This document provides an overview of prenatal care, including when it should begin, what is assessed at prenatal visits, common tests and screenings, risk factors, and how high-risk pregnancies are managed. Prenatal care aims to monitor the health of the mother and fetus, identify potential complications, educate the patient, and promote a healthy pregnancy outcome. Key components of prenatal visits include assessment of gestational age, physical exam, labs, history, abdominal exam checking fundal height and fetal heart tone.
8. Before Pregnancy: IDEALLY , a woman planning to have a child should have a medical evaluation before she becomes pregnant. * Place the patient on PNV-Folic acid (Vit B) 400mcg or .4 mg to prevent neural tube defects ( which are birth defects of the baby's brain (anencephaly) or spine (spina bifida). *
45. Encourage Good Nutrition Should include: Whole and organic foods; Proteins, fats; micronutrients such as, calcium, iron, magnesium, zinc and vitamins; moderate salt restriction, all in a balanced diet .
59. Management based on BPP score Score Interpretation MGT 10 Normal Repeat testing 8 Normal Repeat testing 6 Suspect chronic asphyxia If>36wk, deliver or rpt in 4-6hr 4 Suspect chronic asphyxia If >32wk, deliver Or rpt 4-6 0-2 Strongly suspect chronic asphyxia Extend testing 120min, if score<4 deliver @ any gest. age
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Editor's Notes
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Folate leads to a decrease in homocysteine serum concentrations. Homocysteine in high levels is a known risk factor for cardiovascular disease and stroke .
average duration of pregnancy is about 280 days or 40 weeks counting from the first day of the last menstrual period . It is important to remember that due dates are not exact
hCG, is made in your body when a fertilized egg implants in the uterus. This usually happens about 6 days after conception
The gestational sac can be visualized as early as 4.5 weeks. It increases by about 1 mm per day
The mean gestational sac diameter (MGD) is an effective estimate of gestational age between 5 and 6 weeks, with an accuracy of about +/- 5 days. The yolk sac and embryo should be readily identified when the gestational sac reaches a certain size and the yolk sac is 20 mm in size or the fetal pole is 25 mm in size..
A careful review of the prenatal record should be supplemented by the patient interview with regard to recent illnesses and obstetrical complications.
Too high of a measurement and you could be having twins (or other fetal growth problems). Too low of a measurement and your baby could be having problems with fetal growth such as intrauterine growth restriction (IUGR).
One way to approximate a pregnancy's current gestational age is to use a tape measure to determine the distance from the pubic bone up over the top of the uterus to the very top.
The examiner uses the thumb the fingers of one hand in the suprapubic region (similar to palming a basketball) and attempts to move the presenting part from side to side. If little movement occurs or only the fetal neck is palpable the presenting part is engaged.
While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk . 2 nd =the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palms of his or her hands . 3 rd = provider attempts to determine what fetal part is lying above the inlet, or lower abdomen 4 th :The fetal occipital prominence and flexion of the vertex is determined. If the fetal vertex is flexed, the cephalic prominence may be palpable on a same side as the fetal small parts. If a distinct cephalic prominence is noted on the same side as the spine and head the vertex is not very well flexed.
Amnio: results take 2wks. Amnio: Mother's age of 35 or higher (because older mothers have a higher risk of Down's syndrome occurring in their babies) Previous child with an inherited disorder Family history of an inherited disorder Abnormal findings on ultrasound Abnormal findings on triple screen test (see below) alpha-fetoprotein, a protein produced by the liver of the fetus estriol, a pregnancy hormone human chorionic gonadotropin (HCG), another pregnancy hormone
One important aspect of prenatal care is education of the pregnant woman about her pregnancy, danger signs, things she should do and things she should not do.
<20: premature births, late prenatal care, low birth wt, uterine dysfx, fetal death or neonatal death >35: htn, DM- 6%, preeclampsia 9%, 14/1000 age 35-40
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