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Flashcards in Prenatal Care Deck (20):
1

Calculate the EDD?

ex) Oct 10th, 2015

estimated date of delivery/due date = EDD

Naedele's Rule: 1st day of LMP - 3 months + 7 days + 1 yr

 

ex) July 17th, 2016

2

determine gravida & parity of a pt

G(n)P(fpal)

  • G=GRAVIDITY – HOW MANY TIMES (n) THE PATIENT HAS BEEN PREGNANT INCLUDING THE CURRENT PREGNANCY
  • P=PARITY – RESULTS OF PREVIOUS PREGNANCIES

             f=number of full-term births

             p=number of pre-term births

             a=number of abortions, elected or spontaneous, ectopics

             l=number of living children

            “Florida Power And Light”

3

What is the normal gestational length?

what is pre-term?

term?

post-term?


nGestation: 40 weeks plus/minus 2 weeks
nPre-term=gestational age <37 weeks
nTerm=gestational age 37 to 42 weeks early term, term, late term
nPost-term=gestational age >42 weeks
 

4

what are the approx. lengths of :

1st Trimester?

2nd?

3rd?

nFirst Trimester: from LMP to 12 weeks+

  • embryo develops all the major organs and becomes a fetus

nSecond Trimester: 13 weeks-27 weeks

  •    fetus continues to develop and reaches viability

nThird Trimester: 28 weeks-40 weeks (term)

  •     fetus finishes developing and prepares for delivery

5

What are other ways [besides naegele's rule] of determining EDD


First trimester Ultrasound
Fetal Heart tones
: Doppler 10-12 weeks, Fetoscope 18-20 weeks
Quickening:  Primigravida 18-19 weeks Multigravida 16-17 weeks
 

6

  1. A PREGNANT PATIENT WHO HAS HAD FIVE PREVIOUS PREGNANCIES THAT RESULTED IN TWO FULL TERM DELIVERIES, ONE PRETERM DELIVERY AND TWO MISCARRIAGES AND THREE LIVING CHILDREN
  2. FEMALE PATIENT WITH LIVING TWIN SONS Delivered at Term

  3. PREGNANT PATIENT WITH A 2 YEAR OLD DAUGHTER-FULL TERM DELIVERY

 

tell me what her GP is?

  1. G6 P 2-1-2-3
  2. G I P 2-0-0-2

  3. GII P1-0-0-1

7

What are Drug classifications for pregnancy? [5 of them]

Category A-studies in humans no risk [vitamins]
Category B-studies in animals no risk [acetominophen, penicillins, cephalosporins]
Category C-no adequate studies [many]
Category D-evidence of fetal risk but benefit may outweigh risk [carbamazapine, phenytoin]
Category X-fetal risks clearly outweigh benefit [acutane]
 

8

What labs are performed in the first prenatal visit?

 

would you do a pap?

  • nCBC
  • nUA
  • nABO & Rh factor and antibody screen
  • nRubella Titer
  • nRPR
  • nHBsAg    
  • nHIV antibody 

 

**you would not do Pap unless other reason for concern...cuz what would you do w/ prego & abnormal results

9

What do we do with pregnant patients and the following disease/runimmunized for it

rubella

varicella

influenza

Rubella: All prego women should be screened, if testing was not performed before conception

  • Non-immune should be counseled about risk and vaccinated in the immediate postpartum period

Varicella:  contraindicated in pregnancy….infection in the first 20 weeks of pregnancy is associated with a 1-2% risk of congenital varicella syndrome (low birth weight, limb hypoplasia, ophthalmologic and neurologic abnormalities)

  • Susceptible preg women exposed are candidates for varicella zoster immune globulin
  • Vaccine is safe in breastfeeding women…..maternal shingles is not a risk for the infant….Immunization should be delayed for 3 mos in women who have received Rhogam

Influenza: Recommended for second or third trimester of pregnancy during flu season

10

what is norm weight gain  during prenancy?

