Blue Prints Ch 1-5 📘 Flashcards
Bluish discoloration of vagina and cervix
Chadwick sign
Softening and cyanosis of the cervix at or after 4 week
Goodell sign
Softening of the uterus after 6 week
Ladin sign
B subunit of human chorionic gonadotropin (B-hCG) produced by the placenta, will rise to a peak of _________ by ___ weeks of gestation, _________ throughout the second trimester, and then level off at approximately _________ in the third trimester.
100,000 mIU/mL
10
Decreased
20,000 to 30,000 mIU/mL
A viable pregnancy can be confirmed by ultrasound, which may show the gestational sac as early as ______ on a TVS or at a B-hCG of _____________.
5 weeks, 1,500 to 2,000 mIU/mL
Fetal heart (FH) motion may be seen on TVS as soon as _______ or at a B-hCG of ____________.
6 weeks
5,000 - 6,000 mIU/mL
If the date of ovulation is known, as in assisted reproductive technology, the EDC can be calculated by adding _____ days.
266 days
During pregnancy, cardiac output increases by _________.
30% to 50%
Ratio: The increase in cardiac output is first due to an increase in stroke volume and is then maintained by an increase in heart rate as the stroke volume decreases to near prepregnancy levels by the end of the third trimester.
Systemic vascular resistance _________ during pregnancy, resulting in a _______ in arterial blood pressure.
Decrease; fall
Ratio: This decrease is most likely due to elevated progesterone, leading to smooth muscle relaxation.
There is a decrease in systolic blood pressure of ________ and in diastolic blood pressure of ________ that reaches a nadir at week 24. Between 24 weeks’ gestation and term, the blood pressure slowly returns to prepregnancy levels but should never exceed them.
5 to 10 mm Hg; 10 to 15 mm Hg
There is an increase of 30% to 40% in ________ during pregnancy despite the fact that the ________ is decreased by 5% because of the elevation of the diaphragm.
Tidal volume; Total lung capacity
The caloric requirement is increased by ______ during pregnancy and by _______ when breastfeeding.
300 kcal/day
500 kcal/day
The protein requirement increases from _________.
60 to 70 or 75 g/day
Recommended calcium intake is ________.
1.5 g/day
Folate requirements increase from _________ and are important in preventing neural tube defects.
0.4 to 0.8 mg/day
Cerebellum is pulled caudally and flattened
Banana sign
Concave frontal bones
Lemon sign
While irregular (Braxton Hicks) contractions are common throughout the third trimester, regular contractions occuring more frequently than ________ per hour may be a sign of preterm labor and should be assessed.
Five or six per hour
Screening for maternal serum alpha fetoprotein (MSAFP) is usually performed between _____ and _____ weeks.
15 and 18 weeks
Patients who are Rh negative should receive RhoGAM at _____ weeks.
28 weeks
The Glucose Tolerance Test is a diagnostic test for gestational diabetes. This test is an indicative of gestational diabetes if there is an elevation in two or more of the following threshold values: fasting glucose ______; 1 hour _____; 2 hour ______; or 3 hour ________.
95 mg/dL
180 mg/dL
155 mg/dL
140 mg/dL
The BPP looks at the following five categories and gives a score of either 0 or 2 for each:
- amniotic fluid volume
- Fetal tone
- fetal activity
- Fetal breathing movements
- nonstress test (NST), which is a test of the FHR.
A BPP of 8 to 10 or better is reassuring.
The NST is considered formally reactive (a reassuring sign) if there are _____ accelerations of the FHR in ___ minutes that are at least ____ beats above the baseline heart rate and last for at least ____ seconds.
Two; 20 minutes; 15 beats; 15 seconds
Commonly, ________ increases as the lungs mature, whereas ________ decreases beyond about 32 weeks.
Lecithin
Sphingomyelin
Repetitive studies have shown that an L/S ratio of greater than 2 is associated with only rare cases of ________________.
respiratory distress syndrome (RDS)
____ and ______ will DECREASE because of a 50% increase in the GFR which occurs early in pregnancy.
BUN and CREATININE
Gastric emptying and large bowel motility are ________ as a result of progesterone, leading to reflux and constipation, respectively.
Decrease
Hyperemesis gravidarum is a severe form of morning sickness in which women lose ________ of their prepregnancy weight and go into ketosis.
more than 5%
Hyperemesis gravidarum is a severe form of morning sickness in which women lose ________ of their prepregnancy weight and go into ketosis.
more than 5%
Lecithin increases as the lung matures and sphingomyelin decreases beyond _____ weeks.
32
The most common site of implantation in a tubal pregnancy is the ampulla (_____%), followed by the isthmus (______%) and fimbriae (______%).
70%
12%
11%
The strongest risk factor is a history of a prior ectopic pregnancy. The risk of a subsequent ectopic pregnancy is _____ % after one prior ectopic pregnancy and increases to _____ % after more than one prior ectopic pregnancy
10%
25%
On laboratory studies, the classic finding of ectopic pregnancy is a beta human chorionic gonadotropin (β-hCG) level that is _____ for gestational age and does not increase at the expected rate.
