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Family Medicine Clerkship- Case files > Prenatal care > Flashcards

Prenatal care Flashcards

1
Q

When is an ultrasound indicated in prenatal care?

A
  • Evaluation of uncertain gestational age
  • Size/date discrepancies
  • Vaginal bleeding
  • Multiple gestations
  • Other high risk
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2
Q

What labs are recommended at the initial prenatal visit?

A
  • CBC
  • Hep B surface antigen
  • HIV testing
  • Syphillis screening (RPR)
  • UA + culture
  • Rubella antibody
  • Blood type and Rh status with antibody screen
  • Pap smear
  • Cervical swab for gonorrhea and chlamydia
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3
Q

When is the optimal time to screen for trisomy?

A
  • 16-18 weeks of gestation is optimal

* Trisomy screening may be performed between 15-20 weeks if necessary

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4
Q

At what time is the fetus most exposed to risks against development?

A

-3-8 weeks (organogenesis)

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5
Q

What level of radiation exposure could be harmful to the fetus?

A

> 5 rads (most x-rays provide a small fraction of this)

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6
Q

What drug/supplements are advised to be started in the pre-conception period?

A
  • 400 micrograms of folic acid for one month prior to attempting to conceive
  • 1mg for diabetic or epileptic women
  • 4mg for women who have had children with neural tube defects
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7
Q

Which groups could be genetically screened for sickle cell trait?

A
  • Africans and African Americans
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8
Q

Which groups could be genetically screened for Tay-Sachs trait?

A

French- Canadians or Ashkenazi Jews

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9
Q

Which groups could be genetically screened for thalassemia trait?

A

Middle Easterners and Southeast Asians

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10
Q

Which groups could be genetically screened for cystic fibrosis trait?

A

Ashkenazi Jews and Caucasians

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11
Q

At what age should women be educated about age related risk of pregnancy?

A

> 35

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12
Q

What conditions of the mother constitute high risk pregnancies?

A
  • diabetes
  • asthma
  • thyroid disease
  • hypertension
  • lupus
  • thromboembolism
  • seizures
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13
Q

How is the delivery date calculated?

A
  • Delivery date (Naegele’s rule) = first day of LMP - 3 months + 7 days
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14
Q

What history should be obtained in the initial prenatal visit?

A
  • medical history
  • prior pregnancies
  • delivery outcomes
  • pregnancy complications
  • neonatal complications
  • birth weights
  • gynecologic history: mentruation, contraceptive use, STIs
  • allergies
  • current meds, vitamins, OTC drugs
  • substance use
  • social history: planned, unplanned, unintentional
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15
Q

What should be assessed in initial physical examination at the first prenatal visit?

A
  • Height, weight, blood pressure
  • Thyroid
  • Breast, pelvic, and general physical
  • Gestational age (uterine size or fundal height)
  • Fetal heart tones by doppler (by 10 weeks)
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16
Q

What initial labs should be done during the first prenatal visit?

A
  • blood type and Rh status antibody screen
  • rubella status, HIV, hep B surface antigen, rapid plasma reagin
  • Urinalysis, urine culture
  • Papsmear, cervical swab for gonorrhea and chlamydia
  • CBC
17
Q

What is the typical schedule for prenatal visits?

A
  • Every 4 weeks until 28 weeks
  • Then, every 2 weeks from 28-36 weeks
  • Then, every week until delivery
18
Q

What are the ramifications of a hemoglobin less than 10.5?

A
  • Preterm delivery
  • Low fetal iron stores
  • Thalassemia in the mother
19
Q

What diagnostic test should be done if the mother has a hemoglobin less than 10.5?

A
  • Mild: therapeutic trial of iron

- Moderate: ferritin and Hb electrophoresis

20
Q

Are the ramifications of having negative titers to rubella?

A
  • Mother is susceptible to rubella infection and vertical transmission if contracted
  • Live attenuated vaccine should be given in the postpartum period
21
Q

What are the ramifications of a positive RPR?

A
  • Possible syphillis, test for specific antibody to confirm, then stage disease
  • Penicillin should be administered to the mother if positive
22
Q

What are the ramifications of gonorrhea during pregnancy?

A
  • Preterm labor

- Blindness

23
Q

What should be given to treat gonorrhea during pregnancy?

A
  • IM ceftriaxone
24
Q

What are the ramifications of chlamydia during pregnancy?

A
  • neonatal blindness

- pneumonia

25
Q

What should be given to treat chlamydia during pregnancy?

A
  • Azithromycin
  • Amoxicillin
    • both po
26
Q

What are the ramifications of a positive Hep B surface antigen?

A
  • Mother is potentially infectious and the baby needs Heb B immunoglobins and hepatitis B vaccine
27
Q

What is the ramification of a positive urine culture?

A
  • Asymptomatic bacteriuria that may lead to pyelonephritis in up to 25% of patients
28
Q

How should a positive urine culture be treated in pregnancy?

A
  • Treat with Abx and recheck urine culture

- If the organism is GBS then give penicillin in labor

29
Q

What might nuchal translucency indicate?

A

Nuchal translucency may indicate trisomy

30
Q

What is the next step if nuchal translucency is seen (11-13wks)?

A
  • karyotype and follow up ultrasounds
31
Q

What is the next step with a positive trisomy screen (16-20 weeks)?

A
  • Ultrasound

- Genetic amniocentesis

32
Q

Which is more specific/sensitive, the triple or quad screening?

A
  • Quad screening is 80% sensitive and 95% specific (triple screen is only 65-69% sensitive but just as specific)
33
Q

What is the most common cause of false positives in aneuploidy screening?

A

Incorrect gestational age

34
Q

When can amniocentesis be performed and what is the associated risk?

A
  • Amniocentesis can be preformed at 15 weeks and is associated with a 0.5% risk of spontaneous abortion
35
Q

When should women be tested for gestational diabetes?

A
  • 24-28 weeks with a 1 hr 50mg glucose challenge test
36
Q

When should a pregnant woman receive Rh-o (D) immune globulin if she is Rh-negative?

A
  • 28 weeks
37
Q

When should women receive a GBS screening?

A
  • Vaginorectal culture at 35-37 weeks
38
Q

When would a late term pregnancy be considered for inducing labor?

A

42 weeks

39
Q

What vaccines should be given to pregnant women?

A
  • Flu
  • Tetanus toxoid
  • Rubella after the child is born

Family Medicine Clerkship- Case files (13 decks)

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