Antepartum 2 Flashcards
(74 cards)
1
Q
Preconception care
A
health of women and partner- BEFORE PREGNANCY
2
Q
What info is reviewed?
A
Personal and family history, physical examination, laboratory screening, reproductive planning, nutrition, supplements, weight, exercise, vaccinations, and injury prevention
3
Q
GREATESTS risk time-frame
A
- Between 17 & 56 DAYS AFTER conception
- Up to wk. 14 of gestation
4
Q
prenatal visits:
from conception up to week 28
A
evry 4 weeks
5
Q
Prenatal visits:
Week 28 up to week 36
A
every 2 weeks
6
Q
prenatal visits:
week 36 up to week 40
A
weekly visits
7
Q
First prenatal visit consists of
A
- Counselling & education (Nutrition, do’s & don’ts)
- Laboratory Tests
- Threshold for Dx of GDM in pregnancy
8
Q
Lab tests taken in FIRST prenatal visit
A
- Urine or Blood test
- hCG
- Diabetes Mellitus – Tight control
- Gestational Diabetes (GDM)- on the rise
9
Q
estimated due date (EDD) usinmg NAGELES RULE
A
- FIRST DAY of LAST menstrual period
- Subtract 3 months
- Add 7 days
- Adjust year if needed
10
Q
Terms to know:
GTPAL is used todocument a woman’s obstetric history
A
G= gravida
T= term births
P= Preterm pregnancies
A= abortions
L= living children
11
Q
Total number of pregnancies
A
Gravida
12
Q
Term gestations delivering between 38-42 wks OR after 37 wks.
A
Term
13
Q
Number of preterm pregnancies delivering between 20 & 37 wks.
A
Preterm
14
Q
Number of pregnancies ending before 20 wks. or elective abortions
A
Abortion
15
Q
Number of living children
A
Living
16
Q
HEAD-TO-TOE assessment:
Head and neck
A
- prev. injuries
- sequelae
- limitations of ROM
- enlarged lymph nodes or sweeling?
- edema of nasal mucosa
- hypertorphy of gingival tissue (increased estrogen levels)
- thyroid gland enlargment
17
Q
HEAD-TO-TOE assessment:
Chest
A
- soft systolic murmur=. normal (incr in blood volume)
- incr heart rate
- incr chest diameter
- incr RR
- fuller breasts
- striae gravidarum (stretch marks)
- darker nipple and areola
- enlargement of montgomery glands
18
Q
HEAD-TO-TOE assessment:
extremities
A
- edema
- pulses
- varicose veins
- 3rd trimester edeam =only normal
- pain in calf
19
Q
HEAD-TO-TOE assessment:
Abdomen
A
- rounded and nontender
- decreased muscle tone
- 12 weeks: fundus @ symphysis pubis
- 16 weeks: fundus b/t symphysis and umbilicys
- 20 weeks: @ umbilicus
- 36 weeks: just below xiphoid process
20
Q
Pelvic exam:
3 measurements are assessed:
A
- Diagonal conjugate (DC)
- true conjugate (aka obstetric conjugate)
- ischial tuberosity (transverse diameter of pelvic outlet)
21
Q
Pelvic exam consists of
A
- External genitalia: lesions, discharge, inflammation, STI (visual)
- Internal Genitalia: goodell sign, hegar sign, chadwick sign (blue cervix)
- Pap smear
- bimanual examination
PELVIC EXAM DONE BY HCP ONLY!!
22
Q
type of pelvic measurement:
* Distance b/t anterior surface of sacral prominence & anterior surface of inferior margin of symphysis pubis.
A
Diagonal conjugate
23
Q
Diagonal Conjugate- things to know
A
- DC usually 11.5 cm or >
- represents anteroposterior diameter (AP) of pelvic inlet which fetal passes FIRST.
24
Q
type of pelvic measurement:
- measurement from Ant. surface of Sacral prominence to the Post . surface of inferior margin of symphysis pubis.
- Can not be measured DIRECTLY.
A
True conjugate
(aka obstetric conjugate)
25
Type of pelvic measurement:
* Measurement made OUTSIDE the pelvis at the LOWEST aspect of the ischial tuberosities
ISCHIAL TUBEROSITY
26
Things to know about True conjugate
* roughly 11.5 cm
* SMALLEST Anteroposterior diameter
27
Ischial Tuberosity is best when
* diamter of 10.5 cm or > = adequate passage of the fetal.
28
Additional lab studies include
* **Rh status-mom**
* Rubella titer
* HIV testing
* STI screening
* Cervical smears
* UA
* Glucose
* CBC
29
What to know about RH
* Mom NEEDS to be Rh-sensitive
* If not Rh sensitive you administer **RhoGAM**
30
Rh-NEG mother will receive testing (mom not sensitive)
* at 28 weeks and again within 72 hrs AFTER childbirth (if she is RH-sensitive)
31
* Rubella Titer detects antibodies for virus that causes German measles.
* Things for mom to keep in mind:
* titer is **1:8 or <** = mom is **nOT IMMUNE.**
* requires immunization **AFTER** birth.
* Mom is advised to **AVOID people** with undiagnosed rashes.
32
If mom is HIV +
* Requires more testing, counseling, and tx.
* Rx to prevent transmission to fetus
33
STI screening include following tests
* veneral diseases researh laboratory (VDRL)
* rapid plasma reagin (RPR)
* cultures
* lesions
34
* cervical smears test for
**for syphilis, herpes, HPV, gonorrhea**
35
UA tests for
* albumin
* glucose
* ketones
* bacteria
36
Glucose is tested on patients
that are high-risk
37
What is this called?
