Blue Prints Ch 1-5 📘 Flashcards by Keannah Insular

Bluish discoloration of vagina and cervix

Chadwick sign

How well did you know this?

Not at all

Perfectly

Softening and cyanosis of the cervix at or after 4 week

Goodell sign

How well did you know this?

Not at all

Perfectly

Softening of the uterus after 6 week

Ladin sign

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

If the date of ovulation is known, as in assisted reproductive technology, the EDC can be calculated by adding _____ days.

266 days

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

The caloric requirement is increased by ______ during pregnancy and by _______ when breastfeeding.

300 kcal/day
500 kcal/day

How well did you know this?

Not at all

Perfectly

The protein requirement increases from _________.

60 to 70 or 75 g/day

How well did you know this?

Not at all

Perfectly

Recommended calcium intake is ________.

1.5 g/day

How well did you know this?

Not at all

Perfectly

Folate requirements increase from _________ and are important in preventing neural tube defects.

0.4 to 0.8 mg/day

How well did you know this?

Not at all

Perfectly

Cerebellum is pulled caudally and flattened

Banana sign

How well did you know this?

Not at all

Perfectly

Concave frontal bones

Lemon sign

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Screening for maternal serum alpha fetoprotein (MSAFP) is usually performed between _____ and _____ weeks.

15 and 18 weeks

How well did you know this?

Not at all

Perfectly

Patients who are Rh negative should receive RhoGAM at _____ weeks.

28 weeks

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Commonly, ________ increases as the lungs mature, whereas ________ decreases beyond about 32 weeks.

Lecithin

Sphingomyelin

How well did you know this?

Not at all

Perfectly

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.

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.

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

1. Dilute blood with water 2. Collect the supernatant 3. 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