Simmons FNP Antepartum Care MASTERY GUIDE: Prenatal Assessment, OB Guidelines & Risk Stratification – 68 Expert-Curated Q&A + Clinical Rationales (High-Risk & Low-Risk Pregnancies)

Common Neurological Problems in Pregancy

Bells Palsy and Carpal tunnel

Which test screens for the trisomy 13,18,21

Cell free fetal DNA analysis- highly specific and sensitive- follow up with diagnostic test - us then cvs or amnio

Thyroid needs

T3 & T4 increase- increase estrogen level induce hepatic synthesis of TBG

Recommendations in preg TSH , 2.5

size enlargement normal should be non tender and no nodules

Presumptive signs of pregnancy

nausea, vomitting, amenorrhea, breast changes, increase in urine frequency

Probable signs of pregnancy

urine Hgc or serum hcg

Definite signs of pregancy

FHT, Leopold's manuver, xray,US visual of fetus, delivery

LMP calcualtion

LMP + 7 days - 3 months then add 1 year

Ultrasound

does not decrease incidence of fetal morbidity

Gestational age

Best in early pregnancy crown to rump measurement

Uterine Heights

12 weeks - public symphisis

20 w umbilicus

36 w xyphoid

37-40w regression as baby drops

Hcg does what up to the 10th week

doubles

Prenatal visits should always include these 3 things

BP, Weight, and urine - later fetal heart tones

FHT can be detected 10-12w with electronic stethoscope and how many weeks for normal

18-20 weeks

Lower abdominal pain with leg pain and groin pain are abnormal in pregnancy. T or F

F- this is ligament pain and can be supported with girdle, massage, warm compress, and support pillow

Constipation in pregnancy is normal- What are some treatment options

increase water intake, schedule time for routine, walk, increase fiber

Physiological Edema has multiple causes: some include decrease in venous return and plasma osmolarity, what increases can contribute to this?

Increase in capillary permeability, increase in intercellular space, increase uterine pressure; Suppression of vasopressor osmoreceptors also contribute- TX includes rest, keeping feet up, lay on Left side, increase water intake, and monitor but not limit NA+ intake - no more than 2400mg/day

Exercise Recommendations in pregnancy

keep heart rate less than 140 bpm, do not lift more than 10lbs upper body, avoid breathlessness, avoid excessive heat

msAFP - Alpha fetal protein

produced in yolk 1st trimester then later in liver, can be detected in maternal serum and amniotic fluid

AFP- part of quad test

positive results need ultrasound follow up- increase AFP- attributed to open defects and decrease can be indicative of trisomies, turner, and other syndromes

Vitamin A is in need and increase during pregnancy- True or False

False- Vit A >10,000 is considered Teratogenic

Rhogham is given to neg mothers at what week?

28 weeks

Viability of Ovum and Sperm

Sperm 48-72 hours Ovum 24 hours

Oraganogenesis

2-8 weeks congenital defects and major abnormalities 9-38 functional defects - organs developing ALL through pregnancy

Is drinking ever safe in pregnancy?

NO

For regular cycles 26 to 28 days- When is the fertile period?>

Day 14 is- conception is prime 36 hours after the LH surge which causes ovulation

Name 3 treatment options for Nasal Congestion in Pregnancy.

1- saline nasal spray

2- Chlortimetron (cat B)

3-Nasalcrom nasal spray ( cat B)

Recommended weight gain for single pregnancy and multiple pregnancy-

single 25-35 pounds

multiple 35-45 pounds

Which FDA Pregnancy category states- there is positive evidence of human fetal risk based on adverse reaction but one must weigh benefits versus risks?

D

Which FDA category states- studies fail to demonstrate a risk to fetus

A

Which FDA category states- studies fail to demonstrate risk to human fetus or animal subjects

B

Which FDA category states- studies fail to demonstrate risk to human fetus but have shown adverse effects to animal fetus - weigh risk versus benefits

C

Rubra should last about how many days?

3 days

Lochia expectations include how long for each stage?

nomal shedding of lining - rubra up to 3 days then serosa- pink and watery 3 days to 3 weeks, then alba - yellow white discharge up to 6 weeks

Total volume loss post partum

200-500 ml

Post partum uterine size

24 hours at umbilicus, 7 days - between umbilicus and symphisis pubis, 14 days- not palpable, 6 weeks back to pre pregnancy size

Gingival hyperplasia is normal in pregnancy- what can bleeding indicate?

poor nutritional status

First trimester combined test includes?

nuchal translucency - measure of back of baby's neck, crown to rump measure meant

serum markers - HCG, PAPP-A ( pregnancy associated plasma protein

Second trimester testing-

Quad test - AFP, estriol, hcg, and inhibin A

can do at 15-18 weeks up to 22 week- check with lab

Diagnostic testing in the first trimester is

CVS

Diagnostic testing in 2nd trimester

amniocentesis

Cardiac changes include volume increase by how many liters

6-8 L

Are systolic murmurs common in pregnancy?

YES

True or False: BP is higher in the 1st and 2nd trimesters?

FALSE- BP drops- molar pregnancy may show early pregnancy rise in BP

Women young than 25 may have what cardiac sound?

S3

Compression of the inferior vena cava can cause what in a pregnant woman?

Supine Hypotension syndrome

What deviation may be seen on an EKG in a woman less than 24 weeks?

L axis deviation

Because pregnant women have a 40% increase in minute ventilation- what may happen?

compensatory respiratory alkalosis

What is a common hematological effect of pregnancy?

Anemia

Chloasma is an increased pigmentation of what body part?

Face

The darkened line on the abdomen seen in pregnancy is called?

Linea Nigra

Palmar erythem and spider nevi are common in pregnancy. True or False

True

What treatment do you recommend for women with pruritus in pregnancy due to elevation of bile salts?

Skin lotion or antiprutitcs

Facial edema and lid edema in pregnant women is normal? true or false

False- facial edema should not be evident with lid edema- this could be a sign of toxemia

Common things found in a physical exam of a pregnant woman can include - dull, scaling dry skin and pale conjunctiva- true or false

False- these may be a sign of malnurishment and anemia

How many calories does a pregnant woman need to increase per day

200-300 to total about 2200

Protein should increase by how much daily

10mg per day

Calcium intake should increase by how much per day

400mg/day

women should take folic acid starting when?

3 months prior to conception if possible or as soon as pregnancy is detected

oestradiol starts and increases rapidly or steadily during pregnancy?

steadily

What do you do if a woman is <90% of her ideal body weight prior to pregnancy

She is underweight- encourage healthy weight gain early to improve risk of low birth weight baby

Should a woman weighing >120% of her ideal body weight prior to pregnancy diet while pregnant?

NO- this is no time to diet- counsel patient for appropriate nutritional intake- reduce empty calorie intake- offer options for snaking

Hegar's sign is...

softening of the uterine isthmus

Goodell's sign is ...

softening of vaginal portion of cervix

Chadwick's sign is...

blue-violet color of cervix

Iron requirements during pregnancy

No anemia 30-60mg

anemia 60-120 mg

325mg of ferrous sulfate has how much elemental iron?

65mg

inhibin A are increased or decreased if a woman has an increase risk of carrying a fetus with downsydrome

increased along with hCG

True or False- studies have indicated that women experiencing hyperemesis gravid arum have a higher incidence of H.pylori infections

True