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Flashcards in Pregnancy Care Deck (95)
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1

Preconception History

Chronic diseases
Medications known to be teratogens
Reproductive history
Genetic conditions in the family
Substance use
Infectious diseases & vaccinations
Folic acid intake & nutrition
Environmental hazards & toxins
Mental health & social health concerns

2

Goals of Prenatal Care

Ensure birth of a healthy baby
Minimize risk to mother
Early, accurate estimation of gestational age & due date
Identification of patient risk for complications & continuing risk assessment
Ongoing evaluation of health status of mother & baby
Patient education & communication

3

Preconception Interventions

Folic acid supplementation
Glycemic control in women with DM
Abstinence from alcohol & illicit & prescription drugs
Smoking cessation
UTD vaccinations
Weight management (18-30)
Absence from depression
Teratogen avoidance
Absence of STIs
Planned pregnancy with early prenatal visit

4

Antepartum Care

Diagnosing pregnancy & determining gestational age
Monitoring the ongoing pregnancy with periodic exams & appropriate screening tests
Providing patient education that addresses all aspects of pregnancy
Preparing the patient & family for management during labor, delivery & postartum period
Detecting medical & psychosocial complications & instituting indicated interventions

5

Initiating Prenatal Care

Ideally prenatal care initiated in 1st trimester

6

Determining Gestational Age

IMPORTANT
Need to determine due date (EDC)

7

Usual Methods of Determining Gestational Age

History: date of LMP
Uterine size
Ultrasound (US)

8

Most Accurate Time Frame for Crown Rump Length

6-11 weeks

9

Most Accurate Time Frame for Biparietal Diameter

13-25 weeks

10

Most Accurate Time Frame for Femur Length

13-25 weeks

11

Assessment at First Prenatal Visit

Medical history
Reproductive history
Family history
Genetic history
Nutritional history
Psychosocial history: domestic violence
Contact information
Prenatal menstrual history

12

Factors that Increase the Likelihood of Twins/Multiples

Advancing age
Increased parity
Family history from either parent
Obese & tall women
Fertility drugs

13

Risks of Multiple Gestations

Preterm birth can lead to bed rest early
Intrauterine growth retardation or unequal growth

14

Physical Exam at First Assessment of Pregnant Woman

Baseline BP
Height & weight
General PE
Pay attention to oral hygiene
Cardiac exam
DTR's
Breast exam
Pelvic exam

15

Lab Tests for First Trimester

UA + pregnancy test + culture
CBC
Rubella immunity
Varicella immunity
Syphilis test
Hepatitis B antigen test
Blood type & Rh determination
HIV
Lipids, PPD, HgbA1C, thyroid testing, Hep C, Zika if indicated

16

Why obtain a urine culture?

Asymptomatic bacteriuria

17

Asymptomatic Bacteriuria

Associated with increased risk of preterm birth, low birth weight, & perinatal mortality
Need repeat after treatment

18

Treatment of Asymptomatic Bacteriuria in Pregnancy

Sulfisoxazole
Amoxicillin
Amoxicillin-clavulanate (Augmentin)
Nitrofurantoin
Cefpodoxime proxetil

19

Treatment of Acute Cystitis in Pregnancy

Augmentin
Nitrofurantoin
Cephalexin
Amoxacillin

20

Indications for Rhogam

At 28 weeks of gestation
Spontaneous abortion, threatened abortion, induce abortion
Invasive procedures
Hydatidiform mole
Fetal death in 2nd & 3rd trimester
Blunt trauma to abdomen
Antepartum hemorrhage in 2nd or 3rd trimester
External cephalic version

21

First Trimester prenatal Genetic Screening

Define risk in low-risk population
Can assess for down syndrome, trisomy 18 & trisomy 13

22

Combination of what factors increases detection of down syndrome?

hCG level
Pregnancy associated plasma protein A (PAPP-A)
Nuchal transparency (NT)

23

Define Chorionic Villous Sampling

Get fetal DNA for testing for Down Syndrome & other abnormalities

24

Quadruple Screen in the Second Trimester Screening

Serum alpha-fetoprotein (AFP)
hCG
Unconjugated estrodiol
Inhibin A

25

Define Nuchal Translucency (NT) Measurement

Width of the translucent space at the back of the fetal neck determined by ultrasound

26

What defects can occur when maternal serum alpha fetal protein (MSAFP) is high?

Neural tube defects
Anencephaly
Multiple gestation

27

What defect can occur when MSAFP is low?

Down syndrome

28

Indications for Amniocentesis

Prenatal genetic studies
Assessment of fetal lung maturity
Evaluation of fetus for infection
Degree of hemolytic anemia
Evaluation of diagnosed neural tube defects
Therapeutic: removal of excess amniotic fluid

29

Risks of Amniocentesis

Leakage of amniotic fluid
Fetal injury (rare)

30

1st Visit Prenatal Education

At each visit maternal weight, BP, uterine growth, urine dipstick, fetal activity, & fetal HR
Every 4 weeks until 28 weeks; every 2 weeks until 34-36 weeks; every week until term
How to reach provider after business hours
Avoid hot tubs & saunas
Avoid substance use
Wear seatbelt
Infection precautions
Exercise: moderate, 30 minutes
Work: okay unless excessive lifting or standing
Sexual activity: risk of STI or vaginal bleeding
Travel: increased risk of DVT
Medications: check with provider
Weight gain counseling
Breast Feeding
Childbirth classes/hospital facilities
Diet