Low
An IUP should be seen on transvaginal ultrasonography with β-hCG levels between _________ mIU/mL.
1,500 and 2,000
A fetal heartbeat should be seen with β-hCG level greater than _________ mIU/mL.
5,000
At most institutions, clinicians prescribe methotrexate in order to treat uncomplicated, nonthreatening, ectopic pregnancies. It is appropriate to use methotrexate for patients who have small ectopic pregnancies (as a general rule, ____ cm, serum β-hCG level ______, and ___________) and for those patients who will be reliable with follow-up.
<5 cm
<5,000
Without a fetal heartbeat
Fetus lost before 20 weeks gestation or less than 500 g
Abortus
Complete expulsion of all POC before 20 weeks’ gestation
Complete abortion
Partial expulsion of some but not all POC before 20 weeks’ gestation.
Incomplete abortion
No expulsion of products, but vaginal bleeding and dilation of the cervix such that a viable pregnancy is unlikely.
Inevitable abortion
Any vaginal bleeding before 20 weeks, without dilation of the cervix or expulsion of any POC (i.e., a normal pregnancy with bleeding).
Threatened abortion
Death of the embryo or fetus before 20 weeks with complete retention of all POC.
Missed abortion
Previously known as cervical incompetence, patients with ____________ present with painless dilation and effacement of the cervix, often in the second trimester of pregnancy.
cervical insufficiency
The cerclage is a suture placed vaginally around the cervix either at the cervical–vaginal junction (___________) or at the internal os (_____________).
McDonald cerclage
Shirodkar cerclage
Placement of the elective cerclage is similar to that of the emergent cerclage (with either the McDonald or Shirodkar methods being used), usually at _____________’ gestation. The cerclage is maintained until _____________ of gestation if possible.
12 to 14 weeks; 36 to 38 weeks
B-hCG levels double approximately every _____ in normal intrauterine pregnancies but not in ectopic pregnancies.
48 hours
The ________ in the amniotic fluid cause crystallization of the salts in the amniotic fluid when it dries.
estrogens
A fetus presenting headfirst should actually be designated ________ rather than vertex, unless the head is flexed and the _______ is truly presenting.
Cephalic; vertex
If the fetus is cephalic with an extended head, it may be presenting with either the ___________.
face or the brow
If the fetal vertex is presenting along with a fetal extremity such as an arm, this is deemed a ____________.
compound presentation
With face presentations, the ___________ is the fetal reference point, while with breech presentations, the reference is the ____________.
chin or mentum; fetal sacrum
The vault, or roof, of the fetal skull is composed of five bones: _____ frontal, ______ parietal, and ____ occipital.
2, 2, 1
The _____________ is the junction between the two frontal bones and two parietal bones and is larger and diamond-shaped.
anterior fontanelle
The ____________ is the junction between the two parietal bones and the occipital bone and is smaller and more triangular.
posterior fontanelle
There are both maternal and obstetric contraindications for the use of prostaglandins. Maternal reasons include _________ and ___________. Obstetric reasons include having had a ______________ and _______________.
Asthma and glaucoma
Prior cesarean delivery and non-reassuring fetal testing
Absent fetal heart rate variability
<3 beats/min
Minimal FHR variability
3 to 5 bpm
Moderate FHR variability
5 to 25 bpm
Marked FHR variability
More than 25 bpm
__________ begin and end approximately at the same time as contractions. They are a result of increased vagal tone secondary to head compression during a contraction.
Early decelerations
____________ can occur at any time and tend to drop more precipitously than either early or late decelerations. They are a result of umbilical cord compression.
Variable decelerations
_____________ begin at the peak of a contraction and slowly return to baseline after the contraction has finished. These decelerations are a result of uteroplacental insufficiency and are the most worrisome type.
Late decelerations
Also called restitution or resolution
External rotation
Also called restitution or resolution
External rotation
________ begins with the onset of labor and lasts until dilation and effacement of the cervix are completed.
Stage 1
________ is from the time of full dilation until delivery of the infant.
Stage 2
_______ begins after delivery of the infant and ends with delivery of the placenta.
Stage 3
An average first stage of labor lasts approximately _________ in a nulliparous patient and __________ in a multiparous patient.
10 to 12 hours; 6 to 8 hours
Stage 2 is considered prolonged if its duration is longer than ________ in a nulliparous patient, although at least an extra hour is allowed in patients who have epidurals.
3 hours
In MULTIPAROUS women, stage 2 is prolonged if its duration is longer than _______ without an epidural and at least _________ with an epidural.