Leopold's manuevers
38
Describe each pic
1. locate FUNDUS
2. find ant and post of baby by pressing SIDES
3. Cervical area- find presenting part (head- harder or butt-squishy)
4. Checking position of baby (vertex or breach)- Symphysis pubic
39
fetal heart rate should be
* **Fetal HR (110 to 160 bpm)**
40
Fundal Height measurement
* Reflects fetal growth
* Gross estimate of duration of pregnancy
* **Fundal height = # of wks. until 36 wks.**
41
Fundal height measured in what position?
"Mcdonalds Method"
-supine position
-knees slighly flexed
42
Fetal movement:
Quickening occurs during (baby movements)
2nd TRIMESTER.
43
Fetal movement:
When to start counting fetal movement
28 weeks OF PREGNANCY
44
HOW to count fetal movement
* sit or lie on side
* record time of 1st mvmnt
* count until 10 mvmnts
* record time of 10th mvmnt
* NORM: 10 mcmnts in 2 hrs or SOONER
45
When to call HCP regarding FETAL MVMNTS
more than 2 hrs and only felt 10 movements
46
Call HCP if women experiences MENTRUAL-LIKE CRAMPS that are
* occurring every 10 mins
* low, dull backpain
47
IF menstrual like cramps occur, what should the mother do?
* Stop activity & lie down on left side for 1 hr.
* Drink two or three glasses of water
* If symptoms worsen or DO NOT subside after 1 hr. - Contact health care provider
48
Dx test that
* Measure velocity of blood flow through umbilical cord
* Detect fetal compromise
* ID abnormalities in diastolic cord flow
DOPPLER FLOW STUDIES.
49
when performing ULTRASOUND during EARLY pregnancy, what is needed?
A FULL BLADDER
50
ALPHA FETOPROTEIN ANALYSIS: if found in mothers serum (blood), is this considered normal?
NO! it is a GLYCOPROTEIN which in high levels are related to failure of **neural tube to close.**
51
Alpha Fetoprotein Analysis is TESTED on what weeks?
16-18 weeks
52
Transabdominal puncture of amniotic sac drawn for analysis.
Amniocentesis
53
Amniocentesis test for
* Chromosomal abnormalities
* Evaluate fetal condition
* Diagnose intrauterine infection
* Investigate AFP if MS levels HIGH
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when is Amniocentesis RECOMMENDED
15-20 weeks
Results in 3 weeks!!!
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Amniocentesis:
Normal color
clear, white flecks of vernix caseosa in mature fetus
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Amniocentesis:
Bilirubin levels norm is
absent at term
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Amniocentesis:
Meconium
absent
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Amniocentesis:
creatinine should be
>2 mg/dL in mature fetus
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Amniocentesis:
Lecithin/ Sphyngomyelin should be
>2 fetal pulmonary maturity
60
Amniocentesis:
Bacteria
absent
61
Amniocentesis:
chromosomes
normal karyotype
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At ANY PRE-PROCEDURE YOU ALWAYS NEED ___ SIGNED
Informed consent
63
Administer RhoGAM IM if woman is
Rh -ve
(Rh-pos = dnt do anything)
64
AFTER A AMNIOCENTESIS procedure what symptoms should be notified to HCP
* Fever
* Leaking amniotic fluid
* Vaginal bleeding
* Uterine contractions
* Changes in fetal activity - increased or decreased
65
Chorionic Villus Sampling to know
* 10-13 weeks.
* **Few risk than amniocentesis**
* Results within 48 hrs.
* Lithotomy position
65
What to explain to pt with CHORIONIC VILLUS SAMPLING
* Informed consent – witness sign NEEDED
* Urge not to engage in any strenuous activity for next 48 hrs.
* Administer RhoGAM if Rh-negative
Notify HCP:
* Fever
* Cramping
* Vaginal bleeding
66
ANY test that goes thru amniotic sac a _____ test is done
RhoGAM
67
Test done to/for:
* Measure PERFUSION
* **Recommended 2 X week (after 28 wks.)**
* WHO has:
-Diabetes
-Other high-risk conditions
* Mom presses button every time theres movement
* NON-STRESS TEST
**EMPTY BLADDER**
**MEASURES BABYS HEART RATE**
68
The NORMAL for Non-Stress TEst (NST)
2/15/15
* 2 fetal heart beat acceleration from baseline
* > 15 beats per min
* last 15 seconds
**in 20 min recording**
**anything outside this NEEDS ADDITIONAL TESTING**
69
Best time to travel
18-24 weeks.
(roughly 5 months)
70
IMPORTANT:
IMMUNIZATION while pregnant
1. Avoid LIVE virus (MMR & varicella)
or
2. Avoid pregnancy within 1 M of live vaccines
71
Medications to AVOID while pregnant
1. Midazolam
2. corticosteroids
3. ticagrelor
4. ace-inhibitors (-pril)
5. ARBS
6. Statins
7. NSAIDS (after 24 weeks)
8. Aspirin (after 24 weeks)
9. ASA/Caffeine
10. Tetracyclines
11. Warfarin
12. Lithium
13. CT/IV contrast
72
What is this method called?
*Goodells and hegars method
* test for pregnancy (not 100% method to prove pregnancy)
73
Lab results that states you are positive for GESTATIONAL DIABETES MELITIS
* Fasting plasma glucise: **126 mg/dL**
* HbA1c: **6.5% or higher**
* Random plasma glucose: **200 mg/dL**
