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17 Cards in this Set
- Front
- Back
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What are kick counts?
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Kick counts" are sometimes recommended to patients as a means of quantifying fetal movement.
Count each distinct fetal movement, starting from time of awakening. When reach 10 movements or kicks, done counting for the day. If 12 noon, haven’t reached a count of 10 movements, call OB for evaluation. Ultrasound Doppler for FHR NST if after 22 wks |
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What are some labs that are done during the 2nd trimester?
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Maternal serum testing at 15-18 weeks
Quadruple markers (AFP, unconjugated estriol, uE3, hcg, and inhibin A. Triple screen (w/o inhibin A). Offer genetic amniocentesis to patients who screen + Also offer if birth defect in mother, FOB, or previous offspring. |
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What are some imaging studies done during the 2nd trimester?
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Screening ultrasound
Crown-rump length at 7-14 weeks is most accurate technique for estimation of gestational age; accurate within 3-5 days 18-20 weeks: determine gender 3D ultrasound: 12 wks Dx structural defects ~18w Eval CV, GU, GI, Skeletal systems Measure fetal growth Gest. Age, Fetal wt. Placental status/location Amniotic fluid levels |
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What are some things that Ultrasound can be useful for?
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Transvaginal 5 wks - fetal pole
Dx structural defects ~18w Eval CV, GU, GI, Skeletal systems Measure fetal growth Gest. Age, Fetal wt. Placental status/location Amniotic fluid levels |
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What is polyhydraminos?
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Dx by U/S: Excess amniotic fluid 2000ml+ (>25cm) Nl=6-25cm
Risk Factors Maternal DM fatal anomalies placental anomalies multiple gestation isoimmunization Complications: severe maternal dyspnea, PTL |
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What is oligohydraminos?
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Severe deficiency of amniotic fluid <6cm
Largest pocket <2cm x 2cm Risk Factors PROM Obstruction of fetal urinary tract severe IUGR Fetal demise Congenital fetal anomalies (Potters syndrome) |
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What are some indications for amniocentesis?
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Maternal age >35y
Previous child w/ chromosomal abnl 3+ SAB Pt/FOB w/ chromosomal abnl Family Hx chromosomal abnl Poss female carrier of x-linked dz Metabolic dz risk Neural tube defect risk FLM 32+wks |
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What is the test that needs to be performed in the 2nd trimester between 24-28 weeks:
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1 hr Glucola (blood glucose measurement 1 hr after 50 gm oral glucose) to screen for gestational diabetes.
Those with particular risk (eg. Previous GDM or fetal macrosomia) require testing at initial prenatal visit. If 1 hr result > 140, a 3-hr glucose tolerance test is necessary. Discomforts: backache, round ligament pain, constipation, indigestion |
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What are the abnormal readings for the glucola test?
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Fasting - 95 mg/dl or higher
One hour - 180 mg/dl or higher 2 hr - 155 mg/dl or higher 3 hr - 140 mg/dl or higher |
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What clinical assessments should be done in the 3rd trimester?
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Document fetal movement
Vaginal bleeding, vaginal discharge, CTX, PTL Preeclampsia (blurred vision, HA, rapid wt. gain, edema) Document FHR Fetal orientation: Leopold's maneuver 26-30 wks: repeat Hg/Hct: anemia, iron suppl 28-30 wks: Rh screen, if -, RhoGAM administered, documented 36 wks: repeat serology for syphilis in high risk groups Influenza vaccine: T2 or T3 and any high-risk patient regardless of Trimester |
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What is isoimmunization?
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Problems involving the red cell antigen-antibody system may result in hemolysis and severe newborn illness.
Isoimmunization Development of antibodies to red blood cell antigens following exposure to such antigens from another individual. Transfusion is a source of such antigens, and in pregnancy, the “other individual” may be the fetus, 50% of whose genetic makeup is derived from the father. If the mother is exposed to fetal red cells during pregnancy or at delivery, she may develop antibodies to fetal cell antigens. Later in that pregnancy, or more commonly with a subsequent pregnancy, the antibodies can cross the placenta and hemolyze fetal red cells, leading to fetal anemia, and high-output cardiac failure: Hydrops fetalis |
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When should Rhogam be given to an Rh- mother with a Rh+ baby?
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300 mg of Rhogam should be given at 28 weeks.
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What other clinical assessments should be performed during the 3rd trimester?
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Repeat STD testing in all high-risk patients
< 25 yrs, retest for Chlamydia trachomatis, 36 wks Cervical exam weekly: effacement (thinning of cervix) & cervical dilation 35-37 wks: *grp B streptococcus colonization Swab both vagina & rectum If +, treat at delivery, IV PCN Early or late-onset disease: sepsis, meningitis, pneumonia, fetal demise most common complications Exception: given birth to previous infant w/GBS, GBS dx’d earlier in the pregnancy These groups of patients will receive intrapartum antibiotic prophylaxis regardless of the colonization status |
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How do you confirm the presence of a ruptured fetal membrane?
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confirmed by continuing, steady leakage of amniotic fluid, pooling of clear, Nitrazine positive fluid in the vagina on speculum exam. Vaginal secretions are normally slightly acid, turning Nitrazine paper yellow. Amniotic fluid, in contrast, is a weak base, and will turn the Nitrazine paper a dark blue.
Dried amniotic fluid forms crystals (ferning) on a microscope slide. Vaginal secretions do not. |
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What is some of the patient education that should be given in the 3rd trimester?
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Signs of Labor
ROM or CTX q5 minutes for one hour Braxton-Hicks ctx: irregular, no ROM, false contractions Danger Signs Preterm labor, ROM, vaginal bleeding, edema, signs of preeclampsia (proteinuria, HTN) Common discomforts Cramps, edema, frequent urination |
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What is chorionic villus sampling, and what is it used for?
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Biopsy of placental cells
10-12wks Earlier dx of genetic dz risk of complications (eg., limb defects) Risk SAB: 1:100 Bleeding 1/3 Does not DX Neural Tube Defects - used to diagnose Downs Syndrome, Tay Sachs, and CF to name a few |
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What are some indications for fetal non stress test?
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Gestational Diabetes
DM Hypertension Asthma No prenatal care IUGR Polyhydraminos Oligohydraminos Congenital malformation Multiple Gestation Prev C/S Post Term |
