?

A
  • detection of human chorionic gonadotropin hormone (hCG). 25 mIU/mL or higher will be detected in urine pregnancy test.
  • serum hCG can be detected at lower levels
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4
Q

How early can pregnancy be detected?

A
  • as early as 1 wk after implantation (8th day after ovulation).
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5
Q

*** What is Naegele’s rule?

A
  • from FDLMP: add year, subtract three months, and add 7 days.
  • if unsure of LMP, confirm via ultrasound.
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6
Q

What is a full term pregnancy?

A
  • 37-42 weeks
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7
Q

When will you change the date?

A
  • if the US measurements are off by at least 7 days
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8
Q

According to Naegele’s rule, a 23 y/o P1001 with FDLMP 9/14/13 will have an estimated date of delivery of?

A
  • 6/21/2014
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9
Q

What do we measure with US?

A
  • gestational sac size

- fetal crown rump length (CRL)

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10
Q

Why are allergies important for pregnancy?

A
  • at the end of the pregnancy you will give antibiotics for group B strep prophylaxis.
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11
Q

What medication categories can be used in pregnancy?

A
  • must take into consideration the situation of both the mother and baby (D may be teratogenic, but in order to stop seizure, you may need to use it).
  • aka take with a grain of salt
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12
Q

What are some important past medical history chronic diseases to rule out?

A
  • HTN
  • DM
  • Asthma
  • Fibroids
  • Seizure disorders
  • blood transfusions
  • Thrombophilic disorders…
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13
Q

Why do you care if a pt had surgery on her cervix (LEEP/CKC/Laser/Cryo)?

A
  • can result in CERVICAL INSUFFICIENCY (meaning the baby will come out when it’s not ready).
  • ASHERMAN’S syndrome (scaring from too many D&Cs).
  • Adhesions
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14
Q

What should you do if a pt tells you a prior delivery involved a shoulder dystocia?

A
  • get records and find out what really happen.

- DOCUMENT EVERYTHING!

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15
Q

Why is HPV history important?

A

may have a lot of condyloma acuminata which could be obstructive!

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16
Q

Can you vaccinate for varicella after you are pregnant?

A

NO because this is a live virus!

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17
Q

*** What is Chadwick’s signs?

A
  • bluish hue due to engorgement of blood to the uterus.
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18
Q

What happens to blood volume during pregnancy?

A
  • INCREASES a LOT!
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19
Q

What is McDonald’s sign?

A
  • flexing the cervix and uterus on each other
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20
Q

** What is the EASIEST pelvic architecture to deliver through? (TEST QUESTION)

A
  • gynecoid/gynecoid
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21
Q

What is important to document?

A
  • Fetal heart tones (FHTs)
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22
Q

What if uterine size does not match EGA (estimated gestational age) by LMP?

A

change the delivery date via ultrasound measurement

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23
Q

What could cause larger baby size than is expected for the dat?

A
  • multiple pregnancies, molar pregnancy, wrong EGA, fibroids, polyhydramnios
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24
Q

What could cause smaller baby size than expected for the date?

A
  • wrong EGA, have had spontaneous AB, ectopic pregnancy
25
Q

What are the routine prenatal labs?

A
  • CBC, Blood type and Rh type, Antibody screen, Rubella titer, Varicella, Hepatitis profile, HIV, urinalysis and culture, VDRL or RPR, CF screening, Pap test, GC/CT, BV
26
Q

What should we talk about in pt education?

A
  • review number and frequency of visits
  • discuss weight gain based on ideal body weight (25-35 lbs for normal weight); less weight gain if overweight.
  • discuss labor, anticipated delivery mode
  • start prenatal vitamins (FOLIC ACID 0.4 mg, or 4 mg if prior hx of neural tube defect).
27
Q

What restrictions should we place on the pregnant mother?

A
  • tobacco
  • ETOH
  • drug use
  • travel (Zika…)
  • caffeine intake (too much causes growth restriction)
  • no raw meat
28
Q

Can you receive a flu shot when pregnant?

A

YES now you can for some!

29
Q

** What are the 2 types of tests? (TEST QUESTION)

A
  1. SCREENING= start with this (done in 1st trimester)
  2. DIAGNOSITIC= follows screening test
    * improve with time of gestation.
30
Q

** What are the DIAGNOSTIC tests?

A
  • AMNIOCENTESIS (at 16-22 weeks EGA)

- CHORIONIC VILLUS SAMPLING (CVS) (at 10-12 weeks EGA; done by going up through the vagina)

31
Q

What do we genetic SCREENING do we do by trimester?

A
  • Down syndrome (trisomy 21), open neural tube defect, Edward’s syndrome (trisomy 18)
32
Q

** What SCREENING test should we offer in the 1st trimester?

A
  • NUCHAL TRANSLUCENCY (collection of fluid under the skin at the back of the baby’s neck) via US, with and without BLOOD TEST (serum markers):
  • Pregnancy-Associated Plasma Protein A (PAPP-A)
  • hCG
33
Q

What is a normal NUCHAL TRANSLUCENCY?

