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Clin Med 3 - Exam 3 (Women's Health) > Prenatal Diagnosis > Flashcards

Prenatal Diagnosis Flashcards

1
Q

what is the definition of gestational age?

A

age in days or weeks from the last menstrual period

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2
Q

what is the definition of an embryo?

A

from time of fertilization to 8 weeks (GA 10 weeks)

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3
Q

what is the definition of a fetus?

A

after 8 weeks to time of birth

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4
Q

what is a previable infant?

A

infant delivered before 24 weeks

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5
Q

term is what?

A

37-42 weeks

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6
Q

post-term?

A

past 42 weeks

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7
Q

what is gravidity?

A

number of times a woman has been pregnant

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8
Q

what is parity? includes what?

A

number of pregnancies led to birth after 20 weeks (or >500g infant)

includes:
-term, preterm, abortions, living children

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9
Q

what are the goals of prenatal care?

A
  • accurate estimate of gestational age
  • deliver healthy, term infant w/out impairing mom
  • treat high-risk complications
  • patient education
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10
Q

what’s the cardiac output change in a pregnant mom?

A

cardiac output increases 30-50%

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11
Q

what’s the stroke volume in a pregnant mom?

A

stroke volume increases 10-50%

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12
Q

what’s the pulse change in a pregnant mom?

A

pulse increases about 15-20bpm

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13
Q

is there a murmur associated pregnancy?

A

Yes, common to have systolic ejection murmur and S3 gallop

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14
Q

what happens to the BP to the mom in pregnancy?

A

peripheral vascular resistance falls

fall in BP in 2nd trimester, return to normal during 3rd trimester

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15
Q

what doesn’t change in the respiratory system of a mom in pregnancy?

A

respiratory rate, vital capacity, inspiratory reserve volume

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16
Q

what decreases in the respiratory system of a mom in pregnancy?

A

functional residual capacity, expiratory reserve volume, total lung capacity

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17
Q

what increases in the respiratory system of a mom in pregnancy?

A

inspiratory capacity and tidal volume

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18
Q

what increases in the renal system of pregnant mom?

A

increased kidney size and weight, ureteral dilation, bladder becomes intra-abdominal organ

increase in tubular reabsorption of Na

increase in renin and angiotensin levels but reduced vascular sensitivity to their hypertensive effects

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19
Q

what happens to the GFR, CrCl, BUN, Cr, and glucose excretion when pregnant?

A

GFR increases 50%

CrCl increases 150-200 cc/min

BUN and serum Cr decrease by 25%

increase glucose excretion

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20
Q

what happens to plasma volume, RBC volume, WBC count, and platelet count when pregnant? fibrinogen?

A

Plasma volume increases by about 50%

RBC volume increases by 30%

WBC count increases

Platelet count decreases (but still WNL)

Increased fibrinogen, factor VII-X

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21
Q

what is one of the MOST COMMON complaints when pregnant?

A

CONSTIPATION -> d/t decreased motility b/c of progesterone and uterus squishing bowel

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22
Q

what changes occur in the cervix when pregnant? (HINT: water content/vascularity and cervical mucous secretion)

A

increased water content and vascularity

increased cervical mucous secretion

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23
Q

at 20 weeks pregnant, where do you expect the uterus to be?

A

at the umbilicus

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24
Q

how can you confirm pregnancy?

A

urine HcG or serum HcG = both are the same

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25
Q

when is HcG positive?

A

1 week after fertilization

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26
Q

at how many weeks or Hcg can Trans-vag US show gestational sac? what about fetal heart?

A

gestational sac = as early as 5 weeks or Hcg of 1,500-2,000

fetal heart = as early as 6 weeks or Hcg of 5,000-6,000

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27
Q

First questions for pregnant woman?

A

1) was this pregnancy planned?

2) are you planning to continue this pregnancy?

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28
Q

what is the leading cause of pregnancy-associated death? risk factors?

A

homicide d/t domestic violence

RF’s: age < 20, black race, late or no prenatal care

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29
Q

what are 4 main signs of pregnancy? others?

