Shared Flashcard Set

Details

OB-GYN: Prenatal Care
asdf
53
Anatomy
1st Grade
08/20/2010

Additional Anatomy Flashcards

 


 

Cards

Term

True or False

 

Although higher percentages of women receive early prenatal care than ever before, preterm birth and low birth weight rates are increasing and declines in infant mortality have stalled in the U.S.

Definition
TRUE
Term

Why is there an issue with poor pregnancy outcomes? (one main problem)

 

What are the top two populations that see highest level of poor prenatal care?

Definition

Why is there an issue with poor pregnancy outcomes? (one main problem)

 

Prenatal care starts too late to prevent many of these poor pregnancy outcomes

 

 

 

What are the top two populations that see highest level of poor prenatal care?

Highest level: teenagers

Premenopausal woman-second highest

 

Term
Up to __% of pregnancies are unintended.
Definition
50%
Term
When is the best time for preconceptual counseling?
Definition

The best time for preconceptional counseling is at the time of a negative pregnancy test

Term

What occurs during days 17-56 or 4-10 weeks from LMP?

 

Why is this so important?

Definition

organ formation

 

The period of time from 17-56 days after conception or 4-10 weeks from the last menstrual period (LMP) is the one where the pregnancy is most susceptible for developing major malformations.

Term
During weeks 5-8- what is developing?
Definition
CNS
Term
What is developing during weeks 5-8.5?
Definition
heart
Term

What develops from

 

6.5-10 weeks

6.5 10.5 weeks

6.5-10 weeks

Definition

6.5-10 weeks: arms

6.5 10.5 weeks: eyes

6.5-10 weeks: legs

Term

What develops between

 

8.5 to 11 weeks?

8.5 to 11.5 weeks?

9.5 to almost 12 weeks?

Definition

8.5 to 11 weeks? teeth

8.5 to 11.5 weeks? palate

9.5 to almost 12 weeks? external genitalia

Term

What takes the longes to develop?

 

6.5 to little over 11 weeks?

Definition
EARS
Term

The following are considered what?

 

Giving protection

Managing conditions

Avoiding exposures known to be teratogenic

Needs determined by thorough history and physical

Definition
preconceptual care
Term
What typ eof infectious diseases do you want to protect the baby from?
Definition

·         Rubella

·         Varicella

·         Hepatitis B

·         HIV/AIDs

Term

What should be given to protect against neural tube defects and other congenital anomalies?

 

When should this be given to maximize effectiveness?

Definition

FOLIC ACID

 

give during earlies week sof organogenesis

Term
What are conditions that if poorly managed can have detrimental effects on reproductive outcomes (5)?
Definition

·   Diabetes

·   Maternal PKU

·   Obesity

·   Hypothyroidism

·   Sexually transmitted infections

Term
What are some teratogenic factors that could impact organogenesis? (4)
Definition

·   Medications

·   Many anti-seizure medications

·   Oral anticoagulants

·   Accutane

·   Alcohol

·   Tobacco

· Environmental Hazards

Term
What topics do you discuss during preconceptual visit? (13)
Definition

             Medications

             Drug Allergies

             Racial/Ethnic/Religious background

             Age- increased anemia, IUGR, preterm labor, and infant mortality in young. Increased GDM, PIH, placenta previa/abruption, C/S in old

             Medical History

             Family History- medical disease, genetic disease, reproductive abnormality

             Surgical History

             Gynecologic History

             Obstetric History- infertility, abnormal pregnancy outcome, miscarriage, ectopic, recurrent loss, preterm delivery, other complications

             Social History- use of alcohol, tobacco, illicit drugs, domestic abuse

             Environment- exposure to disease, heavy metals, methyl mercury, pesticides

             Lifestyle- diet, exercise, stress

             Immunizations

Term
What type of preconceptual screening is appropriate?
Definition

·   Genetic abnormality carrier status: Tay-Sachs, Thalassemia, Cystic Fibrosis

·   Immunity: Hepatitis B, Rubella, Varicella

·   Partner screening, as needed

·   Genetic counseling

·Specialty counseling

 

Term
What are the four componenets of a prenatal care visit?
Definition

·   Preconceptional Care

·   Prompt pregnancy diagnosis

·   Initial care visit

·   Follow-up visits

Term
how can you diagnose a pregnancy?
Definition

·   Clinical Findings: cessation of menses, breast changes-darkening of skin around areola, cervical changes, skin changes, uterine changes-bluish tinge to cervix

