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Women's Health Rotation > Prenatal Care/Normal Pregnancy > Flashcards

Prenatal Care/Normal Pregnancy Flashcards

(66 cards)

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1
Q

When is a pregnant woman considered to be at term?

A

37-42 wks completed gestational age

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2
Q

Latent phase of labor

A

The initial part of labor where the cervix mainly effaces (thins) rather than dilates (usually cervical dilation <6 cm)

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3
Q

Active phase of labor

A

The portion of labor where dilation occurs more rapidly, usually when the cervix is >6 cm dilation

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4
Q

Arrest of active phase

A

No progress in the active phase of labor (greater than or equal to 6 cm) with ruptured membranes for 4 hrs with adequate contractions, or 6 hrs of inadequate contractions

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5
Q

Stages of labor

A

First stage: onset of labor to complete dilation of cervix
Second stage: complete cervical dilation to delivery of infant
Third stage: delivery of infant to delivery of placenta

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6
Q

Fetal heart rate baseline

A

Normally between 110-160 bpm. Fetal bradycardia is a baseline <110 bpm, and fetal tachycardia is exceeding 160 bpm

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7
Q

Decelerations

A

Fetal heart rate episodic changes below the baseline.
3 types: early (mirror image of uterine contractions), variable (abrupt jagged dips below the baseline), and late, which are offset following the uterine contraction

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8
Q

Accelerations

A

Episodes of the fetal heart rate that increase above the baseline for at least 15 seconds

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9
Q

What are the 3 Ps that should be evaluated in labor?

A

Powers
Passenger
Pelvis

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10
Q

How are adequate uterine contractions defined?

A

Contractions every 2-3 minutes, firm on palpation, and lasting for at least 40-60 seconds

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11
Q

On a fetal heart rate monitor, what is indicative of a nomal well-oxygenated fetus?

A

A nl baseline between 110-160 bpm, with acceleration, and variability

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12
Q

What is the most common deceleration?

What does it indicate?

A

Variable

Cord compression

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13
Q

What do late decelerations along with decreased variability indicate?

A

Acidosis

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14
Q

What do late decelerations indicate?

A

Fetal hypoxia

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15
Q

What do early decelerations indicate?

