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187 Cards in this Set
- Front
- Back
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Things that should be evaluated at EVERY prenatal appointment |
-BP -U/A -wt check -FH -Nutrition -Lifestyle -Emotional Wellbeing/Preparation/Transition |
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Normal BP |
90/60 - 140/90 what's normal for them? |
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NOT normal limits (pink flag) |
+30/+15 |
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What is the best position to take BP? |
Sitting Make sure it stays the same at each visit |
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urine dip is checking for |
glucose, protein |
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What is too high for protein in a urine dip? |
+1, +2 |
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If you see high glucose in the urine - what should you do? |
Ask about what they've had today, see if that could raise levels. |
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ketones |
when the body/fetus is taking from the fat of the mother b/c not getting enough to eat |
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What can be helpful if ketones are present in a u/a |
More protein |
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luekocytes in a u/a could mean |
fighting an infection - we may not be aware of it |
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specific gravity |
how concentrated the urine is |
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things to consider with specific gravity |
When was the last urination? Have they taken any vitamins? How much water are they drinking? |
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RBCs in urine could indicate |
Inflammation in the bladder, kidneys or ureters. Blood could also be from the vagina. Yeast can release blood from the vagina. |
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Another indication in a u/a of a UTI |
nitrites |
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urobilinogen |
comes from breaking down RBCs |
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urobilinogen in a u/a could indicate |
liver dysfunction b/c urobilinogen |
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FH |
fundal height |
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FH is to measure how many weeks a fetus is at after ____ wks. |
20 |
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At 12 wks the fundus should be |
just above pubis |
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At 16 wks the fundus should be |
1/2 between pubis and u |
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20 wks fundus should be _______ |
@u |
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After 20 wks, when you use a tape measure, the fundal height should be how many centimeters per week? |
cm = wks ex: 26cm, 26wks |
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Fundus measurement could be affected by the fetus' __________. |
position/lie |
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When a fetus is breech, the fundal height measurement may be _________ than "normal". |
higher |
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When a fetus is transverse, the fundal height measurement may be __________ than "normal". |
smaller/lower |
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A 2 MHz doppler can use to listen for FHR at ____ weeks. |
10-12 |
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A 3 MHz doppler can use to listen for FHR ____ weeks. |
8 |
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A fetoscope can be used at how many weeks to listen for FHR? |
20wks |
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MHz |
megahurtz |
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What are you listening for when you check FHT? (with doppler or fetoscope) |
variation rate arryhthmia |
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Normal range for FHT |
120-160 |
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A fetus will have a _________ heart rate earlier in pregnancy. |
higher |
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Leopold's Maneuvers are often begun casually to just palpate and determine general information at ____ weeks. |
12 |
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Many midwives check, but don't require |
pulse edema DTRs warning signs |
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Normal pulse range for a mother during pregnancy is _____bpm. |
60-80 |
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What are you looking for when you check for edema? |
Swelling/water retention |
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How do you check for edema? |
Press into the shin bone briefly, remove, see if there's a mark. (Check on both legs.) |
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third spacing |
AKA pitting |
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General Warning Signs (Is this client still a good HB candidate?) |
-HA -blurry/double vision -abdominal pain -vag bleeding -sudden swelling including hands and face -decreased fetal movement -size don't match dates -elevated BP -glucose in urine |
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CONSULTATION w/ another provider |
May just be a chit-chat. Just so they have the information in case of transfer. Keep information confidential. Non-specify. |
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perinatologist |
high risk OB |
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ND |
Naturopathic Doctor |
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LCSW |
Licensed Social Worker |
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LCPC |
Licensed Clinical Personal Counselor |
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PT |
Personal Trainer |
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CNM |
Certified Nurse Midwife |
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OB |
Obstetrician |
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MD |
Medical Doctor |
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DO |
Osteopathic Doctor |
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NP |
Nurse Practitioner |
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DC |
Doctor of Chiropractic |
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LAc |
Accupuncturist |
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Initial Prenatal Panel |
-Blood Type & Rh Factor -Antibody Screen -CBC of H/H - Rubella Antibody Titer -RPR (or VDRL) -Hepatitis B Surface Antigen |
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RPR |
Rapid Plasma Reagin |
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VDRL |
Venereal Disease Research Laboratory |
