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Flashcards in Prenatal Care Basics Deck (8)
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1
Q

Important tests/tx for 0-12 wks preatal visit

A
  • one visit every 4 weeks
  • First prenatal visit:
    • prenatal profile labs (blood type/antibodies, CBC, rubella status, HIV, hepatitis B, syphilis screen)
    • Pap (if indicated)
    • GC/CT, urine culture
    • Rx for prenatal vitamins
    • early glucola if risk factors
  • Every visit – gestational age, weight, blood pressure, update labs
  • Flu shot as early in pregnancy as possible during flu season
  • If unsure dating, may need dating ultrasound
2
Q

Important tests/tx for 13-24 wks prenatal visit

A
  • one visit every four weeks (more frequently if high risk or diabetic)
  • Genetic Screening: MSAFP/Quad Screen @ 15-22 weeks;
    • if covered by insurance, may qualify for sequential screen – blood draw and U/S @ 10 – 14 weeks
    • second blood draw @ 15 – 22 weeks
    • Materni21 or cell free DNA testing if history indicated
  • Anatomy ultrasound @ 18-22 weeks
  • Fetal movement @ 18-20 weeks
  • Every visit – gestational age, weight, blood pressure, urine dip (DG), update labs, refill PNV if needed
3
Q

Important tests/tx for 25-40 wks prenatal visit

A
  • one visit every 4 weeks until 32 weeks, q2wk visits 32-36 weeks, weekly visits 36-40 weeks (may be more frequent if high risk &/or diabetic)
  • Glucola, CBC @ 24-28 weeks
  • Tdap > 27 weeks, indicated in every pregnancy
  • RhoGam @ 28 weeks for Rh negative patients
  • CBC @ 28 weeks: repeat HCT or reticulocyte count at 34 weeks to eval response to therapy if on iron
  • Start once to twice weekly NSTs/weekly AFI if indication (DM, HTN, IUGR, etc.) Breastfeeding info @ 36 weeks if indicated
  • GBS culture @ 35-37 weeks; if PCN allergy add sensitivity
  • Fetal kick counts BID @ 37 weeks
4
Q

Important tests/tx for 40+ weeks prenatal visit

A
  • one visit q week, or more frequently if desired by MD/NP/CNM
  • NST’s 2x weekly start 40 5/7, with 1x AFI
  • Fetal kick counts BID
  • Each visit – gestational age, weight, blood pressure, urine dip, update labs.
  • Refill PNV if needed
  • Schedule IOL between 40 3/7 - 41 0/7
  • Schedule IOL @ 37 weeks for GHTN, 38weeks for CHTN, and 39 weeks for wellcontrolled A2GDM. 36 to 37 weeks for previa. 37 weeks for h/o myomectomy
5
Q

Calculate Estimated Date of Delivery

A

pregnancy = 280 days, 9 months or 10 lunar months from LMP

Nagele’s rule: 1st day of LMP + 7 days + 1 year - 3 months
-if cycle not 28 days adjust +7 days

6
Q

First Prenatal Visit: History

A
  • Calculate gestational age
  • History of present pregnancy
  • History of all previous pregnancies:
    • -GTPAL, year, sex, weight, gestation age, mode of delivery, length of labour, complications with pregnancy or delivery
  • Gynecological and Past Medical History
  • Medications/OTC/Herbal
  • Family History: ethnicity, genetic disease, birth defects, multiple gestation
  • Social History: current situation, smoking, ETOH, drugs, violence/abuse
7
Q

Symphysis Fundal Height

A

12 weeks: at pubic symphysis
20 weeks: umbilicus
27 weeks: sternum

SFH should be within 2cm of GA between 20 and 37 weeks

8
Q

Types of prenatal testing for aneuploidy + timing, adv./disadv.

A
  • first-trimester combined test = PAPP, B-hCG, nuchal transluceny
    • 9-13 weeks
  • second-trimester quad screen = a-fetoprotein, B-hCG, inhibin A, estriol
    • 15-20 weeks
  • chorionic villouis sampling ==> karyotype/dx
    • 10-13 weeks
  • amniocentesis ==> karyotype/dx
    • 15-20 weeks
  • second trimester US ==> fetal anatomy
    • 15-20 weeks
  • cell-free fetal DNA
    • >10 weeks