Wh Session 8 Preconception And Antepartum

Front 1

what do the terms mean?
gravida

Back 1

• Gravida: describes the number of pregnancies

Front 2

nullgravida?

Back 2

• Nulligravida: describes a woman who is not now and never has been pregnant

Front 3

parity

Back 3

• Parity: describes a woman who has delivered a fetus

Front 4

nullparous

Back 4

• Nulliparous: describes a woman who has never delivered a fetus > 20 weeks

Front 5

primipara

Back 5

• Primipara: describes a woman who is pregnant for the first time or has delivered only once

Front 6

multipara

Back 6

• Multipara: describes a woman who has delivered more than once

Front 7

What do GPTPAL stand for?

Back 7

Gravidity- # of times a pt has been pregnant
Parity- # of deliveries
G_P_ _ _ _
G_: total number of pregnancies including the current pregnancy
P_ _ _ _: referred to as the TPAL system of nomenclature
T = number of full-term deliveries
P = number of preterm deliveries at 20 weeks or greater
A = number of spontaneous or therapeutic abortions as well as ectopic pregnancies occurring before 20 weeks of gestation
L = number of living children

Front 8

when should preconception care be offered and what does it include?

Back 8

• Any visit of a reproductive-aged woman is an opportunity
• Task is to maximize the health before and between pregnancies
o Health promotion through education
o Medical and genetic risk assessments
o Medical and psychosocial interventions
o Folic acid
o Prevention of unintended pregnancy

Front 9

what aspects of the medical history should be updated annually?

Back 9

o Past and chronic medical conditions
o Reproductive history and future plans
o Medications (prescription, OTC, complementary)
o Alcohol, tobacco, and illicit drug use
o Psychosocial information
o Diet, exercise, and immunization status
o Family and genetic history

Front 10

how much folic acid should you take before conception?

Back 10

• Intake of 0.4 mg synthetic folic acid and folate-rich food daily.

Front 11

check on preconception meds in book

Back 11

pg 71-72

Front 12

what does class a drugs mean?

Back 12

Human studies show no risk

Front 13

what does class b drugs mean?

Back 13

Animal studies show no risk, no human studies OR
Animal studies show risk, human studies show no risk

Front 14

what does class c drugs mean?

Back 14

Animal studies show risk, no human studies OR no animal or human studies

benefit only outweighs risk if the drug is necessary

Front 15

what does class d drugs mean?

Back 15

Human studies show risk
benefit only outweighs risk with serious disease

Front 16

what does class x mean

Back 16

Human studies show risk and there is no benefit

Front 17

what are presumptive symptoms of pregnancy?

Back 17

• Amenorrhea
• Nausea with or without vomiting
• Breast changes
• Increased frequency of urination
• Fatigue
• Sensation of fetal movement (quickening)

Front 18

what methods can be used to confirm a pregnancy?

Back 18

enlargement of abdomen
urine preg test
Serum pregnancy test- Serum beta-hCG (human chorionic gonadotropin)
US
fetal cardiac motion
doppler of fetal heart tones

Front 19

how accurate is a urine preg test and how much HCG is needed to be present for a positive test?

Back 19

o Up to 99% accuracy on the 1st day of missed period
o Positive result at approximately 20-25 IU/L hCG

Front 20

how soon is the beta HCG test accurate and what is considered a positive or negative result

Back 20

o Qualitative versus quantitative

First detectable 6 to 8 dayswhat a after ovulation
o < 5 IU/L is considered negative
o > 25 IU/L is a positive result
o Values in between are considered equivocal
o Level should increase at least 53% every 2 days for the first 6 weeks of normal gestation

Front 21

what is the most precise way to estimate the due date?

Back 21

US

o Ultrasound obtained in the first trimester is accurate to within 3-4 days [or rounded to a week].
o The later in pregnancy an ultrasound is obtained, the less accurate is the due date.

Front 22

when should gestational sac be seen on transvaginal US and transabdominal US?

