Preconception & Antenatal Care PDF - Exam Questions & Study Guide

Here's a structured markdown representation of the provided text, aiming for accuracy, completeness, and readability: # PRECONCEPTION & ANTEPARTUM **Condition** | **Description** | **Treatment** ----------|---------------|--------------- NTD (Neural Tube Defect) | Neural tube is structure of the e...

Here's a structured markdown representation of the provided text, aiming for accuracy, completeness, and readability: # PRECONCEPTION & ANTEPARTUM **Condition** | **Description** | **Treatment** ----------|---------------|--------------- NTD (Neural Tube Defect) | Neural tube is structure of the embryo that turns into brain/spinal cord. NTD can lead to problems in fetus like spina bifida & anencephaly | Folic acid supplements before & during early pregnancy (FA promotes DNA synthesis & division → Allows for proper neural closure) Quickening | First baby flutters a preggo mama feels. Usually around 16-20 wks | Chadwick's sign | Blue discoloration of cervix, vagina, & labia from increased blood flow and hormonal changes | Hegar's sign | Softening of the cervix at 6wks | Increased Nuchal translucency (NT) | Enlargement of hypoechoic space posterior to fetal neck → Associated w fetal abnormalities (ex down syndrome) | Image shows sonography of fetus ### Pattern of CO in Gravid Patient NT = Nuchal Translucency * Increases → Beginning of pregnancy (6-8wks) * Peak Increase → 32wks * CO dec. tremendously due to compression of uterus on sup VC (< venous return)→ late in pregnancy * Increase by 40% → During labor contractions * CO increases again from release of pressure on VC → After fetus is born * The image describes the change of the pressure on the superior vena cava in relation to pregnancy Mostly Hyperdynamic CV changes ### Systemic Changes in Pregnant Patient * CV: Hyperdynamic; Increased CO * ↑ 2nd <3 sound, split w/ inspiration * Low grade systolic ejection murmur * ↑ HR 10-15 bpm above normal * Distended neck veins * HEME: Hypercoagulation * Renal system: Enlarged from increased flow * GI: Istentines stomach displaced, Acid reflux (progesterone lowers esophageal sphincter tone), Morning sickness, Hemorrhoids ### Routine US Provides What Info? Pneumonic: "New little baby creates sweet adventures" * Fetal Number * Fetal Lie * Biometry (aka Growth parameters) * Fetal Cardiac activity * Survey fetal anatomy * Assess Amniotic fluid volume ### Pregnancy Screenings * Fetal nuchal translucency + PAPP-A OR free/total B-hCG → Screens for trisomy 21, 18, 13→ By end of 1st trimester * Option maternal serum AFP (screens for neural defects) → 15-18wks * Quad screen (serum BhCG, unconjugated estriol, AFP, inhibin) → 15-20 wks ONLY IF 1st trimester screening was missed ### Fetal Monitoring Tests * Non stress test * Contraction stress test * Oxytocin challenge test * Biophysical profile ### Fetal Monitoring * Non-stress test (NST) → 26-28wks or as needed ### Weeks Breakdown * Contraction stress test → Done after abnormal NST * Biophysical profiles (BPP) → Done after 32wks for women at risk of pregnancy lost → Detects fetal HYPOXIA. What does it measure? Fetal breathing, movement, tone, and amniotic fluid volume * Naegele's rule → EDD → LMP + 1yr, -3M, +7D * 1st trimester 0-14wks * 2nd trimester 14-27wks * 3rd trimester 28-40+ * 4wks after LMP → Urine pregnancy (+) * 4. 5-5→ Gestational sac visualized through TVUS * 4-8wks → Morning sickness * 5-6 wks → Gestational sac visualized through abd. US * 6. 5-10wks → Cardiac activity noted on TVUS * 7. 6wks → (+) Hegar's sign * 6-8wks Moms blood volume increases * 8. 8-12 wks → (+) chadwick's sign * 9. 8-14wks → Hear fetal <3 tone (external U.S. doppler) * 15-18wks → Maternal serum AFP done (checks for neural deficits) * 15-20wks → Quad screening option ONLY if↑ 1st trimester screening was missed * 16-20wks → Quickening flutters * 20wks → Height of fetus at umbilicus * 32wks → Moms blood volume peaks # INTRAPARTUM & POSTPARTUM **Condition** | **Description** | **Treatment** ----------|---------------|--------------- Braxton Hicks "False contractions" | Short and mild contractions/ discomfort in lower abdominal/ groin area, not related to uterus dilation | Ambulation & hydration Lightning | Shape of the abdomen changes, sensation of baby being "lighter" and fetal head descends into the pelvis | Ruptured membranes | Sudden gush of liquid or constant leakage of