Week 6 pt 2 highlights Flashcards by Morgan Evans

What should you counsel pts on regarding smoking/ tobacco, alcohol, illicit drug use?

Stop

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What is the significance of iron and folate in pregnancy?

1) Iron: allows mother to make blood cells
2) Folate: allow fetus to form neural tube and prevent neural tube defects (spina bifida)

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True or false: Spontaneous abortion (SAB) as a medical term does not refer to elective abortion

True

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Which is more comprehensive and used more often, G&P or TPAL?

TPAL

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Explain TPAL

(will probs be on quiz)

G#PTPAL (i.e. G2P1001)
1) Term: delivered > 37 weeks
2) Preterm: delivered < 37 weeks
3) Prior to the COMPLETION of 37 weeks gestation
4) Abortion: delivered < 20 weeks
Spontaneous abortion, elective abortion, miscarriage, ectopic pregnancy
5) Living kids: # of humans still alive

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You should discontinue supine exercises after ________ trimester

1st

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What is one important food for pregnant pts to avoid?

Lunch meat (must be cooked)

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List 3 high-risk situations where sexual intercourse is restricted

1) Placenta previa
2) Premature rupture of membranes
3) History or current pre-term labor

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Most airlines say flying is safe up to ____ weeks

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Baby is most susceptible to X-rays and CT scans early on, particularly in the first ________ weeks

two

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True or false: There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time for alcohol use during pregnancy.

True

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FASDs (fetal alcohol spectrum disorders) are preventable if a baby is not exposed to alcohol before _______

birth

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Rh immune globulin, also known as RhoGAM, is given routinely at _________ weeks when Rh incompatibility exists (Rh- negative)

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What should be given during 1st trimester if woman experiences vaginal bleeding?

Rh immune globulin, also known as RhoGAM

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During pregnancy, body makes special hormones and goes through many changes (such as weight gain)
Because of these changes, body’s cells don’t use insulin very well.

What is this called?

Insulin resistance

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Routine oral glucose tolerance testing (usually between 24-28 weeks); if fail the 1-hour OGTT, then must do the ___________________ test

3-hour OGTT

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What is the most common symptom of gestational diabetes?

No symptoms

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What is safe to take in pregnancy for headaches?

Tylenol (APAP)

(NO NSAIDS!!!)

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List the common Sx of pregnancy

1) Headaches
2) N/v
3) Swollen ankles
4) Heartburn
5) Fatigue
6) Constipation
7) Leg cramps
8) Back pain
9) Groin pain
10) Vaginal discharge
11) Hemorrhoids

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What is the Amnisure test for?

Vaginal discharge

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What is Naegele’s rule for dating pregnancy?

(know this even if it’s not v accurate)

1) Onset of last menses
2) Move back 3 months
3) Then 7 days forward
4) One year forward

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How accurate is Naegele’s rule? Explain

Incredibly inaccurate – there are apps for this these days

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Best way to estimate gestational age is what?

Estimated Due Date (EDD): Transvaginal US in 1st trimester

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What is the margin of error of a Transvaginal US in 1st trimester for dating pregnancy?

~1 week

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What week are heart and heart rate (110-125 bpm) seen on TVUS?

Week 7

A __________ is an agent that can disturb the development of an embryo or fetus (fetal limb defects, bony abnormalities, etc.)

teratogen

What are the pregnancy categories for drugs?

A, B, C, D, X

True or false: Infectious agents (TORCH) are teratogens

True

List the Infectious agents (TORCH)

TORCH Toxoplasmosis Other (Syphilis, Varicella-Zoster, Parvovirus B19) Rubella Cytomegalovirus Herpes

List 2 very teratogenic drugs

1) Thalidomide 2) Warfarin (Coumadin)

What can Warfarin (Coumadin) do to a fetus?

Hypoplastic nose, skeletal/ocular abnormalities, neonatal bleeding, cognitive impairment

What are 5 unsafe epilepsy drugs?

1) Valproate 2) Phenytoin 3) Phenobarbital 4) Topiramate 5) Carbamazepine

What are the most widely used and safe epilepsy meds in pregnancy?

Levetiracetam and Lamotrigine

List 3 other teratogenic meds

1) ACEs/ARBs 2) Isotretinoin (Accutane) 3) Fluoroquinolones

1) Are NSAIDs teratogenic? 2) How do you Tx DM in pregnancy?

