Clinical: Diagnosis of Pregs and Prenatal care Flashcards Preview

Reproductive Exam 1 > Clinical: Diagnosis of Pregs and Prenatal care > Flashcards

Flashcards in Clinical: Diagnosis of Pregs and Prenatal care Deck (80):
1

what are the symptoms of preggers

amenorrhea
urinary frequency
fatigue
n/v
breast tenderness
quickening

2

what is quickening

date of initial perception of fetal activity

3

what are the signs of preggers

Chadwick's sign
Chloasma
Fetal heart tones

4

what is Chadwick's sign

blue-ing/purple hue of the vagina and cervix

5

what is chloasma

hyperpigmentation (face, nose)
raccoon look d/t changes in hormones

6

what are the four tests that can be done to confirm pregnancy

*Beta hCG - gold standard
serum progesterone
US
Doppler

7

what are two different type of beta hCG test

Qualitative - tells YES/NO
Quantitative - gives more specific numbers and used when there's concern for the pregnancy (ie. bleeding/ectopic)

8

Tell me more about quantitative beta hCG, GO!

Used to assess how the pregs is going
usually normal pregs hCG will double in count in about 2.5 days so you need to do another one in 3 days to compare values

9

what does it mean if there's a 40% drop in hCG levels when you compare day1 and day2-3

failing pregnancy

10

when is serum progesterone used and what do the results mean

with quantitative hCG

25 = rules out ectopic pregs

11

around what week should you start using ultrasound to see how the pregs is going

5-6 weeks

12

how is EDD (estimated date of delivery) determined

either by FDLMP or the earliest fetal ultrasound

13

the "gestational wheel" is used for which method of EDD

FDLMP
- can also use Naegele's Rule 9but almost never used)

14

Is the FDLMP or the earliest fetal ultrasound more reliable

it depends .... foo!

15

when is fetal ultrasound most effective for EDD

when its performed early in pregs:
6-11 weeks: +/- 5-7 days
12-20 weeks: +/- 10 days
Third trimester: +/- 3 weeks

16

What are some other factors that make fetal U/S more reliable

-if the FDLMP is not known to certainty
-menstrual cycle is irregular
-the EDD by the FDLMP and the EDD by early U/S differ by MORE than the range of U/S confidence (based upon gestational age)

17

when is FDLMP more reliable

-when FDLMP is known
-menstrual cycel is regular
-the EDD by the FDLMP and the EDD by early U/S DO NOT differ by MORE than the range of U/S confidence (based upon gestational age)

18

gestational age is based upon...

FDLMP

19

embryonic age is based upon...

Conception

20

how many week(s) difference are there btwn gestational and embryonic age

2 weeks

21

most patients more likely know their ... than their ...

FDLMP .... date of conception

22

OB/GyN's use which type of age the most

GESTATIONAL, even though it includes 2 weeks where no pregnancy exisits

23

what is considered "full term"

37-42 weeks

24

T/F: Ob/Gyns use number of weeks to determine how far along the pregs is

TRUE

pts often refer to months which is CLEARLY confusing, huh? dumbass

25

the interval from FDLMP to EDD is ...

40 weeks

26

here we go again:
miscarriage is aka...

spontaneous abortion (ab)

27

threatened ab

bleeding and/or cramping and NOT passing any tissue
-50/50 chance of going to full term

28

incomplete ab

bleeding and/or cramping and tissue HAS passed, BUT not sure if ALL passed

most common in 1st trimester

29

complete ab

bleeding and/or cramping, passed ALL the tissue, and beginning the healing process

30

missed ab

there's no symptoms at all
-body hasn't recognized the pregs failed, so it still thinks its pregnant thus the ab fetus needs to be taken out

31

inevitable ab

threatened ab, no tissue, but cervix is dilated

32

which ab is most common in the 1st trimester

incomplete ab

33

which ab is most common in the 2nd trimester

complete ab

34

And again:
what is an ectopic pregnancy

Includes a pregnancy located anywhere OUTSIDE the endometrial cavity.

