Flashcards in CM: Intro to Obstetrics Deck (16)
What is definitive evidence of pregnancy?
detecting fetal heart rate
What is probable evidence of pregnancy?
ab enlargement, uterine and cervical changes, endocrine tests (serum hCG, urine test)
How can gestational age be estimated from LMP, quickening, or fundal height?
LMP - Nagele's rule - add 7 days to first day of LMP and subtract 3 months = due date
quickening - b/w 16-20 weeks
fundal height- b/w 20-32 wks, cm = wks
What are the recommended routine lab tests at an initial prenatal visit?
hemoglobin and hematocrit
urinalysis and urine culture
blood typing and antibody screen
rubella, syphilis, hep B, gonorrhea and chlamydia screens, pap smear
HIV and CF carrier testing
What additional tests can be used to assess a pregnancy?
1st tri screening - nuchal translucency
2nd tri screening - MSAFP
CVS or amnio if indicated
glucose tt at 24-28 weeks
repeat Hgb/Hct, RPR and HIV, Ab screen at 32 wks
What are the 5 indications for antepartum surveillance?
clinical intrauterine growth restriction
hx of previous stillbirth
post date (after 42 weeks gestation) pregnancy
What results of a non-stress test indicate certain states of fetal well-being?
HR of non-acidotic fetus will temporarily accelerate
well if fetal HR accelerates >15 BPM for 15 sec twice w/i 20 min period
What results of a contraction stress test indicate certain states of fetal well being?
uterine contractions may cause increase in pressure great enough to briefly impair O2 exchange b/w mom and baby
early decelerations (or none or even w fetal movement) indicates well
late decelerations means hypoxic or acidotic
persistent late decelerations = uteroplacental insufficiency
How can the amniotic fluid lecithin/sphingomyelin ratio be used to assess fetal maturation?
>2 means low likelihood of respiratory distress syndrome
What findings on an ultrasound are associated with <1% risk of RDS?
BPD (biparietal diameter) >9.3 cm
FL (femur length) >7.4 cm
What is the recommended weight gain for different mothers w regards to BMI before pregnancy?
underweight - 28-40 lbs
normal weight - 25-35 lbs
overweight - 15-25 lbs
obese - 11-20 lbs
What are the caloric requirements for pregnancy?
300 Kcal/day increase
500 Kcal/day increase postpartum if breastfeeding
also need folate! before pregnancy if trying
What are the different categories of drugs in pregnancy?
A - no risk shown (prenatal vitamins)
B - no risk, or only shown in animals (antibiotics)
C - uncertain safety, animal danger but no adequate human studies (2/3 of meds)
D - unsafe, only if benefits outweigh risks (systemic steroids, seizure meds)
X - NO NO NO
tylenol OK, NSAIDs maybe not
What are 6 more commonly known teratogens?
organic mercury (Minamata Bay syndrome)
aminopterin/methotrexate (craniofacial defects)
How can fetal alcohol syndrome be recognized?
intrauterine growth restriction, craniofacial abnormalities (absent philtrum, flat nasal bridge, maxillary hypoplasia, short palpebral fissures), brain cardiac and spinal defects, behavioral disturbances
cannot be diagnosed prenatally