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Old Flashcards > APP Module (GTown) - Pregnancy (Hrs 1 and 2) > Flashcards

APP Module (GTown) - Pregnancy (Hrs 1 and 2) Flashcards

1
Q

How long is a full gestation term?

A

40 weeks, which includes two weeks from LNMP to conception

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2
Q

Why do we date from a patient’s LNMP?

A

Because date of conception is questionable usually

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3
Q

Why is gestation split into different trimesters?

A

Because these mark important developmental milestones and come with differing physiology

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4
Q

What is considered pre-term?

A

Pregnancy before 37 weeks.

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5
Q

What is considered an early and full term pregnancy?

A

37 to 39 weeks for early term, 39 to 41 weeks for full term

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6
Q

What is considered post-term?

A

More than 42 weeks

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7
Q

What is gravidity?

A

The state of being pregnant or how many pregnancies a woman has had

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8
Q

What is parity?

A

The number of total outcomes of pregnancy

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9
Q

What secretes beta-hcg?

A

placenta

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10
Q

What does hcg usually maintain?

A

corpus luteum

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11
Q

What does the corpus luteum secrete?

A

progesterone

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12
Q

When does the corpus luteum involute?

A

2nd/3rd trimester

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13
Q

What hormone is critical for early pregnancy?

A

progesterone

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14
Q

What are the three ways you can diagnose and detect an early pregnancy?

A

1) beta-hcg levels in serum or urine
2) ultrasound @ around 5 weeks
3) fetal cardiac activity at 6-8 weeks

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15
Q

By how much does plasma volume change in pregnancy?

A

Increases by ~50%

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16
Q

What are sequela of an increase in plasma volume?

A
  • systolic murmur

- decreased blood viscosity

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17
Q

By how much does RBC volume change in pregnancy?

A

20-30% increase

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18
Q

The smaller increase in RBC volume as compared to plasma volume results in what?

A

physiologic dilutional anemia

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19
Q

Why is dilutional anemia not a real anemia?

A

Because there is an increase in RBCs overall

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20
Q

How much does CO change in pregnancy?

A

increases 30-50%

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21
Q

What results from an increase in CO?

A

increase in blood volume, decrease in afterload, uterine blood flow, and increase in HR by late pregnancy

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22
Q

What happens to systemic vascular resistance in pregnancy?

A

SVR falls in first two trimesters of pregnancy

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23
Q

Why is it thought that SVR falls in pregnancy?

A

decreased responsiveness to vasoconstrictive hormones

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24
Q

What drops because of a decrease in SVR?

A

blood pressure (systolic by more than diastolic)

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25
Q

What are the three main pulmonary physiologic changes that happen in pregnancy?

A

1) increase in O2 consumption by 15-20%
2) increase in TV by 30-40%
3) decrease in TLC by 5% due to elevated diaphragm from growing uterus

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26
Q

How many women experience late dyspnea of pregnancy?

A

50-70%

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27
Q

How is minute ventilation increased in pregnancy?

A

By increase in tidal volume, maintaining a normal respiratory rate

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28
Q

The hyperestrogenic state of pregnancy leads to an increased risk of what complication?

A

VTE

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29
Q

A hyperinsulinemic and hyperglycemic state leads to pregnancy being called what?

A

diabetogenic

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30
Q

What does progesterone cause in pregnancy?

A

smooth muscle relaxation of the uterine smooth muscle

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31
Q

What drives the parturition process?

A

the fetus

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32
Q

What induces oxytocin receptors on the uterus?

A

estrogen surge

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33
Q

What is the positive feedback loop of the labor process?

A

increase in oxytocin leads to an increase in contractions of the uterus which calls for more release of oxytocin, etc.

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34
Q

What two things does oxytocin stimulate?

A
  • increased uterine contractions

- uterine prostaglandin secretion

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35
Q

What stimulates maternal oxytocin release?