fluid "water broke" | Bloody show | Passage of blood-tinged cervical mucus, occurs when the cervix begins to thin (effacement), is expressed as a % . This is normal & means labor is near | True Labor | Regular, painful uterine contractions causing cervical dilation and birth increasing and frequent. Felt over uterine fundus with radiation to low back and low abd | ### Decelerations are Classified By * Uniform shape of HR drops * Timing → If decelerations is at same time as peak of contraction * The image describes the relationship of the uniform accelerations: |Variable decelerations | Early decelerations | Acceleratins | Late decelerations | |----|----|----|----| |Cord compression |Head compression | Okay |Placental insufficiency | |Variable shape | Uniform shape | Abrupt Increase | Uniform Shape, gradual change| **Condition** | **Description** | **Treatment** ----------|---------------|--------------- Accelerations (Good😊) | Abrupt increase in fetal heart rate. Baby is moving or well-oxygenated. This is normal and reassuring. | Rasurance Early deceleration | Mild decrease in FHR → Normal and due to baby's head descending into pelvis. Uniform shape, lowest point at SAME time of peak of contraction | Continued monitoring Variable Decelerations (Could be bad 😮) | Sudden drop in heart rate that varies in timing. Umbilical cord compression (cord might be squeezed, reducing oxygen). Sometimes. If mild, it's okay; if severe, interventions may be needed (position change, oxygen, fluids). VARIES in shape, No consistency with peak of contraction | Put mom in knee-chest position (gets baby's head off cord) Late Decelerations (Dangerous 😠) | Heart rate gradually drops after the contraction starts and recovers after it ends. Placental insufficiency (baby isn't getting enough oxygen). This is a sign of fetal distress and needs urgent intervention (position change, oxygen, fluids | Reposition mom. IV fluids. To help decrease *The image shows uniform accelerations* **Condition** | **Description** | **Treatment** ----------|---------------|--------------- Incomplete delivery of placenta | DANGEROUS!!! Can lead to: -Infection +/- SEPSIS -Hemorrhage +/- DIC (as a response to hemorrhage) Evaluating : Palpate uterus to see if it is firm (normal) or "boggy"/atony (abnormal → weak and isn't contracting the placenta out like it should) | External cephalic version | Procedure to try and manually fixed breech presentation (risk of fetomaternal hemorrhage) | Rhogam in case fetus blood enters moms bloodstream, you don't want moms immune system to overreact Epidural block | Local anesthetic + opioid → Continuous IV infusion pumps into epidural space | Bilateral Pudendal block | Numbs perineal area Quick pain relief, mostly for delivery | Image shows which nerves are innervated General anesthesia (GA) | Used during labor and delivery only in emergent situations → LAST RESORT. C-section. Failed epidural & pudendal block. DANGEROUS B/C: Puts mom & baby to sleep → Aspiration risk for baby | Picture demonstrates suprapubic pressure may be neede Cervical effacement | Thinning, softening, and shortening of the cervix → leads to bloody show → Labor is near | Shows cervical dilation Fetal descent (pelvic) stations | Station is the level of fetal presenting part to level of ischial spine -5 station: "Floating". O station: "Engaged" → Presenting part has reached the ischial spine . +1 - +5 station: Presenting part is moving into the introitus . +5 = crowning | Graph of the fetal descent and graph ### Stages of Labor * **Stage 1:** From onset of cervical contractions, to FULL cervical dilation (10cm). * Latent phase: Cervical effacement + gradual cervical dilation * Active phase: Rapid cervical dilation * **Stage 2:** From full dilation (10cm), to delivery of fetus. * Passive phase: From complete dilation, to active maternal pushing * Active phase: From active pushing to actual delivery * **Stage 3:** From post partum to delivery of placenta * **Stage 4:** Mother assess for complications for 1-2 hrs **NOTE:** Stage 4 mother is at highest risk → Readjusting to non-pregnant state. **Condition** | **Description** | **Treatment** ----------|---------------|--------------- | Preeclampsia = High blood pressure + organ damage in pregnancy Eclampsia = Preeclampsia + seizures (life-threatening) # HTN & GESTATIONAL DIABETES **Condition** | **Description** | **Treatment** ----------|---------------|--------------- Transient