Prenatal Care and Screening Flashcards
(20 cards)
msAFP in…
NTDs, abdominal wall defects, cystic hygroma, oligohydramnios
msAFP in…
–chromosomal trisomies (21, 18), molar pregnancy
Elevated msAFP
- -NTDs, abdominal wall defects, cystic hygroma
- -multiple gestations
Low msAFP
- -trisomy 21, trisomy 18
- -molar pregnancy
Four markers in the quad screen?
What weeks?
Quad Screen
–(15-21 weeks gestation)
- msAFP
- hCG
- inhibin A
- unconjugated estriol
Identify the teratogen exposure:
- oligohydramnios, renal tubule dysgenesis, neonatal renal failure, skill anomalies, liimb defects
- heart and great vessel defects
- skeletal defects, limb defects
- facial defects, NTDs
- IUGR, microcephaly, facial defects, excess hair, fingernail hypoplasia
- CNS and skeletal defects
- Valproic acid, carbamazepine can cause?
Identify the teratogen exposure:
- ACE Inhibitor
- -oligohydramnios, renal tubule dysgenesis, neonatal renal failure, skill anomalies, liimb defects - Lithium
–heart and great vessel defects (Ebstein anomaly)
(atrialized R ventricle, ASD) - Methrotrexate
- -skeletal defects, limb defects - Retinoic Acid
- -facial defects, NTDs - Phenytoin (Dilantin)
- -IUGR, microcephaly, facial defects, excess hair, fingernail hypoplasia - Warfarin
- -CNS, skeletal defects - Valproic Acid, Carbamazepine
- -NTDs
Antenatal Testing of Fetal Well-Being
- definition of formally reactive NST
- Biophysical Profile includes NST + what 4 other measurements?
- definition of normal Contraction (Oxytocin) Stress Test
Antenatal Testing of Fetal Well-Being
- NST, formally reactive: at least 2 accelerations of 15+ beats lasting for at least 15 sec
- BPP: amniotic fluid volume, fetal tone, fetal activity, fetal breathing movements + NST
- CST: at least 3 contractions in 10 minute period; with no late or recurrent variable decelerations
Most accurate mode for determining EGA?
–re: modality, measurement, trimester
Ultrasound; crown-rump length; 1st trimester
Universal screening of pregnant women for which 3 STIs?
Screening for other STIs is based on risk factors.
Universal screening: syphillis, HIV, Hep B
- Syphillis screening
- -screening test with VDRL or RPR
- -confirm with FTA
- What group on abx are contraindicated in pregnant women due to risk of harm to teeth and bones of fetus?
- In this group, what should be limited so as to avoid a photosensitivity reaction?
Doxycyclines
–risk of harm to fetus’ teeth and bones
*When taking tetracyclines, sun exposure can lead to a photosensitivity reaction.
In fetus: bilateral renal agenesis, anhydramnios, contractures, and pulmonary hypoplasia
Potter Syndrome
renal agenesis –> anhydramnios –> contractures, pulmonary hypoplasia
Embryology: which germ layer?
- gastrointestinal, respiratory systems
- cardiovascular, musculoskeletal, genitourinary systems
- nervous system, skin, sensory organs (hair, eyes, nose, ears)
Embryology: germ layers
- endoderm
- -gastrointestinal, respiratory systems - mesoderm
- -cardiovascular, musculoskeletal, genitourinary systems - ectoderm
- -nervous system, skin, sensory organs (hair, eyes, nose, ears)
Syndrome?
–clenched fists, overlapping digits, rocker bottom feet; cardiac defects
What are the 3 markers?
Edwards Syndrome (Trisomy 18)
- -decreased MSAFP
- -decreased estriol
- -decreased b-hCG
HIV in Pregnancy
- Prenatal: maternal HAART therapy
- -2 drugs from what class?
- -1 drug from which of two classes? - Intrapartum: IV admin of what drug?
- C-section should be considered at what maternal viral load?
- Post-partum: What NRTI should be administered to the neonate following delivery for at least 6 wks?
HIV in Pregnancy
- Prenatal: maternal HAART therapy
- -2 NRTIs
- -1 nNRTI or 1 protease inhibitor - Intrapartum: IV zidovudine
- maternal viral load > 1,000 –> C-section
- Post-partum: Zidovudine admin to neonate
Biophysical Profile
- Five components?
- Normal score?