A

They are benign

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16
Q

Normal duration of labor in latent phase, nullipara

A

Less than or equal to 18-20h

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17
Q

Normal duration of labor in latent phase, multipara

A

Less than or equal to 14h

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18
Q

Normal duration of labor in active phase, nullipara

A

Continued progress

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19
Q

Normal duration of labor in active phase, multipara

A

Continued progress

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20
Q

Normal duration of labor in second stage, nullipara

A

Less than or equal to 3h

Less than or equal to 4h if epidural

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21
Q

Normal duration of labor in second stage, multipara

A

Less than or equal to 2h

Less than or equal to 3h if epidural

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22
Q

Normal duration of labor in third stage, nullipara

A

Less than or equal to 30 min

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23
Q

Normal duration of labor in third stage, multipara

A

Less than or equal to 30 min

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24
Q

Category I fetal heart rate pattern

A

Reassuring- normal baseline and variability, no late or variable decelerations

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25
Category II fetal heart rate pattern
Bears watching- may have some aspect that is concerning but not ominous
26
Category III fetal heart rate pattern
Ominous and indicates a high likelihood of severe fetal hypoxia or acidosis- examples include absent baseline variablity with recurrent late or variable decelerations or bradycardia, or sinusoidal heart rate pattern (this requires prompt delivery if no improvement)
27
Reasons for C-section delivery
``` Labor dystocia Abnormal fetal heart rate pattern Fetal malpresentation Multiple gestation Suspected fetal macrosomia ```
28
What is the purpose of prenatal care?
To educate and build rapport with the pt and family Establish gestational age Screen for possible conditions that may impact maternal and fetal health Monitor the progress of the pregnancy
29
Cardiovascular changes in pregnancy
CO and plasma volume increased 50% Systemic vascular resistance decreased MAP unchanged/slightly lower Diastolic pressure decreases in 1st and 2nd trimester then returns to pre-pregnant level around 36 wks
30
Respiratory changes in pregnancy
RR unchanged Tidal volume increased Minute ventilation increased O2 consumption increases
31
ABG in pregnancy
pH 7.45 PCO2 28 HCO3 18
32
Renal changes in pregnancy
GFR increased 50% Serum Cr decreased Renal calyces, pelves, and ureters undergo marked dilation Increase in urinary stasis predisposes to UTI
33
Hematologic changes in pregnancy
Hgb decreased slightly Platelet decreased slightly Leukocyte count slightly increased
34
GI changes in pregnancy
Delayed stomach emptying Decreased lower esophageal sphincter tone Decreased gut motility- constipation Increased appetite Reflux may start or worsen Intestinal transit time increases dramatically in 3rd trimester Gallbladder dilates Appendix may be displaced to the right flank Hemorrhoids
35
Ramifications of low Hgb
Preterm delivery Low fetal iron stores Identify thalassemia
36
Next step in low Hgb
Mild therapeutic trial of iron | Moderate ferritin and Hb electrophoresis
37
Ramifications of negative rubella screen
Nonimmune to rubella
38
Next step in neg rubella screen
Stay away from sick individuals | Vaccinate postpartum
39
Ramifications of neg Rh factor screen
May be susceptible Rh disease
40
Next step with neg Rh factor screen
If antibody screen neg, give RhoGAM at 28 wk, and if baby is Rh-pos, then also after delivery
41
Ramifications of positive antibody screen
May indicate isoimmunization
42
Next step in pos antibody screen
Need to identify the antibody, and then titer
43
Ramifications of pos HIV ELISA
May indicate infection with HIV
44
Next step with pos HIV ELISA
Western blot or PCR | If pos, place pt on anti-HIV meds, offer elective Caesarean, or IV ZDV in labor
45
Ramifications of pos RPR or VDRL
May indicate syphilis
46
Next step with pos RPR or VDRL
Specific antibody such as MHA-TP, and if pos, then stage dz <1 yr, PCN x1 If >1 yr or unknown, PCN IM each wk x 3
47
Ramifications of pos gonorrhea screen
May cause preterm labor, blindness
48
Next step in pos gonorrhea screen
Ceftriaxone IM
49
Ramifications of pos chlamydia screen
May cause neonatal blindness, pneumonia
50
Next step in pos chlamydia screen
Azithromycin or amoxicillin orally
51
Ramifications of pos hep B surface antigen
Pt is infectious
52
Next step in pos hep B surface antigen
Check LFTs and hep serology to determine if chronic carrier vs active hepatitis Baby needs HBIG and hep B vaccine
53
Ramifications of pos Pap smear
Only invasive cancer would alter management
54
Next step in pos Pap smear
ASC-US: re-Pap postpartum | LGSIL, HSIL: colposcopy
55
Ramifications of pos urine culture
Asymptomatic bacteriuria may lead to pyelonephritis
56
Next step in pos urine culture
Treat with antibiotic and recheck urine culture
57
Ramifications of pos nuchaltranslucency
May indicate trisomy
58
Next step in pos nuchaltranslucency
Offer karyotype and f/u ultrasounds
59
Ramifications of pos trisomy screen
At risk for trisomy or NTD
60
Next step in pos trisomy screen
Basic u/s for dates; if dates confirmed, offer genetic amniocentesis
61
Ramifications of pos 1h diabetic screen
May indicate gestational diabetes
62
Next step in pos 1h diabetic screen
Go to 3h GTT
63
Ramifications of pos 3h GTT (2 abnormal values)
Gestational DM
64
Next step with pos 3h GTT
Try ADA diet, monitor BGs, if elevated may need meds or insulin
65
Ramifications of pos GBS culture
GBS colonizing genital tract
66
Next step in pos GBS culture
PCN during labor

Women's Health Rotation (15 decks)

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