·   Laboratory testing

·   Urine hCG

·   Blood hCG

·   Ultrasound

Term
What are the three goals of the initial care visit?
Definition

·   Define the health of the mother and embryo/fetus

·   Establish an estimated gestational age

·   Establish a plan of care for duration of pregnancy

Term
What does TPAL stand for?
Definition

TPAL: full term- 37 weeks or beyond

Preterm: about 20 weeks-37 weeks

Abortion: conception to 20 weeks

Living children at this time

Term
What do you discuss specifically related to obstetric hx?
Definition

menstrual hx: menarche, interval, duration, regularity

 

LMP: normalcy, certainty of dates

 

G's and P's

 

EDD by Naegele's rule or US

Term

What size should the fetus be at the following weeks:

 

6

8:

10:

12:

Definition

6 weeks: plum/egg

8: tennis ball

10: large orange

12: grapefruit-becomes abdominal organ- no longer in pelvis

Term
What are the components of the physical exam for pregnant woman?
Definition

·   Height, weight, pregravid weight, baseline blood pressure

·   Complete physical examination, focus on abdomen

·   Pelvic examination: cervix, uterine size, adnexa, pelvimetry

·   Urine dip for protein and glucose

·   Fetal heart tones/fundal height (prn)---if under 10 weeks u wont find

Term
What lab tests are you interested in for pregnant woman? (14)
Definition

·   CBC (HGB/HCT, Plts)

·   Hgb Electrophoresis

·   Blood Type

·   Antibody Screen

·   RPR

·   Rubella

·   HBsAG

·   HIV

·   GC/CT

·   Urine Culture

·   Pap (prn)

·   Cystic Fibrosis, Tay Sachs, Genetic Screening as appropriate/desired

·   VZV (prn)

·   PPD

Term

What is the follow up care for prego woman?

 

how how should she see you?

Definition

·   Q 4 weeks until 28 weeks, then Q 2 weeks until 36 weeks, then Q week until delivery

·   Other models of care: one visit in first trimester, return visits at 26, 32, 38 weeks. Achieve same outcomes

Term

These items would be assessed in what type of hx?

 

 

·   General health and well being

·   Contractions

·   Fetal movement

·   Fluid leaking

·   Vaginal bleeding

·   Headaches/visual changes-esp imp if inc BP

·   Pain

·   Edema

Additional concerns

Definition

Interval Hx

 

Follow up Care

Term
Nuchal translucency on ultrasound is associated with what disorder?
Definition
Down syndrome
Term
What type of genetic screening can you do in the first trimester?
Definition

             Nuchal Translucency (10.3-13.6 weeks): 64-70%

             NT/PAPP-A, Beta hCG (10.3-13.6 weeks): 82-87%. Offer with AFP in second trimester to screen for Open NTD. Not as available as Quad Screen

Term
What type of genetic screening is done during second trimester?
Definition

             Quad Screen: AFP, Beta hCG, unconjugated estriol, Inhibin A (14-21 weeks, optimal 16-18 weeks): 81%. Most practical choice when combined with genetic ultrasound

             Alpha Fetoprotein (14-22 weeks, optimal 16-18 weeks): combine with 1st trimester screening

Term

When can you do chorionic villus sampling?

 

what are you at risk for?

 

what are you looking for? what can it NOT diagnose?

 

how do you do the test?

Definition

When can you do chorionic villus sampling? 10-12 weeks

 

what are you at risk for? spontaneous abortion

 

what are you looking for? chromosomal abnormalities

 

what can it NOT diagnose? NOT diagnose Open NTD

 

how do you do the test? transcervical or transabdominal

Term
What are two types of genetic testing?
Definition

chorionic villus sampling

 

amniocentesis

Term

Amniocentesis: when can you do the test?

 

what can you detect?

 

What are you at risk for?

 

 

what specifically are you retrieving to make a diagnosis?

Definition

Amniocentesis: when can you do the test? 15-20 weeks

 

what can you detect? open neuronal tube defect, down syndrome, trisomy 21

 

What are you at risk for? SAB/SROM

 

 

what specifically are you retrieving to make a diagnosis? amniotic fluid looking at AFP and fetal cells for chromosomal abnormalities

Term

What tests should you do when pt is 24-28 weeks?