Can be in the part of the tube contained within the myometrium, fallopian tube, ovary, or on the bowel or the peritoneum

35

How is ectopic pregs diagnosed

absence of an intrauterine gestational sac on a TRANSVAGINAL U/S once the quantitative hCG level reaches 1500

36

which diagnostic tech RARELY identifies a gestational sac outside the endometrial cavity

U/S

37

what happens during a preconception consultation

1. identify risk factors (personal or in family)
2. optimize pt medical status if medical risk factors are found (diabetes, HTN)
3. current meds and safety in pregs
4. Give prenatal vitamins prior to conception

38

what risk factors from pt reproductive history is important to note bc of risk of REOCURRENCE

-preterm labor or delivery
-low birth weight
-pre-eclampsia
-stillbirth
-congential anomalies
-gestational diabetes

39

what is the prenatal visit schedule like

Every 4 weeks until 28 weeks
Every 2-3 weeks at 28-36 weeks
Weekly from 36 weeks until delivery

Appointments may be closer if risk factors or ongoing medical conditions need closer monitoring

40

which risk factor are most common in first pregnancy and should be check

HELLP/pre-eclampsia

41

what do you except at a first prenatal visit

1. complete HnP
2. cultures and blood work
3. everything in preconception counseling if not done before
4. if previous cesarean - discuss circumstances and current delivery options
5. if >35 at EDD - discuss risks/testing

42

what is prenatal care mostly about

TRENDS! if pt is falling off the normal curve of trend, bring them back asap!

43

Lab tests at first visit

CBC, blood type/Rh, GC/Chlamydia, pap smear, HBsAG, TSH, Urinalysis, HIV and Cystic fibrosis(if pt agrees for both), RPR (syphilis)

Rubella titer - can protect baby, but can't vaccinate
Antibody screen

44

why is antibody screening an important lab test

Erythroblastic fetalis: Tx for exposure of mother and fetal blood (trauma etc..) even if you don't know baby's blood type

45

what needs to be done in subsequent visits

maternal weight
urine dipstick -for protein and glucose
BP
fundal height
fetal heart tones
fetal presentation after 30 weeks --> Leopold's maneuvers

46

whats the importance of maternal weight

average gain. body habitus effects on weight gain
- underweight women gain weight to get to optimal preggers weight
-overweight women actually LOSE weight to get to that optimal preggers weight

47

when to measure fundal height

1st 12 weeks, 12-20wks, after 20 wks

48

what is screened during the 1st trimester

blood work (10-13wks gestation)
U/S (11-13 wks gestation)

49

what do you look for in blood work in the 1st trimester

-PAPP-A (lower than usual with fetal Down's)

-Inhibin A, free beta subunit hCG, total hCG (higher than usual with fetal Down's)

50

what do you look for on U/S in the 1st trimester

nuchal lucency --> naturally occurring fluid space at the back of the neck
(thickening in this area associated with Down's)

51

what is screened during the 2nd trimester

2nd trimester (15-20weeks)
-fasting blood sugar
-trisomies and open neural tube defects
-fetal U/S

52

what is the screening test for trisomies and neural tube defects

-Serum Alpha fetoprotein – still used for twins
-Triple Screen (Alpha fetoprotein, HCG, Estriol)
-Quad Screen (same as triple screen + inhibin A)
-Penta Screen (same as Quad + ITA: invasive trophoblast antigen)

53

what is combined screening

serum sequential, integrated (non-disclosure) screening.