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Antibody Screen checks for |
The antibody related to Rh Factor. Antibodies are created because blood types don't match maternal blood is preparing to fight fetal blood. |
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H/H is part of what larger test? |
CBC |
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CBC |
diff MCV MCHC RBC Hgb Hct |
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Platelet Count is an indicator of how well someone can _____. |
clot |
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MCV |
Mean Cell Volume |
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Hgb |
Hemoglobin |
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MCHC |
Mean Cell Hemoglobin Concentration |
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Ideal Hgb levels in pregnancy |
11-13 |
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Hgb will likely drop by ___pts during pregnancy due to hemodilution? |
1-2 |
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IPNV |
Initial Prenatal Visit |
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RPNV |
Routine Prenatal Visit |
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Ideal Hct levels in pregnancy |
33-39% |
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Ideal RBC level in pregnancy |
about 4 |
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Will the RBC levels increase or decrease at 28 wks? |
increase |
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Which CBC tests check for the quality of cells? |
MCV MCH MCHC |
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Which CBC tests check for the quantity of cells? |
RBC Hgb Hct |
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MCV cells in a CBC are noted as |
tiny or large |
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"tiny" MCV or MCH results indicate |
an issue with iron |
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"large" MCV or MCH results indicate |
B12 or folate issues |
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MCH tells you |
how much Hgb a cell can carry |
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MCV tells you |
how much Hgb is in a cell |
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MCHC |
concentrated cells = dark dark red cells that are not concentrated = pale |
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In an MCHC test, "pale" results indicate a need for |
Iron |
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In an MCHC test, "dark" results indicate a need for |
B12 or folate |
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Rubella Antibody Titer |
Whether or not they've been exposed to rubella which has resulted in an immunity. (illness or vaccine) |
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Rubella Antibody Titer results will be noted by which terms? |
Not Immune Equivocal Immune |
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RPR tests for |
Whether or not a client has syphilis |
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HBSFA test looks for |
Does the client have Hep B? |
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If a client tests positive for Hep B - do they risk out of low-risk? |
Yes |
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Additional Prenatal Testing includes these tests |
Hepatitis C HIV Toxoplasmosis u/a Gonorrhea Chlamydia Pap Smear |
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Screening for Anomalies - 1st Trimester is usually offered at ___-____ wks. |
10 - 14 |
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Which blood tests are standard to offer in the 1st trimester? |
PAPP-A & beta hCG |
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The ultrasound offered in the first trimester as part of the standard screening examines the |
Nuchal Transluscency |
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The 1st Trimester Screening identifies clients that are at an increased risk of having a baby with the following syndromes. |
Trisomy 21 (Down's Syndrome) Trisomy 18 (Edward's Syndrome) sometimes Trisomy 13 (Patau Syndrome) |
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What are possible tests that a client may get if they have a Positive Screening that requires further testing? |
CVS Amniocentesis |
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False positive rate for Down's Syndrome is |
5% |
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It is standard to offer the Quad Screen between ___-___ wks of pregnancy |
15-18 |
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The Quad Screen is a ______ test |
blood |
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The Quad Screen is the only test that screens for _________ _________ |
spina bifida |
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The Quad Screen blood test looks for |
MAFP, Estriol (E3), hCG, inhibin A |
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The Quad Screen identifies clients who are at an increased risk of having a baby with |
Trisomy 21 (Down's Syndrome) Trisomy 18 (Edward's Syndrome) many Trisomy 13 (Patau Syndrome) Open Teural Tube Defects (Spina Bifida, Anancephaly) |
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Positive screening results will require these further tests |
CVS amniocentesis |
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Combined Screening Options include |
Sequential Screening Integrated Screening |
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Sequential Screening includes |
-improves detection and false positive rates -combines 1st+2nd tri screening -must have u/s -still allows for early diagnosis |
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Integrated Screening includes |
-improves detection and false positive rates -combines 1st&2nd tri screening -may have option to decline u/s -results are not provided until process is complete (for ANY results) |
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Dating u/s is offered at around |
8 wks
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How accurate is the dating u/s? |
2-3 days |
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Fetal Survey u/s is offered at around |
18-22 weeks |
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How accurate is the Fetal Survey u/s? |
10-14 days off |
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What does the Fetal Survey include? |
head to toe exam for fetus, includes many internal structures |
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Viability of pregnancy |
20 wks |
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Viability of fetus |
24 wks |
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What are the indications for an u/s |
vaginal bleeding decreased/no fetal movement size doesn't equal dates trauma to abdomen/abdominal |
