Lecture 2: Prenatal Care Flashcards by Enoch Koo

What are the 4 Parity subtypes?

Term = born post 37wks
Preterm = born 20-37 wks
Abortion = All pregnancies lost prior to 20 wks
Living = Any infant that lives beyond 30 days

Written as G1T1P0A0L1 for a woman pregnant once, gave birth to a term baby once, and has 1 living child.

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Define gravity/gravida

The # of times a woman has been pregnant

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What is considered first trimester?

14 wks of gestation

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What is amenorrhea?

Abrupt cessation of menses in healthy, reproductive aged woman with previous spontaneous, predictable menses

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When is amenorrhea a reliable indicator for pregnancy?

10 days after expected menses

Implantation bleeding from blastocyst.

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What is a chadwick sign?

Vaginal mucosa change of dark-bluish/red.

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What can change in the lower reproductive tract due to pregnancy?

Chadwick sign
Cervical softening
Cervical mucus thinning (due to progesterone)

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What is a hegar sign?

Isthmus softening in the uterus

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Who is more likely to feel fetal movement earlier, multigravida or primigravida?

Multigravida, maybe around 16-18 wks vs 20 wks.

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Why is the beta-hCG test used?

Similar to LH, FSH, and TSH
Detectable in both blood and urine 8-9 days post ovulation
False positives are rare

Produced by syncytiotrophoblasts post implantation

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What is the MCC of a false positive b-hCG?

Heterophilic antibodies

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How quickly should b-hCG double once pregnant?

Doubles every 1.4-2 days

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What is some key patient education for home pregnancy tests?

Needs a decent level of 12.3 to detect
Use first urination of the day

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What is the first sonographic evidence of pregnancy seen on TVUS?

Gestational sac of small, anechoic fluid

4-5 weeks

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What confirms that a pregnancy is not ectopic via US?

Yolk sac = bright echogenic ring with an anechoic center

5-6 weeks gestation

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What is crown rump length used for?

Prediction of pregnancy due date

First trimester length = most accurate tool for gestational age.

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Fetal Pole US

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What rule estimates delivery date?

Naegele’s Rule: LMP + 7 days - 3months = EDD (estimated date of delivery)

Pregnancy must have begun 2 weeks prior to ovulation.

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What fruit size corresponds to a 12 week uterus on bimanual exam?

Grapefruit

Uterus should begin exiting bony pelvis

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What maternal Rh blood type is concerning? Tx?

Rh-
Give RhoGAM at 28 wks to prevent alloimmunization
Also give earlier if trauma or vaginal bleeding

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What test is used to check fetal RBCs present in maternal circulation?

Kleihauer-Betke

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How much rhoGAM eradicates fetal RBCs?

0.3mg of Rh IgG eradicates 15mL of fetal RBCs (30mL of fetal blood)

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How is rubella diagnosed?

Serology

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What fetal effects can rubella cause?

Eye defects (Cataracts)
Congenital Heart Defects
Sensorineural deafness
CNS
Hepatosplenomegaly and jaundice
Pigmentary retinopathy

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How is rubella prevented?

* MMR for non-pregnant * Avoid 1 month before or during pregnancy (live virus)

How is syphilis diagnosed?

* VDRL(Venereal disease research lab test) * RPR (rapid plasma reagin)

How is syphilis treated?

Penicillin G | Desensitization if allergic

What historical fact may increase need for folic acid during pregnancy?

Hx of neural tube defect in previous child.

What does obesity increase the risk of in pregnancy?

* Gestational HTN * Preeclampsia * Gestational diabetes * Macrosomia (big baby) * C-section

What seafood should be avoided in pregnancy due to high mercury levels?

* Shark * Swordfish * King mackerel * Tile fish

Up to what week of gestation is airline travel ok?

Up to 35 weeks | I assume that after this, risk of contractions on a flight is high

What specific hobby should be avoided in pregnancy?

Scuba diving due to decompression sickness

What is the most ideal way to counsel smoking cessation for pregnancy?

Person to person | 5 As of smoking: ask, advise, assess, assist, arrange

When is exclusive breastfeeding preferred?

Up to 6 months!

When is BFeeding CId?

* Drugs/alcohol * Infant with galactosemia * HIV * Hep C with cracked nipple * Active TB * Meds * Breast cancer tx * Active herpes

What is the new method of med labeling for pregnancy and lactation use?

PLLR (pregnancy and lactation labeling rule)

What is checked at prenatal visits?

* FHTs * Fetal growth via fundal height * US for dating and anatomy * Maternal BP and wt * Symptoms

What symptoms should be asked at every prenatal visit?

* Leakage of fluid * Contractions * N/V * Pelvic pain * Bleeding

How is gestational diabetes screened for?

1 hour glucola test

What culture is checked at 35-37 weeks? Why?

Group B streptococcus, which can cause sepsis.

When is TDaP given?

3rd trimester so immunity can be passed along.

