Easy Points: Phys OB - Prenatal Care II

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Easy Points: Phys OB - Prenatal Care II
2013-12-12 06:34:31
Phys OB Prenatal Care II olfu2016
Phys Ob: Prenatal Care II
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  1. Weeks 1-14
    First trimester
  2. Weeks 15-28
    Second Trimester
  3. Weeks 29-42
    Third trimester
  4. Goal of prenatal care
    ↓ Morbidity & Mortality rate
  5. Cervical Softening
    Hegar's sign
  6. Bluish discoloration of the cervix
    Chadwick's sign
  7. Most accurate AOG if taken during 1st trimester
  8. Medical problems during pregnancy that puts patients at high risk
    • Asthma
    • Cardiac disease
    • Diabetes mellitus
    • Drug and alcohol use
    • Epilepsy
    • Family history of genetic problems
    • Hemoglobinopathy
    • HTN
    • History of pulmonary/DVT
    • Psychiatric illness
    • Pulmonary disease
    • Renal disease
  9. Factors for high-risk pregnancy
    • >35 years at delivery
    • Prior CS
    • Incompetent cervix
    • Prior fetal structural and chromosomal abnormality
    • Prior neonatal death
    • Prior fetal death
    • Prior preterm delivery
    • Prior low BW
    • Second trimester pregnancy loss
    • Uterine leiomyomas or malformation
    • (+) HIV test
    • Blood group isoimmunization
    • Diagnosed condylomata
  10. Traditional schedule for prenatal care
    • Every 4 weeks up to 28 weeks
    • Every 2 weeks up to 36 weeks
    • Weekly up to delivery
  11. Normal fetal heart rate
    110-160 bpm
  12. Measurement of birth canal, usually done at term or during labor
    Clinical pelvimetry
  13. Detectable by 16 to 29 weeks
    fetal heart sounds
  14. Recommended weight gain for pregnant women
    11.5-16 kg (25-35 lbs)
  15. Recommended weight gain for twin pregnancies
    35-45 lbs (16-20 kg)
  16. Vitamins and minerals with potential toxic effects
    • Fe
    • Zn
    • Se
    • Vit A, B6, C & D
  17. Extra calories needed during pregnancy
    100 to 300 kcal/day
  18. Screening procedure to assess gestational DM
    Glucose Challenge Test
  19. When to do Glucose Challenge Test
    24th week
  20. Confirmatory test for gestational DM
  21. Condition if no pregnancy after regular sexual contact w/o contraception for 1 yr
    Primary infertility
  22. Indications for a baby with large birth weight (LBW)
    • If baby weight is 4.8 kg & small mother
    • Mothers w/ Gestational GM
  23. Whorl-like pattern of myometrial cell, if found very near the cervix, may interfere w/ Normal Vaginal delivery
    Indicates CS delivery
  24. What are condylomata?  What does it indicate?
    genital warts; indicates CS delivery d/t risk of infection during vaginal delivery
  25. BP parameter for hypotension in pregnant women
    110/70 mm Hg
  26. According to WHO, prenatal check-up for which weeks if no risk factors
    26, 32, 38 weeks
  27. During PE, what should the physician focus on?
    on the abdomen unless there is lung or cardiac complaints
  28. Maneuver to examine the uterus
    Leopold's maneuver
  29. Growth of uterus during first trimester is dependent on what?
  30. During the second trimester, what does the size of the uterus indicate?
    size of the fetus
  31. How to measure fundic height
    Measure fundic height by putting tape measure at fundic hump to the pubic symphisis, straight line
