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RDS Test 1 > B8.015 Big Case: Normal Pregnancy > Flashcards

B8.015 Big Case: Normal Pregnancy Flashcards

1
Q

first trimester length

A

weeks 0- 13w6d

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2
Q

second trimester length

A

weeks 14- 27w6d

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3
Q

third trimester length

A

weeks 28- 40w6d

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4
Q

important screening in pregnancy that can often be missed

A

interpersonal violence
pregnancy is when a woman is most likely to experience violence
prevalence is 4-8%

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5
Q

cal increase per day in pregnancy

A

500 cal per day

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6
Q

total weight gain in pregnancy

A

25-35 lbs
more for underweight women, less for overweight women
sometimes weight neutral if obese

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7
Q

vitamin intake in pregnancy

A

calcium- 1000 mg daily
folic acid- 400 mcg daily
vitamin D- 600 IU
iron, vit A, DHA

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8
Q

importance of folic acid

A

prevents 70% of neural tube defects

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9
Q

protein intake in pregnancy

A

half of your weight in lbs

important for tissue development

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10
Q

foods to limit and avoid in pregnancy

A 
limit:
-caffeine
avoid:
-alcohol
-foods with listeria risk
-rare or under-cooked meats
-fish with high levels of mercury
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11
Q

how much caffeine

A

10 oz coffee

2 cans soda

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12
Q

listeria risk foods

A

hot dogs, deli meat, fermented/dry sausage

soft cheeses

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13
Q

rare or undercooked meats

A

sushi with raw fish, raw eggs, caesar dressing

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14
Q

what are teratogens

A

prenatal toxicity causing structural or functional defects in fetus
cross the placenta from maternal circulation

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15
Q

mechanisms of teratogens

A 
folate antagonism
neural crest cell disruption
endocrine disruption
oxidative stress
vascular disruption
specific receptor or enzyme mediated
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16
Q

teratogenicity of benzos

A

specific receptor mediated

4x increase in congenital anomalies

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17
Q

teratogenicity SSRI

A

specifically paroxetine

specific receptor mediated teratogen

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18
Q

methotrexate teratogenicity

A

exposure before 40 days is lethal to embryo
later exposure: IUGR, craniofacial anomalies, abnormal positioning of extremities, mental retardation, early miscarriage, stillbirth

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19
Q

teratogenicity of alkylating agents

A

oxidative stress

IUGR, fetal death, cleft palate, microphthalmia, limb reduction anomalies, poorly developed external genitalia

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20
Q

teratogenicity of warfarin

A

specific receptor mediated
easily crosses placenta, excreted in breast milk
spontaneous abortion, stillbirth, IUGR, CNS defect

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21
Q

fetal warfarin syndrome

A

depressed nasal bridge (saddle nose)
nasal hypoplasia
flat face, chondrodysplasia (bone abnormalities)

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22
Q

teratogenicity of anticonvulsants

A

folate antagonism, oxidative stress
phenytoin and valproic acid
risk for neural tube, cardiac, skeletal defects, and craniofacial malformations

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23
Q

teratogenicity of retinoids

A

acne treatment (accutane)
neural crest cell disruption
risk of spontaneous abortion in first trimester 50%
CNS, cardio, and craniofacial defects (esp ear)

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24
Q

teratogenicity of tobacco

A

vascular disruption
increased risk for fetal death
low birth weight

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25
Q

teratogenicity of alcohol

A

high concentrations in fetus
-fetal liver metabolizes alcohol slower
-amniotic fluid may act as reservoir
neurocognitive and behavioral problems lifelong

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26
Q

fetal alcohol syndrome (FAS)

A 
prenatal/postnatal growth deficiency
diagnostic facial features
-short palpebral fissure length (eyes appear further apart)
-smooth philtrum
-thin upper lip
CNS deficits
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27
Q

embryonic age vs gestational age

A 
GA= first day of last menstrual period
EA= 2 weeks after LMP
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28
Q

week 1 of fetal development

A

fertilization to implantation

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29
Q

week 2 of fetal development

A

implantation to formation of chorion
HCG released
pregnancy test +

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30
Q

week 3 of fetal development

A

neurogenesis, cardiogenesis begins

-these processes usually complete by 12 wks

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31
Q

week 4 of fetal development

A

neural crest differentiation
-closure of the anterior and posterior neuropore
-failure of posterior neuropore closure results in spinal bifida
heart beating
organogenesis begins

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32
Q

week 5 of fetal development

A

limb buds forming
pseudoglandular stage of lung development begins
-fluid filled primitive respiratory tree resembles exocrine gland
-too immature for gas exchange

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33
Q

week 10 of fetal development

A

random movements occurring
organogenesis complete
heartbeat heard with electronic monitor

