Blue Prints Ch 6 📘 Flashcards
Extremely preterm
<28 weeks
Very preterm
28 - <32 weeks
Moderate to late preterm
32 to <37 weeks
The principal goal of tocolytic therapy is to delay delivery by at least _________.
48 hours
In the case of preterm contractions without cervical change, hydration can often decrease the number and strength of the contractions. This operates along the principle that a dehydrated patient has increased levels of _________________________, the octapeptide synthesized in the hypothalamus along with oxytocin.
vasopressin or antidiuretic hormone (ADH)
Because ADH differs from oxytocin by only one amino acid, it may bind with oxytocin receptors and lead to contractions.
_____________ increase the intracellular levels of calcium and enhance myometrial gap junction function, thereby increasing myometrial contractions.
Prostaglandins
__________________ —a nonsteroidal anti-inflammatory drug (NSAID) that blocks the enzyme cyclooxygenase and decreases the level of prostaglandins —is used as a tocolytic.
Indomethacin
Magnesium decreases uterine tone and contractions by acting as a ___________ and a membrane stabilizer.
calcium antagonist
Deep tendon reflexes (DTRs) are depressed at magnesium levels of ______________.
6 to 10 mg/dL
The most significant risk of PROM is the development of ______________.
chorioamnionitis
The __________________ is the distance between the sacral promontory and the midpoint of the symphysis pubis, and the shortest anteroposterior (AP) diameter of the pelvic inlet.
obstetric conjugate
The AP diameter of the pelvic outlet is the distance from the tip of the sacrum to the inferior margin of the pubic symphysis and usually ranges from ______________.
9.5 to 11.5 cm
When the fetal skull is properly flexed, the suboccipitobregmatic diameter presenting to the pelvis averages ________ in a term infant.
9.5 cm
Has flexed hips and extended knees and thus the feet are near the fetal head.
Frank breech
Has flexed hips but one or both knees are flexed as well, with at least one foot near the breech.
Complete breech
Has one or both of the hips not flexed so that the foot or knee lies below the breech in the birth canal.
Incomplete or footling beech
The diagnosis of face presentation can be made with vaginal examination and palpation of the nose, mouth, eyes, or chin (mentum). _________________ is the only face presentation that will allow for a vaginal delivery.
Mentum anterior
Occurs when the portion of the fetal skull just above the orbital ridge presents.
Brow presentation
A fetal extremity presenting alongsid the vertex or breech is considered a _________________.
Compound presentation
A common complication of compound presentation is _______________.
Umbilical cord prolapse
The fetal position that optimizes the probability of the fetal head passing through the maternal pelvis is ______________.
occiput anterior (OA)
The most common position of the fetus at the onset of labor is either ________________.
left OT (LOT) or right OT (ROT)
From the transverse position, the cardinal movement of ______________ usually converts the fetus to the OA position.
internal rotation
A persistent OT position leading to arrest of labor is more common in women with a _________________.
platypelloid pelvis
During ___________, OP positions may rotate to OA, although this does not always occur and can slow progress in labor.
descent
Hyperflexion of the maternal hips towards the maternal abdomen flattens the lumbar spine and ventrally rotates the maternal pelvis and symphysis increasing the space of the posterior outlet and allowing for easier disimpaction of the anterior shoulder.
McRoberts manuever
Pressure applied just above the maternal pubic symphysis at an oblique angle to dislodge the anterior shoulder from behind the pubic symphysis
Suprapubic pressure
pressure on either accessible shoulder toward the anterior chest wall of the fetus to decrease the bisacromial diameter and free the impacted shoulder
Rubin manuever
pressure behind the posterior shoulder to rotate the infant and dislodge the anterior shoulder.
Wood corkscrew manuever
If these maneuvers fail, the ___________________, which involves placing the infant’s head back into the pelvis and performing cesarean delivery, can be attempted as well.
Zavanelli maneuver
Patients may feel a “popping” sensation or experience sudden abdominal pain.
Uterine rupture
The definitive diagnosis of _______ is the finding of fetal cells in the pulmonary vasculature at autopsy.
Acute Fluid Embolism
In pregnancy, ______________ is the antiseizure medication of choice.
magnesium sulfate
____________ decreases uterine tone and contractions by acting as a calcium antagonist and a membrane stabilizer.
Magnesium
____________ acts by increasing conversion of ATP to cAMP, which decreases free calcium ions through sequestration in the sarcoplasmic reticulum.
Terbutaline
__________________ decrease intracellular calcium, which reduces uterine contractility.
Calcium channel blockers
_______________ blocks the enzyme cyclooxygenase and decreases the level of prostaglandins, which decreases intracellular levels of calcium and therefore decreases myometrial contractions.
Indomethacin
Common side effects of Magnesium sulfate
- Flushing
- Diplopia
- Headache
Common side effects of Terbutaline
Headache
Tachycardia
Anxiety
Calcium channel blockers such as Nifedipine can cause:
Headache
Flushing
Dizziness
Indomethacin has been associated with:
Premature closure of the ductus arteriosus in the neonate
The goals of GBS prophylaxis are to have antibiotics in the mother _________ prior to ruptured membranes or delivery.
