Antepartum

Maternal serum ____-_______ (MSAFP) is a maternal blood screening test usually done around __-__ weeks.

Alfa-fetoprotein, 15-20 weeks.

High AFP can indicate open _____-_____ defects, _______-wall defects, multiple ________, or underestimated gestational age.

Neural-tube, abdominal-wall, gestation.

Low AFP can indicate an increased risk for chromosomal abnormalities, especially ______ ________ (trisomy 21).

Down syndrome

Abnormal AFP is followed up with an ______ to verify gestational age, fetal _____, and anatomy. Can then be followed by _________.

Ultrasound; number. Amniocentesis

A pregnant patient that is Rh- has a fetus that is Rh+; The pregnant patient should receive ________ to prevent the forming of _______ against the fetus.

RhoGAM/Rho(D), antibodies

When is RhoGAM administered?

At 28 weeks and within 72 hours postpartum

Negative vs Positive indirect Coombs and RhoGAM?

Negative = no antibodies, give RhoGAM

Positive = already sensitized, RhoGAM ineffective

How does viral load determine delivery method with maternal HIV?

<1,000 copies/mL: vaginal delivery acceptable

>1,000 or unknown: scheduled cesarean around 38 weeks before labor

What medications is classically associated with preventing perinatal HIV transmission?

Maternal combination ART

Zidovudine (AZT) to newborn intrapartum or after birth

What immediate care does an HIV-exposed newborn need?

Bathe before injections, begin antiretroviral prophylaxis promptly, f/u testing, and avoiding breastfeeding

Which nutrient prevents fetal neural tube defects?

Folic acid; 600mcg/day during pregnancy

How many additional calories are needed during pregnancy?

First trimester: none

Second trimester: +340cal/day

Third trimester: +450cal/day

Which foods should be avoided during pregnancy?

Raw/undercooked foods, unpasteurized products, high-mercury fish, deli meats (unless heated).

Limit caffeine to >200mg/day

What does GTPAL represent?

Gravida, Term births after 37wks

Preterm births, Abortions before 20wks

Living children

How are twins counted in GTPAL?

G1, T1, P0, A0, L2

How is gestational diabetes commonly screened and diagnosed?

Screened at 24-28 weeks with a 1hr 50g glucose test

If abnormal: fasted 3hr 100g glucose OGTT

Why can a newborn of a diabetic mother become hypoglycemic?

Maternal glucose stops after birth while the newborn’s elevated insulin level persists.

What are the major fetal/newborn risks of gestational diabetes?

Macrosomia, shoulder dystocia/birth injury, neonatal hypoglycemia, and respiratory distress

Chronic HTN occurs _____ pregnancy or before ___ weeks, or persists for >__weeks postpartum

Before; 20, 12 weeks

Gestational HTN occurs after ___ weeks without _________ or organ damage

20 weeks; proteinuria

Preeclampsia includes HTN after ___ weeks with proteinuria or _____ dysfunction

20 weeks; organ dysfunction

Eclampsia presents as _________ with ________.

Preeclampsia with seizures

What BP is considered severe in pregnancy?

>160/110

Labetalol vs Magnesium Sulfate in preeclampsia?

Labetalol lowers severe BP; mag prevents/treats seizures

Antidote for magnesium toxicity? Symptoms?

Calcium gluconate;

Absent DTRs, respiratory depression, decreased LOC, oliguria

Betamethasone vs Terbutaline in preterm labor?

Betamethasone matures fetal lungs and increases surfactant;

Terbutaline relaxes uterus to delay contractions temporarily

Major adverse effects and hold parameter for terbutaline?

Maternal/fetal tachycardia, palpitations, tremores, hyperglycemia, hypokalemia, and pulmonary edema

Hold for maternal HR >120

What is the purpose of adminstering a tocolytic in preterm labor?

Temporarily delay birth often about 48hrs to allow corticosteroid administration or maternal transfer

A missed spontaneous abortion includes ____ _____ with ______ tissue and a _____ cervix.

fetal death; retained tissue, closed cervix

What medication may an Rh- patient need after a pregnancy loss?

RhoGAM if not already sensitized

CVS (Chorionic villus sampling) is done at __-__ weeks by taking a sample of villi from the _______ for early genetic diagnosis. Cannot detect ____-____ defects.

10-13wks, placenta; Neural-tube

Amniocentesis is done after __ weeks by taking _ fluid to detect genetic disorders and open [][] defects through AFP.

15 weeks, amniotic. Neural-tube

What teaching follows CVS or amniocentesis?

Report any bleeding, fluid leaking, contractions, fever, or decreased fetal movements; RhoGAM given if unsensitized.

What is the 15×15 rule and what does it mean for a reactive NST at >32 weeks?

At least two accelerations of >15bpm lasting >15sec within 20 mins. Makes the NST reactive.

What are the 5 components of a Biophysical Profile (BPP)?

Fetal breathing,

Gross movement

Fetal muscle tone,

Amniotic fluid volume,

NST reactivity

How are BPP scores interpreted?

8-10 reassuring

6-8 equivocal

<4 abnormal/concerning

How are fetal kick counts commonly performed?

Rest on side when fetus is normally active;

10 movements within 2hrs

Report fewer han 10 or significant decrease from baseline

What do negative and positive contraction stress tests(oxytocin challenge) mean?

Negative CST = no late decels during stim, reassuring

Positive CST = late decels with >50% of contractions and suggests uteroplacental insufficiency

What is the goal pattern during a CST?

Three contractions in 10 mins, usually stimulated with low dose oxytocin drip or nipple stimulation