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DU PA Prenatal Care

Duke PA Prenatal Care

The only sonogram that is indicated in a normal pregnancy is done at __, it is called the anatomy ultrasound 18 weeks
Two major goals of prenatal care in the last half of pregnancy are diagnosis of __ Preeclampsia and fetal malpresentation
What are the routine examination pieces that are done at each prenatal visit Measurement of blood pressure, measurement of uterine fundus to assess fetal growth, auscultation of fetal heart tones/assessment of fetal activity, (determination of fetal presentation in the third trimester)
What are some safe and common medications used during pregnancy Acetaminophen, Benadryl, Claritin/Zyrtec, Sudafed (with caution/elevation of BP), Metamucil
Two main medications to avoid in pregnancy NSAIDS, fluoroquinolones
In general what antibiotics are safe in pregnancy Any of the penicillins
If the patient is allergic to penicillin what is another antibiotic that can be used during pregnancy Clindamycin
Presumptive symptoms of pregnancy Amenorrhea, N/V, breast tenderness, fatigue, urinary frequency, quickening, increased basal body temp, chloasma, linea nigra, stretch marks, spider telangiectases
When do most women experience quickening 18-20 weeks primigravidas, 14-16 weeks multigravidas
Name the sign: Bluish or purplish discoloration of vagina and cervix Chadwick’s sign
Name the sign: Softening of the uterine isthmus Hegar’s sign
Name the sign: Softening of the cervix Goodell’s sign
Positive manifestations of pregnancy Fetal heart tones, palpation of fetus, ultrasound of fetus
When can fetal heart sounds be heard with Doppler 10 weeks
When can the fetus be palpated 22 weeks
When can you discover cardiac activity on ultrasound of the fetus 5-6 weeks
When can you see limb buds on ultrasound of the fetus 7-8 weeks
When can you see general movement on ultrasound of the fetus 9-10 weeks
Serum pregnancy test can detect pregnancy as early as __ after conception 1 week
When should a serum pregnancy test be done When question of normal development, ectopic, signs of pregnancy loss, previous loss
hCG is produced by the placenta about __ after fertilization 8 days
hCG is detectable __ after conception 8-11 days
hCG doubles every __ 48 hours
when does hCG peak 10-12 weeks
when do hCG levels return to normal after termination or delivery 21-24 days
what does a very rapid increase in hCG indicate Multiples, or molar pregnancy
what does a very slow rising level of hCG indicate Ectopic or non-viable pregnancy
how long does a normal pregnancy last 280 days, 40 weeks, 10 lunar months, 9 calendar months
What is Nagele’s rule From the date of the last normal menstrual period, subtract 3 months and add 7 days
What is the most accurate noninvasive method of finding gestational age Ultrasound (esp early US); also is most widely used method to determine GA
If cardiac activity can be seen by transvaginal ultrasound by 8 weeks there is only a __% risk of pregnancy loss 3
When is a transabdominal ultrasound done Once uterus above pelvic brim, about 8-12 weeks
What is the window of time during which a transabdominal ultrasound can be used to evaluate fetal growth/anatomy After 16 weeks, before 22 weeks
__% of pregnancies are dangerous to the health of the mother and or fetus 5-20
What are some major structural anomalies that can be detected on transabdominal ultrasound DS markers; 2 vessel cord, neural tube defect, anencephaly, hydrocephaly, cleft lip/palate, diaphragmatic hernia
When should prenatal care ideally start 3 months before conception
A pregnant woman can get supine hypotensive syndrome after __ weeks 20
The fundus of the uterus is at the pubic symphysis at __ 8 weeks
The fundus of the uterus is palpable in the abdomen at __ 12 weeks
The fundus of the uterus is at the midpoint between symphysis and umbilicus at __ 16 weeks
The fundus of the uterus is at the umbilicus at __ 20 weeks
When do you start measuring from the symphysis to fundus in centimeters 26-34 weeks
When does fundal height start to decrease (as the head descends) 36 weeks
What is included in the maternal blood tests CBC, type and screen, RPR (syphilis), Rubella, Hep B, HIV, glucose tolerance test, maternal serum screen
When is the maternal serum screen offered 15-20 weeks
What is the purpose of the maternal serum screen Screen for open neural tube defects (spina bifida, anecephaly) and chromosomal abnormalities (trisomy 21 and 18). If the mother would not do anything different with her pregnancy regardless of results test should not be done
When is the 1 hour glucose challenge test done 26-28 weeks, earlier if at high risk for gestational diabetes (by 24, ideally by 12 wk)
When should you check mom for group B strep 35-37 weeks
What do you tell mom to do if she doesn’t feel baby move later in pregnancy Tell her to drink some juice or water, lay on her left side and feel for movement for one hour. If there is still no movement tell her to come in for evaluation
What is the normal fetal heart rate 110-160
What is fetal bradycardia <110
What is fetal tachycardia >160
What is part of the fetal biophysical profile Non-stress test, fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume
What score on the biophysical profile is considered normal 8-10
What score on the biophysical profile is considered abnormal and requires intervention 4 or less
Fetal US: 5-13 weeks, measure: fetal crown-to-rump length
Fetal US: after 13 weeks, measure: femur length, abdominal circumference and biparietal diameter; after 30 weeks, accuracy decreases
Quad screen: diff btw Trisomy 21 & 18 DS: high hCG/DIA, low AFP/uE3; Edwards: low AFP, hCG, uE3; diff is high hCG in DS
GDM RFs FH, h/o previous stillbirth, h/o macrosomia (>9lbs), prenatal wt >180lbs, advanced maternal age, history of HTN
Antenatal visits start: at 8-12 weeks (unless prior PG loss, fertility tx, or maternal illness)
Most widely used test of fetal lung maturity Fluorescence polarization; direct measure of surfactant concentration
erythroblastosis fetalis = heart failure, edema, ascites & pericardial effusion; d/t RBC destruction exceeding production
Screening for Down syndrome can be performed when: 1st or 2nd trimester; 1st trimester test characteristics are better than those in 2nd trimester only
Follow-up antenatal visits detect __% of fetuses with growth abnormality, prevent __% of eclampsia, & uncover __% of breech presentations prior to labor 50% of growth abnormality, prevent 70% of eclampsia, 80% of breech presentations
Created by: bwyche