Back 22

vaginal- 3-4 wks
abdomen- 5 to 6 wks

Front 23

when should fetal cardiac motion be seen?

Back 23

5-6 weeks by TVUS

Front 24

when can fetal heart tones be heard?

Back 24

10-12 weeks gestation

Front 25

what are the goals of antepartum care?

Back 25

• Ensure a healthy baby and minimize maternal risk
• Early accurate estimation of gestational age
• Identification of high risk patients
• Anticipation and prevention of possible future problems
• Patient education and communication

Front 26

when should F/u visits be done for antepartum care

Back 26

after initial visit

o Every 4 weeks until 28 wks
o Every 2-3 weeks from 28 to 36 wks
o Weekly from 36 wks until delivery

Front 27

what should be done on each F/U visit?

Back 27

o Check blood pressure, weight, urine dipstick, measurement of fundal height and auscultation of fetal heart tones
o Ask about vaginal bleeding/discharge, leaking of fluid, urinary symptoms, fetal movement, contractions (after 20 wks), blood pressure sx
o Obtain appropriate testing based on fetal gestational age

Front 28

what should be done on initial visit ?

Back 28

• Complete physical exam, including breast and pelvic exam and Pap smear if 21 years or older
• Assessment of uterine size, pelvimetry
• Lab
• Pregnancy dating

Front 29

what labs should be done in the initial visit?

Back 29

o CBC
o Blood type and antibody screen
o RPR
o Rubella antibody screen
o Hepatitis B surface antigen
o HIV
o Gonorrhea & Chlamydia culture
o Urinalysis +/- culture
o Pap smear as appropriate
o Offer Sickle cell, cystic fibrosis and other genetic screening as indicated

Front 30

what is included in pregnancy dating?

Back 30

o OBSTETRICAL MANAGEMENT IS DEPENDENT UPON GESTATIONAL AGE!
o Proper decisions regarding presumed preterm labor or postdate pregnancies are only possible when gestational age is accurately estimated
o Timing of repeat cesarean section requires accurate dates

Front 31

what is the best time for a pregnancy dating?

Back 31

• This ultrasound measurement of the embryo can be made from 7 to 13 weeks and gives the most accurate estimation of the gestational age. Accuracy with the CRL can be within 3-4 days when performed in the 1st trimester.

Front 32

how to date a pregnancy?

Back 32

• Naegele’s rule: LMP – 3 months + 7 days = EDC (estimated date of confinement)
• If the patient’s last period began on April 1, you subtract 3 months (January) and add 7 days (the 8th). In this case it equals January 8!

Front 33

what is the US general rule for pregnancy dating?

Back 33

• Ultrasound General rule: US should not differ from LMP by more than:
o 1 week in 1st trimester
o 2 weeks in 2nd trimester
o 3 weeks in 3rd trimester

Front 34

how does fundal height relate to gestational age?

Back 34

• Measurement of the uterine height from the pubic symphysis to the fundus in centimeters is a rough estimate of gestational age as well. The number of weeks pregnant roughly equals the fundal height in centimeters.
• For example, if you measure the fundal height at 24 centimeters, the patient is approximately 24 weeks pregnant.

Front 35

when is fundal height a helpful measurement?

Back 35

• Fundal height is a useful measurement after 20 weeks.
• At 20 weeks fundus should be at umbilicus

Front 36

what is the crown-rump length and what does it tell you?

Back 36

• Ultrasound performed in the first 13 weeks of pregnancy is the most accurate way to date a pregnancy. The measurement obtained is called the crown-rump length and it is accurate within 3-4 days.

Front 37

what labs should you get in 1st trimester?

Back 37

• Familiarize patient with pregnancy symptoms and what to expect at routine visits
• Review labs
• Offer early genetic screening for Down Syndrome between 10-5/7 and 13-6/7 wks

Front 38

what labs should you get in second trimester?

