Childbearing Flashcards
(28 cards)
Full term vs early term vs late term vs post-term
Full term → 39 - 40 weeks 6 days
Early term → 37 weeks - 38 weeks 6 days
Late term → 41 weeks - 41 weeks 6 days
Post-term → after 42 weeks
Common signs occurring at 8 weeks of pregnancy
- Hegar sign: softening of uterine isthmus
- Goodell sign: softening of vaginal portion of cervix
- Chadwick sign: blue-violet vaginal color
Common signs occurring at 10 weeks of pregnancy
First fetal heart tone can be heart via abdominal US at 10-12 weeks
Common signs occurring at 12 weeks of pregnancy
Uterine fundus palpable through abdominal wall as it rises above symphysis pubis
Common signs occurring at 16 weeks of pregnancy
- Uterine fundus halfway between symphysis pubis and umbilicus
- Quickening (fetal movement) during weeks 16 and 17 if second pregnancy
- Week 18 if first pregnancy
Common signs occurring at 20-36 weeks of pregnancy
- 1 cm gain in fundal height per week
- Uterine fundus at umbilicus at 20 weeks
CDC recommendation of folic acid intake/supplementation during pregnancy
400 mcg supplementation daily
- 4 mg/day for one month before pregnancy and during first 3 months of gestation if previous history of neural tube defect
Recommended range of total weight gain during pregnancy
- Underweight vs normal vs overweight vs obese
Underweight (BMI <18.5) - 28-40 lb
Normal (BMI 18.5-24.9) - 25-35
Overweight (BMI 25-29.9) - 15-25
Obese (BMI >30) - 11-20
Frequency of prenatal visits
- Up to 28 weeks, 28-36 weeks, 36 weeks or more
Up to 28 weeks → every 4 weeks
28-36 weeks → every 2 weeks
36 weeks or more → every week
Prenatal care - testing at 10-13 weeks
- First trimester screen with plasma protein A (PAPP-A)
- hCG
- US nuchal translucency for trisomy
Can proceed with Quad screening at 15-21 weeks (
Prenatal care - testing at 15-21 weeks (ideally 16-18 weeks)
- Quad screen/AFP4/tetra marker for trisomy or neural tube defect
- US to detect physical defects
Prenatal care - testing at 24-28 weeks
- One hour glucose tolerance test
- If Rh-neg, will need antibody screen and given RhoGAM at 28 weeks
Prenatal care - testing at 28-32 weeks
- Hemoglobin
- STIs
- Administer RhoGAM, if needed, at 28 weeks
Prenatal care - testing at 32-36 weeks
- Fetal presentation
- Kick count
- 4+ in 1 hour
- 10+ in 2 hours
Prenatal care - testing at 35-37 weeks
- Group B strep culture (rectal and vaginal)
Prenatal care - testing at 40-42 weeks
- Vaginal examination to assess cervical ripeness
- Fetal station
Prenatal care - testing at 41+ weeks
- Nonstress test and BPP to check fetal status
- BPP consists of five components:
- Fetal breathing movements
- Gross body movements
- Tone
- Amniotic fluid index
- Nonstress test
Instead of a Quad screen, when can the provider offer a cell-free fetal DNA test for pregnant mothers?
- Maternal age 35+ years
- Fetal US findings indicating increased risk of aneuploidy
- History of prior pregnant with trisomy
- Positive test result for aneuploidy
- Parental balanced Robertsonian translocation with increased risk of fetal trisomy 13 or 21
Diagnostic criteria for preeclampsia
- Elevated BP diagnosed after 20th week of pregnancy
- 140/90 or greater on two readings at least 4 hours apart
- 160/110 or higher for one reading)
- Proteinuria
- >300 mg per 24 hour urine collection
- Protein/creatinine ratio of 0.3 mg/dL or more
- Dipstick of 2+
Other findings:
- Thrombocytopenia (less than 100,00 platelets)
- Renal insufficiency
- Impaired liver function
- Pulmonary edema
- New onset headache unresponsive to medication and not accounted for by another diagnosis
What syndrome can preeclampsia progress to?
HELLP syndrome
- Elevated lactate dehydrogenase
- Elevated AST/ALT
- Platelets less than 100,000
Preeclampsia treatment and management
- Definitive treatment = birth
- Considered after 34 weeks gestation
- Referral to expert obstetrics
- Supportive → rest, ongoing maternal and fetal monitoring
- Antihypertensives and/or anticonvulsants
GBS treatment
Intrapartum IV antibiotics (PCN) - beings at onset of labor and continues through delivery
Stages of labor: early labor (also called latent phase of labor)
- Longest part (lasts 2-3 days)
- Mild to moderate contractions lasting 30-45 seconds, 5-20 minutes apart
- Cervix dilates to 3 cm
- Membranes intact
Stages of labor: active labor
First stage
- Cervix dilates to 3-4 cm or more
- Contractions every 2-3 minutes and last 50-70 seconds or more
- Go to hospital or birthing center when contractions are every 5 minutes apart and last 1 minute
Final stage
- Cervix dilates to 7-10 cm
