Prenatal Care

Question 1

Calculate the EDD?

ex) Oct 10th, 2015

Answer 1

estimated date of delivery/due date = EDD

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

ex) July 17th, 2016

Question 2

determine gravida & parity of a pt

Answer 2

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”

Question 3

What is the normal gestational length?

what is pre-term?

term?

post-term?

Answer 3

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

Question 4

what are the approx. lengths of :

1st Trimester?

2nd?

3rd?

Answer 4

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

Question 5

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

Answer 5

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

Question 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?

Answer 6

1. G6 P 2-1-2-3
2. G I P 2-0-0-2
3. GII P1-0-0-1

Question 7

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

Answer 7

• *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]

Question 8

What labs are performed in the first prenatal visit?

would you do a pap?

Answer 8

• 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

Question 9

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

rubella

varicella

influenza

Answer 9

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

Question 10

what is norm weight gain during prenancy?

[healthy]

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

Answer 10

25-35 lbs

Folic Acid Supplementation 0.4 mg/day

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 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?

Answer 15

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.

Question 16

What is Rhogam?

Who should get a shot of it?

Answer 16

• 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…

Question 17

Whan is Tdap given in pregnancy?

What does it prevent?

Answer 17

• 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

Question 18

what tests are done at each week thru preg?

Answer 18

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)

Question 19

What is the risk with GBS?

What is current protocol for this?

Answer 19

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]