Uncomplicated pregnancy Flashcards
(65 cards)
1
Q
at home tests are
A
qualitative. only positive or negative
2
Q
if more specificity is needed, use what hCG test?
A
quantitative
3
Q
1,000 quan. hCG
A
5 weeks
4
Q
2,500 quan. hCG
A
6 weeks
5
Q
5,000 quan. hCG
A
7 weeks
6
Q
15,000 quan. hCG
A
8 weeks
7
Q
what’s the average length of pregnancy?
A
266 days after conception, 280 days after 1st day of last menstrual period
8
Q
The first trimester is
A
conception - 13 weeks
most pregnancy losses here
9
Q
second trimester is
A
14-27 weeks (with lots of changes)
10
Q
third trimester is
A
28-40 weeks
11
Q
estimated delivery date = last menstrual period + 7 days - 3 months (+1 year)
A
Naegele’s Rule
12
Q
what helps determine the exact age of fetus, assist in diagnosis of abnormal pregnancies, and miscarriages?
A
quantitative hCG
13
Q
how are fetal heart tones detected?
A
doppler
normal = 110-160
14
Q
what week do you want to aim for at minimum before delivery?
A
28 weeks
15
Q
What is quickening?
A
first fetal movement felt
16
Q
how is quickening different in nulliparous versus multiparas?
A
18-22w for nulliparous
14-18w for multiparas
17
Q
what is most accurate for pregnancy dating +/-5 days?
A
crown rump length on US
starting at 6 or 7 weeks of pregnancy up until 14 weeks
18
Q
fundal height can also be used to measure
A
length of pregnancy
19
Q
can you give live immunizations in pregnancy?
A
no
but give inactivated!
20
Q
what vaccines are safe in pregnancy?
A
COVID
Hep B
influenza
TDAP
21
Q
What vaccines are CI in pregnancy?
A
HPV
MMR
pneumococcal
varicella
22
Q
grand multigravida
A
pregnant 5+ times
23
Q
grand multipara
A
already delivered by 5 or more infants
24
Q
postterm delivery
A
> /= 42 weeks
25
term delivery
37-41 weeks
26
premature delivery
28-36 weeks
27
immature delivery
22-27 weeks
28
non-viable delivery
<22 weeks
29
abortion is loss before
20 weeks
30
a stillbirth is an intrauterine fetal death before or during labor
>/= 20 weeks gestation
31
what is essential to evaluate during the first trimester ?
history, physical exam
risk factors! tobacco, drugs/alcohol, advanced maternal age, obstetrical history, STDs, health issues
32
are these drugs safe:
alcohol
andorgens
ARBs
antiepileptics
benzos
cyclophosphamide
disulfiram
estrogens
lithium
methotrexate
NSAIDs (3rd)
opioids
sulfonamides
tetraycycline
thalidomde
smoking
warfarin
no
33
What are prenatal vitamins to recommend?
folic acid!!!!!!!!!!!!
iron!!!!
ca, c, d, b1, b2, b3, b12, e, iodine, zinc
34
What are risk factors for pregnancy complications?
tobacco, drugs, alcohol, advanced maternal age, OB history, STDs, health
35
what is a biophysical profile?
fetal heart monitoring + fetal US to assess baby's well being
NST, fetal breathing, tones, gross body movement, amniotic fluid levels
36
what does the non-stress testing look for?
fetal heart response to fetal movements
reactive NST >/= 2 accelerations of FH in 20 minutes OR FHR >/= 15 bpm from baseline >/= 15 seconds (want)
nonreactive = no FH acceleration
37
what does the contraction stress testing test for?
measures FHR during uterine contractions (requires 3 contractions in 10 minutes)
to make sure baby can get oxygen needed from placenta during labor but this is rarely done!
38
what are contraindications for induction?
abnormal lie (transverse) or presentation (breech), prior c section, prior uterine rupture, placenta previa and vasa previa, umbilical cord prolapse, active genital herpes
39
which ⇒Episiotomy has a higher risk of fourth grade tear?
midline
40
what are complications of a C section?
fetal; breathing problems (transient tachypnea), surgical injury
maternal: infection (endometritis), postpartum hemorrhage, reactions to anesthesia, blood clots, wound infection, surgical injury, increased risk
41
what are risks of episiotomy?
uncomfortable recovery
extensive incision
infection is possible
pain during sex in months after delivery
midline = fourth degree tear
fecal incontinence
42
what are complications of induction?
maternal: failure with increased risk of c section, uterine inertia and prolonged labor, tumultous labor and tetanic contractions of uterus that can cause premature separation of placenta, rupture of uterus, laceration of cervix, intrauterine infection, postpartum hemorrhage
fetal: prematurity if EDC inaccurately calculated, prolapse of cord following amniotomy, fetal heart rate abnormalities, delivery of baby with poor Apgar scores
43
the highest fundal height should be at the ---- at 20-22 weeks
umbilicus
44
Amenorrhea, breast enlargement & tenderness, fatigue, syncope/vertigo, urinary frequency
N/V → hyperemesis gravidarum
Palpable fetal movements, elevated basal body temperature
Skin: Chloasma (darkening of forehead, nose, cheekbones), linea nigra (umbilicus to pubis), striae, spider telangiectasias
pregnancy
45
what are risk factors for a complicated pregnancy?
