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RDS Test 1 > B8.019 Maternal and Fetal Health > Flashcards

B8.019 Maternal and Fetal Health Flashcards

(61 cards)

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1
Q

typical pattern of prenatal care

A

every 4 weeks during 1st and 2nd trimester
every 2 weeks in 3rd trimester
weekly in last month

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2
Q

initiation of care in prgenancy

A

preferably no later than 10 wks GA

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3
Q

screening for underlying health issues at initiation of care

A 
documentation of weight and BP
screen for domestic violence/sexual abuse
review of medications
review of obstetrical history, PMH
family/genetic history
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4
Q

establishing gestational age

A

first day of LMP, compared to early US looking at crown rump length
US very good at establishing due date in 1st trimester bc we all grow at the same speed

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5
Q

initial patient counseling

A 
tobacco, alcohol, drug abuse
weight gain recs
exercise recs
dietary restrictions
travel precautions
encourage breastfeeding
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6
Q

initial diagnostic studies

A 
blood and Rh typing
Ab screen
hep B surface Ag
rubella
HIV
RPR
chlamydia and gonorrhea
CBC (anemia and WBCs)
A1C if at risk for DM
urine analysis and culture
cervical cancer screening if needed
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7
Q

Rhesus D alloimmunization

A

Rh neg women are given anti-D immune globulin with and bleeding during pregnancy and routinely around 28 weeks and again postpartum if the baby is Rh pos

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8
Q

why is Rhesus D alloimmunization important?

A

Rh neg women who have a fetus that is Rh positive are at risk for developing anti-D Abs
in subsequent pregnancies, when fetus is Rh positive, those Abs attack and can cause hemolytic disease of the newborn

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9
Q

who should be offered aneuploidy screening?

A

all women who seek prenatal care before 20 wks GA

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10
Q

when is nuchal translucency performed

A

11-13 wks GA

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11
Q

other components of first trimester screening

A

B-HCG and PAPP-A

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12
Q

second trimester screening

A 
ideally between 15-18 wks GA
quad screen
-AFP
-inhibin A
-unconjugated estriol
-B-HCG
best available screen for Down syndrome
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13
Q

who does cffDNA screening have the most value for?

A

higher risk populations

for low risk populations, conventional screening is preferred

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14
Q

carrier screening

A

CF and SMA
ethnic specific
fragile X

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15
Q

how is zika acquired?

A

mosquito bite

can live in sperm and be transmitted sexually

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16
Q

zika complications

A

microcephaly
fetal brain malformations
fetal growth restriction

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17
Q

zika areas

A

central and south america
africa
india and pakistan

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18
Q

travel restrictions with zika

A

dont travel is pregnant or hoping to become pregnant
wait 8 wks to conceive if recent travel occured
if partner traveled, wait 6 months before conception

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19
Q

additional calories during pregnancy

A 
340-450 extra cals per day
1.1 g/kg/day protein
175 g/day carbs
min 28 g/day fiber
2.5 L/day water
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20
Q

supplements in pregnancy

A 
folic acid: 0.4-0.8 mg
iron: 30 mg
calcium: 1000 mg/day
iodine: 150 mcg
vit D: 200-600 IUs
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21
Q

women at risk of micronutrient deficiency in pregnancy

A 
multiples
heavy smokers
adolescents
vegans
substance abusers
history of bariatric surgery
GI disease
women w lactase deficiency
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22
Q

is listeria scary?

