Einstein baby

Prenatal Care

By ericpbergh

  • 1st day of LMP

    1st day of LMP
    Dating...EXTREMELY IMPORTANT!
    Duration of pregnancy typically lasts 280days or 40weeks Gestational Age: Dating begins with the first day of last menstrual period
    Negele's rule:
    add 7 days to first day of LMP, count back 3 months Embryologists/Reproductive biologists study ovulatory age
  • Period: to

    Typical Prenatal Care

  • Pregnancy Testing

    Pregnancy Testing
    At missed menses, detection limit of 12.5 mIU/mL rin urine equired to dose 95 percent of pregnancies Cole et. al (2004) evaluated effectiveness of 18 different HPTs.
    First Result, Ealy Response the only proven to detect at time of missed menses Qualitative hCG typically orderdd within 1 week - 10day of HPT

  • First Prenatal Visit @ 8 weeks

    First Prenatal Visit @ 8 weeks
    Most extensive workup (3 categories)Blood work: HCT, T+SInfections: RPR, Rubella, HepB, G+C/PAP, PPD, U/A and Cxs, VZV titer, HIV

  • CVS at 10-13 weeks

    CVS at 10-13 weeks
    Chorionic Villus Sampling Benefits:
    Genetic testing: Downs/Cystic Fibrosis...
    Paternity testing
    Results in 1-7 Days Disadvantage:
    Cannot evaluate NT defects
    Miscarriage rate of about 1:100

  • Fetal Heart Beat with Doppler @ 10weeks

    Fetal Heart Beat with Doppler @ 10weeks

  • First trimester screen @ 11-13 weeks:

    First trimester screen @ 11-13 weeks:
    First Tri Screen:
    evaluates NT, hCG, PAPP-A in combination with maternal age and risk factors Pos Test
    -Increase in nuchal translucency as measured in mm
    -Low PAPP-A levels
    -High hCG levels Advantage:
    looks for chromosomal abnormalities (t21,t18...)
    Identifies about 85/100 abnormal individuals
    5% of normals have a positive test
    test positive: 1/100-1/300 chance of abnormality- f/u with CVS or amnio ACOG pamphlet

  • 14-20 week AMNIO

    14-20 week AMNIO
    Amniocentesis
    Detects chromosomal abnormalities, genetic defects, neural tube defects
    +Paternity testing Disadvantage:
    miscarriage: 1/200-1/400 = risk equivalent to age > 35
    infection, LOF, preterm labor

  • 15-22weeks (best at 16-18weeks) Triple Screen/MSAFP/Quad screen

    15-22weeks (best at 16-18weeks) Triple Screen/MSAFP/Quad screen
    Triple Screen:
    AFP (fetal)
    hCG(placenta)
    Estriol(fetal and placenta)
    35 yo, 80% sensitivity
    increased MSAFP: increased NTD, or GI/abd wall abn. Add Inhibin-A for Quad screen:
    more accurate test for t21

  • Level 1 U/S 18-22 weeks

    Level 1 U/S 18-22 weeks
    Anatomy scan at 18-22 weeks

  • GCT/GTT at 26-28 weeks

    GCT/GTT at 26-28 weeks
    26-28 weeks GCT:
    no prep, not fasting
    1 hour glucose >130 abnormal GTT
    must eat at least 150mg carbs for 3 days prior
    fast 14 hours prior
    100g oral glucose load cannot be above these cutoffs
    fasting 90
    1hr 180
    2hr 155
    3hr 140

  • 28 weeks give Rhogam

    28 weeks give Rhogam
    for Rh - mothers

  • BPP at >32 weeks

    BPP at >32 weeks
    BPP: at greater than 32 weeks -NST (20-30 min)
    -U/S
    breathing
    movement
    tone
    hr
    Amniotic fluid

  • GBS at 35-37 weeks

    GBS at 35-37 weeks
    Broup B strep culture 5 weeks prior to delevery
    with Abx tx, 1:4000 risk of baby with GBS
    25% of all healthy adult women are carriers

  • Third Tri Blood work cultures

    Third Tri Blood work cultures
    HCT, RPR, HIV