Tobacco, drugs/alcohol, advanced maternal age, obstetrical history, STDs, health issues
46
Pelvic exam:
Chadwick’s sign (bluish discoloration of vagina and cervix after 8-12 weeks)
Hegar’s sign (widening and softening of body/isthmus of uterus after 6-8 weeks)
Ladin’s sign (softening of the uterus after 6 weeks)
Leukorrhea, relaxation of joints and pelvic ligaments, abdominal enlargement, contractions
pregnancy
47
Quantitative hCG can be read as soon as
5 days
serial quantitative levels can be used to evaluate abortion, doubles every 2 days
48
what are the timelines for qualitative hCGs?
Serum = 7-12 days after conception
Urine = 14 days after conception
49
XR: fetal bones >/= 14 weeks of gestation
US: vaginal probe in 1st trimester, abdominal probe >12 weeks
→ gestational sac at 5-5.5wks
→ 2mm embryo at 5.5-6 weeks
→ cardiac activity at 5.5-6 weeks
Handheld doppler for fetal heart tones after 10 weeks
Normal = 110-160, higher earlier
pregnancy
50
What do the 1st trimester checkups involve?
complete history + PE, address risk factors
Recommend prenatal vitamins, patient education
Weight, BP, urine dip
LABS: routine testing
SCREENING:
-maternal serum screening (11-13 weeks)
Free b-hCG
PAPP-A (low = down syndrome)
-cell-free DNA testing (10+)
-chorionic villus sampling (10-13w) - especially for women with increased risk of chromosomal abnormality
IMAGING: TVUS to confirm IUP, gestation age
51
how often do you have checkups in the first trimester?
every 4 weeks
52
What do the 2nd trimester checkups involve?
LABS/SCREENING:
-maternal alpha-fetoprotein (16-18w) (high = neural tube defects)
-triple/quad screening (15-22w) - chromosomal abnormalities, aFP
-amniocentesis (15-20 w)
-gestational diabetes (24-28w)
IMAGING: TAUS
53
How often do you have a 2nd trimester checkup?
every 4 weeks
54
What do you the 3rd trimester checkups involve?
LABS/SCREENING – 28 weeks:
-gestational DM
-alloimmunization (AB titer), Rh
-maternal anemia
-repeat syphilis, STIs
-HIV
LABS/SCREENING – 33-36w:
-chlamydia/gonorrhea
-fetal presentation
-group B strep
-Hgb + hct
IMAGING: TAUS
55
How often do you have 3rd trimester checkups?
Every 2 weeks until 36w, then once weekly until delivery
56
How do you manage your pregnant patient (generally)?
Patient education on diet and wellbeing
Vitamin recommendations: folic acid, iron, calcium, Vitamins C, D, B1, B2, B12, E, iodine, zinc
No live vaccines in pregnancy
57
What are extra studies for pregnancy wellbeing?
-biophysical profile for wellbeing
-non-stress testing (heart response to fetal movements)
-contraction stress testing
58
On a nonstress testing, you want the baby to be
reactive
59
on a biophysical profile, you want the BPP score to be
high --> 8-10 means no fetal asphyxia!
if less than 8, deliver (as long as >36 weeks)
60
When can you see the baby on US?
6 weeks
61
Every prenatal visit requires
Maternal weight
Blood pressure
fundal height
fetal size and presenting part
urine dipstick for protein, glucose, ketones
62
Review: first trimester
Fetal heart tones: 10-12 weeks
Screening:
PAPP-A
Free beta HCG
Nuchal translucency- ultrasound (10-13 weeks)
>3.5 mm – trisomy or neural tube defect
CVS (10-13 weeks)
63
Review: second trimester
Fetal movement:
-Nullipara: 18-20 weeks
-Multipara: 14-16 weeks
Uterine growth
At umbilicus – 20 weeks
=Weeks gestation should equal fundal height in cm
Screening:
Maternal AFP
-Increased- neural tube defects
-Decreased- trisomy
Inhibin A
Unconjugated estriol
Ultrasound (18-20 weeks)
anatomy scan, gender reveal
Amniocentesis (15-18 weeks)
64
Review: 3rd trimester
Full term is 37 weeks. Plan for induction after 40 weeks.
Vaccines:
Tdap (28 weeks)
Rhogam (28 weeks) – for Rh-negative mothers only
Screening:
Gestational diabetes (24-28 weeks)
Rh antibodies for Rh-negative mothers (28 weeks)
Vaginal-rectal culture for Group B strep (35 weeks)
If positive, treat with IV penicillin during delivery
Nonstress test
20-minute monitoring, should see two accelerations (15 BPM above baseline, for 15 seconds), and no decelerations
Biophysical profile
NST, amniotic fluid level, fetal movements, fetal tone, fetal breathing
65
At the first prenatal visit, what are you testing?
Hemoglobin and hematocrit (or CBC), urinalysis (urine culture is recommended by most), blood group, Rh type, antibody screen, rubella antibody titer, syphilis screen, culture for gonorrhea and chlamydia, hepatitis B virus screen, and cervical cytology.