What is hyperemesis gravidarum and the danger?

* Severe vomiting that can result in **dehydration, electrolyte, and acid-base disorders** * Can also result in **Wernicke encephalopathy**

How is N/V generally treated in pregnancy?

Vit B6 (pyri**dox**ine) +/- **dox**ylamine | Puking needs dox

Why does heartburn occur very commonly in pregnancy and how is it treated?

* Upward displacement/compression of stomach by uterus * Relaxation of LES * Antacids > H2 blockers > PPIs

A pregnancy woman presents with intense cravings for ice/dirt; what is the most likely underlying etiology?

Iron deficiency anemia

What is leukorrhea and why does it occur?

* Increased mucus secretion by cervical glands due to **estrogen** * Increased vaginal discharge * **Usually not pathological**

When are most prenatal screenings done prior to in terms of gestational age?

Prior to 20 weeks.

What maternal age is fetal trisomy risk increased?

After 35y

What are the 2 most common classes of birth defects?

1. Cardiac 2. Neural tube defects

What serum/amniotic elevation is associated with neutral tube defects?

Alpha feto protein (AFP)

What is the most sensitive test for NTDs in pregnancy?

**2nd trimester** fetal US

What should be offered to all pregnant women in terms of screening?

* Prenatal genetic screening * Diagnostic testing

What tests are done in first trimester screening?

* Nuchal translucency * Serum analytes | Down syndrome screening

What serum analytes are associated with down syndrome?

* Elevated hCG * Decreased PAPP-A | If both trisomy 13 and 18, both will be lowered. ## Footnote One up one down for down syndrome

What is in a quad screen in the 2nd trimester?

1. hCG 2. AFP 3. Unconjugated estriol 4. inhibin (elevated = down syndrome)

What US finding may suggest aneuploidy?

* Major structural abnormality * 2+ minor structural abnormalities

If a fetus has a major anomaly on US, what is the next step? What if it is only a minor anomaly?

* Major: Invasive testing * Minor: Genetic testing

What is considered a minor US abnormality for a fetus?

* Nuchal fold > 6mm * Pyelectasis * Hyperechogenic bowel * Choroid plexus cyst

What is cell free DNA?

* Fetal components in maternal circulation * **Most sensitive and specific screening test for common fetal aneuploidies** | Not equivalent to diagnostic testing

What is the MC procedure to **diagnose fetal aneuploidy**?

**Amniocentesis**, performed at 15-20 wks

What can amniocentesis measure?

* Fetal karyotyping * Polyhydramnios (>25mm of amniotic fluid) * Fetal Anemia * Fetal lung maturity (L/S ratio)

When is Chorionic Villus Sampling (CVS) done and why?

* 10-13 weeks gestation (very early) * Used if high suspicion and if early termination may be desired. | Performed earlier than amniocentesis

What are the complications of performing CVS?

* Pregnancy loss * Limb-reduction defect * Vaginal spotting * Infection

What is the MC indication for fetal blood sampling/cordocentesis?

Fetal anemia

What are the complications of fetal blood sampling?

* Fetal loss * Cord bleeding * Fetal-maternal bleeding * Fetal bradycardia

Image of fetus response to stress

What is antepartum fetal assessment mainly used to assess?

* Risk of intrauterine death * Complications of intrauterine asphyxia

What factors can affect fetal movement?

* Amniotic fluid (less fluid = less activity) * Multigravida (earlier) * Gestational age (older = less space) * Fetus sleeps also

On average, what is the normal amt of fetal movements daily?

1. 10 mvmts in 2 hrs. 2. Assess daily! (can just do 5 mvmts/hr)

What is the next step if a fetus prevents with decreased # of movements?

Non-stress test.

What is a normal/reactive Nonstress test (NST)?

2+ accelerations in a 20 min time span. ## Footnote Under 32 wks = 10 bpm change for 10s or more Over 32 wks = 15 bpm change for 15s or more

When is a biophysical profile (BPP) performed?

Abnormal/nonreactive NST

How is a BPP graded and what is part of it?

1. NST 2. Fetal Breathing via US 3. Fetal Movement via US 4. Fetal Tone via US 5. Amniotic Fluid volume/index via US | 0 = abnormal, 2 = normal.

At what point is a BPP considered concerning for fetal asphyixa?

6/10, or 8/10 if AFI is abnormal | Amniotic fluid index

What is the modified BPP?

AFI + NST

What 3 things are measured in doppler velocimetry?

* Umbilical artery * Middle cerebral artery * Ductus Venosus

When is umbilical artery velocimetry abnormal?

Absent or reversed end diastolic flow. | Used for fetal growth restriction ## Footnote AREDV (velocity)

When is middle cerebral artery velocimetry indicated?

1. **Fetal anemia** 2. Intrauterine growth restriction 3. Isoimmunization

Lecture 2: Prenatal Care Flashcards

(78 cards)