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ENRP Exam 1 > Pregnancy and Antepartum Care > Flashcards

Pregnancy and Antepartum Care Flashcards

1
Q

what is the goal of preconception care?

A

reduce risk of adverse effects for mom and baby

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2
Q

what risks need to be addressed prior to conception?

A 
smoking cessation
EtOH cessation
illicit drug cessation
folic acid supplementation
proper nutrition
weight issues
diabetes management
stress reduction
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3
Q

why is folic acid supplementation vital to fetal health?

A

reduces risk of neural tube defects

  1. 4 mg/day without hx of NTD
  2. 0 mg/day with hx of NTD
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4
Q

Gravidity

A

number of times a woman has been pregnant

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5
Q

parity

A

number of pregnancies that result in a birth beyond 20 weeks

can be broken down into full-term, pre-term, abortions and living

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6
Q

abortions

A

include ectopic, spontaneous, and elective pregnancy loss prior to 20 weeks

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7
Q

woman has given birth to a set of twins at term and both are currently living. what is the GPA?

A

G1P1002

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8
Q

woman has given birth to one term infant, one set of preterm twins, 1 miscarriage and 1 ectopic pregnancy. she has 3 living children. GPA?

A

G4P1123

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9
Q

history obtained on first prenatal visit

A

medical (DM, HTN)
reproductive (GPA)
family (DM)
nutritional (folic acid, weight gain)
social (EtOH, drugs, smoking, employment)
psychosocial issues (depression, anxiety, domestic violence)

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10
Q

normal prenatal exam findings

A 
systolic murmurs, exaggerative splitting and S3
palmar erythema
spider angiomas
linea nigra
striae gravidarum
chadwicks sign
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11
Q

labs obtained at first prenatal visit

A 
CBC
type and screen (Rh factor)
rubella
syphilis
Hep B surface Ag
HIV
DM screen
urine culture
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12
Q

what lab values tend to increase with pregnancy?

A 
fibrinogen
urine protein
amylase
leukocyte count
clotting factors 7-10
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13
Q

fetal monitoring during first prenatal visit

A 
confirm pregnancy and viability
estimate gestational age and due date
genetic counseling if necessary
discuss teratogens
advice on decreasing early pregnancy sx
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14
Q

when can hCG first be detected in serum?

A

6-8 days after ovulation

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15
Q

what hCG level is considered positive for pregnancy?

A

25 IU/L

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16
Q

hCG trend within first 30 days of pregnancy

A

doubles ever 2.2 days

*can determine early IUP vs ectopic

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17
Q

transvaginal US findings and hCG level at 5 weeks

A

gestational sac

hCG = 1500-2000

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18
Q

transvaginal US findings and hCG level at 6 weeks

A

fetal pole

hCG = 5200

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19
Q

transvaginal US findings and hCG level at 7 weeks

A

cardiac activity

hCG = 17,500

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20
Q

estimating due date based on last menstrual period

A

Naegels rule!

minus 3 months + 7 days

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21
Q

what US findings are best for estimating due date?

A

crown rump length (CRL)
femur length
biparietal diameter
abdominal circumference

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22
Q

who needs genetic counseling?

A 
advanced maternal age (35+)
previous hx of birth defects or genetic disorder
previous child with MR
previous neonatal death
multiple fetal losses
abnormal serum marker screening
consanguinity
maternal conditions
teratogen exposure
abnormal fetal US
parent is a known carrier of a genetic disorder
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23
Q

what is the miscarriage rate of fetal chromosomal disorders?

A

50%

24
Q

who is most at risk for chromosomal disorder development?

A

women who are 35+

25
Q

what is the chance that a couple who previously had a child with Down syndrome would have another child with a chrom abnormality?

A

1%

26
Q

when should a chromosomal study/karyotype be performed on couples?

A

3 or more spontaneous abortions

*may have balanced translocation

27
Q

first trimester screening

A

maternal age
fetal nuchal translucency thickness (increased associated with abnormalities)
maternal serum b-hCG
pregnancy-associated plasma protein A (PAPP-A)

28
Q

what could an elevated b-hCG and low PAPP-A indicate?

