Prenatal Diagnosis and Care Flashcards
(76 cards)
1
Q
First trimester
A
1st 14 weeks GA
2
Q
Gestational Age
A
age in days or weeks from the last menstrual period
3
Q
Second trimester
A
14-28 weeks GA
4
Q
Third trimester
A
28 weeks until delivery
5
Q
Previable
A
infant delivered before 24 weeks
6
Q
Preterm
A
24-37 weeks
7
Q
Term
A
37-42 weeks
8
Q
Post term
A
past 42 weeks
9
Q
What happens to moms cardiovascular system when pregnant
A
- CO increases by 30 to 50%
- stroke volume increases 10 to 15%
- pulse increases 15 to 20 bpm
- systolic ejection murmur and S3 gallop common
10
Q
What happens to a pregnant womans blood pressure
A
- peripheral vascular resistance falls
- fall in BP in 2nd trimester, returns to normal in 3rd
11
Q
What parts of the respiratory system remain unchanged during pregnancy
A
- respiratory rate
- vital capacity
- inspiratory reserve volume
12
Q
What parts of the respiratory system change during pregnancy
A
Decreased: functional residual capacity, expiatory reserve volume, residual volume, total lung capacity
Increased: inspiratory capacity, tidal volume
13
Q
Normal ABG from a pregnant lady
A
pH: 7.44, pCO2=30, bicarb=20-25, pO2>=100
14
Q
What happens to the renal system during pregnancy
A
- increase kidney size and weight
- ureteral dilation
- bladder becomes intra abdominal organ
- GFR increases 50%
- creatinine clearence increases 150 to 200 cc/min
- BUN and SCr decrease by 25%
- increase in renin and angiotensin
- increased glucose excretion
15
Q
What happens to the hematologic system during pregnancy
A
- plasma volume increases by 50%
- RBC volume increases by about 30%
- WBC count increases
- platelets decrease
- increased levels of fibrogen, factor Vii-X
- placenta produces plasminogen activator inhibitor
16
Q
What happens to the GI system during pregnancy
A
- decreased motility
- reduced gastric acid secretion
17
Q
TVUS shows gestational sac as early as ___ wks or Hcg of ___. Fetal HR as early as ___ or Hcg of ___.
A
gestational sac: 5wks or Hcg of 1,500-2,000
FHR: 6 wks or Hcg of 5,000-6,000
18
Q
Chadwick’s sign
A
bluish discoloration of vagina and cervix
19
Q
Hegar’s sign
A
softening of uterine consistency and ability to palpated or compress the connection between the cervix and the fundus
20
Q
Goodell’s sign
A
softening and cyanosis of cervix at or after 4 weeks
21
Q
Ladin’s sign
A
softening of the uterus after 6 weeks
22
Q
Signs of pregnancy
A
- breast swelling and tenderness
- linea nigra
- telangiectasias
- palmar erythema
23
Q
What is Nagele’s rule
A
calculate EDC by subtracting 3 months from the LMP and adding 7 days
24
Q
First trimester labs
A
- CBC
- blood type and screen
- RPR/VDRL
- rubella antibody screen
- hep B surface antigen
- VZV titer
- STD cultures
- PPD
- pap smear
- urine
25
When do you check CBC in pregnancy
initial labs and 28 weeks
26
When should you consider thalaseemia in pregnancy
if MCV low
27
Normal CBC findings with pregnancy
- slightly elevated WBC
- dilutional anemia
- thrombocytopenia
28
What do you do if pt is Rh negative
Rhogam at 28 weeks or anytime she has vaginal or uterine bleeding
29
What do you do if Rh antibodies are found
consult perinatologist: Rh antibodies cause fetal red blood cells to be destroyed causing hemolytic anemia
30
What do you do if gonorrhea and chlamydia is positive
treat pt and partner, promote abstinence during treatment and test again 4 weeks after treatment
31
If RPR/VDRL is reactive what do you do next
Fluorescent treponemal antibodi absorption- check presence of antibody to bacteria that causes syphilis
32
What do you do if pt is non immune to rubella
administer vaccine post partum
33
HBsAb shows what
recovery and immunity
34
HBeAg shows what
acute infection
35
What is acute hep B infection diagnosed by
IgM HbcAb
36
What is chronic hep B infection diagnosed with
IgG HBcAb
37
Advanced maternal age
women over he age of 35
38
What should be offered to pregnant women of advanced maternal age
- maternal serum screening
| - genetic counseling with possible diagnostic tests
39
Elevated MSAFP during the second trimester tells you
increased risk of NT defects
40
Decreased MSAFP in second trimesters tells you
aneuploidies including down syndrome
41
What is a quad screen
test done during the second trimester
includes MSAFP, HCG, estriol, inhibin-A
42
When is a quad screen done
between 15-18 weeks
43
When can you not do a quad screen
multiple gestations
44
What do you do if quad screen is positive
- refer for genetic counseling
- high resolution US
- +/- amniocentesis
45
What does cffDNA test for
fetal trisomies- 21,18,13
46
When should cffDNA be done
- maternal age over 35
- FUS findings indicating an increased risk of aneuploidy
- hx of prior pregnancy w/ trisomy
- postive rest result for aneuploidy
- parental balanced robertsonian translocation with increased risk of fetal trisomy 13 or 21
47
When should ultrasounds be done during pregnancy
- at minitial visit to measure CRL if uncertain LMP
- first trimester bleeding
- anatomy survey between 18 and 20 weeks
- any time fundal height is >3cm discrepant from GA
- confirm presentation at or after 37 weeks
48
When is amniocentesis done? Why?
