Pregnancy Care Flashcards
(95 cards)
1
Q
Preconception History
A
Chronic diseases Medications known to be teratogens Reproductive history Genetic conditions in the family Substance use Infectious diseases & vaccinations Folic acid intake & nutrition Environmental hazards & toxins Mental health & social health concerns
2
Q
Goals of Prenatal Care
A
Ensure birth of a healthy baby
Minimize risk to mother
Early, accurate estimation of gestational age & due date
Identification of patient risk for complications & continuing risk assessment
Ongoing evaluation of health status of mother & baby
Patient education & communication
3
Q
Preconception Interventions
A
Folic acid supplementation Glycemic control in women with DM Abstinence from alcohol & illicit & prescription drugs Smoking cessation UTD vaccinations Weight management (18-30) Absence from depression Teratogen avoidance Absence of STIs Planned pregnancy with early prenatal visit
4
Q
Antepartum Care
A
Diagnosing pregnancy & determining gestational age
Monitoring the ongoing pregnancy with periodic exams & appropriate screening tests
Providing patient education that addresses all aspects of pregnancy
Preparing the patient & family for management during labor, delivery & postartum period
Detecting medical & psychosocial complications & instituting indicated interventions
5
Q
Initiating Prenatal Care
A
Ideally prenatal care initiated in 1st trimester
6
Q
Determining Gestational Age
A
IMPORTANT
Need to determine due date (EDC)
7
Q
Usual Methods of Determining Gestational Age
A
History: date of LMP
Uterine size
Ultrasound (US)
8
Q
Most Accurate Time Frame for Crown Rump Length
A
6-11 weeks
9
Q
Most Accurate Time Frame for Biparietal Diameter
A
13-25 weeks
10
Q
Most Accurate Time Frame for Femur Length
A
13-25 weeks
11
Q
Assessment at First Prenatal Visit
A
Medical history Reproductive history Family history Genetic history Nutritional history Psychosocial history: domestic violence Contact information Prenatal menstrual history
12
Q
Factors that Increase the Likelihood of Twins/Multiples
A
Advancing age Increased parity Family history from either parent Obese & tall women Fertility drugs
13
Q
Risks of Multiple Gestations
A
Preterm birth can lead to bed rest early
Intrauterine growth retardation or unequal growth
14
Q
Physical Exam at First Assessment of Pregnant Woman
A
Baseline BP Height & weight General PE Pay attention to oral hygiene Cardiac exam DTR's Breast exam Pelvic exam
15
Q
Lab Tests for First Trimester
A
UA + pregnancy test + culture CBC Rubella immunity Varicella immunity Syphilis test Hepatitis B antigen test Blood type & Rh determination HIV Lipids, PPD, HgbA1C, thyroid testing, Hep C, Zika if indicated
16
Q
Why obtain a urine culture?
A
Asymptomatic bacteriuria
17
Q
Asymptomatic Bacteriuria
A
Associated with increased risk of preterm birth, low birth weight, & perinatal mortality
Need repeat after treatment
18
Q
Treatment of Asymptomatic Bacteriuria in Pregnancy
A
Sulfisoxazole Amoxicillin Amoxicillin-clavulanate (Augmentin) Nitrofurantoin Cefpodoxime proxetil
19
Q
Treatment of Acute Cystitis in Pregnancy
A
Augmentin
Nitrofurantoin
Cephalexin
Amoxacillin
20
Q
Indications for Rhogam
A
At 28 weeks of gestation Spontaneous abortion, threatened abortion, induce abortion Invasive procedures Hydatidiform mole Fetal death in 2nd & 3rd trimester Blunt trauma to abdomen Antepartum hemorrhage in 2nd or 3rd trimester External cephalic version
21
Q
First Trimester prenatal Genetic Screening
A
Define risk in low-risk population
Can assess for down syndrome, trisomy 18 & trisomy 13
22
Q
Combination of what factors increases detection of down syndrome?
A
hCG level
Pregnancy associated plasma protein A (PAPP-A)
Nuchal transparency (NT)
23
Q
Define Chorionic Villous Sampling
A
Get fetal DNA for testing for Down Syndrome & other abnormalities
24
Q
Quadruple Screen in the Second Trimester Screening
A
Serum alpha-fetoprotein (AFP)
hCG
Unconjugated estrodiol
Inhibin A
25
Define Nuchal Translucency (NT) Measurement
Width of the translucent space at the back of the fetal neck determined by ultrasound
26
What defects can occur when maternal serum alpha fetal protein (MSAFP) is high?
Neural tube defects
Anencephaly
Multiple gestation
27
What defect can occur when MSAFP is low?
