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Clin Med III exam III > Prenatal Diagnosis and Care > Flashcards

Prenatal Diagnosis and Care Flashcards

1
Q

First trimester

A

1st 14 weeks GA

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2
Q

Gestational Age

A

age in days or weeks from the last menstrual period

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3
Q

Second trimester

A

14-28 weeks GA

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4
Q

Third trimester

A

28 weeks until delivery

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5
Q

Previable

A

infant delivered before 24 weeks

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6
Q

Preterm

A

24-37 weeks

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7
Q

Term

A

37-42 weeks

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8
Q

Post term

A

past 42 weeks

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9
Q

What happens to moms cardiovascular system when pregnant

A
  • CO increases by 30 to 50%
  • stroke volume increases 10 to 15%
  • pulse increases 15 to 20 bpm
  • systolic ejection murmur and S3 gallop common
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10
Q

What happens to a pregnant womans blood pressure

A
  • peripheral vascular resistance falls

- fall in BP in 2nd trimester, returns to normal in 3rd

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11
Q

What parts of the respiratory system remain unchanged during pregnancy

A
  • respiratory rate
  • vital capacity
  • inspiratory reserve volume
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12
Q

What parts of the respiratory system change during pregnancy

A

Decreased: functional residual capacity, expiatory reserve volume, residual volume, total lung capacity

Increased: inspiratory capacity, tidal volume

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13
Q

Normal ABG from a pregnant lady

A

pH: 7.44, pCO2=30, bicarb=20-25, pO2>=100

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14
Q

What happens to the renal system during pregnancy

A
  • increase kidney size and weight
  • ureteral dilation
  • bladder becomes intra abdominal organ
  • GFR increases 50%
  • creatinine clearence increases 150 to 200 cc/min
  • BUN and SCr decrease by 25%
  • increase in renin and angiotensin
  • increased glucose excretion
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15
Q

What happens to the hematologic system during pregnancy

A
  • plasma volume increases by 50%
  • RBC volume increases by about 30%
  • WBC count increases
  • platelets decrease
  • increased levels of fibrogen, factor Vii-X
  • placenta produces plasminogen activator inhibitor
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16
Q

What happens to the GI system during pregnancy

A
  • decreased motility

- reduced gastric acid secretion

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17
Q

TVUS shows gestational sac as early as ___ wks or Hcg of ___. Fetal HR as early as ___ or Hcg of ___.

A

gestational sac: 5wks or Hcg of 1,500-2,000

FHR: 6 wks or Hcg of 5,000-6,000

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18
Q

Chadwick’s sign

A

bluish discoloration of vagina and cervix

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19
Q

Hegar’s sign

A

softening of uterine consistency and ability to palpated or compress the connection between the cervix and the fundus

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20
Q

Goodell’s sign

A

softening and cyanosis of cervix at or after 4 weeks

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21
Q

Ladin’s sign

A

softening of the uterus after 6 weeks

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22
Q

Signs of pregnancy

A
  • breast swelling and tenderness
  • linea nigra
  • telangiectasias
  • palmar erythema
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23
Q

What is Nagele’s rule

A

calculate EDC by subtracting 3 months from the LMP and adding 7 days

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24
Q

First trimester labs

A
  • CBC
  • blood type and screen
  • RPR/VDRL
  • rubella antibody screen
  • hep B surface antigen
  • VZV titer
  • STD cultures
  • PPD
  • pap smear
  • urine
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25
Q

When do you check CBC in pregnancy

A

initial labs and 28 weeks

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26
Q

When should you consider thalaseemia in pregnancy

A

if MCV low

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27
Q

Normal CBC findings with pregnancy

A
  • slightly elevated WBC
  • dilutional anemia
  • thrombocytopenia
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28
Q

What do you do if pt is Rh negative

A

Rhogam at 28 weeks or anytime she has vaginal or uterine bleeding

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29
Q

What do you do if Rh antibodies are found

A

consult perinatologist: Rh antibodies cause fetal red blood cells to be destroyed causing hemolytic anemia

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30
Q

What do you do if gonorrhea and chlamydia is positive

A

treat pt and partner, promote abstinence during treatment and test again 4 weeks after treatment

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31
Q

If RPR/VDRL is reactive what do you do next

A

Fluorescent treponemal antibodi absorption- check presence of antibody to bacteria that causes syphilis

32
Q

What do you do if pt is non immune to rubella

A

administer vaccine post partum

33
Q

HBsAb shows what

A

recovery and immunity

34
Q

HBeAg shows what

A

acute infection

35
Q

What is acute hep B infection diagnosed by

A

IgM HbcAb

36
Q

What is chronic hep B infection diagnosed with

A

IgG HBcAb

37
Q

Advanced maternal age

A

women over he age of 35

38
Q

What should be offered to pregnant women of advanced maternal age

A
  • maternal serum screening

- genetic counseling with possible diagnostic tests

39
Q

Elevated MSAFP during the second trimester tells you

A

increased risk of NT defects

40
Q

Decreased MSAFP in second trimesters tells you

A

aneuploidies including down syndrome

41
Q

What is a quad screen

A

test done during the second trimester

includes MSAFP, HCG, estriol, inhibin-A

42
Q

When is a quad screen done

A

between 15-18 weeks

43
Q

When can you not do a quad screen

A

multiple gestations

44
Q

What do you do if quad screen is positive

A
  • refer for genetic counseling
  • high resolution US
  • +/- amniocentesis
45
Q