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Questions surround u/s |
-Is it really safe? What are the short & long term effects? -Cavitation -Is u/s linked to autism? -Increased left-handedness in male fetuses -Higher rates of IUGR or low birth weight babies? -Is u/s causing more problems or are we identifying more problems using u/s? |
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cavitation |
u/s heats up cells by about 1-2C It can explode the cells and release toxins |
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What are some reasons you would be concerned about the Mother and Infant's blood mixing? |
-placenta previa -trauma -version -amniocentisis
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Why is the risk of Rh issues with subsequent pregnancies? |
Because the defense system needs time to build up. |
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When do you offer RhIG issues? |
28 wks 72 hours pp |
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How long does RhIG protect? |
12 wks |
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What are you looking for in the blood draw you take postpartum in relation to Rh issues? |
Maternal cells in fetal blood |
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What percentage of the following populations are likely to have Rh issues? Basque African American & Hispanics Pacific Islanders, Asians, Native Americans |
Basques - 30% African Americans & Hispanics - 7-8% Pacific Islanders, Asians, Native Americans - 2% |
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If a client chooses to have just RhIG in the pp, they have a ___% chance of making anitbodies. |
2 |
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If a client chooses to have both the prenatal dose of RhIG at 28 wks and the pp dose, they have a ____% chance of making antibodies. |
0.2 |
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If a client choose to decline all RhIG, they have a ____% chance of making antibodies. |
12 |
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RhIG is a product that is derived from ______. |
blood |
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What is one of the risks of the RhIG treatment? |
It is blood so there could be some contamination Some religions restrict use of blood based products It is a category C drug |
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RhIG is a Category ___ drug. |
C |
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Category A drugs are |
believed to safe in pregnancy Tested, shown no teratogenic |
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Category B drugs are |
likely safe No proof there is harm to human babies, animal testing good |
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Category C drugs are |
No testing on humans Teratogenic effects shown in animals |
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Individualized Care Plan IPNV |
What is their EDD How many wks are they now? What can they do for any sx? What do you think about her BP, urine dip, FH, FHT check? What might you offer them today? When would you like to schedule their next appt? |
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Individualized Care Plan 2nd PNV |
How many wks are they now? When can they expect to feel FM? When can they expect to get an u/s report of fetal sex? What do you think of their BP, urine dip, FH, FHTs? When would you like to schedule their next appt? |
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Individualized Care Plan 3rd PNV |
How many wks are they now? What suggestions do you have for their concerns? What do you think of their BP, urine dip, FH, FHTs? When would you like to schedule their next appt? |
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Individualized Care Plan 4th PNV |
How many wks are they now? What tests/options will you discuss with them today - to be performed at the next visit? (Antibody Screen, CBC or H/H, gestational diabetes screening, RhIG) What do you think of their BP, urine dip, FH, FHTs? What is the likely cause of any sx? When would you like to schedule their next appt? |
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What is included at an 8-12wk visit? |
Initial PNV Initial Prenatal Panel 1st Trimester u/s 1st & 2nd Trimester Screen Complete Physical Discuss Pap Smear |
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What is included at a 12-16wk visit? |
Review Labs Review u/s Revisit 2nd Trimester Screen Review Diet Journal |
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What is included at a 16-20wk visit? |
Review Screening Results Fetal Anatomical Survey |
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What is included at a 20-24wk visit? |
Review fetal anatomical survey results |
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What is included at a 24-48wk visit? |
Gestational Diabetes Screening CBC (of H/H) Antibody Screen for Rh (-) clients RhIG |
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What is included at a 28-30wk visit? |
Review lab results |
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After the 28wk mark, how often do you see your client? |
2wk |
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How often do you see your client before the 28wk mark? |
4wk |
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What is included at a 32-34wk visit? |
Assess fetal presentation-is baby in cephalic/vertex position or breech? |
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What is included at a 34-36wk visit? |
GBS Screening |
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What is included at a 36wk visit? |
Home visit Supplies Ready Logistics Birth Plan/Vision Emotional Preparation Immediate Postpartum Vitamin K Eye prophylaxis |
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After 36wks, how often do you see your client? |
q 1 wk |
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What is included at a 37-40wk visit? |
weekly visits |
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What is included at a 41wk visit? |
BPP AAT NST |
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AAT |
Accelerated Auscultation Test |
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NST |
Non-stress Test |
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What is included at a 42wk visit? |
Visit q 3 days BPP AAT NST |
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Prenatal Abdominal Exam includes |
Palpation - Leopold's Maneuvers FH measurement FHTs check |
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Leopold Maneuvers include how many steps? |
4 |
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The first step of Leopold Maneuvers include what and are looking for what? |
