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1

What is the definition of preconception counseling?

Health of women and men during reproductive years

2

What issues should you address in women ages 15-44 in order to improve outcomes in event of pregnancy?

- ID/stabilize chronic conditions
- Minimize med risk
- Maintain IZ
- Address weight, nutrition, exercise
- ID potential genetic disorders

3

What should be weight loss goal for obesity?

5-10% of baseline 6mo prior to pregnancy

4

What is the first change women will notice when preggo?

Breast tenderness

5

What are clinical S/S of a suspected preggo lady?

Fatigue, N/V, breast tenderness, frequent urination, missed menses

6

When is there enlargement and softening of the uterus?

6 weeks

7

What are PE findings in a newly preggo lady?

Congestion and bluish discoloration of the vagina (Chadwick sign)
Softening of the cervix (hegar sign)

8

How should you confirm a suspected pregnancy?

UCG and beta- HCG

9

What does a UCG measure?

hcg/alpha unit which overlaps w/LH structure

10

What does the Q/Q beta-hCG measure?

Beta subunit

11

What can you visualize on US at 5-6 wks?

-embryonic cardiac activity at >4000 mIU/mL
-gestational sac (beta-hCG 5000-6000 mIU/mL)

12

What can TVUS detect at 3-4 wks gestation?

GA (beta-hCG 1000-2000 mIU/mL)

13

When can the Doppler detect fetal heart tones?

10-12 wk GA

14

What are the risks you want to assess during antepartum care?

- advanced maternal age (>35) and or paternal age (>50)
- hx of early preggo loss
- previous IUP complicated by chromosomal abnormality

15

What are genetic testing options when assessing for risk?

- carrier testing
- CVS
- Amniocentesis

16

What are the common chromosomal abnormalities we want to screen for?

Trisomy 21, fragile X, turner syndrome, klinefelter syndrome, and cri du chat

17

What weeks during the first trimester can you do screening? What tests are you going to do?

10-13 week GA
obtain beta-hCG and preggo associated plasma protein A ( PAPP-A) and a CVS

18

When during the second trimester do you screen? What tests do you run?

15-20wk GA
triple(no inhibin) or quad marker( AFP, estriol, hCG, and inhibin A marker)
-need maternal age, wt, ethnicity, and EGA
amniocentesis

19

What is the integrated 1st and 2nd trimester screen?

Combines PAPP-A plus triple or quad

20

What is nuchal translucency? What is it used for? When do you screen this?

Early US at initial prenatal visit
Fluid collection at the back of the neck used as a marker for Downs( 10-14wk GA)

21

What A/P needs to be addressed during the initial prenatal visit?

—RTC q 4 weeks until 28-30 weeks GA
—RTC q 2 weeks 28-30 to 36 weeks GA
—RTC q week >36 weeks GA

22

What initial labs do you want to run on the mother at the first prenatal visit?

CBC, glucose, blood type/Rh, urinalysis, Pap, STD: RPR/FTA, HIV, gc, chlamydia, hepatitis B

23

What are some common symptoms in preggo?

—Headache
—Edema
—N/V
—Heartburn
—Constipation
—Fatigue
—Leg cramps
—Back pain
—Round ligament pain
—Varicose veins, hemorrhoids
—Vaginal discharge

24

What should be done at all the subsequent antenatal visits?

BP, wt
Fundal ht
FHR ( tachy >160, brady

25

Whats the scoop with Leopold?

26

What are the goals of antenatal care?

—Maternal state of health
—Favorable in utero fetal environment
—Placental positioning
—Fetal growth & development
—Healthy birth passage
—Successful L&D progression

27

What is normal birth weight? Low? Very low? Extremely low?

—5.5 lbs = 2,500 grams or 2.5 kg; > 2,500 grams (> 5.8 lbs) = normal BW

28

What is large for GA?

9lbs or 4800 grams or 4.8kg
MACROSOMIA- pathology counterpart

29

What is low birth weight? Very? Extremely?

30

What is the pathology counterpart for SGA?

IUGR