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

Prenatal care, Norm L&D, Puerperium Flashcards

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
Q

What is the most important lab to do at 1st visit to confirm pregnancy

A

Urine HCG

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26
Q

In what population is Hgb A1C/ OGTT recommended

A

Obese

PCOS

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27
Q

Test of choice to confirm EDD

A

U/S

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28
Q

When can fetal cardiac motion be detected on transvaginal U/S

A

5.5- 6wks

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29
Q

1st trimester

A

1-12wks

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30
Q

2nd trimester

A

13-26wks

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31
Q

3rd trimester

A

27 wks to end of pregnancy

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32
Q

What is the freq of visits

A

1st 28 wks - q 4wks
28-36wks - q 2wks
36 wks to delivery - q 1wk

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33
Q

What is fetal quickening and when does it occur

A

First fetal moves
1st preg - 18 to 20 wks
≥2nd preg - 16 to 18 wks

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34
Q

When is it important to pay attention to kick counts

A

3rd trimester

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35
Q

What things are done at subsequent prenatal visits

A

Hx, PE (BP, Fetal heart tones, fundal height), extremities

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36
Q

Fundal height at pubic symphysis

A

12 wks

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37
Q

Fundal height at umbilicus

A

20 wks

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38
Q

Maneuvers done to determine position of baby’s parts

A

Leopold maneuvers

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39
Q

When are Leopold maneuvers done

A

3rd trimester

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40
Q

Routine labs during subsequent prenatal visits

A 
Urine protein and sugar
Gestational DM screen
CBC
Ab screen for Rh -ve women
Group B strep testing
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41
Q

Diagnostic test for gestational DM

A

100g 3hr OGTT

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42
Q

When do you need to start Gestational DM screen

A

24-28wks

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43
Q

What is the screening test for Gestational DM

A

50g 1hr OGTT (fail if ≥130-140)

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44
Q

How many total Rh Ab screens are done

A

2; one at initial visit and again in 3rd trimester

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45
Q

What do you do if mom has a -ve Rh screen

A

300µg Rho Gam btn 28-30 wks

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46
Q

Where do you swab for Grp B strep screen

A

Lower vagina + rectum (35-37wks) : if +ve Abx prophylaxis

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47
Q

ACOG recommendation for aneuploidy screen

A
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48
Q

1st trimester aneuploidy screen includes

A

Nuchal translucency and serum markers for Down’s synd, Trisomy 13, 18

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49
Q

Quad screen includes

A

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

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50
Q

Which lab tests are optional

A

Down’s syndrome screen

Cell free fetal DNA

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51
Q

Purpose of 1st trimester U/S

A

Dating
Location of preg, eval of bleeding/pain
True to 5-7days

52
Q

Purpose of 2nd trimester U/S

A

Fetal anatomy
Fetal growth placental location, possible sex
True to 10-14 days

53
Q

When can sex of baby be determined

A

18-20wks

54
Q

Purpose of 3rd trimester U/S

A

Fetal growth, presentation, biophysical profile

True to 3 wks

55
Q

How many extra calories do you need in pregnancy

A

300 cal /day

56
Q

Recommended weight gain for BMI

A

28-40lbs

57
Q

Recommended weight gain for BMI 18.5-24.9

A

25-35lbs

58
Q

Recommended weight gain for BMI 25-29.9

A

15-25lbs

59
Q

Recommended weight gain for BMI >30

A

11-20lbs

60
Q

Tests of fetal well being

A

Fetal movt/kick counts
Non stress test
Contraction stress test
Biophysical profile

61
Q

Common complaints of pregnancy

A 
Nausea/Vomiting
Back ache
Varicosities
HA
Hemorrhoids
Heartburn
Pica
Fatigue, vaginal discharge, round ligament pain, constipation, urinary req, sexual activity
62
Q

Recommended kick counts

A

4x/hr or 10x/2hrs

63
Q

DOC nausea

A

Diclegis after behavioral mods

64
Q

Tx hyper emesis

A

IV hydration + steroids

65
Q

Ominous signs of vaginal discharge

A

Odor or pruritis

66
Q

What are the processes of labor

A

Labor - Effacement - Dilation - Station - presenting part

67
Q

Defn. labor

A

Uterine activity that results in progressive dilation + effacement of cervix

68
Q

Defn. Effacement

A

Thining/shortening of length of cervix

69
Q

What is the normal length of the cervix

A

> 2.5cm

70
Q

Defn. Dilation

A

Diameter of cervical os in cm

71
Q

Diameter for complete dilation

A

10cm + 100% effacement

72
Q

Defn. Presenting part

A

Part of the baby coming 1st through the birth canal

73
Q

Defn. Station

A

Degree of descent of presenting part in the birth canal relative to ischial spines

74
Q

True labor

A

Regular intervals of gradually increasing freq w/ back + abd. discomfort and no relief from sedation

75
Q

Braxton Hick’s contraction (not true labor)

A

Irregular intervals and duration w/ lower abd. discomfort and relief from sedation

76
Q

components of L&D eval

A 
Review of Hx and PE
Brief Hx
Vitals
Cervical exam
Status of membranes
Fetal monitoring
77
Q