Down syndrome
28
Indications for Amniocentesis
Prenatal genetic studies
Assessment of fetal lung maturity
Evaluation of fetus for infection
Degree of hemolytic anemia
Evaluation of diagnosed neural tube defects
Therapeutic: removal of excess amniotic fluid
29
Risks of Amniocentesis
```
Leakage of amniotic fluid
Fetal injury (rare)
```
30
1st Visit Prenatal Education
At each visit maternal weight, BP, uterine growth, urine dipstick, fetal activity, & fetal HR
Every 4 weeks until 28 weeks; every 2 weeks until 34-36 weeks; every week until term
How to reach provider after business hours
Avoid hot tubs & saunas
Avoid substance use
Wear seatbelt
Infection precautions
Exercise: moderate, 30 minutes
Work: okay unless excessive lifting or standing
Sexual activity: risk of STI or vaginal bleeding
Travel: increased risk of DVT
Medications: check with provider
Weight gain counseling
Breast Feeding
Childbirth classes/hospital facilities
Diet
31
Education on Warning Signs of 1st Visit Prenatal Education
```
Vaginal bleeding
Cramping
Fever
Passing clots or tissue (save)
Dizziness
Fainting or abdominal pain
```
32
Diet During Pregnancy
High dose iron, vitamin A, selenium may be teratogenic
Fully cooked meats, fish, poultry, & eggs
Unpasteurized dairy products or fruit/vegetable juices
Can get listeria from processed deli meats
Fish
Increased daily calories
Breastfeeding
33
Common Symptoms of Pregnancy
```
Headaches
N/V
Heartburn
Constipation
Fatigue
Back pain
Round ligament pain: sharp groin pain
Edema
Hemorrhoids
Increased vaginal discharge
Pica
```
34
Define Pica
Inclination for non-nutritious substances such as clay or dirt is is often associated with anemia
35
Complications of the First Trimester
Vaginal bleeding
36
Types of Vaginal Bleeding in the First Trimester
```
Ectopic pregnancy
Threatened miscarriage
Inevitable miscarriage: incomplete/complete
Vanishing twin
Vaginal tract bleeding
Implantation bleeding
```
37
What needs to be ruled out with first trimester bleeding?
Ectopic pregnancy
38
Unstable Patient with Bleeding in First Trimester
Check ABCs
Pay attention to CV status
Start fluids
Get to OR
39
Stable Patient with Bleeding in First Trimester
```
History of bleeding
Pain or cramping
LMP
Any prenatal care
Blood type & Rh
```
40
Evaluation of First Trimester Bleeding
Pelvic US
Transvaginal US
CBC with type & cross & Rh
Serum quantitatve beta hCG
41
Second Trimester Evaluations
```
Fundal height
Fetal movement
Maternal BP & weight
Urine dip for glucose & protein
Documentation of fetal cardiac activity
Assessment of significant events: travel, illness, stressors, infections, abuse
```
42
Fundal Height at 20 weeks, up to 36 weeks, & later
20 weeks: uterus reaches umbilicus
36 weeks: grows up to 1 cm/week after 20 weeks
Then baby drops into pelvis
43
Fetal Movement
Begin to feel fetus & 18-29 weeks
Ask about fetal movement
Decreased movement: have mother come in
44
Complications of 2nd Trimester
```
Premature labor
Vaginal bleeding: placenta previa, placental abruption
Premature rupture of membranes
HTN in pregnancy
Pre-eclampsia
```
45
Signs & Symptoms of Preterm Labor & Premature Rupture of Membranes
Uterine contractions, low back pain, cramping, diarrhea
Leakage or gushing of fluid from vagina
Low pelvic pressure, low back pain
Advised on selecting newborn care provider
Lamaze or similar type class especially for 1st time parents
Tobacco cessation if still smoking
Depression counseling if appropriate
Asked about intimate partner violence
Postpartum family planning/tubal sterilization
Patient to lay on left lateral side
46
Third Trimester
28-36 weeks
| Abdomen examined to determine of position
47
Tests at 28 Weeks
```
Random glucose >200
Fasting glucose >126
Glucose challenge test: abnormal >130 after 1 hour
Glucose tolerance test
Rhogham if Rh Negative
```
48
Adverse Outcomes Associated with Gestational Diabetes Mellitus
```
Pre-eclampsia
Polyhydramnios
Fetal macrosomia
Birth trauma
Operative delievery
Perinatal mortality
```
49
Neonatal Metabolic Complications
Hypoglycemia
Hyperbilirubinemia
Hypocalcemia
Erythremia
50
32-36 Week Screening Labs
CBC
US when indicated
HIV when indicated
Depression screening when indicated
51
35-37 Week Labs
Group B strep (anal/vaginal swab)
| Resistance testing if penicillin allergic
52
3rd Trimester Education/Planning
```
Anesthesia/birth plans
Labor signs
Vaginal bleeding
Signs & symptoms of pre-eclampsia
Post-term counseling
Circumcision
Breastfeeding
Postpartum depression
Intimate partner violence
Newborn education
Family medical leave or disability forms
```
53
Braxton Hicks Contractions
Commonly last 2-3 weeks of pregnancy
Regular & strong
Don't result in change in cervix
Not active labor
54
When to come into the hospital?