A

Chadwick’s sign, Hegar’s sign, Goodell’s sign, Ladin’s sign

others: breast swelling/tenderness, lines nigra

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30
Q

what is Chadwick’s sign?

A

Pregnancy sign

bluish discoloration of vagina and cervix (d/t increased water content in cervix)

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31
Q

what is Hegar’s sign?

A

Pregnancy sign

softening of uterine consistency and ability to palpate or compress the connection b/w the cervix and the fundus

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32
Q

what is Goodell’s sign?

A

Pregnancy sign

softening and cyanosis of cervix at or after 4 weeks

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33
Q

what is Ladin’s sign/

A

softening of uterus after 6 weeks

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34
Q

what is the MOST COMMON pregnancy sx?

A

Amenorrhea

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35
Q

initial physical exam findings for pregnancy?

A

Vitals, thyroid, heart, lungs, breast, abdomen (Check for scars), pelvic (pap, GC/CT, bimanual), extremities

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36
Q

what vaccine should ALL pregnant women get at first initial PE?

A

influenza vaccine

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37
Q

what is Nagele’s Rule for determining the due date (dating) of pregnancy?

A

subtracting 3 months from the LMP and adding 7 days

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38
Q

how do you determine the due date if pt has uncertain LMP?

A

US used to determine estimate date of confinement (due date)

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39
Q

when is US most accurate in determining the due date? measure how?

A

most accurate in 1st trimester

done by crown-rump length in the 1st half of the 1st trimester

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40
Q

when do you check CBC w/diff of pregnant pt?

A

1st trimester and at 28 weeks

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41
Q

what is normal to see on CBC w/diff of pregnant pt?

A

slightly elevated WBC, dilution anemia, thrombocytopenia

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42
Q

if pregnant pts Hct is <32% in 1st trimester, what do you start them on?

A

FeSO4 and Colace

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43
Q

if MCV is low in 1st trimester pregnant pt, what should you consider and what should you get?

A

consider thalassemia if MCV is low

get iron studies first, if not deficient get Hgb electrophoresis

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44
Q

at what level of platelets should you be concerned about in pregnant pt? beware of?

A

< 100 -> thrombocytopenia

BEWARE OF HELLP SYNDROME, PRE-ECLAMPSIA

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45
Q

what are the 1st trimester labs to get?

A
  • CBC w/diff
  • Blood type and screen
  • RPR/VDRL
  • Rubella antibody screen
  • Hep B surface antigen
  • VZV titer
  • Gonorrhea and Chlamydia cultures
  • PPD
  • Pap smear
  • UA
  • HIV test
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46
Q

if mom is Rh negative, what med does she need and when?

A

RhoGAM at 28 weeks or any time she has vaginal/uterine bleeding

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47
Q

if antibody screen for Rh is positive, who do you consult?

A

perinatologist

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48
Q

what can Rh antibodies do to fetal RBCs? Fatal?

A

destroy fetal RBCs and cause hemolytic anemia -> fatal to fetus

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49
Q

what is RPR/VDRL? testing for?

A

rapid plasma regain/venereal disease research lab

testing for antibodies to syphillis

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50
Q

pregnancy is a risk for what false positive?

A

false positive RPR/VDRL -> need to check FTA-ABS

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51
Q

if reactive/positive for RPR/VDRL, what do you check and what are you looking for? when is it a true positive?

A

check FTA-ABS (Fluorescent Treponemal Antibody - Absorption test)

Looking for presence of antibodies to Treponema pallidum bacteria (the bacteria that causes syphilis)
-If presence of antibodies, then is true positive

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52
Q

consult who if true positive for syphilis?

A

consult perinatologist

-baby can get infected if mom not treated

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53
Q

risk of what if mom is positive for syphillis?

A

miscarriage, stillbirth, neonatal death, or baby with severe neurological problems

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54
Q

when is Rubella vaccine given to pregnant woman?

A

after delivery (if non-immune)!!! b/c it is a live vaccine

55
Q

HBsAg detects Hep B when?

A

detects Hep B 1-12 weeks post exposure

56
Q

HBsAb means what?

A

recovery and immunity

57
Q

HBeAg?