2 hours; 3 hours
If a prolonged deceleration is felt to be the result of uterine hypertonus or tachysystole which can be diagnosed by palpation or examination of the tocometer, the patient can be given a dose of ___________ to help relax the uterus.
terbutaline
a single contraction lasting 2 minutes or longer
Hypertonus
greater than five contractions in a 10-minute period
Tachysystole
When a delivery needs to be expedited, a ____________ using the heel of the delivering hand to exert pressure on the perineum and the fingers below the woman’s anus to extend the fetal head to hasten delivery and maintain station between contractions may be performed.
modified Ritgen maneuver
A rare complication from the vacuum extractor is the _______________, which can be a neonatal emergency.
subgaleal hemorrhage
Placental separation usually occurs ______________ of delivery of the infant; however, up to 30 minutes is usually considered within normal limits.
within 5 to 10 minutes
The diagnosis of retained placenta is made when the placenta does not deliver within __________ after the infant.
30 minutes
Retained placenta is common in preterm deliveries, particularly previable deliveries. However, it is also a sign of ___________, where the placenta has invaded into or beyond the endometrial stroma.
placenta accreta
The most common indication for primary cesarean delivery is that of _____________.
failure to progress in labor
The epidural catheter is placed in the _______ interspace when the patient requires analgesia, although usually not until labor is deemed to be in the active phase.
L3–L4
A common complication of both forms of anesthesia is ______________ secondary to decreased systemic vascular resistance, which can lead to decreased placental perfusion and fetal bradycardia.
maternal hypotension
A more serious complication can be _______________ if the anesthetic reaches a level high enough to affect diaphragmatic innervation.
maternal respiratory depression
A ______________ due to the loss of cerebrospinal fluid is a postpartum complication seen in less than 1% of patients.
spinal headache
___________ is defined as abnormal implantation of the placenta over the internal cervical os.
Placenta previa
Occurs when the placenta completely covers the internal os.
Complete previa
Occurs when then the placenta covers a portion of the internal os.
Partial previa
Occurs when the edge of the placenta reaches the margin of the os.
Marginal previa
A _____________ is implanted in the lower uterine segment in close proximity but not extending to the internal os.
Low-lying placenta
A fetal vessel may lie over the cervix
Vasa previa
Up to ___% of pregnant women display sonographic evidence of placenta previa on early ultrasound.
6%
In cases where the atrophy is incomplete, leaving a placental lobe discrete form the rest of the placenta, it is termed a _____________.
Succenturiate lobe
_____________ is a condition in which the placenta invades into and is INSEPARABLE from the uterine wall.
Placenta accreta
When the invasion extends into the myometrium, this is termed a _______________.
placenta increta
When the invasion is through the myometrium and the serosa, this is termed a _____________.
placenta percreta
The average blood loss at delivery in women with placenta accreta is _________________.
3,000 to 5,000 mL
Historically, the most frequent indication for a peripartum hysterectomy has been ____________.
uterine atony
In remaining 80% of placental separations, the blood dissects downward toward the cervix, resulting in a __________________.
revealed or external hemorrhage
The strongest factor associated with increased incidence of abruption is history of previous abruption, carrying an ____________ increase in risk.
8- to 12-fold
The risk of abruption in future pregnancy is _____ % after one abruption and _____ % after two prior abruptions.
10%
25%
The classic presentation of placental abruption is __________________ associated with _______________ and/or ________________.
third-trimester vaginal bleeding; severe abdominal pain; frequent, strong contractions
A classic sign of placental abruption that can only be seen at the time of cesarean delivery is the ____________________, which is a life-threatening condition and occurs when there is enough blood from the abruption that markedly infiltrates the myometrium to reach the serosa, especially at the cornua, that it gives the myometrium a bluish purple tone that can be seen on the surface of the uterus.
Couvelaire uterus
However, because abruption can present clinically in a similar fashion to placenta previa with vaginal bleeding, __________________ is routinely performed to rule out previa in cases of suspected abruption.
ultrasonography
Importantly, negative findings on ultrasound examination do NOT exclude placental abruption.
The diagnosis of abruption may be confirmed by inspection of the placenta at delivery. The presence of a _________________ with overlying placental destruction confirms the diagnosis.
retroplacental clot
The presentation of uterine rupture is highly variable. Typically, it is characterized by the sudden onset of intense ____________.
Abdominal pain
Most pregnancies complicated by rupture of a fetal vessel are due to ________________ where the blood vessels insert between the amnion and chorion away from the placenta instead of inserting directly into the chorionic plate.
Velamentous cord insertion
In this case, the bulk of the placenta is implanted in one portion of the uterine wall, but a small lobe of the placenta is implanted in another location.
Succenturiate lobe
Steps of Apt test (Examination of the blood for nucleated (fetal) RBCs - diagnosis for Fetal Vessel Rupture
- Dilute blood with water
- Collect the supernatant
- Combine with 1% NaOH
Pink = fetal blood
Yellow brown color = maternal blood
The special precautions regarding placenta previa are _____________ and _____________.
Complete pelvic rest and close observation
________ is the imaging modality of choice to evaluate for the myometrial and/or bladder invasion of the placenta, particularly when it is not clear on ultrasound.
MRI
A sinusoidal pattern on continuous FHR monitoring indicates _____________.
Fetal anemia