1. Superior surface of fundus palpated to determine consistency, shape and mobility. |
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The second step of Leopold Maneuvers include what and are looking for what? |
Both sides of the uterus are palpated to determine the direction of the fetal back is facing. |
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The third step of Leopold Maneuvers include what and are looking for what? |
This step determines the part of the fetus at the inlet and its mobility. |
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The fourth step of Leopold Maneuvers include what and are looking for what? |
This step determines the fetal attitude and degree of fetal extension into the pelvis |
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During Leopold's Maneuvers you are determing |
Fetal Presentation Fetal Lie (Where is baby's long axis compared to Mother's lie?) Fetal Denominator (Where is a piece of the presenting part?) Fetal Position Fetal Attitude (Is fetus well flexed or up/down or head extended?) |
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oblique lie |
diagonal lie |
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After how many wks should you use a tape measure to take fundal ht? |
20 |
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Fundal measurements are taken in ___________. |
centimeters |
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When Size |
EDD correct? Missed abortion? Fetal demise? Maternal nutrition? Oligohydramnios? Fetal position? Chromosomal anomalies? IUGR? SGA? Measure correct? Maternal build? Engagement? |
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When Size>Dates |
EDD correct? Multiple preg? Maternal nutrition? Gestational Diabetes? Fetal position? Chromosomal anomalies? Uterine masses? LGA? Measure correct? Maternal build? |
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Normal range for FHTs |
120s-160s |
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How long do you have to listen to establish a bsl for FHT? |
2 minutes |
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It is normal for there to be an acceleration of HR with FM or stim at around ___ wks and beyond. |
28 |
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FHTs are best heard over the fetal ______ in breech and vertex positions. |
back |
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PMI |
Point of Maximum Intensity (refers to where the best place to listen to the fetal heart rate is) |
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GDM |
Gestational Diabetes |
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Gestational Diabetes is |
carbohydrate intolerance with the onset of pregnancy |
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GDM affects ___% of population |
5-6 |
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Elevated glucose levels can be seen in the _______ and urine in cases of GDM |
blood |
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GDM can be caused by an absence of/inadequate insulin levels OR insulin __________ |
resistance |
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Hormonal changes of pregnancy make tissues more resistant to ________ |
insulin (esp p 20wks) |
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HPL peak effect is between ___wks |
26-28 |
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Who is at greatest risk for GDM? |
>25yo Obesity Family hx of diabetes hx of GDM in prior pg hx or unexplained stillbirth Previous infant weighing >8lbs 13oz Member of ethnic group with high prevalence of GDM |
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Implications of GDM for Mother |
Polyhydramnios Increased risk of birth trauma Increased incidence of htn and pre-eclampsia Increased risk of developing Type II DM later in lifeI |
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Implications of GDM for fetus |
Macromasia Increased risk of stillbirth Shoulder dystocia Increased risk of birth trauma Increased risk of RDS in immediate newborn period |
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RDS |
Respiratory Distress Syndrome |
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Concerns surrounding GDM screening |
Should every pregnant woman be screened for GDM? Should we screen everyone for GDM with risk factors? If someone is at high risk for GDM, what can we do prenatally to prevent GDM from occurring in the pg? |
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What is the Standard of Care for GDM screening in the US? |
GCT |
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GCT |
Glucose Tolerance Test |
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How many grams of glucose does the standard GDM have? |
50 |
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Blood glucose is drawn __hour after glucose load during GCT. |
1 |
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For those that don't pass their GCT - |
Oral Glucose Tolerance Test
Carbo load for 3 days prior to the test Fast for 8-14 hour period (water ok) oral 100g glucose load Fasting blood glucose drawn; 95mg/dL or less, ideal 1hr blood glucose drawn; 180mg/dL or less, ideal 2hr blood glucose drawn; 155mg/dL or less, ideal 3hr blood glucose drawn; 140mg/dL or less, ideal |
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Alternatives to GDM screening (GCT & OCTT) |
2hr OGTT, 75g oral glucose load 2hr Post-Prandial Test |
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What is involved in the 2hr OGTT |
Fasting blood glucose drawn; 95mg/dL or less, ideal 1hr blood glucose drawn; 180mg/dL or less, ideal 2hr blood glucose drawn; 155mg/dL or less, ideal |
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2hr Post Prandial Test |
Fasting blood glucose drawn, 95mg/dL or less, ideal Eat 75-80g of complex carbs, 600 calories for breakfast Moderate exercise, like walking after meal is completed Draw glucose levels 2 hours after the meal began 2 hour blood glucose drawn, 120mg/dL or less, ideal (@lab) 2 hour blood glucose drawn, 140mg/dL or less, ideal (@home) |
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prandial |
after a meal |
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Steps taken for the client with GDM in the homebirth midwifery practice |
Schedule more frequent appts Nutritiona counseling/diet journal wkly until well controlled Lifestyle counseling At home blood glucose monitoring qid If blood glucose levels consistently elevated, transfer of care necessitated |
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Other factors to monitor closely for GDM |
FH FM htn/Pre-Eclampsia Glucosuria |
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Why do you perform the 2 hour 75g OGTT or 3 hour 100g OGTT in the postpartum? |
To find out if GDM was "Gestational" or there before? |