A 
acute infection (may or may not be present in chronic infection)
-higher titer = great infectivity
58
Q

acute infection of Hep B diagnosed by what antibody? detectable when? declines when?

A

IgM HBcAb

-detectable at clinical onset, declines w/in 6 months

59
Q

chronic infection of Hep B diagnosed by what antibody?

A

IgG HBcAb

60
Q

if mom is infected with Hep B, who do you notify?

A

Peds!

61
Q

if mom is positive for Gonorhea/Chlamydia, who do you treat? when do you do test of cure?

A

If positive, treat pt and partner, promote abstinence during treatment

do test of cure 4 weeks after tx

62
Q

if PPD is positive in mom in 1st trimester, what do you do?

A

wait and do CXR in 3rd trimester

63
Q

what testing should be offered to all 1st trimester women?

A

HIV testing

64
Q

what screening should be offered at pre-conceptual or new OB visit, especially if white?

A

Cystic Fibrosis Carrier Screening

65
Q

what is advanced maternal age (AMA)?

A

35 y/o or greater at time of delivery

66
Q

what screening is offered all pregnant women, but esp to AMA pregnant women?

A

maternal serum screening
-blood test that looks at fetal chromosomes (MS-AFP, Quad screen, Sequential Screen, NIPT testing)

also offer genetic counseling w/possible diagnostic test (chorionic villus sampling or amniocentesis)

67
Q

what is 2nd trimester diagnostics?

A

MSAFP, Quad screen, US (18-20 weeks)

68
Q

when is MS-AFP done? what does it mean when elevated? decreased?

A

16-18 weeks

Elevated: increased risk of NT defects

Decreased: increased risk of aneuploidies including down Syndrome

69
Q

what is the Quad screen? what does it check for? when is it done? what if positive?

A

MSAFP, HCG, estriol, inhibin-A (checks for trisomy 21, trisomy 18, NTD)

Done b/w 15-18 weeks (can go up to 20)

If positive, refer for genetic counseling, high resolution US, +/- aminocentesis

70
Q

everyone in 2nd trimester gets what?

A

US - 18-20 weeks

71
Q

what does US look for in 2nd trimester?

A

Fetal survey, amniotic fluid volume, placental location, gestational age

72
Q

what is Part 1 of sequential screening in 2nd trimester?

A

Blood tests for serum levels of PAPP-A and free B-hCG (11-13 weeks)

US for nuchal translucency (11-13 weeks)

detects 70% of down Syndrome, 80% of trisomy 18

73
Q

what is Part 2 of sequential screening in 2nd trimester?

A

Blood tests for serum levels of MS-AFP, estriol, B-hCG, and inhibin (15-18 weeks)

Detects 91% of down Syndrome, 90% of trisomy 18, and 80% of NTD

74
Q

what is the new testing for trisomy’s in maternal blood? what trisomy’s does it test for?

A

CFFDNA analysis (cell-free fetal DNA analysis)

tests for fetal trisomy’s 21, 18, 13 in maternal blood

75
Q

what are the ACOG recommendations for use of CFFDNA analysis?

A

maternal age 35 y/o or older at delivery

fetal US findings indicating increased risk of aneuploidy

hx of prior pregnancy w/ trisomy

positive test result for aneuploidy, including 1st trimester, sequential, or quadruple screen

parental balanced robertsonian translocation w/increased risk of fetal trisomy 13 or trisomy 21

76
Q

if pregnant woman has 1st trimester bleeding, what do you do?

A

US

77
Q

US can be used to determine anatomy of baby at what weeks?

A

18-20 weeks

78
Q

do US when fundal height is what?

A

any time fundal heigh is >3cm discrepant from GA

79
Q

why is US done at or after 37 weeks?

A

to confirm presentation

80
Q

reasons to do US?

A

At initial visit to measure CRL (crown-rump length) if uncertain LMP

First trimester bleeding

Anatomy survey b/w 18-20 weeks

Any time fundal height is >3cm discrepant from GA

Confirm presentation at or after 37 weeks

81
Q

when is amniocentesis done and what is obtained?

A

b/w 15-20 weeks to obtain fetal karyotype

82
Q

complications of amniocentesis?

