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45 Cards in this Set
- Front
- Back
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what is prenatal care
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is the medical and nursing care recommended for women before and during pregnancy
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what is the purpose of prenatal visitsÉ
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to detect potential problems early
to prevent potential problems to refer to specialists as needed |
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what were some of the outcomes of prenatal care
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reduced maternal mortality
increased birthweight decreased preterm weight prevention of child abuse and neglect |
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when should prenatal care start
what are its 3 main goalsÉ |
preconception
identification of risk factors dietary and lifestyle modification folic acid supplementation |
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what are some risk factors that need to be identified prenatally
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chronic medical disorders
family history of genetic illness medications lifestyle assessment |
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what are some lifestyle and dietary modifications
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heart healthy diet
regular physical activity reduced alcohol reduced smoking weight reduction |
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why who and when for preconception folate
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to prevent NTD
all women who could or plan to become pregnant 3 months prior to pregnancy and during first trimester |
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how much preconception folate needs to be taken
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no risk factors: 0.4 mg per day
NTD risk factor or prior pregnancy affected with folate related anomaly: 1 mg per day - taper down to 0.4 after 12 weeks PErsonal or PobHx of NTD-4 mg per day and taper to 0.4 mg per day after 12 weeks |
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when should the first prenatal visit be done and what are the main aspects of it
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ideally less than 12 weeks gestation
establish rapport and patient education complete prenatal record- history and physical requisition for initial investigations |
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what is the prenatal recordÉ
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standardized form to record assessments, investigations and tx during prenancy
-systematic sequential approach to prenatal care info regarding screening and testing at specific gestational ages medico-legal documents provided pregnancy related problems list and care plan |
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what are some components of the demographics portion of the form
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general info + ethnicity
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pregnancy dating calculation
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from LMP, last normal- first day of LMP- if you are certain of date
regular menses- 28 days need to correct for longer or shorter cycles |
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for IVF what do you need to know about dates
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the date the embryo was transferred, whether day 3 or 5
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when would you use ultrasound datingÉ
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uncertain LMP
irregular bleeding or abnormal menstrual cycle less than 3 cycles since last pregnancy or stopping OCP |
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what are components of obstetrical history
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gravida
para abortus stillbirth neonatal deaths complications and comments |
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gravida
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total number of pregnancies including this one
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para
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total number of deliveries greater than 20 weeks
multiple gestations=1 |
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abortus
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spontaneous or therapeutic losses less than 20 weeks
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stillbirth
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fetal death greater than 20 weeks
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neonatal deaths
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early less than 7 days of age
late less than 28 days of age |
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name some complications in pregnancy
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-antepartum
IUGR, HTN, abruption -intrapartum IOL, operative vaginal delivery -postpartum PPH, PP depression, NICU admission |
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what is included in the section on maternal health
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- medications, allergies, past illnesses, substance abuse
winRHo smoking alcohol, street drug pharmacological and other therapies for NéV |
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why are past illnesses important to ask about
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past medical, surgical gynecologic and social histories
identification of risks to current pregnancy and need for specialist referral |
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what are psychosocial and environmental risk factors to ask about
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activity concerns
food security housing security adequate support abuse need for social assistance |
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what are indications for genetic screening
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age greater than 35 at delivery
family history of congenital abnormalities fx of inherited disease or disorder fx diabetes ethnic risk consanguinity |
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what are topics for education of the patient
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prenatal education
flu vaccination breast feeding pregnancy expectations and concers healthy eating physical activity signs and symptoms of preterm labor labor and birth expectations newborn screening vitamins cord blood banking intercourse |
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what are antenatal screening tests offered to all women in 1st prenatal visit
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hbg
hepatitis B antigen Syphilisé VDRL ABO and Rh HIV, RUbella, pap and swabs and urine C and S |
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what are antenatal sceening tests are offered to some women during 1st prenatal visit
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varicella, early diabetes screen, fatherès Rh, hep c, TSH
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when would you screen for diabetes
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glycosuria
maternal obesity fx DM POBhx of GDM or LGA multiple gestations |
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what are antenatal screening tests for aneuploidy offered to all womenÉ
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maternal serum testing:
First trimester MST: 9-13 wks PAPP-A and bHCG second trimester MST: 15-20 wks msAFP, estriol, and free bHCG |
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what is a sceening test offered to women with increased risk factors
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between 11-13 weeks
early pregnancy review ultrasound to assess viability, dating, early antomic development and nuchal translucency |
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who is offered early pregnancy review
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advanced maternal age
multiple gestation medical comorbidties recurrent pregnancy loss, IVF poor POBHX |
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when is complete routine 2nd trimester obstetrical ultrasound offered to women and what are they looking for
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offered to all women 18-21 weeks
fetal biometry amniotic fluid volume placentation anatomical review for anomalies markers for fetal aneuploidy |
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what is the screening test offered to all at 24-28 weeks looking forÉ
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hgb,
diabetic screen maternal ab screen |
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what are some screens offered to some women 24-28
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HIV, syphilis, WinRho
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what is the last antenatal screening 35-37 weeks looking for
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Group B strep screening
vaginal rectal swab to determine need for intrapartum abx prophylaxis to prevent early onset neonatal GBS disease |
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what are some things to explore on follow up prenatal visits
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weight gain
urine protein or sugar BP Fundal height fetal heart rate |
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what is appropriate weight gain in pregnancyÉ
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normal: 25-35 pounds
overweight: 15-25 obeses: 11-20 |
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why are you testing urine protein and sugar
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UTI, HTN and GDM
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why test BP
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screen for hypertensive disorders of pregnancy
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what are normal fundal heightsÉ
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12 weeks pubic symphysis
20 weeks umbilicus greater than 20 weeks: GA +(-) 2 cm may want to screen for fetal growth or amniotic fluid volume disorders |
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what is normal fetal HR
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110-160
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what is the freq of prenatal visits
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-4-28 weeks GA:
every 4 weeks -28-36 weeks GA: every 2 weeks -greater than 36 weeks GA: weekly until delivery see the patient again 6 weeks post partum |
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issues to address in the postpartum visit
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The Bs
baby breasts bladder bowel bleeding birthcontrol blues |
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name in order all the antenatal tests offered a normal pregnancy
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MST 9-13 weeks
MST 15-20 weeks routine ultrasound 18-21 weeks maternal screening 24-28 weeks GBS screening: 36-37 weeks |
