Term
True or False
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Although higher percentages of women receive early prenatal care than ever before, preterm birth and low birth weight rates are increasing and declines in infant mortality have stalled in the U.S.
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Definition
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Term
Why is there an issue with poor pregnancy outcomes? (one main problem)
What are the top two populations that see highest level of poor prenatal care? |
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Definition
Why is there an issue with poor pregnancy outcomes? (one main problem)
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Prenatal care starts too late to prevent many of these poor pregnancy outcomes
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What are the top two populations that see highest level of poor prenatal care?
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Highest level: teenagers
Premenopausal woman-second highest
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Term
| Up to __% of pregnancies are unintended. |
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Definition
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Term
| When is the best time for preconceptual counseling? |
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Definition
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The best time for preconceptional counseling is at the time of a negative pregnancy test
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Term
What occurs during days 17-56 or 4-10 weeks from LMP?
Why is this so important? |
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Definition
organ formation
The period of time from 17-56 days after conception or 4-10 weeks from the last menstrual period (LMP) is the one where the pregnancy is most susceptible for developing major malformations. |
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Term
| During weeks 5-8- what is developing? |
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Definition
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Term
| What is developing during weeks 5-8.5? |
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Definition
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Term
What develops from
6.5-10 weeks
6.5 10.5 weeks
6.5-10 weeks |
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Definition
6.5-10 weeks: arms
6.5 10.5 weeks: eyes
6.5-10 weeks: legs |
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Term
What develops between
8.5 to 11 weeks?
8.5 to 11.5 weeks?
9.5 to almost 12 weeks? |
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Definition
8.5 to 11 weeks? teeth
8.5 to 11.5 weeks? palate
9.5 to almost 12 weeks? external genitalia |
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Term
What takes the longes to develop?
6.5 to little over 11 weeks? |
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Definition
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Term
The following are considered what?
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Giving protection
Managing conditions
Avoiding exposures known to be teratogenic
Needs determined by thorough history and physical
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Definition
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Term
| What typ eof infectious diseases do you want to protect the baby from? |
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Definition
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· Rubella
· Varicella
· Hepatitis B
· HIV/AIDs
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Term
What should be given to protect against neural tube defects and other congenital anomalies?
When should this be given to maximize effectiveness? |
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Definition
FOLIC ACID
give during earlies week sof organogenesis |
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Term
| What are conditions that if poorly managed can have detrimental effects on reproductive outcomes (5)? |
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Definition
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· Diabetes
· Maternal PKU
· Obesity
· Hypothyroidism
· Sexually transmitted infections
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Term
| What are some teratogenic factors that could impact organogenesis? (4) |
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Definition
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· Medications
· Many anti-seizure medications
· Oral anticoagulants
· Accutane
· Alcohol
· Tobacco
· Environmental Hazards
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Term
| What topics do you discuss during preconceptual visit? (13) |
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Definition
• Medications
• Drug Allergies
• Racial/Ethnic/Religious background
• Age- increased anemia, IUGR, preterm labor, and infant mortality in young. Increased GDM, PIH, placenta previa/abruption, C/S in old
• Medical History
• Family History- medical disease, genetic disease, reproductive abnormality
• Surgical History
• Gynecologic History
• Obstetric History- infertility, abnormal pregnancy outcome, miscarriage, ectopic, recurrent loss, preterm delivery, other complications
• Social History- use of alcohol, tobacco, illicit drugs, domestic abuse
• Environment- exposure to disease, heavy metals, methyl mercury, pesticides
• Lifestyle- diet, exercise, stress
• Immunizations |
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Term
| What type of preconceptual screening is appropriate? |
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Definition
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· Genetic abnormality carrier status: Tay-Sachs, Thalassemia, Cystic Fibrosis
· Immunity: Hepatitis B, Rubella, Varicella
· Partner screening, as needed
· Genetic counseling
·Specialty counseling
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Term
| What are the four componenets of a prenatal care visit? |
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Definition
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· Preconceptional Care
