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Women's Health > Prenatal care, Norm L&D, Puerperium > Flashcards

Prenatal care, Norm L&D, Puerperium Flashcards

(127 cards)

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1
Q

What is the goal of prenatal care

A

healthy mom healthy baby

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2
Q

What factors are taken into consideration for preconception care

A 
BMI
Age
Medical Hx
Reproductive use
Family Hx
Substance use
Nutrition
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3
Q

What factor must be included in the preconception phyical

A

check for dental carries

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4
Q

What labs are indicated for preconception care

A

Routine HIV, Rubella/Varicella titer, HepB Ag, RPR, Gonorrhea, Chlamydia, CBC
FBS, Hb A1C, HepC Ab, TB skin test, CF carrier stat, Tay Sachs

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5
Q

What vaccinations are contraindicated in pregnancy

A

MMR

Varicella

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6
Q

When do you give Rubella vaccine if the titer is negative

A

After the baby is born

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7
Q

What is the preconception recommendation for folic acid

A

0.4-0.8mg daily

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8
Q

When does a pregnant woman need a daily folic acid dose of 4mg

A

+ve Hx of neural tube defects

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9
Q

What are the recommendations for preconception care

A 
Daily folic acid
Abstain from alcohol + smoking
Prevent HIV
Good control of medical illnesses
Keep menstrual diary
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10
Q

When is the first prenatal care visit recommended

A

Btw 6-7wks, no later than 10wks (1st trimester)

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11
Q

What happens at 1st prenatal visit

A 
Full Hx (including inheritable dz)
Gyn Hx (STD, PID, Abn pap)
Obstetric Hx -G, P (TPAL)
Social Hx (domestic violence, tobacco, alcohol, rec drug use, barriers to prenatal care)
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12
Q

What does LMP mean

A

First day of last menstrual period

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13
Q

EDC

A

Estimated date of confinement

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14
Q

EDD

A

Estimated date of delivery

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15
Q

How do you calculate EDC

A

Naegele’s rule

LMP + 7days - 3mos

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16
Q

Term gestation

A

37 weeks

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17
Q

Early term

A

37-0 to 38-6

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18
Q

Full term

A

39-0 to 40-6

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19
Q

Late term

A

41-0 to 41-6

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20
Q

Post term

A

≥ 42-0

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21
Q

What is the most important thing to determine during the 1st trimester gen physical exam

