Flashcards in Normal Pregnancy—Routine Prenatal Care, Labor, Delivery & Postpartum Care Deck (102)
9 things to ask about
1. Chronic diseases**
2. Medications known to be teratogens
3. Reproductive history
4. Genetic conditions in the family
6. Infectious diseases and vaccinations
7. Folic acid intake and nutrition
8. Environmental hazards and toxins
9. Mental health and social health concerns
Goals of Prenatal (Antepartum) Care
1. Ensure birth of a healthy baby w/ minimal risk to the mother
2. Early, accurate estimation of gestational age
3. Identification of the patient at risk for complications & continuing risk assessment
4. Ongoing evaluation of the health status of both mother and fetus
5. Patient education and communication
1. Folic acid supplementation
2. Glycemic control in women with diabetes
3. Abstinence from alcohol and illicit and prescription drugs
4. Smoking cessation
5. Up date vaccinations—live vaccines should be administered 1 month or more prior to pregnancy
6. Weight management (BMI >18 less than 30)
7. Absence from depression
8. Teratogen avoidance
9. Absence of STI’s
10. Planned pregnancy with an early prenatal visit
Antepartum Care Includes:
1. Diagnosing pregnancy & determining gestational age
2. Monitoring the ongoing pregnancy w/ periodic exams & appropriate screening tests
3. Providing patient education that addresses all aspects of pregnancy
4. Preparing the patient and her family for her management during labor, deliver and postpartum period
5. Detecting medical and psychosocial complications and instituting indicated interventions
When in the first trimester?
Initiating Prenatal Care
1. Ideally prenatal care will be initiated in the what?
1. first trimester
1. How do we deteremine the Gestational age?
2. Other usual methods of determining gestational age? 3
1. Add 7 days to the LMP than subtract 3 months—Naegele’s rule
2. Usual methods:
-History: using the date of the last menstrual period (LMP)
The First Prenatal Visit
LOTS of information to collect/assess/review:
1. Medical hx
2. Reproductive hx
3. Family hx
4. Genetic hx
5. Nutritional hx
6. Psychosocial hx: critical to screen for domestic violence (20% of women are physically abused when pregnant*)
Factors that influence the likelihood of twins?
INCREASED _______ needed for pregnant mother with multiple babies
Factors that increase the likelihood:
1. Advancing age
2. Increased parity
3. Family history from either parent
4. Obese and tall women greater chance
5. Fertility drugs
Risks of multiple gestations
1. Preterm birth can lead to bed rest early in pregnancy
2. Intrauterine growth retardation or unequal growth
1. Baseline BP
2. Height and weight—calculate baseline BMI
3. General PE
4. Pay attention to oral hygiene**
5. Cardiac exam
7. Breast exam
8. Pelvic exam
Lab tests for pregnancy?
1. Urine specimen for pregnancy test
2. Urine is checked each visit for glucose and protein
3. 1st visit UA and urine culture are done
4. CBC: to detect anemia and screen for thalassemia
5. Rubella immunity (if nonimmune counselled & immunized postpartum [PP]*)
6. Varicella immunity (if nonimmune varicella vaccine PP)
7. Syphilis test: mandated
8. Hepatitis B antigen test [HepBsAg]
Why Get a Urine Culture?
Asymptomatic bacteriuria: occurs in 2-7% pregnant women:
1. Untreated—30-40% will get a what?
-low birth weight, and
3. What is considered is considered “positive” and requires treatment?
4. Some providers choose to handle the risk of this how?
2. Associated w/ increased risk of what? 3
3. 2 consecutive voided specimens w/ same bacterial strain or 1 cath specimen w/ 1 isolated bacterial species—
4. Some providers choose to give suppressive therapy throughout pregnancy
Why do you need to repeat the culture for asymptomatic bacteriuria?
Need to repeat culture to know it is sterile after treatment/some repeat urine culture each month of pregnancy
Tx of Asymptomatic Bacteriuria
1. Sulfisoxazole: 500 mg PO TID for 3-7 days
2. Amoxicillin: 500 mg PO TID for 3-7 days
3. Amoxicillin-clavulanate: 500 mg PO BID 3-7 days
4. Nitrfurantoin: 50 mg PO QID for 7 days
5. Cefpodoxime proxetil: 100 mg PO Q12 hrs for 3-7 days
Acute Cystitis in Pregnancy
2. Tx? 3
3. What abx do you not use?
1. UA and midstream urine culture for diagnosis
2. Tx: empiric:
3. NO fluroquinolones!
Pregnancy: And more lab tests...
What blood testing?
Blood type and Rh determination and antibody screen
1. Rh status necessary. Why?
2. If mother is Rh neg another antibody screen is drawn at ___ wks if it is still negative then the Rh neg mother is given Rhogam
3. What other circumstances is an Rh neg woman given Rhogham? 2
4. If an Rh neg woman DOES get exposed to Rh pos blood from her baby she will produce antibodies against Rh pos blood in subsequent pregnancies causing what?
1. if mother Rh neg then Anti-D immune globulin (Rhogam) is given whenever there is a risk of fetomaternal hemorrhage to prevent alloimmmunization
4. fetal hemolytic disease (fetalis hydrops)*
Which test is routinely done unless patient refuses, retesting at 36 wks gestation in high risk patients or those who refused earlier is recommended?
What labs may be indicated for pregnancy but are not always done?
1. Lipids if indicated
2. PPD if indicated
3. Hgb A1C if indicated
4. Thyroid testing if indicated
5. Testing for other infections as indicated: Hep C, Zika
First Trimester Prenatal Genetic Screening
2. Can assess for what? 3
1. Purpose is to define the RISK of genetic disorders in a low-risk population
2. Can assess for
-Trisomy 18 and
First Trimester Prenatal Genetic Screening: Combining these markers yields an 82-87% Detection of Down Syndrome?
1. hCG level
2. Pregnancy associated plasma protein a (PAPP-A)
3. Nuchal transparency (NT)
Women found to have increased risk of aneuploidy with these tests should be offered what?
chorionic villous sampling**
1. What is chronic villous sampling?
2. Can be done how? 2
3. Should not be done before 10 weeks gestation because of what?
1. A procedure to get fetal DNA for testing for Down syndrome & other abnormalities
2. Can be done under US guidance through the vagina or by abdominal US
3. increased pregnancy loss**
Second Trimester Screening
1. May be used when?
2. Quadruple screen: ?
Using this combination improves the detection of Down syndrome to 80%
1. May be an option if a woman is seen later in pregnancy
-Serum alpha-fetoprotein (AFP)
1. Uses both the first trimester and second trimester markers to do what?
2. Early amniocentesis (before 14 weeks of gestation) has what kind of risks? 2
3. Individuals who may be carriers can do what?
1. adjust a woman’s age-related risk of having a child’s with Down syndrome
-high pregnancy loss and
-more amniotic fluid culture failures
3. undergo carrier testing
Maternal Serum Alpha Fetal Protein (MSAFP)
1. Measurement can be used to treat what?
2. MSAFP is high = ? 3
3. MSAFP is low = ?
1. Measurement can be used to detect abnormalities in the fetus**:
-Neural tube defects: MSAFP is high
-Anencephaly: MSAFP is high
-Multiple gestation: MSAFP is high
3. Down Syndrome: MSAFP is low**
1. Prenatal genetic studies (most common)
2. Assessment of fetal lung maturity
3. Evaluation of the fetus for infection
4. Degree of hemolytic anemia
5. Evaluation of diagnosed neural tube defects
6. Therapeutic—removal of excess amniotic fluid