A

Down Syndrome

29
Q

second trimester screening

A

Triple screen = b-hCG, estriol and maternal AFP

Quadruple screen = b-hCG, estriol, AFP and inhibin A

30
Q

what is a noninvasive test to screen for fetal abnormalities?

A

cell-free fetal DNA detected in maternal blood

*can detect chrom abnormalities but not NTD

31
Q

when would a cell-free fetal DNA be ordered?

A 
advanced maternal age
hx of prior pregnancy with trisomy
fam hx of chrom abnormalities
fetal US abnormalities
\+ serum screening test
32
Q

what is the next step if you have a positive cell-free fetal DNA?

A

invasive diagnostic test such as amniocentesis or CVS

33
Q

when can you perform an amniocentesis?

A

16-20 weeks

0.3% miscarriage rate

34
Q

when can you perform a chorionic villi sampling?

A

11 weeks

1% miscarriage rate

35
Q

teratogen

A

any agent or factor that can cause abnormalities of form or function in an exposed fetus

36
Q

describe the medication risk factor categories for pregnancy and breast feeding

A 
A - its fine to take
B - no human studies have shown fetal harm
C - no studies have been conducted 
D - studies have shown risk
X - dont fucking take it
37
Q

fetal susceptibility to teratogenicity

A

dependent on genetic make-up of mother and fetus

38
Q

dose dependence and teratogenicity

A

obviously small dose has lower risk vs high dose has greater risk

39
Q

timing and teratogenicity

A

fetus is most vulnerable at 17-57 days post-conception (organogenesis)

40
Q

what drugs are considered teratogens?

A 
alcohol
tobacco
illicit drugs
anti-anxiety
anti-neoplastic
anti-coagulants
anti-convulsants
Diethylstilbestrol (DES)
retinoids (accutane)
41
Q

fetal alcohol syndrome

A 
growth restriction
low set ears
smooth philtrum
thin upper lip
short palpebral fissures
flat midface
microcephaly
MR
behavioral disorders
42
Q

fetal hydantoin syndrome (FHS)

A 
caused by Dilantin during pregnancy:
craniofacial abnormalities
limb reduction defects
pre-natal onset growth restrictions
MR
CV anomalies
43
Q

valproic acid and carbamazepine are associated with what specific fetal defect?

A

spina bifida

44
Q

are OCPs teratogenic?

A

meh not really

may cause masculinization of fetal female external genitalia

45
Q

what infectious agents are teratogens?

A

TORCH

toxoplasmosis
other (syphilis, parvo B19, zoster)
rubella
CMV
herpes
46
Q

what is the rule of thumb for radiation exposure for pregnancy women?

A

less than 5 rads of exposure has no risk of teratogenicity

47
Q

unpleasant sx of pregnancy

A 
nausea/vomiting
constipation
heart burn
hemorrhoids 
leg cramps
backache
48
Q

frequency of prenatal visits

A

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

49
Q

normal pregnancy weight gain for BMI < 19

A

28-40 lbs

50
Q

normal pregnancy weight gain for BMI 19-25

A

25-35 lbs

51
Q

normal pregnancy weight gain for BMI > 25

A

15-25 lbs

52
Q

what normally occurs during routine prenatal office visits?

A 
BP
weight
urine protein
measure uterine size
fetal heart rate
fetal movement/kick counts
educate on complications
discuss lifestyle
53
Q

what is evaluated for near term office visits?

A 
fetal lie (longitudinal, oblique or transverse)
fetal position (vertex or breech)
54
Q

what tools are used to assess fetal well-being?

A

kick count (10 movements in 2 hours)
nonstress test
contraction stress test (oxytocin)

55
Q

what is a normal nonstress test result?

A

2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 mins of monitoring

56
Q

what are the components of the reassuring biophysical profile?

A
  1. nonstress test
  2. fetal breathing movements
  3. fetal movement
  4. fetal tone
  5. amniotic fluid volume

*correlates to incidence of stillbirth

57
Q

reassuring biophysical profile results

A

8-10 = good
6 = okay, deliver if patient is at term
4 or less = very concerning, consider delivery

ENRP Exam 1 (20 decks)

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