4 hours
Montevideo units are a measure of average uterine strength of contractions in millimeters of mercury multiplied by the number of contractions in 10 minutes, and _______________ Montevideo units define adequate labor in the active phase of labor.
200 to 250
This injury is due to traction on the anterior shoulder, because it is trapped behind the pubic symphysis.
Erbs palsy (brachial plexus injury)
Hypoxic brain injury occurs when a shoulder dystocia is prolonged. This risk increases after ____________ but is highly variable and depends on the reserve of the fetus prior to the shoulder dystocia. This is the rarest of complications from shoulder dystocia and the most severe apart from fetal demise.
3 minutes
The criteria recommended to offer a trial of breech labor include an:
- adequate pelvis as determined by pelvimetry and imaging (generally X-ray, CT, or MRI)
- frank or complete breech
- flexed fetal head, and
- estimated fetal weight of 2,500 to 3,800 g.
Almost all cases of eclampsia occur in the third trimester (91%), 7.5% of cases will occur in the second trimester, and approximately 1.5% cases in the first trimester. Eclampsia in the first trimester is often associated with a __________________.
molar or hydropic degeneration of the placenta
Fetuses whose estimated fetal weight (EFW) is less than the 10th percentile are termed ______________.
small for gestational age (SGA)
SGA fetuses are further described as either symmetric or asymmetric. Symmetric implies that the fetus is proportionally small. Asymmetric implies that certain organs of the fetus are disproportionately small. Classically, an asymmetric infant will have wasting of the torso and extremities while preserving the brain.
Fetuses whose EFW is greater than the 90th percentile are termed _______________.
large for gestational age (LGA)
Once the fetus is at or greater than _______ weeks’ gestational age, the uterine fundal height (in centimeters) should be approximately equal to the gestational age (in weeks).
20
If the fundal height varies by more than _______ from the gestational age, ultrasound is usually obtained.
3 cm
Fetal growth can be divided into two phases: prior to 20 weeks of gestation, growth is primarily ___________ (increasing number of cells), and after 20 weeks, it is primarily ________ (increasing cell size).
hyperplastic; hypertrophic
An insult occuring prior to 20 weeks will most likely result in ____________________.
Symmetric growth restriction
An insult occuring after 20 weeks in a prolonged fashion, will most likely result in _______________.
Asymmetric growth
______________ is presumably caused by decreased nutrition and oxygen being transmitted across the placenta, which is then shunted to the fetal brain.
Asymmetric growth
A birthweight greater than 4,500 g.
Macrosomia
The most classically associated risk factor for fetal macrosomia is preexisting or ________________.
gestational diabetes mellitus
Maternal obesity, with a BMI greater than _____ or weight greater than ____ kg, is also strongly associated with an increased risk for fetal macrosomia, as is increased maternal weight gain in pregnancy.
30; 90 kg
________________ is an independent risk factor for LGA infants.
Maternal obesity
The amniotic fluid reaches its maximum volume of about ______ at approximately _____ weeks. This volume is maintained until close to term when it begins to fall to about ______ at week _____.
800 mL; 28 weeks
500 mL; 40 week
An AFI of less than 5
Oligohydramnios
An AFI greater than 20 or 25
Polyhydramnios
____________________ can lead to oligohydramnios because the fetus likely does not have the nutrients or blood volume to maintain an adequate glomerular filtration rate.
Chronic uteroplacental insufficiency (UPI)
A standard dose of RhoGAM, _____ mg of Rh IgG, will eradicate ____ mL of fetal RBCs (30 mL of fetal blood with a hematocrit of 50%). This dose is adequate for a routine pregnancy.
0.3 mg; 15 mL
A retained IUFD greater than 3 to 4 weeks can lead to hypofibrinogenemia secondary to the ____________________ from the decomposing fetus.
release of thromboplastic substances
Early term
37 0/7 to 38 6/7
Full term
39 0/7 to 40 6/7
Late term
41 0/7 to 41 6/7
A postterm pregnancy is defined as one that goes beyond 42 weeks’ gestational age or greater than _____ days past the last menstrual period (LMP).
294
The average gestational age of delivery for twins is between _____ and _____ weeks.
36 and 37
The average gestational age of delivery for triplets is between ____ and _____ weeks.
33 and 34
The average gestational age of delivery for triplets is between ___ and ___ weeks.
33 and 34
The average gestational age of delivery for quadruplets it is between ____ and ____ weeks.
28 and 29
The ___________ hypothesis proposes that maternal hyperglycemia results in fetal hyperglycemia and hyperinsulinemia, which in turn results in excessive fetal growth.
Pedersen
All women with GDM should have a 2-hour glucose challenge test at or around their ____-week postpartum visit.
6
________________ twinning results from cleavage between 3 and 8 days and occurs after placental differentiation has occurred but prior to amnion formation. This leads to the formation of a single placenta but two amnions.
Monochorionic–diamniotic
_______________ twins result from cleavage of the fertilized ovum during the first 2 to 3 days. Cleavage at this stage occurs before cells are differentiated to form the trophoblast. As a result, two placentas (chorions) and two amnions develop.