HTN | Occurs late in pregnancy w/o any other features of preeclampsia + normalization of BP postpartum. Short term and d/t stress or labor related | Chronic HTN (in pregnancy) | BP ≥140 mm Hg systolic &/or 90 mm Hg diastolic -Before pregnancy, or -Before 20 wks gestation, or Use of antihypertensive meds before pregnancy, or Persistence of HTN >12 wks after delivery. Mild: Systolic *BP* 140-159 *mmHg*; Diastolic 90-109*mmHg*. Severe: Systolic *BP* ≥ 160*mmHg*; Diastolic ≥ 110*mmHg* | Goal Reduce risk of CV & cerebrovascular event, Medication ONLY for severe. Major risk of developing preeclampsia or eclampsia later on Pregnancy induced HTN (aka Gestational HTN) | Happens within 2nd half of pregnancy (>20wks) w/ NO proteinuria → RESOLVES by 12wks postpartum. Systolic *BP* ≥ 140 OR Diastolic *BP* ≥ 90 on 2 readings in one week at least 4 hours apart. 20% will progress to preeclampsia. ~**Develops in** 5-10% pregnancies and 30% in multiple generations, Increased risk of Perinatal morbidity. Mortality for mom & fetus & causes ~ 20% of maternal death in the US | Pre-eclampsia | HTN WITH proteinuria (0.3g (300mg) or higher in 24hr urine collection; Urine dipstick reading of +1) Systolic *BP* ≥ 140 OR Diastolic *BP* ≥ 90 Develops: *After* 20w gestation | Management of MILD : before 37wks. Rest, frequent monitor. Labetalol, methyldopa or nifedipine. Test fetal growth restrictions ~2x weekly/Asses amniotic fluid e/3wks, At or over 37wks, Induce labor or schedule C-section ECLAMPSIA⚠️ | Convulsions in women w/ preeclampsia (that is not explained by another neurological disorder). Occurs in ~0.5-4% of pts w/ preeclampsia, usually W/I delivery | Seizure prec: Protect airway →O2 via face Mask. Fetal monitoring mom aft IS stable. BP management Hydralazine; MgSO4→ sezuires HELLP SYNDROME ⚠️ | -Hemolysis Preeclampsia WITH - Elevated Liver enzymes (2x) | To Dx> need 2 Tx- deelivery best (best) **The following values apply to Preeclampsia** * *Mild*: Systolic BP 140-159 mmHg; Diastolic 90-109 mmHg, 300*mg*/24 *hr* urine or 1+ on dipstick * *Severe*: Systolic BP ≥ 160 mmHg; Diastolic ≥ 110 mmHg, ≥5,000 *mg* (5g) protein/24 *hr* urine Nullipara multiple gestation twins Age is 35+ with FMH of eclampsia. Pre-gestational in DM, obesity, and kidney disease. ### S&S of the following Proteinuria + HTN is the defining feature of Preeclampsia/Edema, which is common in pregnancy but is worse especially in hands and face!! H/A disturbances and visual extensive H/. **Complication rates as follows** Occurs in 4-12% pts with SEVERE preeclampsia or usually before High mortality in Fetus (the rest) * Low platelets (<100,000) 37wks NOTE * Higher mortality in Fetus (10-60%) Dysfunction Complications for mother after birth includes ABDS DIC death Retinal Bed rest or evaluations include hospitalizations due to seizures. ### Gestational Diabetes (DDM) Usually the symptomatic Baby is 8x. If the mom becomes insulin then you need to see why they are higher in numbers and make sure they get insulin. ***Risk factors associated with gdm*** * Screening usually requires screening at 24-28 weeks ,screening first **Risks** Increased rates of infections as noted. Fetest baby's shoulder. * Medications to AVOID w/ HTN in pregnancy: * ACEI * ARBS * Direct renin inhibitors **Why**?? → RAAS is essential for fetal kidney development!! | PostPartum care| | | |---|---|---| | Condition | Effect + Associations | TX | | Medications for HTN with breast feeding | Better with fetal renal and Cardiac anomalies , with beat blocker and calcium as needed | | **Condition** | **Description** | **Treatment** ----------|---------------|--------------- PP Hemorrhage Uterine a tony MC |Early+ Delayed with death | transfusion or Decrease in Hct w Bimanual massage w/ immediate feeding Lochia |Heavy + uterine - red pink white after birth | stages and stages of postpartum Peuerperium | defined as 6- to 8 week | Birth and infection rates PP changes normal | uterus 1 - 2cm within 346 from preg | cervical and post-pregnancy stats Hosp care vaginal stay complication of breast block sex activity. ### Breast engorgement Lce, analgesia, supportive bra Perineal care: Analgesis as needed with C-Section post Op _Not recommended for all patients after C-section should exclusively bleed by all weeks_ PP Followup with birth or mental State with the uterus. Bimanuel of the Bimanual exam. Pp anxiety and depression.