done between 15-20 weeks to obtain fetal karyotype
49
What are the complications of an amniocentesis
- transient vaginal spotting
- amniotic fluid leakage
- preterm labor
- chorioamnionitis
- rarely needle injury to fetus
50
When is chorionic villus sampling done? Why?
done between 10-13 weeks to obtain a fetal karyotypes
51
How is a CVS done
catheter placed into intrauterine cavity and small amount of chrorionic villi aspirated from placenta
52
Complications of CVS
- preterm labor
- PROM
- previable delivery
- fetal injury
53
Cordocentesis
percutaneous umbilical blood sampling
54
When is PUBS done
rarely done but may be useful to further evaluate chromosomal mosaicism discovered after CVS or amniocentesis
55
Diagnostic done during the third trimester
- CBC
- GLT
- RPR/VDRL
- CXR if PPD+
- group B strep culture
if high risk:
- repeat gonorrhea and chlamydia
- HSV screening
56
When is group B strep culture done
36 weeks, culture from lower vagina and anus (swab must go through sphincter)
57
What things are done at all routine prenatal visits
- BP
- weight
- urine (protein and glucose)
- fundal height, estimated fetal weight, fetal position)
- asculatation of fetal heart tones
58
When should a pregnant woman have routine prenatal visits
less than 28 weeks: every 4 weeks
28-36 weeks: every two weeks
>36 weeks: every weeks
59
How much folic acid should a pregnant lady be having
800 mcg
60
What supplements should be avoided in pregnancy
excessive fat soluble vitamins (A,D,E,K)
61
Caffeine limit in pregnancy
500mg/day
62
How many calories hsould be consumed a day in pregnancy? Protein? Iron? Calcium?
increase 15% kcal/day (2200)
additional 10-30 g protein
30-60 mg iron
1200mg calcium
63
Average weight gain during pregnancy
25 to 35 pounds
64
Indication for fetal movement assessment
maternal perception of decreased or absent fetal movement
65
What does a fetal non stress test measure? What is normal? Abnormal?
-measurement of fetal heart rate with movement
normal=2 or more fetal heart rate accelerations within a 20 minute period
nonreactive=insufficient fetal heart rate accelerations over a 40 min period
66
What does a contraction stress test look for
the presence or absence of late fetal heart rate decelerations in response to uterine contractions
67
What are late decels
decels that reach their nadir after the peak of the contractions and usually persist beyond the end of the contraction
68
Variable decels= ???
cord compression
69
What are the components of a biophysical profile
- NST
- fetal breathing movements
- fetal movements
- fetal done
- AFI (amniotic fluid index)
70
Scoring of the biophysical profile
each component gets a 2 or 0
normal: 8 or 10
equivocal: 6
abnormal: 4 or less
71
What is the amniotic fluid index
summation of the largest cord-free vertical pockets in each of the 4 quadrants of an equally divided uterus
72
Oligohydramnios
no US measured pocket of fluid >2cm
OR
AFI of 5 cm or less
73
Polyhydramnios is an AFI of
typically greater than 24 cm
74
Polyhydramnios can cause what two things
PROM or malpresentation
75
Postpartum visits for vaginal delivery. Cesarean.
Vaginal: at 6 weeks
Cesarean: 2 and 6 weeks
76
When should you consider sooner post -partum followup appointments
if complications present (3rd or 4th degree tear, HTN)