A
  • Transient vaginal spitting
  • Amniotic fluid leakage
  • Preterm labor
  • Chorioamnionitis
83
Q

what does ACOG recommend about doing an early amniocentesis (<15 weeks)?

A

DON’T DO EARLY AMINOCENTESIS (<15 weeks) b/c of higher risk of pregnancy loss and complications compared with traditional amniocentesis

84
Q

what is Chorionic Villus Sampling? when is it done?

A

test to obtain fetal karyotype b/w 10-13 weeks (99% detection rate)

Catheter placed into intrauterine cavity and small amount of chorionic villi aspirated from placenta

85
Q

complications of Chorionic Villus Sampling?

A
  • Pre-term labor
  • PROM
  • Previable delivery
  • Fetal injury
86
Q

procedure-related loss rates for Chorionic Villus Sampling, the same for amniocentesis?

A

Yes, similar

87
Q

what is cordocentesis?

A

percutaneous umbilical blood sampling (PUBS) - puncture umbilical vein w/ US guidance

get karyotype of fetal blood in 24-48 hrs

88
Q

when is cordocentesis done?

A

Rarely needed but may be useful to further evaluate chromosomal mosaicism discovered after CVS or amniocentesis is performed

89
Q

what are 3rd trimester diagnostics?

A

CBC, gestational DM screening , RPR/VDRL, CXR if PPD+, Group B strep culture (36 weeks)

if high risk, repeat Gonorrhea and Chlamydia cultures, HSV screening

90
Q

when do you do CXR if pregnant woman’s PPD is positive in 1st trimester?

A

in 3rd trimester

91
Q

when do you get group B strep culture in pregnancy? how is it done?

A

36 weeks

Culture from lower vagina and anus (swab must go through sphincter)

92
Q

what is assessed at routine prenatal visits?

A
  • BP, weight
  • Urine dipstick (protein and glucose)
  • Fundal height, estimated fetal weight, fetal position
  • Auscultation with doppler of the fetal heart tones
93
Q

frequency of OB/GYN visits when pregnant?

A

Less than 28 weeks: every 4 weeks

28-36 weeks: every 2 weeks

> 36 weeks: every week

94
Q

do you give Zofran in pregnancy?

A

NO!!! give a different antiemetic

95
Q

common problems associated with pregnancy?

A

constipation, hemorrhoids, GERD, Pica, urinary frequency (may be normal or UTI), carpal tunnel syndrome

96
Q

who gets prenatal vitamins and when are they most effective?

A

EVERYONE GETS PRENATAL VITAMINS

800mcg folic acid - most effective when given 2 months prior and during 1st month

97
Q

what should pregnant women avoid?

A

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

98
Q

limit caffeine to what when pregnant?

A

limit to 500mg/day

99
Q

consider nutritional referral in pregnancy when?

A
  • Inadequate weight gain
  • PICA
  • Eating disorder
100
Q

how much Ca is needed per day when pregnant?

A

1200mg

101
Q

what is average weight gain in pregnancy?

A

25-35 pounds

102
Q

if BMI >30 when pregnant, how much weight can they NOT gain? if BMI < 20, how much weight can they gain?

A

BMI > 30 - shouldn’t gain >15lbs

BMI < 20 - gain up to 40 lbs

103
Q

how do you tell pregnant pt to prevent listeriosis, toxoplasmosis, CMV, varicella, parvo B19?

A
  • Handwashing
  • Gloves for changing cat litter or gardening
  • Wash produce and cutting boards
  • Cook or freeze meats
  • No raw eggs or unpasteurized dairy
104
Q

limit radiation exposure to how many episodes when pregnant?

A

5 episodes

105
Q

what are safe medications in pregnancy?

A
  • PNV (prenatal vitamins)
  • Tylenol
  • Benadryl
  • Sudafed (if no HTN)
  • Tums
  • Iron Sulfate
  • Colace
106
Q

what abx do you use for UTIs in pregnancy? can you use Bactrim?

A

Macrobid (nitrofurantoin)

can use Bactrim except in 3rd trimester

107
Q

what meds can you use for BV or yeast infection in 1st trimester? after 1st trimester?