What does cffDNA test for

A

fetal trisomies- 21,18,13

46
Q

When should cffDNA be done

A
  • maternal age over 35
  • FUS findings indicating an increased risk of aneuploidy
  • hx of prior pregnancy w/ trisomy
  • postive rest result for aneuploidy
  • parental balanced robertsonian translocation with increased risk of fetal trisomy 13 or 21
47
Q

When should ultrasounds be done during pregnancy

A
  • at minitial visit to measure CRL if uncertain LMP
  • first trimester bleeding
  • anatomy survey between 18 and 20 weeks
  • any time fundal height is >3cm discrepant from GA
  • confirm presentation at or after 37 weeks
48
Q

When is amniocentesis done? Why?

A

done between 15-20 weeks to obtain fetal karyotype

49
Q

What are the complications of an amniocentesis

A
  • transient vaginal spotting
  • amniotic fluid leakage
  • preterm labor
  • chorioamnionitis
  • rarely needle injury to fetus
50
Q

When is chorionic villus sampling done? Why?

A

done between 10-13 weeks to obtain a fetal karyotypes

51
Q

How is a CVS done

A

catheter placed into intrauterine cavity and small amount of chrorionic villi aspirated from placenta

52
Q

Complications of CVS

A
  • preterm labor
  • PROM
  • previable delivery
  • fetal injury
53
Q

Cordocentesis

A

percutaneous umbilical blood sampling

54
Q

When is PUBS done

A

rarely done but may be useful to further evaluate chromosomal mosaicism discovered after CVS or amniocentesis

55
Q

Diagnostic done during the third trimester

A
  • CBC
  • GLT
  • RPR/VDRL
  • CXR if PPD+
  • group B strep culture

if high risk:

  • repeat gonorrhea and chlamydia
  • HSV screening
56
Q

When is group B strep culture done

A

36 weeks, culture from lower vagina and anus (swab must go through sphincter)

57
Q

What things are done at all routine prenatal visits

A
  • BP
  • weight
  • urine (protein and glucose)
  • fundal height, estimated fetal weight, fetal position)
  • asculatation of fetal heart tones
58
Q

When should a pregnant woman have routine prenatal visits

A

less than 28 weeks: every 4 weeks

28-36 weeks: every two weeks

> 36 weeks: every weeks

59
Q

How much folic acid should a pregnant lady be having

A

800 mcg

60
Q

What supplements should be avoided in pregnancy

A

excessive fat soluble vitamins (A,D,E,K)

61
Q

Caffeine limit in pregnancy

A

500mg/day

62
Q

How many calories hsould be consumed a day in pregnancy? Protein? Iron? Calcium?

A

increase 15% kcal/day (2200)
additional 10-30 g protein
30-60 mg iron
1200mg calcium

63
Q

Average weight gain during pregnancy

A

25 to 35 pounds

64
Q

Indication for fetal movement assessment

A

maternal perception of decreased or absent fetal movement

65
Q

What does a fetal non stress test measure? What is normal? Abnormal?

A

-measurement of fetal heart rate with movement

normal=2 or more fetal heart rate accelerations within a 20 minute period

nonreactive=insufficient fetal heart rate accelerations over a 40 min period

66
Q

What does a contraction stress test look for

A

the presence or absence of late fetal heart rate decelerations in response to uterine contractions

67
Q

What are late decels

A

decels that reach their nadir after the peak of the contractions and usually persist beyond the end of the contraction

68
Q

Variable decels= ???

A

cord compression

69
Q

What are the components of a biophysical profile

A
  • NST
  • fetal breathing movements
  • fetal movements
  • fetal done
  • AFI (amniotic fluid index)
70
Q

Scoring of the biophysical profile

A

each component gets a 2 or 0

normal: 8 or 10
equivocal: 6
abnormal: 4 or less

71
Q

What is the amniotic fluid index

A

summation of the largest cord-free vertical pockets in each of the 4 quadrants of an equally divided uterus

72
Q

Oligohydramnios

A

no US measured pocket of fluid >2cm
OR
AFI of 5 cm or less

73
Q

Polyhydramnios is an AFI of

A

typically greater than 24 cm

74
Q

Polyhydramnios can cause what two things

A

PROM or malpresentation

75
Q

Postpartum visits for vaginal delivery. Cesarean.

A

Vaginal: at 6 weeks
Cesarean: 2 and 6 weeks

76
Q

When should you consider sooner post -partum followup appointments

A

if complications present (3rd or 4th degree tear, HTN)

Clin Med III exam III (10 decks)

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