Dichorionic–diamniotic
Embryo cleavage between days 8 and 13 again occurs after differentiation of the trophoblast but also after formation of the amnion. This results in a ________________ gestation.
monochorionic and monoamniotic
HELLP syndrome is more likely to be less than _____ weeks’ gestation at the time of presentation.
36
The diagnosis of GH is reserved for patients with elevated systolic BP of above _____ and/or diastolic BP above ____ mm Hg on _____ occasions at least ____ to _____ hours apart.
140
90
2
4 - 6 hours apart
Preeclampsia without severe features is classically defined as a third-trimester BP greater than or equal to 140 mm Hg systolic and/or 90 mm Hg diastolic on two occasions, at least 6 hours apart, accompanied by proteinuria greater than ____ mg/24 hours or a protein to creatinine ratio of greater than or equal to _____.
300 mg/24 hours
0.3
Criteria for preeclampsia with severe features include:
- BP greater than or equal to 160 mm Hg systolic and/or 110 mm Hg diastolic minutes apart
- proteinuria (24-hour urine protein greater than or equal to 300 mg or a protein to creatinine ratio greater than or equal to 0.3)
- BP greater than or equal to 140 mm Hg systolic and/or 90 mm Hg diastolic on two occasions
- thrombocytopenia (platelets less than ___________)
- Renal insufficiency (creatinine greater than ____ mg/dL or double baseline serum creatinine)
- Impaired liver function (liver transaminases twice normal)
- pulmonary edema
- cerebral or visual disturbances.
100,000 μL−1
>1.1 mg/dL
Patients diagnosed with preeclampsia with severe features should be delivered at ___________.
34 weeks
Seizures in the eclamptic patient are _________ in nature and may or may not be preceded by an aura. These seizures may develop before labor (59%), during labor (20%), or after delivery (21%). Most postpartum seizures occur within the first _____ hours after delivery, but will occasionally occur as late as several weeks after delivery.
tonic–clonic; 48 hours
*Fetal bradycardia can also occur during and after an eclamptic seizure.
In the case of MgSO4 overdose, _______________ or _______________ should be rapidly administered intravenously for cardiac protection.
10 mL 10% calcium chloride or calcium gluconate
Serum MgSO4 concentration:
Therapeutic seizure prophylaxis
4.8 - 8.4
Serum MgSO4 concentration:
CNS depression
8
Serum MgSO4 concentration:
Loss of deep tendon reflexes
10
Serum MgSO4 concentration:
Respiratory depression/paralysis
15
Serum MgSO4 concentration:
Coma
17
Serum MgSO4 concentration:
Cardiac arrest
20-25
________________ is defined as hypertension that is present before pregnancy, sustained hypertension before 20 weeks’ gestation, or hypertension persisting for more than 6 weeks postpartum.
chronic hypertension
It is thought that the pathophysiology of ______________ involves endothelial dysfunction, vasospasm, hemoconcentration, and capillary leakage, resulting in ischemia and hemorrhage of maternal organs such as a hepatic subscapular hematoma leading to RUQ pain.
preeclampsia
______________________ and other hormones produced by the placenta act as anti-insulin agents leading to increased insulin resistance and generalized carbohydrate intolerance.
human chorionic somatomammotropin (human placental lactogen)
The best time to screen for diabetes during pregnancy is at the end of the second trimester between ___________ of gestation in women with low risk for GDM.
24 and 28 weeks
The ADA diet plan of ___________ calories per day is recommended for all patients with diabetes during pregnancy.
2,200 calories
The recommended intake is approximately _________ g of carbohydrates per day.
200 to 220 g
During pregnancy, the smooth muscle relaxation effects of progesterone ___________ bladder tone and cause ureteral and renal pelvis dilation, as well as __________ ureteral peristalsis.
Decrease
- This results in urinary stasis throughout the urinary tract that can be seen radiologically as physiologic hydronephrosis of pregnancy.
____________ is inhibited during pregnancy, and this has a major role in responding to uropathogenic Escherichia coli.
TLR4 response
Because ASB has been shown to be higher in the _____________, commonly, a routine urine culture is used to screen for ASB between 12 and 16 weeks of gestation.
first trimester
Some authorities advise caution when using nitrofurantoin or trimethoprim/sulfamethoxazole in the third trimester because it may cause _____________ in fetuses/neonates with G6PD deficiency.
kernicterus
Women with positive GBS cultures are subsequently treated with ___________ at the time of labor or rupture of membranes (ROM).
IV penicillin G
_______ is an important risk factor for all types of urinary incontinence.
Age
*The prevalence of urinary incontinence INCREASES as women age.
In postmenopausal women, ______ estrogen levels may contribute to urinary incontinence.
low
________ has been shown to be a significant risk factor for urinary incontinence in multiple large-scale studies, with a greater impact on stress incontinence compared with urgency and mixed incontinence.
Obesity
__________ is a strong independent risk factor for urinary incontinence, particularly urgency incontinence.
Type 2 diabetes mellitus