A

not if something is pasteurized

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23
Q

caffeine intake

A

limit to 200 mg daily

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24
Q

weight gain BMI <18.5

A

28-40

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25
weight gain BMI 18.5-24.9
25-35
26
weight gain BMI 25-29.9
15-25
27
weight gain BMI >30
11-20
28
recommended exercises in pregnancy
3 hrs per week | can do most stuff fine
29
activities to avoid in pregnancy
``` contact sports activities with a high risk of falling scuba diving sky diving hot yoga/pilates avoid sustained HR > 160 ```
30
benefits of exercise in pregnancy
shorter labor times improved glycemic control reduced risk of GDM
31
what meds can/can't you take in pregnancy
for pain: APAP, avoid NSAIDs for constipation: docusate, senna, milk of magnesia for cough: guafenasin for heartburn: tums, famotidine, ranitidine sleep: benadryl
32
what to evaluate regularly at subsequent prenatal visits
FHR fundal height BP check urine for protein and glucose
33
anatomic US
20 wks
34
AFP testing
15-21 weeks | screening for neural tube
35
28 week testing
GDM screen CBC Ab screen, Rhogam if needed RPR
36
36 week testing
GBS rectovaginal swab | assessment of fetal position
37
immunizations in pregnancy
avoid live vaccines (MMR) flue during each flu season Tdap between 27-36 wks
38
immediate postpartum adaptations
within first 10 min after delivery, CO and SV increase and remain increased until about 2 weeks postpartum
39
post delivery hemostasis
uterine involution: contraction of the interlacing myometrial muscle bundles -constricts the intramyometrial vessels and impedes blood flow main mechanism preventing hemorrhage secondary mechanism: large vessels at the placental site thrombose
40
fundal assessment post delivery
fundus should be at the umbilicus 24 hours after delivery | decreases from 1000g immediately postpartum > 60g at 6-8 weeks
41
postpartum hormones
HCG levels return to zero within 2-4 weeks after the delivery FSH, LH, P, and E are low 2-3 weeks after delivery
42
return to menstruation
average = 45-64 days | 70% by 12 weeks
43
breast feeding disruption of ovulation
prolactin induced inhibition of pulsatile GRH release from the hypothalamus
44
objectives of postpartum recovery
discuss concerns expressed after delivery describe physiological changes in postpartum period explain benefits of breast feeding discuss sexual health in postpartum period emphasize importance of monitoring for preeclampsia in postpartum period
45
fourth trimester
views mother and infant as a mutually dependent unit which requires intense caregiving demands difficult w pressure to return to work
46
maternal leave in US
12 weeks unpaid | 23% return within 10 days
47
initial postpartum assessment
3 weeks | comprehensive after 12 weeks
48
postpartum hair and skin problems
striae and skin laxity persist rectus diastasis can cause discomfort and cosmetic concerns hair loss noted 1-5 months after delivery
49
prolactin
maintains lactation, decreases ovulation
50
oxytocin
assists in milk let down | causes uterine contractions
51
initiation of milk production
early in 2nd trimester - can be expresses as early as 16 wks - placental progesterone production inhibits milk production
52
activation of milk production
once placenta is delivered, negative feedback is removed and copious amounts of milk begin to be produced avg time for this to occur = 2-3 days, but can take up to 7 or longer
53
properties of breast milk
ideal nutrition for infants contain maternal Igs, mostly IgA, which confers passive immunity to infants DO GIVE VIT D contains minerals
54
how to regulate milk production
regular breast emptying
55
milk build up and distention
alveolar and mammary duct compression disrupts connections between cells and their attachment to the BM, disrupting the synthesis and secretion of milk components involution occurs when intervals of feeding/breast emptying are prolonged
56
benefits of breastfeeding for newborn
bacteriostatic and immune modulating properties anti-inflammatory growth promotion of crypt cells in infant's gut or other cells in the body aid in digestion reported reductions in infant mortality
57
maternal benefits of breast feeding
``` reduction in stress lower rates of neglect and child abuse enhanced weight loss longer period of anovulation reduction in DM2 reduced long term risks for breast and ovarian cancer decreased risk for cardio disease ```
58
when to return to activities?
when comfortable | avoid pain and excessive fatigue
59
postpartum weight loss
mean postpartum weight retention is 11.8 lbs 50% of gestational weight gain is lost in the first 6 weeks after delivery slower rate of loss through first 6 months
60
things to address at postpartum visit
``` health of infant patients mood contraception plan return to sexual activity breastfeeding difficulties review of complications that occurred during pregnancy or postpartum ```
61
optimal inter-pregnancy interval
18-59 months

RDS Test 1 (22 decks)

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