1) Only Tylenol (APAP) is approved for pain, fever, etc. 2) First-line medication of choice is insulin Second-line is Metformin. Glyburide is also commonly used.

1) What is methotrexate? When is it used? 2) What is ribavirin used?

1) Chemotherapy/immunosuppressant drug Used commonly for complicated miscarriages and ectopic pregnancies; teratogenic 2) In treating RSV, Hepatitis C

1) Name a teratogenic antifungal medication 2) Are emergency contraceptives teratogenic? 3) Is chemo teratogenic?

1) Griseofulvin 2) Plan B (Levonorgestrel) 3) Chemotherapy

List some groups that have teratogenic drugs

1) Hypertension medications 2) Acne medication 3) Abx 4) Psych meds 5) DM 6) Antifungal medication 7) Emergency contraceptives

Why are ultrasounds important in ob care?

No known adverse fetal effects

Define TVUS

Inducer (probe) is inserted into vagina to visualize organs within pelvic cavity

What is commonly used during 1st trimester to accurately determine the estimated due date and check fetal location and number?

TVUS

When done in the 1st trimester, ________ is more accurate than Naegele's rule

TVUS

What is used to identify patients at risk of pre-term delivery?

Transvaginal sonographic measurement of cervical length

There's a _______ trimester transabdominal ultrasound for structural abnormalities

2nd

______________________ correctly detects fetal anomaly 17-74% of the time, but is not reliable in detecting fetal abnormalities

Transabdominal US

What correctly detects normal fetus ~100% of the time and is very reliable in ruling out fetal abnormalities?

2nd trimester transabdominal ultrasound and structural abnormalities

3rd trimester transabdominal ultrasound and fetal growth has an error rate of what?

~15% error (less utility with fetuses larger than 8 lbs.)

What measures body movement, muscle tone, breathing movement, heart rate, and amniotic fluid levels?

Biophysical profile score (>28wks)

Amniocentesis and Chorionic Villus Sampling (CVS) is used for what?

Prenatal tests used to detect for genetic abnormalities or birth defects

Prenatal test to remove a sample of fluid from the amniotic cavity to test for certain health conditions or infections is called what?

Amniocentesis (“Amnio”)

Most common invasive prenatal diagnostic procedure is what?

Amniocentesis (“Amnio”)

RhoGAM should be given to Rh- mother due to small risk of procedure-related isoimmunization with what?

Amniocentesis (“Amnio”)

What test is Performed at 15-20 weeks?

Amniocentesis for genetic Dx

List 4 uses for amniocentesis

1) Genetic diagnosis 2) Biochemical testing 3) Prenatal infections 4) Therapeutic amniocentesis

What may you use to Tx Polyhydramnios?

Therapeutic amniocentesis

Chorionic villus sampling (CVS): Prenatal test used to diagnose certain birth defects and genetic abnormalities by taking a small tissue sample of ____________ , which is composed of maternal and _____________ tissue

placenta; embryonic

What can be performed earlier than amniocentesis but not performed before 9th week due to increased risk of malformation?

CVS

What is usually done around weeks 10-13?

CVS

Percutaneous umbilical blood sampling (PUBS) is done via what?

Cordocentesis

Name a Treatment for cervical insufficiency (cervical weakness, cervical incompetence)

Cervical Cerclage Also known as “cervical stitch”

What are some risks of Cervical Cerclage?

Bleeding, infection, amniotic rupture, damage to bowel/bladder

_____________ deliveries are the most common and most preferred method of delivery.

Vaginal

What may be done when labor is not progressing (stalled in the second stage)?

Forceps delivery

What are some risks of forceps delivery?

Vaginal tears/muscle injury, injury to fetus (skull fracture, surface wounds, bleeding)

1) What birth procedure is only recommended under certain conditions? 2) What are the risks?

1) Vacuum-assisted delivery 2) Vaginal tears, bruising, bleeding, hematoma, skull fracture, etc.

Some breech babies can be born vaginally, but a C-section is usually _____________

recommended

List the risks for C-sections (important)

Anesthesia, longer recovery time, major surgery, future need for c-sections, bowel/bladder injuries

What is the biggest risk of VBAC? (Vaginal birth after cesarean section)

Uterine rupture