Back 38

• Offer second-trimester genetic screening for Down Syndrome, neural tube defects, and trisomy 18
• Obtain fetal anatomy ultrasound at 18-20 weeks
• Patients start to feel the baby move (called quickening)
o First-time moms average ~19 weeks
o Repeat moms average ~16 weeks

Front 39

what labs should you get in the third trimester?

Back 39

• Glucose screen to test for gestational diabetes at 24 to 28 wks
• RhoGAM is given to Rh-negative patients at 28 wks
• GC/CT repeated in high-risk populations at 35 wks
• Group B Streptococcus screen at 35-37 wks
• Palpate the maternal abdomen to check for fetal presentation (Leopold’s maneuvers)

Front 40

what are proper nutrition tips in pregnancy?

Back 40

• Always eat breakfast
• Avoid skipping meals
• Eat several small meals each day or three meals and 2-3 snacks
• Take prenatal vitamins with folic acid
• Eat a balanced diet and drink plenty of water

Front 41

what is recommended weight gain if underweight/ BMI <18.5

Back 41

28-40lbs

Front 42

what is recommended weight gain if normal weight/BMI 18.5-24.9

Back 42

25-35 lbs

Front 43

what is the recommended weight gain if you are overweight/ BMI 25-29.9

Back 43

15-25 lbs

Front 44

what is the recommended weight gain if you are obese/ BMI> 30

Back 44

11-20 lbs

Front 45

what kind of activity should be done in pregnancy?

Back 45

• Encourage to continue exercise unless there are complications with pregnancy
• Avoid supine exercises, weight lifting, jumping, and exercises that require a lot of balance
• Walking is good
• Patients can continue to work and/or go to school
• Sexual activity is safe in low-risk pregnancies

Front 46

what should pregnant pts be counseled on about N/V?

Back 46

• Complicates up to 70% of all pregnancies
• Maintain oral fluid hydration
• Dietary counseling
• Eat small frequent meals; avoid empty stomach
• Identification and avoidance of nausea triggers- Smells, foods, heat, humidity, pets
• Consider Vitamin B6 50 mg tid +/- Unisom, ginger
• Consider antiemetic medication
• Dehydration, weight loss, & altered electrolytes may need hospitalization

Front 47

what should pregnant pts be counseled on about back pain?

Back 47

• Very common due to changes in center of gravity
• Avoid excessive weight gain
• Mild exercise & stretching
• Gentle massage
• Acetaminophen for muscle strain
• Emotional support
• Rule out preterm labor

Front 48

what should pregnant women be counseled on about constipation?

Back 48

• Common due to decreased bowel motility
• Dietary modification- Increase water intake and fiber
• Consider stool softeners or bulking agents

Front 49

what should pregnant pts be counseled on about GERD?

Back 49

• Affects about 2/3 of pregnancies
• Due to relaxation of lower esophageal sphincter
• Eat multiple small meals
• Avoid lying down for 1 to 2 hours after eating
• Consider antacids, H2 blockers, or proton pump inhibitors

Front 50

what should pregnant pts be counseled on about hemrrhoids?

Back 50

• Caused by increased venous pressure in rectum
• Avoid constipation
• Increased rest with elevation of legs
• Treat symptomatically

Front 51

what should pregnant pts be counseled on about leg cramps?

Back 51

• Common, usually occurring during the latter half of pregnancy
• Exact etiology is unknown
• Stretching exercises may be an effective preventive measure (do not point the toe!)
• Increased hydration

Front 52

what should pregnant pts be counseled on about round ligament pain?

Back 52

• Described as a sharp pain on the lower sides of abdomen
• Often occurs upon waking, suddenly rolling over in bed, or with activity
• Likely secondary to the rapid expansion of uterus and stretching of ligamentous attachments
• Diagnosis of exclusion
• Self-limited

Front 53

what should pregnant pts be counseled on about contractions?

Back 53

• Dehydration may cause increased contractions
• Regular contractions as often as every 10 minutes should be evaluated in preterm patient

Front 54

what are braxton hicks contraction?

Back 54

occasional irregular contractions that do not cause cervical change