How to confirm membrane rapture

A

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
Q

Fern test

A

Air dried amniotic fluid sample under microscope shows fern pattern = +ve rapture of membranes

79
Q

pH that indicates rapture of membranes

A

6.5-8 (paper turns blue)

80
Q

1st stage of labor

A

interval btn onset of labor and full cervical dilation and effacement

81
Q

Latent phase

A

From first regular contractions to 3-4cm dilation (slow rate of dilation

82
Q

Active phase

A

From latent phase to complete dilation (rate of 1cm/hr)

83
Q

What increases the rate of 1st stage of labor

A

Parity

84
Q

2nd stage of labor

A

Complete dilation to delivery of infant (pushing phase)

85
Q

3rd stage of labor

A

After delivery of infant to delivery of placenta

86
Q

3 Ps of labor

A

Power (uterine contractions)
Passenger (size + presentation of baby)
Passage (Pelvic size)

87
Q

Adequate rate of contractions

A

3-5 in 10min

88
Q

What causes the incr in freq and strength of contractions

A

PGI E2 and F2 alpha -> incr sensitivity to circulating oxytocin

89
Q

How is power of contractions measured

A

Tocodynamometry

  • Ext (freq + duration)
  • Int = IUPC (freq + duration + intensity)
90
Q

Macrocosmic infant

A

> 4500g

91
Q

potential baby presentation

A 
Vertex
Face/Brow
Breech: Frank, complete, Footling
Transverse lie
Compound (2 fetal parts)
92
Q

What does position refer to during progress of labor

A

Relation of fetal presenting part in relation to left or right of mom’s pelvis

93
Q

Parts of the bony pelvis

A

Inlet
Midpelvis
Outlet

94
Q

Most common and best suited pelvic shape to child birth

A

Gynecoid

95
Q

Least common pelvic shape

A

Platypelloid

96
Q

Most unfavorable pelvic shape for delivery

A

Android

97
Q

Pelvic shape that has occiput presentation most common

A

Anthropoid

98
Q

Engagement

A

Passage of the widest diameter of the presenting part below plane of pelvic inlet

99
Q

Flexion

A

Head completely flexed, fetus presents smallest diameter of its head

100
Q

Descent

A

Greatest rate of descent during the latter part of 1st and 2nd stage of labor

101
Q

Internal rotation

A

Rotation of presenting part from original position to anteroposterior position as it passes through the pelvis

102
Q

Extension

A

Head extends beneath maternal pubic symphysis once the fetus descends to the level of the introitus- head delivers

103
Q

External rotation (Restitution)

A

Head rotates 45deg to line up w/ shoulders which are oblique in maternal pelvis

104
Q

Time frame for separation of placenta

A

within 30min

105
Q

What are the signs of placenta seperation

A

Uterus rises in abdomen
Globular configuration
Gush of blood/lengthening of umbilical cord

106
Q

Indications for manual separation of placenta

A
  • Doesnt separate spontaneously

- Bleeding

107
Q

How is fetal monitoring done

A

External ultrasound transducer

Int scalp ECG electrode

108
Q

Baseline fetal heart rate

A

120-160
Tachycardia 160-180
Bradycardia 100-120

109
Q

Short term heart rate variability

A

Variation in amplitude beat to beat

110
Q

Long term heart rate variability

A

Wave like pattern that changes 4-6 cycles/min

111
Q

Periodic acceleration of heart rate

A

incr 15bpm above baseline for 15sec

112
Q

Periodic deceleration

A

Early: head compression, physiologic
Variable: Cord compression,
Late: Fetal hypoxia/placental insuff/maternal hypotension , ominous

113
Q

1st degree obstetric laceration

A

Vaginal mucosa/perineal skin but no underlying tissue

114
Q

2nd degree obstetric laceration

A

Underlying SQ tissue but not rectal

115
Q

3rd degree obstetric laceration

A

Extends through rectal sphincter

116
Q

4th degree obstetric laceration

A

Extends into rectal mucosa

117
Q

Determination of successful likelihood of induction

A

Bishop score 9-13 points

118
Q

What factors are used in the determination of Bishop score

A 
Dilation
Effacement,
Station
Cervical consistency
Position of cervix
119
Q

Ways in which labor can be induced

A 
Stripping membranes
Amniotomy
Prostaglandin gel
Oxytocin
Misoprostol
120
Q

What are the complications of using oxytocin

A

uterine hyperstim (>5contractions in 10min) fetal distress, water intoxication

121
Q

Puerperium

A

6wk period following delivery of baby + placenta

122
Q

What anatomic resolutions happen during puerperium

A
  • 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
Q

How long does mom stay in the hospital after the baby

A

Vaginal: 1-2 days

C-section: 2-4 days

124
Q

When is the first postpartum exam

A

4-6wks

125
Q

What is lactation supression

A

Someone who doesnt want to nurse

126
Q

When is colostrum produced

A

1st day of lactation

127
Q

When is mature milk produced

A

After day 3-5

Women's Health (4 decks)

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