A
  • less than 3 mm (anything over this is associated with trisomy 21).
34
Q

What screening test should we offer in the 2nd trimester?

A

quad screen

35
Q

What is the newer SCREENING test with better sensitivity and specificity?

A
  • NIPT= non-invasive prenatal testing

* currently used only for high risk pts, but Dr. Monzao thinks it will become standard of care in the near future.

36
Q

Will NIPT also show you the sex of the baby?

A

YES bc it also tests the DNA.

37
Q

What will you do if a screening test is abnormal?

A
  • confirm with DIAGNOSTIC TEST: CVS (can be done at 10-12 weeks) or AMNIOCENTESIS (16-22 weeks).
38
Q

After the first prenatal visit, how many times will you see your pt?

A
  • every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, and then every week thereafter until delivery.
39
Q

What will you do at each prenatal visit?

A
  • BP, weight, urine dip for glucose and protein, fundal height, FHTs, fetal movement, and signs of labor.
40
Q

What are Leopold’s maneuvers?

A
  • way to determine the position of a fetus inside the woman’s uterus by feeling the woman’s belly
41
Q

If a pt doesn’t have prior risk factors for gestational DM, when do you test them (glucose tolerance test)?

A
  • between 26-28 weeks.

* If they have risk factors (prior GDM or obese then test in first trimester).

42
Q

What will be tested/look at in the 2nd trimester?

A
  • fetal screening
  • 1’ GTT if needed (normal is 130 or less). If abnormal do 3’ GTT.
  • 20 wk fetal anatomy ultrasound.
  • CBC
43
Q

What should you look for on your ultrasound during the 2nd trimester?

A
  • # fetuses
  • EGA based on measurements
  • location of placenta
  • structures (4 heart chambers, cord insertion, stomach, bladder, kidneys…).
  • cardiac activity
44
Q

When should you administer Rho GAM if indicated?

A
  • 28 weeks
45
Q

What should you instruct the mother to do with fetal kick counts?

A
  • tell her that if she doesn’t feel the baby kick in a while, do her fetal kick counts (normal is 10 in an hour).
46
Q

What should you do in the 3rd trimester?

A
  • talk about SIGNS AND SYMPTOMS OF LABOR (explain what going into labor feels like, when to call you, what to look for or be concerned for (ruptured membranes…), SOB, eating tiny meals).
  • GROUP B STREP swab, chlamydia and gonorrheal cultures, and cervical exams.
  • ANESTHESIA/PAIN CONTROL for labor (epidural vs natural).
  • BIRTH PLANS
  • BREAST OR BOTTLE FEEDING
47
Q

If the mother has symptoms of getting a herpes lesion what must you do?

A

go straight to C-section

48
Q

What heart beat tests can you do on the baby to learn a lot about the baby?

A
  • non-stress test (NST)= reactive vs. nonreactive. This is non-invasive.
  • contraction stress test (CST)
49
Q

What is a biophysical profile (BPP)?

A

test that looks at the fluid around the baby, the movement of the baby, and tone of the baby

50
Q

What should you look for on a fetal non-stress test (NST)?

A
  • reactive= accelerations of 15 beats above baseline that last 15 seconds, 2 times in 15 mins.
51
Q

What are contraction stress tests?

A
  • stresses baby with uterine contractions (via medications; Pitocin) to see if the baby can tolerate labor. Evaluate baby’s response via heart rate.
  • SHOULD NOT HAVE DECELERATIONS WITH MORE THAN 50% OF CONTRACTIONS. This means the baby is not ready for delivery yet.
52
Q

What is a POSITIVE contraction stress test?

A
  • deceleration with MORE than 50% of contractions.
53
Q

What is a NEGATIVE contraction stress test?

A
  • decelerations with LESS than 50% of contractions
54
Q

How long is a contraction stress test good for?

A

1 week

55
Q

How long is a non-stress test good for?

A

must do 2x per week

56
Q

** What 5 things will you look for on the biophysical profile (BPP) in the 3rd trimesters?

A
  1. amniotic fluid (greater than 5).
  2. Fetal movements (limb movements)
  3. Fetal breathing (for 30 s or more).
  4. Fetal tone (extension and flexion of extremity).
    - NST
57
Q

** How do you score the BPP?

A
  • each component is assigned a score of 0 or 2.
  • BPP 8 or higher= fetal well being :)
  • BPP less than 4= DELIVER!
  • BPP of 6= MONITOR closely.
58
Q

*** If an amniotic fluid index (AFI) shows too MUCH fluid (POLYhydramnios), what should you think?

A
  • CNS or GI MALFORMATIONS
59
Q

*** If an amniotic fluid index (AFI) shows too LITTLE fluid (OLIGOhydramnios), what should you think?

A
  • PULMONARY HYPOPLASIA

- CRANIAL, FACIAL, or SKELETAL ABNORMALITIES

RGU 2 (24 decks)

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