 

What tests at 36 weeks?

Definition

24-28 weeks

·   One hour glucose tolerance test

·   CBC

·   RPR

·   HIV

 ·   Antibody Screen/RhoGAM (prn)

 

36 weeks

·   GBS-sepsis-screened vaginal and rectal culture treatd with PNC

·   Cervical cultures- gonorrhea dn chlamydia

HIV

 

Term
What type of information can US provide? (7)
Definition

             Pregnancy Dating (early is more accurate)

             Anatomy (18-22 weeks)

             Fetal Weight (LGA/SGA, macrosomia, IUGR)

             Placental abnormalities: grade, previa, accreta/increta/percreta

             Amniotic fluid volume

             Doppler flow

             High-risk follow-up: twins, GDM, HTN, etc.

Term

What type of anticipatory guidance is necessary for pregnant woman?

 

What do you tell them specifically about immunications and travel?

Definition

             Diet

             Weight Gain 25 lbs is max

             Exercise

             Sleep

             Sex

             Dental Care

             Travel-counsel pt and get up and walk often, consume fluids/biggest risk: DVT

             Immunizations- can vaccinate against rubella or varicella during pregnancy/pertussis vaccine-whooping cough-vaccine anyone who is going to be near neonate- careproviders, fathers, etc.

Term

What is ptyalism?

 

What causes?

Definition

excessive spitting during pregnancy

 

due to progesterone

Term
What hormone causes the common discomforts of pregnancy?
Definition
progesterone
Term
What ligament causes pain during pregnancy?
Definition
round ligament
Term
What is leuokorrhea?
Definition

thick, whitish yellowish discharge

 

part of pregnancy-due to estrogen imbalance

Term
What are types of puerpueral infections?
Definition

             Endometritis

             Perineal laceration ie episiotomy

             Incision

             Mastitis

             Urinary tract

Term

Pt presents with the following: what could it be?

 

             Fever: 100.4+

             Pain

             Tachycardia

             Chills

             Subinvolution

             Foul lochia/drainage

             Erythema

             Leukocytosis-sometimes normal to see bump right after delivery

 

Definition
Puerperal Infections
Term
When should you expect to menstruate post partum?
Definition
7-9 weeks
Term

When is the cervical os completely closed after giving birth?

 

When does vagina return to normal size?

Definition

When is the cervical os completely closed after giving birth?

4 weeks

 

When does vagina return to normal size?

3 weeks

Term
What is lochia?
Definition
contains blood, mucus and placental tissue
Term
What are postpartum mood disorders?
Definition

blues

depression

psychosis

Term
Up to 85% of women, characterized by mild depressive symptoms, tearfulness (often for no discernible reason), anxiety, irritability, mood lability, increased sensitivity and fatigue
Definition
Post partum Blues
Term

Post partum blues:

 

When does it peak?

 

When does it resolve?

Definition
Peaks postpartum day 3-5, spontaneously resolves by day 10
Term

Occurs in up to 10% of women

             Can occur any time in the first postpartum year

             Diagnosed using DSM-IV criteria for ______

Definition

Post partum depression

 

diagnosed by major depressive disorder criteria

Term
What are sxs of post partum depression?
Definition

Depression

           depressed mood

             Lack of pleasure or interest

             Sleep disturbance (insomnia or hypersomnia)

             Weight loss

             Loss of energy

             Agitation or retardation

             Feelings of worthlessness or inappropriate guilt

             Diminished concentration, or indecisiveness

             Frequent thoughts of death or suicide

Term
When is the treatment for postpartum depression?
Definition

             Psychotherapy

             Antidepressant Therapy

             Tricyclics or SSRI’s

             Support Groups

Term

Pt presents with the following symptoms:

 

Inability to sleep for several nights

Agitation

Expansive or irritable mood

Avoidance of the infant

Delusions

Hallucinations

what could it be? how do you treat?

Definition

Postpartum psychosis

 

Tx: MEDICAL EMERGENCY, treat inpatient with neuroleptics and mood stabilizers

Term
is postpartum psychosis an emergency?
Definition
YES!
Supporting users have an ad free experience!