A

cervical dilation

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36
Q

What are the three stages of labor? Which is the longest?

A

1) dilation and effacement (longest)
2) expulsion of the fetus
3) placental delivery

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37
Q

Which stage is the biggest risk for hemorrhage?

A

the delivery of the placenta

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38
Q

What is considered full dilation of the cervix?

A

10 cm

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39
Q

What are the top three indications given for a C-section?

A

1) labor arrest
2) non-reassuring fetal tracing
3) malpresentation

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40
Q

What is the rate of C-sections in the US?

A

~30%

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41
Q

What is the recommended rate for C-sections according to WHO?

A

10-15%

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42
Q

What is a spontaneous abortion?

A

pregnancy loss at less than 20 weeks gestation

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43
Q

When are spontaneous abortions the most common? rare?

A

1st trimester is the most common. 2nd trimester is the rarest.

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44
Q

What is the most common cause of spontaneous abortions?

A

fetal chromosomal abnormalities (~50%)

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45
Q

What are some other causes of miscarriage?

A

anembryonic ovum, teratogen exposure, endocrine (thyroid) abnormalities, and ↓ space in the uterus

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46
Q

What are some risk factors for miscarriage?

A
  • advanced maternal age
  • previous miscarriages
  • smoking
  • intrauterine trauma
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47
Q

What are the symptoms of a miscarriage?

A
  • abdominal pain
  • vaginal bleeding
  • open cervical os
  • expulsion of fetal content
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48
Q

What is a threatened abortion?

A

vaginal bleeding in the first trimester with a closed cervical os

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49
Q

What is a complete and incomplete abortion?

A

Complete means all the fetal contents have been expelled; incomplete means there is fetal content being retained.

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50
Q

What is there an increased risk of if there are retained products of conception?

A

endometritis

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51
Q

How do you surgically remove retained products of conception?

A

Dilatation and curettage (D and C)

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52
Q

What is the medical treatment for retained products of conception?

A

methotrexate

53
Q

What does ectopia mean?

A

abnormal location or position

54
Q

What is an ectopic pregnancy?

A

fetal implantation outside the uterus

55
Q

Where do the majority of ectopic pregnancies happen?

A

~90% in the Fallopian tubes

56
Q

What is the incidence of ectopics and where is it going?

A

1-2% and rising

57
Q

What are the main risk factors for ectopic pregnancy?

A

1) PID
2) prior tubal surgeries
3) endometriosis
4) IUD
5) smoking
6) IVF

58
Q

Why is PID a risk factor for ectopic pregnancy?

A

Because it causes scarring in the reproductive tract upon healing

59
Q

How does a ectopic pregnancy present?

A

pelvic pain, missed menses, vaginal bleeding

60
Q

Is ectopic pregnancy an emergency?

A

Yes, if it ruptures!

61
Q

Why is it difficult to assess if a pregnancy is ectopic or not?

A

Early on its difficult to distinguish an ectopic pregnancy from a pregnancy of unknown location. It also presents similarly to other pathologies

62
Q

What is the first thing any female of reproductive age complaining of acute onset of abdominal pain gets when they come to the emergency room?

A

Test to see if preggers or no

63
Q

What is the beta-hgc threshold limit for visualization of a fetus on ultrasound?

A

1500 IU/L (or mIU/mL)

64
Q

What makes an abnormal pregnancy likely?

A

if beta-hcg is positive but does not increase appropriately over time

65
Q

How should a beta-hcg increase over time in early pregnancy?

A

It should DOUBLE every 2-3 days

66
Q

What would you consider as a possible diagnosis if the patient had IVF?

A

Heterogenous pregnancy (one ectopic and one normal)

67
Q

When do you repeat the beta-hcg if it is positive but below threshold?

A

2-3 days

68
Q

What happens if the patient is hemodynamically unstable?

A

Means rupture is likely, active hemorrhage means SURGERY PRONTO!

69
Q

What is the medical treatment for ectopic pregnancy?