· Prompt pregnancy diagnosis
· Initial care visit
· Follow-up visits
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Term
| how can you diagnose a pregnancy? |
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Definition
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· Clinical Findings: cessation of menses, breast changes-darkening of skin around areola, cervical changes, skin changes, uterine changes-bluish tinge to cervix
· Laboratory testing
· Urine hCG
· Blood hCG
· Ultrasound
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Term
| What are the three goals of the initial care visit? |
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Definition
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· Define the health of the mother and embryo/fetus
· Establish an estimated gestational age
· Establish a plan of care for duration of pregnancy
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Term
| What does TPAL stand for? |
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Definition
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TPAL: full term- 37 weeks or beyond
Preterm: about 20 weeks-37 weeks
Abortion: conception to 20 weeks
Living children at this time
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Term
| What do you discuss specifically related to obstetric hx? |
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Definition
menstrual hx: menarche, interval, duration, regularity
LMP: normalcy, certainty of dates
G's and P's
EDD by Naegele's rule or US |
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Term
What size should the fetus be at the following weeks:
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Definition
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6 weeks: plum/egg
8: tennis ball
10: large orange
12: grapefruit-becomes abdominal organ- no longer in pelvis
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Term
| What are the components of the physical exam for pregnant woman? |
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Definition
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· Height, weight, pregravid weight, baseline blood pressure
· Complete physical examination, focus on abdomen
· Pelvic examination: cervix, uterine size, adnexa, pelvimetry
· Urine dip for protein and glucose
· Fetal heart tones/fundal height (prn)---if under 10 weeks u wont find
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Term
| What lab tests are you interested in for pregnant woman? (14) |
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Definition
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· CBC (HGB/HCT, Plts)
· Hgb Electrophoresis
· Blood Type
· Antibody Screen
· RPR
· Rubella
· HBsAG
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· HIV
· GC/CT
· Urine Culture
· Pap (prn)
· Cystic Fibrosis, Tay Sachs, Genetic Screening as appropriate/desired
· VZV (prn)
· PPD
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Term
What is the follow up care for prego woman?
how how should she see you? |
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Definition
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· Q 4 weeks until 28 weeks, then Q 2 weeks until 36 weeks, then Q week until delivery
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· Other models of care: one visit in first trimester, return visits at 26, 32, 38 weeks. Achieve same outcomes
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Term
These items would be assessed in what type of hx?
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· General health and well being
· Contractions
· Fetal movement
· Fluid leaking
· Vaginal bleeding
· Headaches/visual changes-esp imp if inc BP
· Pain
· Edema
Additional concerns
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Definition
Interval Hx
Follow up Care |
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Term
| Nuchal translucency on ultrasound is associated with what disorder? |
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Definition
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Term
| What type of genetic screening can you do in the first trimester? |
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Definition
• Nuchal Translucency (10.3-13.6 weeks): 64-70%
• NT/PAPP-A, Beta hCG (10.3-13.6 weeks): 82-87%. Offer with AFP in second trimester to screen for Open NTD. Not as available as Quad Screen |
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Term
| What type of genetic screening is done during second trimester? |
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Definition
• Quad Screen: AFP, Beta hCG, unconjugated estriol, Inhibin A (14-21 weeks, optimal 16-18 weeks): 81%. Most practical choice when combined with genetic ultrasound
• Alpha Fetoprotein (14-22 weeks, optimal 16-18 weeks): combine with 1st trimester screening |
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Term
When can you do chorionic villus sampling?
what are you at risk for?
what are you looking for? what can it NOT diagnose?
how do you do the test? |
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Definition
When can you do chorionic villus sampling? 10-12 weeks
what are you at risk for? spontaneous abortion
what are you looking for? chromosomal abnormalities
what can it NOT diagnose? NOT diagnose Open NTD
how do you do the test? transcervical or transabdominal |
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Term
| What are two types of genetic testing? |
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Definition
chorionic villus sampling
amniocentesis |
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Term
Amniocentesis: when can you do the test?
what can you detect?
What are you at risk for?
what specifically are you retrieving to make a diagnosis? |
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Definition
Amniocentesis: when can you do the test? 15-20 weeks
what can you detect? open neuronal tube defect, down syndrome, trisomy 21
What are you at risk for? SAB/SROM
what specifically are you retrieving to make a diagnosis? amniotic fluid looking at AFP and fetal cells for chromosomal abnormalities |
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Term
What tests should you do when pt is 24-28 weeks?
