prenatal care
this vitamin supplement should ideally be started at least 4wks before conception to help prevent neural tube defects.
what is folic acid
provide 2 examples of medical indications for IOL
- hypertensive disorders of pregnancy
- gestational diabetes
- intrauterine growth restriction (IUGR)
- cholestasis of pregnancy.
what is the purpose of oxytocin during induction of labor.
Oxytocin is used to strengthen and regulate uterine contractions once labor begins
explain the diagnostic criteria used to identify chronic HTN in pregnancy and how it differs from HTN that develops later in pregnancy.
Chronic HTN is defined as blood pressure ≥140/90 that occurs before pregnancy or before 20 wks gestation, indicating a pre-existing hypertensive condition rather than one caused by pregnancy.
what are some of the health benefits of human milk
- fewer allergies
- fewer infections (ear, GI, UTI)
- decreased incidence of many diseases (DM, asthma, SIDS)
- "customized" food
- less constipation
what is the 1hr glucose challenge test (GCT)
Compare mechanical cervical ripening methods to medication based methods in terms of safety.
Mechanical methods have fewer risks than medications and are considered very low risk
when is betamethasone given and what are the side effects in the birthing person and the newborn
given prior to 37 wks
side effect is HYPERglycemia in the birthing person and hypoglycemia in the newborn
describe how gestational HTN is diagnosed.
gestational HTN is diagnosed when a pregnant patient develops blood pressure ≥140/90 after 20 wks gestation without proteinuria or severe features.
describe two key techniques used to achieve a proper latch during breastfeeding.
1. position the infant nose to nipple
2. bring baby to breast
3. wide open mouth
3. parent's hand in a "C" shape
this prenatal test performed at 15-20 wks evaluates alpha-fetoprotein levels, where elevated levels may indicate neural tube defects.
what is the AFP screening test
Describe appropriate patient education for someone undergoing induction of labor regarding how long the process might take
Each induction is different and may require different medications or interventions, and the length of time to delivery can vary depending on cervical readiness - the process is longer for primiparous patients.
name one common adverse effect of misoprostol, dinoprostone or pitocin that requires close monitoring during induction
uterine tachysystole or fetal heart rate distress
what is preeclampsia without severe features
preeclampsia without severe features includes blood pressure ≥140/90 after 20 wks on two occasions at least 4hrs apart plus a protein/creatinine ratio of 0.3 or higher
name two true contraindications to breastfeeding
- HIV disease
- untreated opiate use disorder
- chemotherapy treatments
- active tuberculosis
- infant with galactosemia
exposure to harmful substances that cause congenital malformations is most dangerous during this stage of fetal development when organ systems are forming.
what is organogenesis (first 8 wks of pregnancy)
Explain why cervical ripening is often performed before starting other induction methods in a patient with an unfavorable Bishop score.
Cervical ripening is performed first when the Bishop score indicates an unfavorable cervix because it helps soften and prepare the cervix, increasing the likelihood that induction methods will be successful and reducing the time to delivery.
how is pitocin administered for IOL and what is the typical dose
pitocin is given IV for IOL. 1-2 mu q30-40min and can be titrated up q30mins
what are some of the criteria for diagnosing preeclampsia with severe features.
Preeclampsia with severe features includes one of the following
- BP in "severe range" systolic 160 or higher OR diastolic 110 or higher (either number meets criteria)
- Abnormal liver function (elevated AST and ALT), epigastric pain
- Renal dysfunction- increasing creatinine concentration
- New onset headache or visual changes (not relieved with acetaminophen)
- Pulmonary edema
- Thrombocytopenia (less 100,000)
what are some practical breastfeeding tips
- baby should feed on demand or q 2-3 hrs round the clock
- nighttime sleeping shouldn't be beyond 4-5 hours
- avoid bottles and pacifiers until latch is established
these two vaccines are contraindicated during pregnancy but should ideally be given before conception or postpartum.
what are MMR and varicella vaccines
Explain the Bishop score and describe what score indicates a “ripe” cervix for both a multiparous and primiparous patient.
The Bishop score assesses cervical readiness for labor. A score of 6 indicates a ripe cervix in a multiparous patient, and a score of 8 indicates a ripe cervix in a primiparous patient.
what is magnesium sulfate used for, what are some side effects and what is the reversal agent?
- maternal seizure prophylaxis
- Side effects: respiratory depression, fetal intolerance, generalized weakness, flushing/sweating, lack of energy
- reversal agent: calcium gluconate
what is HELLP syndrome and how is it managed?
HELLP Syndrome - Hemolysis, Elevated Liver enzymes, Low Platelets is a complication of preeclampsia and eclampsia.
- the only cure is birth (resolves 72hrs after delivery of placenta) and may give blood products if patient is actively bleeding.
explain the difference between breast engorgement and mastitis and how each is managed.
Breast engorgement is breast swelling from milk buildup and it can be managed by frequent feeding. Mastitis is a bacterial infection with a fever and flu like symptoms and requires antibiotics like dicloxacillin.