A

MTX, methotrexate and very close management to make sure beta-hcg goes to zero, but only in select healthy patients

70
Q

What are the two surgical options for ectopic pregnancy? Which one is more invasive?

A

salpingostomy and salpingectomy. The salpingectomy involves removal of the whole fallopian tube and is more invasive

71
Q

What is the mechanism of action of methotrexate?

A

folic acid antagonist which inhibits DNA synthesis and thus targets rapidly dividing cells

72
Q

What are the two possible criteria for diagnosing gestational hypertension?

A

BP over 140/90; or increased over pre-pregnancy levels

73
Q

When does gestational hypertension usually happen?

A

3rd trimester

74
Q

What percentage of pregnancies have hypertensive problems?

A

5-10%

75
Q

What is a risk factor for gestational hypertension?

A

Multiple gestations

76
Q

What is gestational hypertension a risk factor for?

A

pre-eclampsia

77
Q

What are the two criteria to diagnose pre-eclampsia?

A
  • hypertension

- proteinuria

78
Q

What other symptom do you usually see in pre-eclampsia?

A

non-dependent edema

79
Q

What is severe pre-eclampsia defined by?

A
  • BP >160/110
  • severe proteinuria
  • edema
  • signs of end organ damage
  • HELLP syndrome
80
Q

What is HELLP syndrome?

A

Syndrome of Hemolysis, Elevated Liver Enzymes, and Low platelets

81
Q

What lab criteria are seen in hemolysis?

A

Increased bilirubin and LDH (RBC breakdown products)

burr cells, schistocytes, and other abnormal RBCs

82
Q

What are schistocytes?

A

They are RBC fragments

83
Q

What is eclampsia diagnosed by?

A

Symptoms of pre-eclampsia and seizures

84
Q

What lab criteria are seen with low platelets?

A

Platelet count below 100

85
Q

What lab criteria are seen with elevated liver enzymes?

A

Increased AST, ALT, Alk Phos, and LDH

86
Q

What is the key pathophysiological concept behind pre-eclampsia?

A

shallow placental implantation

87
Q

What are the three main pathophysiological aberrations seen in pre-eclampsia?

A
  • abnormal placental vasculature
  • coagulopathies
  • endothelial dysfunction and imbalance in angiogenesis and antiangiogenesis factors
88
Q

What do the placental changes cause?

A

Placenta will release chemicals that cause maternal systemic vasoconstriction and endothelial dysfunction

89
Q

Why is a shallow implantation of the placenta and failure for the cytotrophoblast to invade the myometrium a cause of problems?

A

Does not allow for the remodeling of spiral arteries which lead to narrow vessel formation and placental hypoperfusion

90
Q

What is the immune system rejection of the paternal antigen?

A

There is some evidence that closer the father is to the mother and more intimate, the less likely the pregnant mother is to experience pre-eclampsia

91
Q

What are the risk factors for pre-eclampsia?

A
  • genetics
  • previous personal and/or family hx of pre-eclampsia
  • hx of vascular dysfunction
92
Q

What is the treatment of pre-eclampsia?

A

delivery!

93
Q

What criteria factor into delivery of the fetus?

A
  • disease severity and amount of maternal or fetal distress

- fetus’ gestational age

94
Q

What can be used to buy more time if delivery would be too premature?

A
  • inpatient monitoring
  • mag sulfate
  • corticosteroids for fetus
95
Q

What are four other major complications of pre-eclampsia/eclampsia?

A

1) possibility of seizures post-delivery
2) high recurrence rate with severe disease
3) fetal risks in eclamptic state
4) maternal long-term vascular disease

96
Q

What is the problem with delivering a fetus before it is due?

A

prematurity adds morbidity to infant’s life

97
Q

What is gestational DM?

A

DM in pregnancy! Not including those who were diagnosed with DM prior to pregnancy

98
Q

When does GDM usually manifest? When is it usually screened for?