What tests at 36 weeks? |
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Definition
24-28 weeks
· One hour glucose tolerance test
· CBC
· RPR
· HIV
· Antibody Screen/RhoGAM (prn)
36 weeks
· GBS-sepsis-screened vaginal and rectal culture treatd with PNC
· Cervical cultures- gonorrhea dn chlamydia
HIV
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Term
| What type of information can US provide? (7) |
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Definition
• Pregnancy Dating (early is more accurate)
• Anatomy (18-22 weeks)
• Fetal Weight (LGA/SGA, macrosomia, IUGR)
• Placental abnormalities: grade, previa, accreta/increta/percreta
• Amniotic fluid volume
• Doppler flow
• High-risk follow-up: twins, GDM, HTN, etc. |
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Term
What type of anticipatory guidance is necessary for pregnant woman?
What do you tell them specifically about immunications and travel? |
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Definition
• Diet
• Weight Gain 25 lbs is max
• Exercise
• Sleep
• Sex
• Dental Care
• Travel-counsel pt and get up and walk often, consume fluids/biggest risk: DVT
• Immunizations- can vaccinate against rubella or varicella during pregnancy/pertussis vaccine-whooping cough-vaccine anyone who is going to be near neonate- careproviders, fathers, etc. |
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Term
What is ptyalism?
What causes? |
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Definition
excessive spitting during pregnancy
due to progesterone |
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Term
| What hormone causes the common discomforts of pregnancy? |
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Definition
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Term
| What ligament causes pain during pregnancy? |
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Definition
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Term
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Definition
thick, whitish yellowish discharge
part of pregnancy-due to estrogen imbalance |
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Term
| What are types of puerpueral infections? |
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Definition
• Endometritis
• Perineal laceration ie episiotomy
• Incision
• Mastitis
• Urinary tract |
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Term
Pt presents with the following: what could it be?
• Fever: 100.4+
• Pain
• Tachycardia
• Chills
• Subinvolution
• Foul lochia/drainage
• Erythema
• Leukocytosis-sometimes normal to see bump right after delivery
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Definition
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Term
| When should you expect to menstruate post partum? |
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Definition
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Term
When is the cervical os completely closed after giving birth?
When does vagina return to normal size? |
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Definition
When is the cervical os completely closed after giving birth?
4 weeks
When does vagina return to normal size?
3 weeks |
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Term
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Definition
| contains blood, mucus and placental tissue |
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Term
| What are postpartum mood disorders? |
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Definition
blues
depression
psychosis |
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Term
| Up to 85% of women, characterized by mild depressive symptoms, tearfulness (often for no discernible reason), anxiety, irritability, mood lability, increased sensitivity and fatigue |
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Definition
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Term
Post partum blues:
When does it peak?
When does it resolve? |
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Definition
| Peaks postpartum day 3-5, spontaneously resolves by day 10 |
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Term
Occurs in up to 10% of women
• Can occur any time in the first postpartum year
• Diagnosed using DSM-IV criteria for ______ |
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Definition
Post partum depression
diagnosed by major depressive disorder criteria |
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Term
| What are sxs of post partum depression? |
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Definition
Depression
• depressed mood
• Lack of pleasure or interest
• Sleep disturbance (insomnia or hypersomnia)
• Weight loss
• Loss of energy
• Agitation or retardation
• Feelings of worthlessness or inappropriate guilt
• Diminished concentration, or indecisiveness
• Frequent thoughts of death or suicide |
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Term
| When is the treatment for postpartum depression? |
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Definition
• Psychotherapy
• Antidepressant Therapy
• Tricyclics or SSRI’s
• Support Groups |
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Term
Pt presents with the following symptoms:
Inability to sleep for several nights
Agitation
Expansive or irritable mood
Avoidance of the infant
Delusions
Hallucinations
what could it be? how do you treat?
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Definition
Postpartum psychosis
Tx: MEDICAL EMERGENCY, treat inpatient with neuroleptics and mood stabilizers |
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Term
| is postpartum psychosis an emergency? |
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Definition
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