Pre-partum OB Flashcards
Explain GPtpal
Gravida: how many times you were pregnant
Para: how many times you have given birth
term: # of full term babies, 37-42 weeks
preterm: # of deliveries 20-36 weeks
abortion: spontaneous or induced prior to 20 wks
live: # of living kids (if twins, 2)
A fetus is considered viable at
> 23 weeks or >500 g
What are the stages of a baby from conception
Embryo: fertilization-8 wks Fetus: 9 wks-birth Preterm: born prior to 37 wks Neonate: birth-28 days Infant: 28d- 1 y/o Post-term: live born after 42 wks (increased perinatal mortality)
What is Nagele’s rule
a way to determine the due date! Date of LMP + 7 days - 3 months ex: LMP was on 2/20/2018 20+7=27 Due date= Nove,ber 27, 2013
Standard pregnancy is
280 days (40 weeks)
Explain gestational age vs fetal age
Gestational: age of fetus is calculated from 1st day of LMP and includes 2 weeks that woman is not pregnant
Fetal: age of fetus is calculated from implantation (2 weeks less than G age)
What are the trimesters in pregnancy
First: 1-12 weeks
Second: 13-28 weeks
Third: 29-40 weeks
How does mom’s physiology change with pregnancy (by system)
- Skin: melasma, linea nigra, striae
- Resp: increased VT and O2, decreased ERV and CO2
- Cardio: increased CO and SV, decreased systemic vascular resistance
- GI: slow motility, delayed gallbladder emptying
- GU: increased GFR
- Heme: increased plasma volume and WBC
How much folic acid do moms need
Low risk: 0.4mg (400 mcg)
High risk: 4mg (4000 mcg)
How does a home pregnancy test work
measures HCG (picks up level of 25) most are + by the time of missed menses
Where is HCG made
By the placenta!
It rises exponentially for the first 10 weeks, then plateaus (doubles every 48 hours)
-HCG and progesterone are what cause morning sickness usually
Where is progesterone made
By the corpus luteum until 6 weeks post-fertilization
Then placenta takes over
Sypmtoms of pregnancy include
amenorrhea n/v breast tenderness fatigue urinary frequency/nocturia increased incidence of UTI Linea nigra (umbilicus-pubis) Melasma (at 16+ weeks) Leukorrhea (white discharge) Striae
PE findings in pregnancy include
Systolic ejection murmur
Goodell’s sign (cervical softening at 4-6 wks)
Hegar’s sign (uterine isthmus softening at 6-8 wks gestation)
Chadwick’s sign (cervix looks blue from 8-12 wks gestation)
At your initial OB visit, these labs should be done
CBC blood type and Rh Ab screen Rubella immunity Syphilis testing Hep B antigen testing HIV UA C&S Chlamydia/gonorrhea Pap (if they fall into guidelines)
At the first OB appointment, docs should get this confirmation test
US!
can detect a fetal heart (but not get a full heart tone) at 5-6 weeks gestation
What genetic screening is available in the first trimester (11-13 wks)
US for nuchal translucency (if thick, trisomy 21) and fetal nasal bone
Maternal blood (very high hCG, trisomy 21) (low plasma protein A, trisomy 21)
-Chorionic villus sampling at 10-12 weeks, extract cells from placenta
What genetic screening is available in second trimester (16-18 wks)
Quad screen: maternal blood + AFP, HCG, Estriol, and inhibin A
AFP (increase if w/ neural tube defects or twins)
-Amniocentesis: 15-20 weeks, extract amniotic fluid
How often do pregnant women go to visits
First: 6-8 weeks after LMP
Monthly until 28 weeks (7 months)
2x month from 28-36 weeks
weekly from 36 weeks-delivery
How much weight should mamas gain
1st trimester: 1.5-3 lbs
2nd trimester: 0.8lb x week
Total pregnancy weight gain: 25-35 lbs
Prenatal monitoring tests
Fetal heart tone (handheld doppler): start at 10-12 wks (120-160 is NL)
Fundal height: start at 20 wks
Cervical exams: start at 37 wks
What is “quickening”
first perception of fetal movement by mama
Primigravida: 18-20 wks
Multigravida: 16-20 wks
What is the count to 10 method
Should have 10 fetal movements over 2 hours OR 4 over 1hr while mom rests
(activity is higher at night)
What are normal fundal height measurements
12 weeks: pubic symphysis
20 weeks: umbilicus
ad 1cm for each week after 20 wks
DROP: 36-38 weeks