A

Usually manifests in third trimester when insulin resistance is highest. Screened for in second trimester

99
Q

What is the incidence of GDM among pregnancies?

A

2-12%

100
Q

What is the hormonal dysfunction thought to cause GDM?

A

human placental lactogen

101
Q

What does human placental lactogen do endocrine wise?

A

increases BS and increases IR

102
Q

What does hPL do to the mother’s carbohydrate metabolism?

A

STRESSES it. Increased risk for DM later in life

103
Q

What are the risk factors for GDM?

A

Same as those for T2DM: obesity, high cholesterol, ethnicity, sedentary lifestyle

104
Q

What is the initial screen for GDM?

A

Drink 50g glucose load and check BS after 1 hr.

105
Q

What is a positive on an OGTT?

A

2 blood glucose readings over 200 up to 2 hours after 100g glucose load

106
Q

How is GDM managed?

A
  • prepregnancy weight counseling, i.e. fetus should only add 300 calories to diet a day
  • same management of T2DM after diagnosis: exercise, weight management, oral diabetic drugs, etc
107
Q

What complications does GDM lead to for the mother?

A
  • pre-eclampsia
  • C-section delivery
  • future risk for T2DM
108
Q

What complications does GDM lead to for the infant?

A
  • macrosomia (BIG baby)
  • neonatal hypoglycemia due to decreased glucose load and increased insulin levels
  • poorer outcomes, higher morbidity
109
Q

What is placenta previa?

A

Placental placement obstructing the cervical os

110
Q

What is placental abruption?

A

premature separation of the placenta from uterus AFTER 20 weeks gestation

111
Q

What does placenta previa present as?

A

painless bleeding after 20 weeks gestation

112
Q

What does placental abruption present as?

A

painful bleeding after 20 weeks gestation

113
Q

What are the two things that determine risk factors for placenta previa?

A

1) anything that interferes with normal placental migration

2) abnormal endometrium in the upper uterine cavity

114
Q

What are the risk factors for placenta previa?

A
  • prior C-section or prior previa
  • uterine surgery
  • multiple gestations
  • multiparity
  • smoking
  • advanced age
115
Q

How is placenta previa diagnosed?

A

Via transabdominal ultrasound

116
Q

What is contraindicated with placenta previa?

A

pelvic exam

117
Q

What is there a higher risk for during a placenta previa pregnancy?

A

hemorrhage

118
Q

How are placenta previa babies delivered?

A

Through C-section at 36-37 weeks

119
Q

What is placental abruption linked to and what does it cause?

A

Linked to early placental disease and causes uteroplacental insufficiency.

120
Q

What is the fetal mortality rate in placental abruption?

A

12%

121
Q

What are risk factors for placental abruption?

A
  • HTN, pre-eclampsia
  • cocaine use
  • trauma with shearing force
122
Q

How is placental abruption diagnosed and managed?

A
  • clinical diagnosis as it is difficult to diagnose on US
  • support and preparation for possible delivery
  • vaginal delivery is mild, but immediate delivery if unstable
123
Q

What are the three other abnormal placental attachments?

A

1) placenta accreta
2) placenta increta
3) placenta percreta

124
Q

What do abnormal placental attachments in general lead to a higher risk of in birth?

A

hemorrhage

125
Q

What does overuse of C-section lead to?

A

Increased risks of complications in birth

126
Q

What does underuse of C-section lead to?

A

increased overall maternal and fetal risk

127
Q

What are the maternal risks of C-section?

A

Those of general surgery: longer hospital stay, longer recovery, risk of cardiac event or VTE

128
Q

What are the fetal risks of C-section?

A
  • considered high-risk delivery for fetus
  • future risk of asthma
  • increased fetal mortality, fetal resp. distress
129
Q

What is shown in CXRs of babies with C-section more so than those in natural deliveries?

A

increase in retained fluid

Old Flashcards (7 decks)

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