This replaces 2nd trimester screening

54

when do you use a diagnostic test for trisomies/ONTD (open neural tube defects)

screening tests for these are replaced by Diagnostic testing if there are high risk factors for these conditions
- advanced maternal age
-previously affected babies

also used when screening comes back with a higher than normal risk status

55

so what is diagnostic testing for trisomies/ONTD

-amniocentesis at 15-20 wks
-chorionic villi sampling at 12-14 wks
1. transabdominal
2. transcervical

56

what is cell-free fetal DNA

analyses fetal DNA in Maternal serum
it's non-invasive - reliability that approaches amniocentesis or CVS (Chorionic villus sampling)

57

when is cell-free fetal DNA done and why

can be done as early as 10 wks gestation
checks for trisomy 21, 18, 13

58

what labs are done at 24-28 weeks

CBC
1hr 50gm Glucola test
Rhogram, if Rh neg (regardless of baby's blood type)
vaginal culture (optional)

59

what do you do if 1hr 50gm Glucola test is abnl

3 hr GTT, 100gm loading dose

60

when do you give Rhogam

antepartum at 28 weeks, it has a 12 week lifesapn
post-partum if infant is Rh pos.

61

Rh incompatibility occurs in ...

Rh neg mothers

62

what is Rh incompatibility

when maternal exposure to Rh pos. blood from teh fetus causes an antibody response in teh mother

63

T/F; Rh incompatibility effects the first (exposure) pregnancy

FALSE; it effects future pregnancies

erythroblastosis fetalis (destruction of fetal red blood cells) => fatal fetal hydrops

64

Rh incompatibility:
what are some feto-maternal hemorrhage sufficient to cause sensitization (alloimmunization)

At the time of delivery – most common
Abruptio placenta
Bleeding placenta previa
Abdominal trauma
Amniocentesis
Ectopic pregnancy
Miscarriage

65

RhoGam is passive or active immunity

passive immunity

66

when should group B beta strep be cultured

35-36 weeks

67

where is group B beta strep cultured from

lower 1/3 of vagina and rectum in the same culture medium

68

T/F: group B beta strep should be treated in labor

TRUE; treatment in labor

69

what are the risk factors of group B beta strep (GBBS)

1. preterm labor
2. preterm premature rupture of the membranes
3. rupture of the membranes > 18 hrs
4. temp >38C (100.4F)

70

T/F: treat only those effected with GBBS

TRUE; treat ALL women, regardless of strategy who have:
1. GBBS bacteriuria at ANY time in preggers
2. given birth to an infant with GBBS

71

intrapartum prophylaxis for GBBS

1. IVPB penicillin G 5 million units initially and 2.5 million units every 4hrs until delivery

2. IVPB Ampicillin, 2 gm initially and 1 gm every 4 hrs until delivery

72

what do you give to moms who have GBBS but is allergic to penicillin

Now: request sensitivites as teh efficacy of Clindamycin and Erythromycin have been drawn into question

used to: empirically use Clinda and Erythro

73

what are the older testing methods for fetal well-being

non-stress test (NST)
contraction stress test (CST)
Biophysical profile (BPP)

74

what is NST

testing thats done after 28 weeks
fetal heart beat will go up 15 beats for a few seconds with movement and that's normal

-this test means that adequate oxygen is required for fetal activity and heart rate to be within normal ranges. When oxygen levels are low, the fetus may not respond normally

75

what is CST

The aim is to induce contractions (usually 3) and monitor the fetus to check for heart rate abnormalities.

stimulate uterine contractions:
-nipple stimulation
-IV pitocin (oxytocin)

76

what is the newest testing for fetal well-being

Cord Doppler Velocimetry (CDV) :
-Used largely in pregnancies at risk for FGR (fetal growth restriction, AKA IUGR).

77

What does a normal CDV mean

Normal cord doppler studies indicate forward motion of blood flow both in systole and diastole.

78

What does an abnormal CDV mean

Abnormal cord doppler studies indicate increased placental resistance to blood flow that results in either absent or reversed blood flow during the end-diastolic phase

79

whats the damn purpose of pre-natal visit

-pt education
-evaluation for presence/development of preg risk factor
-assuring fetal well-being
-look at developing trends**

80

What should you be thinking when approaching preg pt

dang you HUGE!

-Proving to yourself that the baby is better off left in-utero,
-The benefits of leaving the baby in-utero outweigh the risks of delivery.
-It’s not just about the numbers and the trends!