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34
Q

GxPxxxx

A 
gravida = total number of times pregnant
para = births
TPAL
term = >37 weeks
preterm = 20-36w6d
abortus = spontaneous or induced miscarriage <20 wks
living = living children
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35
Q

pregnancy confirmation labs

A 
urine HCG (qualitative test)
serum HCG
(quantitative test)
-doubles every 48h
-peaks 8-9 wks
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36
Q

initial prenatal labs

A 
hematologic
-CBC
-blood type and screen for alloimmunization Abs
urine
-urinalysis
-screen for asymptomatic bactiuria
infectious disease
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37
Q

asymptomatic bactiuria

A

risk factor for miscarriage or preterm birth

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38
Q

infectious disease prenatal testing

A 
syphilis (RPR)
HIV
hep B
hep C, if risk factors
gonorrhea/chlamydia
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39
Q

concerning infectious exposures in pregnancy

A 
zika
parvovirus B19
CMV
varicella zoster
HSV
coxsackievirus
rubella
40
Q

zika transmission

A

sexually

mosquito

41
Q

zika birth defects

A

can cause microcephaly and other brain defects
-confirmed zika in pregnancy = 5-10% zika associated birth defects
-highest risk of birth defects with exposure in 1st trimester
avoid travel to affected areas

42
Q

parvovirus B19 transmission

A

respiratory secretions

43
Q

parvovirus B19 symptoms

A

children: 5ths disease, slapped cheek rash, fever, body rash, joint pain
adults: reticular rash on trunk, peripheral arthropathy, transient aplastic crisis

44
Q

parvovirus B19 birth defects

A

spontaneous abortion, non-immune hydrops fetalis, stillbirth

45
Q

CMV transmission

A

body fluid
ubiquitous herpesvirus; remains latent in host cells
risk of vertical transmission highest in 3rd trimester
most common congenital infection

46
Q

symptoms of CMV

A

jaundice, grow restriction, myocarditis, non immune hydrops

**most infants asymptomatic

47
Q

VZV transmission

A

respiratory droplets

remains dormant in sensory ganglia

48
Q

symptoms of VZV

A

children: primary infection- fever, malaise, maculopapular pruritic rash that turns vesicular
reactivation: painful, vesicular, erythematous rash in dermatome
adults: encephalitis, pneumonia

49
Q

congenital chickenpox

A

skin scarring
limb hypoplasia
chorioretinitis
microcephaly

50
Q

HSV transmission

A

direct contact

51
Q

how to avoid HSV in neonates

A

acyclovir at 36 wks to avoid outbreak

if genital outbreak, c-section delivery

52
Q

neonatal HSV

A

limited skin/eye/mouth
encephalitis
disseminated infection: CNS, lung, liver, adrenal

53
Q

coxsackievirus transmission

A

enterovirus - common in summer and fall
spread by respiratory droplets and fecal-oral
contraction near delivery can infect infant

54
Q

coxsackie symptoms

A

hand, foot, mouth disease

high fever leading to miscarriage

55
Q

rubella transmission

A

respiratory droplets

exposure worst in first 12 wks

56
Q

congenital rubella syndrome

A

deafness**

cataracts, heart defects, intellectual disabilities, liver and spleen damage, low birth weight

57
Q

MMR vaccine

A

do not give in pregnancy, live vaccine

vaccinate after delivery

58
Q

week 12 of fetal development

A

external genitalia differences may be seen

59
Q

week 16 of fetal development

A

canalicular stage of lung development begins

  • resp tree expands
  • angiogenesis occurs along airways
  • resp bronchioles and alveolar ducts form
  • cranial portion of lungs develop quicker
60
Q

week 17 of fetal development

A

pseudoglandular stage of lung development ends

61
Q

week 22 of fetal development

A

general cut off for viability (resuscitation attempted in this time frame)
survival outside womb = 65%
survival without major morbidity = 9%

62
Q

weeks 22-24 of fetal development

A

terminal saccular stage of lung development begins

  • alveolar cells differentiating into cells that can make surfactant (needed to sustain gas exchange)
  • capillaries form complex network, lymphatic system developing
63
Q

week 25 of fetal development

A

canalicular stage of lung development ends

64
Q

first trimester genetic screen (10-14 weeks)

A

US for nuchal translucency
-thickness at space in back of fetus neck
HCG
PAPP-A

65
Q

second trimester genetic screening (16-20 weeks)

A

quad screen

  • msAFP
  • UE3
  • HCG
  • inhibin A
66
Q

what is cfDNA/NIPT

A

cell free fetal DNA
-screened for trisomy 13,18,21 and sex
-can be done as early as 10 weeks
CANNOT be done with multiple gestations

67
Q

confirmation of genetic screens

A

amniocentesis or chorionic villus sampling

more invasive and carry risks

68
Q

what is AFP

A

alpha fetoprotein
screens for neural tube defects
found in fetal circulation and amniotic fluid, enters maternal circulation through placenta and amniotic fluid