  32. Measurement of fundic height at full term
    35 cm
  33. How do you measure amniotic fluid?
  34. When to perform Leopold's maneuver?
    24 weeks
  35. Components of maternal evaluation:
    • Blood pressure
    • Weight
    • Symptoms
    • Fundic height in centimetres
  36. Range of fundic height that correlates with AOG
    20-34 cm
  37. Average weight gain per week for pregnant women
    1 lb/week
  38. Recommended protein intake during pregnancy
    5-6 g /day
  39. Proteins that increase during pregnancy
    Glutamic acid and alanine concentration ↑
  40. Iron requirement for singletons
    27 mg/day
  41. 60-100 mg/day of iron for which conditions
    • Large women
    • Twin pregnancies
    • Anemia
  42. RDA for calcium
    RDA 1000 to 1300 mg/day
  43. RDA for zinc
    RDA 12 mg
  44. Which mineral deficiency?
    Poor appetite
    Suboptimal growth
    Impaired wound healing
  45. RDA for iodine
    RDA 200 ug
  46. Which mineral deficiency?
    Maternal subclinical hypothyroidism
    Cretinism & neuro-development defects in the fetus
    Seen in pt’s who live in high altitudes
  47. Cause of magnesium deficiency
    Deficiency due to pregnancy has not been recognized.
  48. Trace minerals required during pregnancy
    • Copper
    • Selenium
    • Chromium
    • Manganese
    • Potassium
    • Fluoride
    • Magnesium
    • Iodine
    • Zinc
    • Calcium
    • Iron
  49. RDA Vitamin C
    RDA 80 to 85 mg
  50. RDA Thiamine
    RDA 1.4 mg
  51. RDA Riboflavin
    RDA 1.4 mg
  52. RDA Niacin
    RDA 18 mg
  53. RDA Vitamin B6
    RDA 1.9 mg
  54. Combine this with doxylamine to reduce vomiting
    Vitamin B6
  55. RDA Vitamin B12
    RDA 2.6 ug
  56. Deficiency of these vitamins will lead to neural tube defects
    B12, folic acid
  57. Recommended Folic acid intake
    4 mg before and during the 1st trimester
  58. RDA Vitamin A
    RDA 750 to 770 ug
  59. Potentially teratogenic vitamin
    Vitamin A
  60. Deficiency of which vitamin:
    Spontaneous preterm birth
    Vitamin A
  61. Components of pragmatic nutritional surveillance
    • Eat what she wants in amounts she desires and salted to taste
    • Ensure the availability of food
    • Monitor weight gain
    • Periodically explore food intake
    • Supplements: iron at least 27 mg, folate Recheck Hgb and Hct at 28 to 32 weeks.
  62. What is the concern re: fish consumption during pregnancy
    Avoid fish with potentially high methylmercury levels (bottom-dwellers)
  63. Up to what week should pregnant women travel on airplanes
    safe to travel up to 36 weeks
  64. What is the concern re: oral sex during pregnancy?
    suffering from air embolism from partner blowing air inside vagina
  65. Recommended caffeine intake during pregnancy?
    <300 mg/day
  66. Management for hyperemesis gravidarum
    • Mild: vit B6 and doxylamine
    • May also give phenothiazine or H1 receptor blocker
  67. Congenital predisposition
    Can be present in the legs & perineum
    Exaggerated with:
    Prolonged standing
    Weight increase
    Length of time standing
  68. Treatment for varicosities
    • periodic rest w/ legs elevated and use elastic stockings
    • Lay down in lateral decubitus
  69. Tx for hemorrhoids
    Rx. Topical anesthetics, warm soaks, stool softeners but better to ask patient to have high fiber diet
  70. Management for heartburn
    • Small frequent meals
    • Avoid bending or lying flat
    • Antacids ex. AlMgOH
    • High back rest when you lay down to decrease chances of reflux
    • Eat small meals
  71. Condition that may be related to severe Fe deficiency anemia
  72. cravings of pregnant women for strange foods
    can be non-food items such as ice—pagophagia, starch—amylophagia, or clay—geophagia may predominate.
  73. Usually unexplained: craving for unusual food
    Women during pregnancy are occasionally distressed by profuse salivation.
    Although usually unexplained, the cause of this condition sometimes appears to be stimulation of the salivary glands by the ingestion of starch.
  74. Fatigue can be due to the effects of this hormone
  75. May be normal in pregnancy
    thick, whitish or yellowish vaginal discharge
    Due to hyperestrogenemia
    But may predispose to bacterial vaginosis, candidiasis, trichomoniasis.
    d/t pH form 3.5 to 6