[healthy]

 

what vitamin and how much should be taken by all women?

25-35 lbs

 


Folic Acid Supplementation 0.4 mg/day
 

11

What does increased nuchal translucency on US of a fetus mean?

Thickened nuchal translucency (measurements within the 2 white + markings) and absence of nasal bone (white arrow pointing to where the nasal bone should be) in a baby with Down Syndrome. 

A image thumb
12

What conditions/things are we worried about in 1st trimester?

  • Assess and Counsel
  •   Lifestyle 
  • Nutrition          
  • Tobacco/Alcohol/Drug use
  • Risk Factors  

       

13

What conditions or things are we concerned with in the 2nd trimester?

  • Nutrition
  • Fetal Assessment
  • Fetal Growth
  • Symptoms and psychosocial concerns
     

14

What conditions/things are we concerned about in the 3rd trimester of pregnancy?

  • Preterm Labor
  • Gestational Diabetes
  • PIH/Preeclampsia
  • Fetal growth
  • Fetal well-being/position
  • Screening for infection (GBS)
  • Symptoms and psychological concerns
     

15

What is the Quad screen?

When is it usually done?

What would we see in Downs syndrome?

what would you see in Edwards syn?

What would you see in Patau Syn?

Look at levels of: maternal serum alpha fetoprotein [MSAFP] for open neural tube defects, hCG, unconjugated estriol [UE3], pregnancy-associated plasma proteina A [PAPP-A]

  • done @ 16-18 wks gestation
  • downs syndrome [trisomy 21] [2nd trimester screen]: decreased α-fetoprotein,  ^^β-hCG, decreased estriol, ^^inhibin A.
  • Edwards syndrome [trisomy 18]: ALL decreased  α-fetoprotein,  β-hCG, estriol, or normal inhibin A.
  • patau syndrome [trisomy 13]: [First-trimester screen] decreased free β-hCG & PAPP-A, and ^^nuchal translucency.

     

16

What is Rhogam?

Who should get a shot of it?

 

  • Testing for ABO blood group and RhD antibodies first trimester
  • Rho(D) immune globulin 300mcg for nonsensitized women  at 28 weeks gestation and within 72 hours of delivery if infant has RhD-positive blood
  • Administered if increased risk(chorionic villus sampling, amniocentesis etc)

 

Rh(-) mom w/ Rh(+) baby.... only after 1st baby???? cuz mom has seen Rh+ before aand makes antibodies...

17

Whan is Tdap given in pregnancy?

What does it prevent?

 

  • Between 27 and 36 weeks
  • To protect mother and her baby from pertussis
  • Fathers, grandparents and people who will spend time with baby 2 weeks before expected delivery
     

18

what tests are done at each week thru preg?

10-12     Chorionic villus sampling

13-18     Amniocentesis (early vs routine) with ultrasound

16-20     Ultrasound for anomalies

16-18     Maternal serum quad-marker screening

24-28     Diabetes screening and Hct; repeat as needed

28          Rh-negative patients, repeat antibody test, administer Rho(D) Ig

32-36     Consider repeat STD screening, ultrasound, Hct, FBS

36          Assess for fetal position, confirm vertex

35-37     Consider group B streptococcal screening (vaginal and rectal)

41+       Biweekly prenatal fetal testing (nonstress test and amniotic fluid index)        

       

19

What is the risk with GBS?

What is current protocol for this?

Group B Streptococcus – vaginal and rectal screen without speculum

  • Risk for Neonatal Sepsis (2-3 neonates/1000 births)

OPTION 1:  CULTURE ALL WOMEN 35-37 WEEKS (RECTAL/VAG)**

  if positive intrapartum prophylaxis with IV Penicillin (Clindamycin   or Erythromycin)

OPTION 2:  Screening Culture not done but Antibiotics given if High Risk

  PROM>12-18 Hours etc.

Tx w/ penicillin [clinda if allergic]

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