OB Week 1

# of pregnancies regardless of gestational age

gravida

pregnancies delivered between 38 weeks and 42 weeks gestation

term

births between 20 weeks and 37 weeks 6 days gestation

preterm

elective therapeutic abortions and miscarriages before 20 weeks (after 20 weeks the baby is considered preterm whether it was dead or alive)

abortions

current living children - each child is counted individually (ex. twins is too children if both are living)

living children

syphillis

VDRL lab tests for

frequency of prenatal visits from conception to 28 weeks

every 4 weeks

frequency of prenatal visits from 29 to 36 weeks

every 2 weeks

frequency of prenatal visits from 37 weeks to birth

weekly

down syndrome

what does multiple marker screen test for

infection

nitrates and/or bacteria in urine indicates

preeclampsia

protein in urine indicates

gestational diabetes

glucose in urine indicates

inadequate food intake or dehydration

ketones in urine indicate

110-160

fetal HR

16-20

at what weeks can you start feeling fetal movement

blood glucose screen

what assessments/screenings should be done at 24-48 weeks

• fetal kick counts

• rhogam injection if indicated

• TDAP vaccine

what assessments/screenings should be done at 28 weeks

• group B strep screen

• Hgb and Hct if indicated

• leopold’s maneuvers (to make sure head is down)

• STI testing (gonorrhea and chlamydia)

what assessments/screenings should be done at 36 weeks

at least 10 kicks an hour - if less, call HCP

how many fetal kick counts in an hour at 28 weeks

• human papillomavirus

• live attenuated influenza vaccine in nasal spray form

• MMR

NO LIVE VACCINES

• TDAP at 28 weeks

• flu

• COVID

• RSV

• Rhogam if indicated

SAFE VACCINES

• uterine contractions

• cramps

• constant/irregular low backache

• pelvic pressure

signs of preterm labor

alpha-fetoprotein (AFP)

main protein in fetal plasma

• neural tube defects

• esophageal obstruction

• abdominal wall defects

• increased amount leaked by fetal kidney

elevated AFP indicates

• chromosomal abnormalities (trisomy 21)

• gestational trophoblastic disease

low AFP indicates

16-18 weeks (otherwise you get false positives/negatives)

when does alpha-fetoprotein screen NEED to be completed if indicated

lightening

baby drops into pelvis, reduced pressure in diaphragm at about 36 weeks gestation

braxton hicks contractions

irregular contractions (baby getting ready for delivery) - preparing mom for contractions in labor

postpartum hemorrhaging

what is the pt at risk for with a dramatic blood flow increase

chadwick’s sign

blueish/purple color of cervix during pregnancy

goodell’s sign

softening/elasticing of the cervix (feels like an earlobe) during pregnancy

increased BP

there is increased cardiac output with pregnancy but what should NOT change

pseudoanemia of pregnancy

dilution of RBC mass leads to a decline in maternal Hgb and Hct during pregnancy

10-12

hgb level for psuedoanemia

<10

hgb level for true anemia

15-20 beats/min (gotta pump to uterus)

how much does the HR inc by in pregnancy

left

what side is best to lay on during pregnancy

20%

how much does oxygen consumption increase by in pregnancy

4 cm

how much is the diaphragm displaced by the enlarged uterus in the third trimester

• inc salivation

• heartburn (pyrosis)

• constipation (decreased mobility)

GI changes in pregnancy

• amenorrhea

• N and V (4-8 weeks)

• fatigue

• urinary frequency

• breast and skin changes

• vaginal and cervical color changes

• fetal movement (16-20 weeks)

PRESUMPTIVE indicators of pregnancy

• abdominal enlargement

• cervical softening

• changes in the uterus (braxton hicks contractions, fetal outline palpation by non-health professional, uterine consistency)

• pregnancy (NOT a positive sign to confirm pregnancy)

PROBABLE indicators of pregnancy

• auscultation of fetal heart tones (9 weeks)

• fetal movement by examiner

• visualization of fetus (via ultrasound)

POSITIVE indicators of pregnancy

16-20 weeks

when can you start feeling fetal movement

weeks 4-8

when does mom start getting N/V

• 9 weeks

• 8 weeks with ultrasound

when can you auscultate fetal heart tones

primigravida

woman who is pregnant for the first time

multigravida

woman who has been pregnant more than once

para

number of pregnancies that end at 20 weeks or more

first day of last menstrual period, subtract 3 months, add 7 days, update the year if necessary

formula to determine EDD

+ or - 2cm of gestational age (20 weeks → 18-22 fundal height)

what should the fundal height be

magnesium sulfate

what medication to give prior to an eclampsia seizure and/or after to prevent another one from occuring

4-8 mg/dL

therapeutic serum level of magnesium

calcium gluconate

antidote for magnesium toxicity

• hemolysis

• elevated liver enzymes

• low platelets

HELLP Syndrome

72 hours

how long til recovery begins after delivery from HELLP syndrome

macrosomiac

higher birth weight

Apgar score

score given at birth to determine how well the baby is transitioning from intrauterine life to external uterine life

1.1-4.4 lbs

how much weight should be gained during the first trimester of pregnancy

0.8-1 lb

how much weight should be gained each week after the first trimester

2200-2900

how many calories to take in during pregnancy

340

how many additional calories in 2nd trimest

452

how many additional calories in 3rd trimester

46

how many grams of protein during pregnancy

71+

how many grams of protein during 2nd trimester

600 mcg

how much folic acid to take during pregnancy

1000 mg

how much absorbed iron is needed during pregnancy

animal sources (well absorbed)

heme iron

plant sources + fortified foods (not well absorbed

nonheme iron

6 oz

how much albacore weekly when pregnant

12 oz

how much shrimp, light canned tuna, salmon, pollack or catfish each week when pregnant

• deli meats and hot dogs (unless STEAMING HOT)

• soft cheeses (unless made with PASTEURIZED MILK)

avoid what foods during pregnancy

• raw/undercooked meat, poultry, eggs

• shark, swordfish, king mackerel, tilefish

• refrigerated pate or meat spreads

• refrigerated smoked seafood

do NOT consume what foods during pregnancy

PICA (ice, clay, dirty, laundry starch or cornstarch)

practice of craving non food or some food components not considered part of a normal diet during pregnancy

ice

what PICA craving do you have if you are iron deficient

• clay

• dirt

• laundry starch or cornstarch

what PICA craving do you have if you are zinc deficient

330

first 6 months after birth how much to increase calories by for lactation

400

second 6 months after birth how much to increase calories by for lactation

• inc mom metabolic rate

• dec mom appetite

• lower infant BW

• prematurity

what does smoking during pregnancy do

• dec absorption of Ca, Zn, thiamine, Iron

what does caffeine during pregnancy do

200 mg

how much caffeine is correlated to miscarriage and preterm birth

• fetal alcohol syndrome

• interferes with absorption of B12, folic acid, Mg

• takes the place of food in the diet

what can alcohol during pregnancy cause

• inc appetite (but not nutritoius foods)

• crosses placenta

what does marijuana during pregnancy cause

• alters metabolism

• malnourishment

what does heroine during pregnancy cause

• appetite suppression

• interferes with nutrition

what does cocaine during pregnancy cause