A

BMI, >30 = obesity = high risk

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22
Q

Chadwick’s sign

A

Bluish/purplish coloration of vagina/cervix

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23
Q

Hegar’s sign

A

Palpable softening at isthmus

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24
Q

Pelvic exam findings for 1st visit

A
  • Uterine shape/size/adnexa
  • Chadwick’s sign
  • Hegar’s sign
  • Clinical pelvimetry
  • Specimen collection : Pap, Chlamydia + gonorrhea swab
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25
What is the most important lab to do at 1st visit to confirm pregnancy
Urine HCG
26
In what population is Hgb A1C/ OGTT recommended
Obese | PCOS
27
Test of choice to confirm EDD
U/S
28
When can fetal cardiac motion be detected on transvaginal U/S
5.5- 6wks
29
1st trimester
1-12wks
30
2nd trimester
13-26wks
31
3rd trimester
27 wks to end of pregnancy
32
What is the freq of visits
1st 28 wks - q 4wks 28-36wks - q 2wks 36 wks to delivery - q 1wk
33
What is fetal quickening and when does it occur
First fetal moves 1st preg - 18 to 20 wks ≥2nd preg - 16 to 18 wks
34
When is it important to pay attention to kick counts
3rd trimester
35
What things are done at subsequent prenatal visits
Hx, PE (BP, Fetal heart tones, fundal height), extremities
36
Fundal height at pubic symphysis
12 wks
37
Fundal height at umbilicus
20 wks
38
Maneuvers done to determine position of baby's parts
Leopold maneuvers
39
When are Leopold maneuvers done
3rd trimester
40
Routine labs during subsequent prenatal visits
``` Urine protein and sugar Gestational DM screen CBC Ab screen for Rh -ve women Group B strep testing ```
41
Diagnostic test for gestational DM
100g 3hr OGTT
42
When do you need to start Gestational DM screen
24-28wks
43
What is the screening test for Gestational DM
50g 1hr OGTT (fail if ≥130-140)
44
How many total Rh Ab screens are done
2; one at initial visit and again in 3rd trimester
45
What do you do if mom has a -ve Rh screen
300µg Rho Gam btn 28-30 wks
46
Where do you swab for Grp B strep screen
Lower vagina + rectum (35-37wks) : if +ve Abx prophylaxis
47
ACOG recommendation for aneuploidy screen
48
1st trimester aneuploidy screen includes
Nuchal translucency and serum markers for Down's synd, Trisomy 13, 18
49
Quad screen includes
Down's synd, Trisomy 13, 18, neural tube defects (serum markers: AFP, HCG, inhibin A) done btn 15-18 wks or as late as 22wks
50
Which lab tests are optional
Down's syndrome screen | Cell free fetal DNA
51
Purpose of 1st trimester U/S
Dating Location of preg, eval of bleeding/pain True to 5-7days
52
Purpose of 2nd trimester U/S
Fetal anatomy Fetal growth placental location, possible sex True to 10-14 days
53
When can sex of baby be determined
18-20wks
54
Purpose of 3rd trimester U/S
Fetal growth, presentation, biophysical profile | True to 3 wks
55
How many extra calories do you need in pregnancy
300 cal /day
56
Recommended weight gain for BMI
28-40lbs
57
Recommended weight gain for BMI 18.5-24.9
25-35lbs
58
Recommended weight gain for BMI 25-29.9
15-25lbs
59
Recommended weight gain for BMI >30
11-20lbs
60
Tests of fetal well being
Fetal movt/kick counts Non stress test Contraction stress test Biophysical profile
61
Common complaints of pregnancy
``` Nausea/Vomiting Back ache Varicosities HA Hemorrhoids Heartburn Pica Fatigue, vaginal discharge, round ligament pain, constipation, urinary req, sexual activity ```
62
Recommended kick counts
4x/hr or 10x/2hrs
63
DOC nausea
Diclegis after behavioral mods
64
Tx hyper emesis
IV hydration + steroids
65
Ominous signs of vaginal discharge
Odor or pruritis
66
What are the processes of labor
Labor - Effacement - Dilation - Station - presenting part
67
Defn. labor
Uterine activity that results in progressive dilation + effacement of cervix
68
Defn. Effacement
Thining/shortening of length of cervix
69
What is the normal length of the cervix
>2.5cm
70
Defn. Dilation
Diameter of cervical os in cm
71
Diameter for complete dilation
10cm + 100% effacement
72
Defn. Presenting part
Part of the baby coming 1st through the birth canal
73
Defn. Station
Degree of descent of presenting part in the birth canal relative to ischial spines
74
True labor
Regular intervals of gradually increasing freq w/ back + abd. discomfort and no relief from sedation
75
Braxton Hick's contraction (not true labor)
Irregular intervals and duration w/ lower abd. discomfort and relief from sedation
76
components of L&D eval
``` Review of Hx and PE Brief Hx Vitals Cervical exam Status of membranes Fetal monitoring ```
77
How to confirm membrane rapture