Contractions every 5 minutes for an hour
Mother getting very uncomfortable or feeling pressure in pelvis
Sudden gush or leaking of fluid from vagina
Significant vaginal bleeding
Decreased fetal movement
55
Complications of 3rd Trimester
```
Pre-eclampsia/eclampsia
HELPP syndrome
Vaginal bleeding
Premature labor
Premature rupture of membranes
```
56
Biophysical Profile
```
Non-stress test
Fetal breathing movements (US)
Fetal movement (US)
Fetal tone (US)
Amniotic fluid volume (US)
```
57
Common Topics of Birth Plan
```
Mobility, massage, music
Pain relief, medical procedures
Positioning for pushing
Mother & baby together
Breastfeeding in first hour
Rooming in
```
58
Define Labor
Physiologic process by which regularly occurring uncomfortable-to-painful uterine contractions result n progressive effacement & dilation of the cervix
Permits passage through the birth control
Increased synthesis of prostaglandins: stimulate contractions, soften cervix
Increase in myometrial oxytocin receptors: amplify biologic effect from oxytocin
59
Exam for delivery
Determine presenting part
Digital vaginal exam
Fetal station
60
Parts of the Digital Vaginal Exam
Consistency of cervix: hard vs. soft
Effacement: shortening of cervical canal to paper thin
Dilation
61
Define Fetal Station
Position of fetal head in the birth canal in relation to the ischial spines
62
Stages of Labor
1st Stage: leading up to delivery
2nd Stage: delivery of the infant
3rd Stage: delivery of the placenta
4th Stage: hour immediately after delivery
63
1st Stage of Labor
Latent phase: cervical effacement & early dilation
Active phase: begins when cervix is 3-4 cm dilated
Onset of contractions to complete dilation & effacement
64
Minimal Dilation During Active Phase
Primiparous: 1 cm/hr
Multiparous: 1.2 cm/hr
Not progressing need to evaluate
65
Early Labor Contractions
Every 5-10 minutes
| last for 30-45 seconds
66
Late Labor Contractions
Every 2-3 minutes
| Lasting 60-70 seconds
67
Management of 1st Stage
```
Ambulation if head engaged
Left lateral position
Membranes intact: bathe or shower
Hydration with IV fluids
NPO except for ice chips
```
68
Fetal Monitoring
Continuous or intermittent monitoring of fetal HR
69
Warning Signs of Fetal HR
Late decelerations
Bradycardia
Decreased variability
70
Pain Control During Labor
```
Systemic narcotics: early
Spinal anesthesia
Epidural block
Local block of vagina or perineum
General anestetic
```
71
2nd Stage Management
Begins with complete dilation of cervix & ends with delivery of baby
Fetus needs to be monitored carefully
72
Crucial Items for Delivery
Power
Passenger
Passage
73
Cardinal Movements of Labor
```
Engagement
Flexion
Descent
Internal rotation
Extension
External rotation or restitution
Expulsion
```
74
Define Engagement
Biparietal diameter has passed the plane of the pelvic inlet
75
Define Flexion
Forces cause descent of the fetus through the pelvis, soft tissue, & bony resistance is encountered
76
Define Descent
Successful passage of the presenting part through the birth canal
77
Define Internal Rotation
Facilitates optimal diameters of the fetal head to the bony pelvis
78
Define Extension
Fetal head reaches introitus
| Flexed head now extends
79
Define External Rotation
Occurs after delivery of the head
| Head rotates "face forward" relative to shoulders
80
Define Expulsion
Rapid delivery of the body
81
Continued Delivery
```
Suction oral cavity & nares
Check nuchal umbilical cord
Deliver the shoulders, trunk & legs
Clamp & cut cord
Place infant on mom's chest
```
82
3rd Stage
```
Obtain cord blood
Check for lacerations
Don't pull on cord
Delivery placenta
Check cord & placenta
Give oxytocin after delivery of placenta
```
83
Stage 4
Uterine relaxation
Retained placental fragments
Cervical or vaginal lacerations
Monitor pulse, BP, uterine blood loss
84
Breastfeeding: Colostrum
Minerals, protein, & IgG antibodies
| less fat & sugar
85
Breastfeeding: Milk Production
Adequate insulin, cortisol, & thyroid hormone
| Adequate nutrients & fluids in mother's diet
86
Breastfeeding: Nipple Care
Wash with water
Expose to air for 15-20 minutes
after feeding
Lanolin or A&D ointment
87
Induction of Labor
When benefits of induction outweigh those of continuing the pregnancy
88
Cervical Ripening for Induction of Labor
Misoprostol
Prostaglandin E2
Laminaria: mechanical dilation
89
What medication stimulates uterine contractions?
Pitocin
90
Involution of the Uterus occurs by what week post partum?
6 weeks
91
Define Lochia
Discharge from the uterus after birth as the diced differentiates into a superficial layer which sloughs off
92
Lochia PostPartum
Heavy at first
Rapid decreases in first 2-3 days
May last for several weeks
Breastfeeding: may occur more rapidly
93
How long does it take the vulvar & vaginal tissue return to normal?
First several days
94
General Rule for the Vagina
Nothing in the vagina for 4 weeks
95
Ovarian Function PostPartum
Non-lactating woman: ovulate ~45 days
| Lactating: 189 days