A

in 1st trimester: metrogel, monistat

after 1st trimester: flatly, diflucan

108
Q

what SSRI should pregnant women avoid?

A

Paxil

109
Q

what med is used to treat HSV in pregnancy?

A

Acyclovir

110
Q

can pregnant women exercise? HR should be at what? what should they avoid?

A

YES!!!! - continue exercising at usual activity level
-want to keep HR at 140 or below

Avoid over-heating (heat is a teratogen)

111
Q

avoid what position after 20 weeks when pregnant? why?

A

avoid supine position after 20 weeks b/c uterus will press on vena cava

112
Q

2nd trimester counseling?

A
  • Birthing classes
  • Preterm labor risks after viability
  • Breastfeeding
  • RhoGAM at 28 weeks if Rh negative
113
Q

3rd trimester counseling?

A
  • Analgesia/anesthesia in labor
  • Operative vaginal delivery or C-section
  • Fetal kick counts
  • Labor and Delivery Tour (things to bring to hospital - (i.e. car seat)
  • Circumcision if boy

GBS (group B strep) -> if positive, then need abx before you deliver

114
Q

how long does a woman need to heal from C-section before getting pregnant again?

A

1 year

115
Q

if pt has had prior C-section, what must be documented? discuss what?

A

uterine scar (if possible)

discuss risk/benefits of vaginal birth after C-section trial vs. repeat C-section

risks to bladder and bowel

116
Q

what is the goal of antepartum fetal surveillance?

A

to prevent fetal death

117
Q

what techniques are used for antepartum fetal surveillance?

A

Fetal movement assessment

Non-stress test (NST)

Contraction stress test (CST)

Fetal Biophysical Profile (BPP)

Amniotic Fluid Index (AFI)

118
Q

what is the indication for fetal movement assessment? technique? tips?

A

Indication: maternal perception of decreased or absent fetal movement

Technique: mother counts number of “kicks” during a specified amount of time

Tips: have mom eat or drink something, and sit or lay still

119
Q

what is the Non-Stress Test (NST)?

A

Measurement of fetal heart rate with movement

-fetal HR will accelerate with fetal movement if not acidotic or neurologically depressed infant

120
Q

what is reactive (normal) NST?

A

2 or more fetal HR accelerations w/in a 20-min period

121
Q

what is non-reactive NST?

A

insufficient fetal HR accelerations over a 40-min period

122
Q

what is the contraction stress test (CST)?

A

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

123
Q

what are late decels of fetal HR?

A

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

124
Q

what may variable decels of fetal HR mean?

A

cord compression (think oligohydramnios)

125
Q

what are the components of fetal biophysical profile (BPP)?

A

NST, fetal breathing movements, fetal movement, fetal tone, AFI (amniotic fluid index)

126
Q

scoring of BPP?

A
  • Normal: 8 or 10
  • Equivocal: 6
  • Abnormal: 4 or less
127
Q

what warrants further evaluation regardless of BPP score?

A

oligohydramnios

128
Q

what is the Amniotic Fluid Index (AFI)? tells you what?

A

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

tells you if have oligohydramnios or polyhydramnios

129
Q

what is oligohydramnios? is it bad? what does it require?

A

No US measured pocket of fluid >2cm or AFI of 5cm or less (not enough amniotic fluid)

***BAD - think anomalies or placental dysfunction

Requires close maternal/fetal surveillance or delivery

130
Q

what is polyhydramnios? can it be normal? what can it cause?

A

too much amniotic fluid

-can be normal, can cause PROM or malpresentation

131
Q

when do you do antepartum fetal surveillance?

A

b/w 32-34 weeks

repeat weekly or bi-weekly until delivery

132
Q

when is postpartum visit to OB/GYN for vaginal delivery? what do you assess?

A

6 weeks for vaginal delivery

Assess:

  • Lochia, voiding, bowel movements, breastfeeding, depression, contraception
  • Most women will bleed somewhere b/w 4-6 weeks
133
Q

when is postpartum visit to OB/GYN for C-section delivery? when is incision checked?

A

2 and 6 weeks for C-section delivery

incision checked at 2 weeks

Clin Med 3 - Exam 3 (Women's Health) (9 decks)

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