69
Q

when should the neural tube close

A

week 4 of fetal development
anterior neuropore closes day 24, posterior neuropore day 26
AFP not found in maternal serum until second trimester

70
Q

how neural tube defects manifest in screening

A

AFP leaks into amniotic fluid

if defect is covered by a membrane however, testing may miss it

71
Q

where is AFP produced

A

yolk sac > GI tract > liver

filtration by fetal kidney > amniotic fluid

72
Q

how are AFP results reported

A

multiples of the median

-adjusted for multiple variables: weight, race, multiple gestation, diabetes

73
Q

best time to test AFP

A

embryonic age 14-16 weeks (GA 16-18 weeks)

  • acceptable between 15-22 wks GA
  • inaccurate dating common cause for false positives
74
Q

reducing risk for NTD

A

taking folic acid (400 mcg per day)

1 month prior to conception and during the first 3 months of pregnancy

75
Q

gestational diabetes prevalence

A

7% of pregnancies affected by diabetes
-86% of these are gestational
USPSTF recommends all pregnant women be screening

76
Q

complications of gestational diabetes

A

preeclampsia
c-section
maternal development of DM2

77
Q

when do you screen for gestational diabetes

A

24-28 weeks gestation

78
Q

OGTT

A 
2 step:
50 g glucose > serum glucose in 1 hr
if posivite:
100 g glucose > serum glucose 1, 2, 3 hr
if 2 abnormal, diagnose GDM
79
Q

if diagnosed with gestational diabetes

A

nutrition referral
monitor blood sugar
treat if blood sugar levels high (meds or insulin)

80
Q

week 26 of fetal development

A

survival outside the womb 94%

survival without major morbidity 59%

81
Q

what is the late fetal period

A

week 30 of fetal development and beyond

82
Q

processes that occur in the late fetal period

A

alveolar stage of lung development
-majority of gas exchange surface formed
maturation of surfactant system

83
Q

how to treat surfactant deficits in preterm babies

A

surfactant and corticosteroid injections

84
Q

when should you rescreen for STIs?

A 
3rd trimester if risk factors
risk factors:
-prior positive test
-new or multiple partners
-partner w STI
-inconsistent condom use
-exchanging sex for money or drugs
-living in areas with high prevalence
85
Q

Group B strep transmission

A

streptococcus agalactiae
-10-30% of pregnant women colonized in vagina or rectum
lives in GI tract and can spread to GU tract (not an STI)

86
Q

Group B strep infection in pregnancy

A

can cause ascending infection: neonatal sepsis due to GBS

vaginal and rectal culture performed 35-37 weeks

87
Q

treatment of group B strep in pregnancy

A

routine intrapartum antibiotics (penicillin) given in labor

-80% reduction in neonatal sepsis due to GBS

88
Q

effects of cocaine/meth on pregnancy

A

vascular disruption
-preterm birth, placental abruption, fetal distress, IUGR
irritability, hyperactivity, tremors, high pitched cry

89
Q

effects of marijuana on pregnancy

A

no withdrawal signs

not sure of long term outcomes

90
Q

effects of SSRIs on pregnancy

A

irritability, restlessness, tremor, respiratory distress
-consistent with gradual resolution of hyperserotonergic state
onset hours to days after birth, resolves in 1-2 weeks
no adverse neurodevelopmental outcomes

91
Q

worst/best SSRIs for pregnant women

A

paroxetine = worst

fluoxetine and sertraline = best

92
Q

neonatal abstinence syndrome

A

opioid withdrawal
irritability, autonomic over reactivity, GI dysfunction
excess environmental stimuli/ hunger exacerbates
treated with morphine

93
Q

why are preterm infants at lower risk of opiate withdrawal

A

less length of exposure
lower fat stores
immaturity of CNS

94
Q

important time points of fetal development

A

all in EA
week 3: neurogenesis, cardiogenesis begin
week 4: neural crest differentiation, organogenesis
week 5-17: pseudoglandular stage of lung development
week 10: organogenesis complete
week 16-25: canalicular stage of lung development
week 22-late: terminal saccular stage of lung development
week 30: alveolar stage of lung development, maturation of surfactant system

95
Q

things 2 do in the first trimester

A
  1. confirm pregnancy (HCG)
  2. initial prenatal labs: CBC, type and screen, HIV, RPR, hep B, rubella, G/C, UA, urine culture
  3. 10 w GA - NIPT
  4. 10-14 w GA - 1st trimester genetic screen
96
Q

things 2 do in second trimester

A

16-20 w GA - quad screen
16-18 w GA - msAFP
24-28 w GA - GDM (gestational diabetes)

97
Q

things 2 do in third trimester

A

STI rescreen
-HIV, RPR, gonorrhea
35-37 w GA - GBS

RDS Test 1 (22 decks)

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