- Score that is an indication for delivery?
Biophysical Profile
- Five components
- -NST (reactive)
- -AFI (AFI > 5)
- -Fetal movements (3+ movements)
- -Fetal tone (1+ movement of flexion/extension)
- -Fetal breathing movements (1+ movements for 30s) - Normal score = 8+
- Score = 4 or less –> delivery
Timing of chorionic villus sampling?
Timing of amniocentesis?
Timing of 2nd trimester ultrasound?
Timing of quad screen?
Timing of cell-free fetal DNA?
CVS: 10-13 wks
Amniocentesis: 15-20 wks
2nd trimester ultrasound: 18-21 wks
Quad screen: 15-20 wks
cell free fetal DNA (cffDNA): 10+ wks
IUGR: symmetric, asymmetric
Which type of IUGR occurs prior to 20 wks?
Which type of IUGR occurs after 20 wks?
IUGR
Symmetric IUGR (prior to 20 wks)
- -hyperplastic growth prior to 20 wks
- -insult has symmetrical effect
Asymmetric IUGR (after 20 wks)
- -hypertrophic growth after 20 wks
- -decreased nutrient transmission across placenta –> nutrients shunted to fetal brain –> increased head-to-abdominal measurements
IUGR: symmetric, asymmetric
Symmetric IUGR usually occurs prior to 28 weeks.
- -usually due to FETAL factors
- -chromosomal abnormalities
- -congenital anomalies
- -congenital infections
Asymmetric IUGR
- -fetal adaptation to suboptimal MATERNAL factors
- -etiologies associated with vascular disease: HTN, diabetes, preeclampsia, smoking
- -shunting of blood to vital organs –> increased head-to-abdominal measurements
Most common infectious etiology?
IUGR: symmetric, asymmetric
Symmetric IUGR usually occurs prior to 28 weeks.
- -FETAL etiology
- -chromosomal abnormalities
- -congential anomalies
- -congential infections
Asymmetric IUGR
- -fetal adaption to suboptimal MATERNAL factors
- -etiologies associated with vascular disease: HTN, diabetes, preeclampsia, smoking
- -shunting of blood to vital organs –> increased head-to-abdominal measurements
Cytomegalovirus – most common infection
Women with hx of genital herpes infection should receive prophylactic acyclovir or valacyclovir at how many weeks?
Pregnant women with hx of genital herpes
- -prophylactic acyclovir or valacyclovir at 36 weeks
- -reduces risk of outbreak at time of delivery, thus reducing risk of C-section
- does NOT reduce risk of neonatal infection
Mode of inheritance?
- Osteogenesis Imperfecta
- Sickle Cell
- Complete androgen insensitivity
- G6PD deficiency
- Diabetes Insipidus
Mode of Inheritance
- Osteogenesis Imperfecta – AD
- Sickle Cell – AR
- Complete androgen insensitivity – XLR
- G6PD deficiency – AR
- Diabetes insipidus – XLR
Mode of inheritance?
- Cystic Fibrosis
- Achondroplasia
- Hemophilia A
- Congenital Adrenal Hyperplasia
- Tay-Sachs
Mode of Inheritance
- Cystic Fibrosis – AR
- Achondroplasia – AD
- Hemophilia A – XLR
- Congenital Adrenal Hyperplasia – AR
- Tay-Sachs – AR
- Trisomy 21
- -Which two markers are decreased?
- -Which two markers are increased? - Trisomy 18
- -Which three markers are decreased?
- -Which marker is normal-low? - NTD
- -Which marker is increased?
- -the other markers are normal
Trisomy 21 (Down Syndrome)
- -decreased msAFP, estriol
- -increased hCG, inhibin
- -often associated with duodenal atresia
Trisomy 18 (Edwards Syndrome)
- -decreased msAFP, estriol, hCG
- -normal-low inhibin
NTD
- -increased msAFP
- -normal estriol, hCG, inhibin
What type of culture is used to screen for GBS? When is it performed?
When during pregnancy should anti-D immune globulin be administered to an Rh- mother?
When should pregnant women be screened for asymptomatic bacteriuria?
GBS Screening
–rectovaginal culture at 35-37 weeks (3-5 weeks prior to EDC)
Anti-D immune globulin prophylaxis
- -28-32 weeks
- for potentially Rh-positive fetus
- -administer again within 72 hours of delivery of Rh-positive infant
