Lecture 5 - Prenatal Care Flashcards by Indy P

What are early signs of prengnancy?

amenorrhea
N/V/food aversions
breast enlargement and tenderness
increased frequency of urination without dysuria 
fatigue 
cramping 
constipation 
heartburn 
nasal congestion 
mood changes

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Serum Bhcg can confirm pregnancy how long after conception?

1 week

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Urine Bhcg levels need to be how high to confirm a positive pregnancy?

> 25-50 mIU/mL

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EGA

estimated gestational age

ideally determined between 6-8 weeks GA (confirming viability - fetal pole and fetal heartbeat)

EDD = EDC
estimated date of delivery
estimated date of confinement

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Naegele’s Rule

Used to determine the estimated date of delivery

EDD = (LMP - 3 months) + 7 days

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What provides accurate EDD?

Crown Rump Length

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What weeks are considered first trimester?

13 weeks

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If the LMP (Naegele’s Rule) doesn’t match the ultrasound in regards to EDD, what do you base the EDD on?

also if the pts doesnt know her LMP you solely base the EDD on the US

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Gravida and Para

Gravida - how many times pt has been pregnant 
Para - what are the outcomes of those pregnancies - broken down into T (term), P (preterm), A (abortion), L (living) 
G P(TPAL)

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What is considered to term?

> 37 weeks

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What is considered preterm?

20-37 weeks

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G3 P2012

G P(TPAL)

3 pregnancies
2 term pregnancies
1 abortion

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What are the components of the first prenatal visit?

Med Hx 
Surgical Hx 
Genetic Hx 
Domestic Violence screening 
Teratogen exposure screening 
Vitals (BP, BMI) 
PE 
-thyroid
-heart and lungs
-breast
-abdomen
-pelvic
US - determine EDD
Labs 
-ABO, antibody
-CBC
-Hep B
-Rubella
-Syphilis
-HIV
-Pap smear 
-Urine Culture (we treat asymptomatic bacteruira in pregnant pts only)  
CF screening 
SMN screening

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What are the two most common cancers dx during pregnancy?

breast and cervical

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When do pts typically start showing during pregnancies?

20 weeks

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What can you tell a pt in regards to weight gain during pregnancy?

if their BMI is: 
<18.5 -- 25-40 lbs 
18.5-25 -- 25-35 lbs
25 - 29.9 -- 15-25 lbs
>30 - 10-20 lbs

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Is there a specific max HR for pregnant pts to avoid during exercise while pregnant?

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What foods do you need to advice your pts to avoid during pregnancy?

undercooked meat (no pink d/t risk of toxoplasmosis)
cold deli meat
unpasteurized cheese or dairy
high mercury fish (shark, tilefish, mackerel, swordfish, tuna)
raw sprouts
raw eggs
EtOH, smoking, and dugs
Cat litter (esp. outdoor cats)
Hot tubs and saunas - NTD risk with hot environments

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Which vaccinations are NOT to be given during pregnancy?

MMR, varicella

any live vaccines

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Which vaccinations are given during pregnancy?

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influenza 
Tdap Vaccine (during third trimester 28-35 weeks) --this is given during EVERY pregnancy

Why is travel avoided >36 weeks?

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risk of delivering somewhere without care

What prenatal vitamins should be taken and when?

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ideally 1 month prior to conception to help decrease N/V and NTD risk

folic acid 400 ug( increase to 4mg if hx of NTD)
DHA
Iron

What vitamins should pregnant pts avoid?

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fat soluble vitamins

ADEK

How much caffeine is can a pregnant pt be allotted?

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<200 mg/day

When are the prenatal visits

every 4 weeks until 28 weeks every 2 weeks from 28 - 36 weeks weekly after 36 weeks

What are the 6 main things you check at every prenatal visit?

``` weight BP urine dipstick (protein, glucose) fetal heart rate fundal height (>20wk) ```

What is the best way to measure if the fetus is growing properly?

fundal height

Fundal height

measured via the top of uterus to pubic bone | cm should equal roughly the number of weeks gestation (+/-2)

What labs are done 15-20 weeks of pregnancy?

Genetic - MSAFP, QUAD screen, amniocentesis

What labs are done 24-28 weeks of pregnancy?

GCT, ABO, antibody, CBC, HIV, RPR

When is chromosomal screening done?

aneuoploidy screening | screened <20 weeks

What are the 4 main things we test for with genetic screening?

Trisomy 21, 18, 13 and NTD

How is genetic screening done during the first trimester?

``` Nuchal translucency (neck pole of the baby) and PAPP-A and Bhcg of the mother ```

What is the genetic screening done during the second trimester?

``` QUAD screen msAFP Bhcg Estriol Inhibin ```

During the first trimester, what does it mean if PAPP-P is low, Bhcg is high, and NT is high?

Trisomy 21

During the first trimester, what does it mean if PAPP-P is low, bHcg is low and NT is low?

either trisomy 18 or 13 depending on how much of NT is high and bhcg is low

msAFP

genetic screen for NTD

NIPT

noninvasive prenatal testing cell free fatal DNA (in maternal blood) >9-10 weeks only offered if >35yo, US findings, hx of trisomy, +FTS, balance Robertsonion translocation this can also tell you the sex of the baby by 10 weeks rather than 18 weeks based on anatomy

What is the difference between genetic screenings like QUAD, NIPT from CVS?

CVS - chronic villus sampling along with amniocentesis are genetic dx rather than screening - 100%

What is tested on routine anatomy US?

18-20 weeks ``` growth anatomy sex determination placentation cervical length screening ``` this allows you to check congenital anomalies that arent chromosomal short cervix (<2.5cm) = increased risk of preterm birth

What is the first line treatment for N/V in pregnancy?

vitamin B6 and Doxylamine (unisom)

What is the MC pain seen in first and second trimester?

first trimester - N/V second trimester - round ligament pain

When do you start the discussion of birthing, breastfeeding, infant CPR?

once the gestation has become viable - 24 weeks

5/1/1

rule of contractions >37 weeks | contractions every 5 minutes lasting 1 minutes for 1 hour

Before 37 weeks, when should a pt come in for contractions?

if they have contractions every 15 minutes that have not improved with rest and hydration

Kick counts

10 kicks/2 hours a rule you can tell pts to help relieve them of worry that something is wrong have them drink something sugary and lay down for 2 hours they should feel at least 10 kicks if not--come in then get NST BPP

NST

fetal non-stress test performed after 28 weeks monitoring for baby HR and contractions checks for acid//base, oxygination

BPP

biophysical profile ``` 30min US test to check for NST Breathing Tone AFI Movement ``` Score 8-10 = low risk 6 = monitor and redo test in 6-12 hours <4 - move towards delivery - baby is at risk of hypoxia

How can you prevent post-term pregnancies?

sweeping of membranes ambulation intercourse nipple stimulation induction recommended >42 weeks

Lecture 5 - Prenatal Care Flashcards

(49 cards)