Sterile speculum Pooling of amniotic fluid in vagina Direct visualization of fluid leakage thru cervix when asked to cough or bear down Nitrazine test
78
Fern test
Air dried amniotic fluid sample under microscope shows fern pattern = +ve rapture of membranes
79
pH that indicates rapture of membranes
6.5-8 (paper turns blue)
80
1st stage of labor
interval btn onset of labor and full cervical dilation and effacement
81
Latent phase
From first regular contractions to 3-4cm dilation (slow rate of dilation
82
Active phase
From latent phase to complete dilation (rate of 1cm/hr)
83
What increases the rate of 1st stage of labor
Parity
84
2nd stage of labor
Complete dilation to delivery of infant (pushing phase)
85
3rd stage of labor
After delivery of infant to delivery of placenta
86
3 Ps of labor
Power (uterine contractions) Passenger (size + presentation of baby) Passage (Pelvic size)
87
Adequate rate of contractions
3-5 in 10min
88
What causes the incr in freq and strength of contractions
PGI E2 and F2 alpha -> incr sensitivity to circulating oxytocin
89
How is power of contractions measured
Tocodynamometry * Ext (freq + duration) * Int = IUPC (freq + duration + intensity)
90
Macrocosmic infant
>4500g
91
potential baby presentation
``` Vertex Face/Brow Breech: Frank, complete, Footling Transverse lie Compound (2 fetal parts) ```
92
What does position refer to during progress of labor
Relation of fetal presenting part in relation to left or right of mom's pelvis
93
Parts of the bony pelvis
Inlet Midpelvis Outlet
94
Most common and best suited pelvic shape to child birth
Gynecoid
95
Least common pelvic shape
Platypelloid
96
Most unfavorable pelvic shape for delivery
Android
97
Pelvic shape that has occiput presentation most common
Anthropoid
98
Engagement
Passage of the widest diameter of the presenting part below plane of pelvic inlet
99
Flexion
Head completely flexed, fetus presents smallest diameter of its head
100
Descent
Greatest rate of descent during the latter part of 1st and 2nd stage of labor
101
Internal rotation
Rotation of presenting part from original position to anteroposterior position as it passes through the pelvis
102
Extension
Head extends beneath maternal pubic symphysis once the fetus descends to the level of the introitus- head delivers
103
External rotation (Restitution)
Head rotates 45deg to line up w/ shoulders which are oblique in maternal pelvis
104
Time frame for separation of placenta
within 30min
105
What are the signs of placenta seperation
Uterus rises in abdomen Globular configuration Gush of blood/lengthening of umbilical cord
106
Indications for manual separation of placenta
- Doesnt separate spontaneously | - Bleeding
107
How is fetal monitoring done
External ultrasound transducer | Int scalp ECG electrode
108
Baseline fetal heart rate
120-160 Tachycardia 160-180 Bradycardia 100-120
109
Short term heart rate variability
Variation in amplitude beat to beat
110
Long term heart rate variability
Wave like pattern that changes 4-6 cycles/min
111
Periodic acceleration of heart rate
incr 15bpm above baseline for 15sec
112
Periodic deceleration
Early: head compression, physiologic Variable: Cord compression, Late: Fetal hypoxia/placental insuff/maternal hypotension , ominous
113
1st degree obstetric laceration
Vaginal mucosa/perineal skin but no underlying tissue
114
2nd degree obstetric laceration
Underlying SQ tissue but not rectal
115
3rd degree obstetric laceration
Extends through rectal sphincter
116
4th degree obstetric laceration
Extends into rectal mucosa
117
Determination of successful likelihood of induction
Bishop score 9-13 points
118
What factors are used in the determination of Bishop score
``` Dilation Effacement, Station Cervical consistency Position of cervix ```
119
Ways in which labor can be induced
``` Stripping membranes Amniotomy Prostaglandin gel Oxytocin Misoprostol ```
120
What are the complications of using oxytocin
uterine hyperstim (>5contractions in 10min) fetal distress, water intoxication
121
Puerperium
6wk period following delivery of baby + placenta
122
What anatomic resolutions happen during puerperium
* Uterus from 1000g to 50-100g * Cervix loses vascularity, glandular hypertrophy, hyperplasia * Ovarian fxn resumes (+/- period; affected by lactation = 3mos) * Vagina vault dear in size, thin inelastic walls
123
How long does mom stay in the hospital after the baby
Vaginal: 1-2 days | C-section: 2-4 days
124
When is the first postpartum exam
4-6wks
125
What is lactation supression
Someone who doesnt want to nurse
126
When is colostrum produced
1st day of lactation
127
When is mature milk produced
After day 3-5

Women's Health (4 decks)

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