Blueprints 1 Flashcards
What is the urine pregnancy test specifically testing for?
Beta subunit of HCG
What is the normal peaking and decreasing pattern of beta HCG in a pregnant woman?
Peaks at 100k miliunits per ml at 10 weeks gestation
Decreasing throughout second trimester
Levels off at 20k to 30k in third trimester
A viable pregnancy can be confirmed by transvaginal US as early as when? What does this mean?
A viable pregnancy can be confirmed by what level of BHCG?
5 weeks on transvaginal US
Viable IUP showing gestational sac
1500 to 2000
Fetal heart motion can be seen on transvaginal US as early as when?
Fetal heart motion can be seen at what level of HCG?
6 weeks
5k to 6k
What range do we call a baby embryo? Fetus? Infant?
What range is first trimester? Second trimester? Third trimester?
0-8 weeks
8 weeks to birth
Birth to 1 year
0-12-14, 12-14 to 24-28, 24-28-delivery
What are the ranges of Previable, preterm, term, and posterm babies?
Delivered prior to 24
24-37
37-42
Beyond 42
What does gravidity and parity refer to?
Number of times a lady has been pregnant
Number of pregnancies at or beyond 20 weeks or over 500 g
What does nulli, primi and multi refer to?
O pregnancies, 1 pregnancy, more than 1
What is the difference between gestational age and developmental age?
Gestational age is measured from first day of last menstrual period
Development age is measured from fertilization which is 14 days after
How do we use the Naegele’s rule to estimate due date?
A typical pregnancy lasts how many days or weeks?
- Determine first day of last menstrual period
- Subtract 3 calendar months from that date
- Add 1 year and 7 days
280 days or 40 weeks
Auscultation of fetal heart at what week?
Heart sound by Doppler at what week?
Mom awareness of baby movement at what week?
20
10
16-20
A safe rule of thumb is that the US should not differ from LMP dating for sure date by more than how much in each trimester?
Trimester 1, 1 week
Trimester 2, 2 weeks
Trimester 3, 3 weeks
What is the possible issue for a lady with oligo-ovulatory?
These ladies ovulate past the 14 day mark so we would estimate their due date further out, resulting in thinking we might have a postterm baby at the end.
How much does cardiac output increase in a pregnant lady and when does it peak?
The increase in cardiac output is first due to what and then maintained by what?
Systemic vascular resistance does what in a pregnant lady and what is the mechanism?
30-50%, 20-24 weeks
SV first, and then maintained by HR as SV drops to normal levels by 3rd trimester
Decreases which leads to BP dropping due to progesterone causing smooth muscle relaxation.
What does tidal volume and total lung capacity do during pregnancy and why the total lung capacity change?
What happens to PaCO2 during pregnancy and why is it significant?
Why does PaO2 go up?
Tidal volume goes up, TLC goes down because the diaphragm is elevated.
Drops. This is important because it increases the gradient between mom and baby allowing for increased o2 to baby and co2 to mom from baby.
Increased tidal volume with constant RR, increases minute ventilation.
What is likely the cause of morning sickness?
How do we define hyperemesis gravidarum?
Elevation in estrogen, progesterone and bHCG
Severe morning sickness with weight loss and ketosis
What happens to GFR during pregnancy and what happens to renin system and what does that mean?
GFR increases by 50% and the renin system increases as well which means more salt and water reabsorbed. However, the plasma level doesn’t change because GFR is so high.
How much does blood volume increase during pregnancy, but what does that mean for RBC?
What factors increase which contribute to pregnancy being a hypercoagulable state?
What is Virchows triad?
50%, however RBC mass not that much so there is dilution all anemia
Fibrinogen, factors 7-10
Hypercoagulable, venous stasis and endo damage
the alpha subunit of HCG is identical to the alpha subunit of what 3 things?
LH, FSH and TSH
Caloric requirement increases to what during pregnancy and breastfeeding?
300kcal/day
500kcal/day
What is the protein, calcium and folate requirements during pregnancy?
75 grams
1.5g
.8mg
4 symptoms of pregnancy?
Amenorrhea
Nausea
Breast pain
Fetal movement
What is chadwick, goodell and Ladin signs of pregnancy?
Blue discoloration of cervix
Softening of cervix at 4 weeks
Softening of uterus after 6 weeks
When do we normally check alpha fetoprotein for neural therapy defects?
What do high levels of it and low levels of it suggest?
15-18 weeks
High: neural tube defects, multiple pregnancies and wrong date
Low: Down syndrome
Low levels of estrogen suggest what?
Down syndrome, wrong dates
High levels of HCG suggest?
Down syndrome, wrong date, multiple gestations
When do we do the glucose loading test and what is it?
28 weeks
Drink 50 g glucose and check glucose level 1 hour later. If its 140 or higher, need to do glucose tolerance test.
Explain the glucose tolerance test?
Check a fasting glucose. Then have them drink 100 g of glucose. Check levels at 1,2 and 3 hours after drinking.
Need 2 or more to say gestational diabetes.
Fasting over 95
1 hour 180, 2 hour 155 and 3 hour 140.
In high risk populations, when do we check for chlamydia and gon infections?
How do we treat latent herpes simplex virus?
Active HSV is an indication for what?
When do we screen for group b strep and how to treat?
Third trimester
Antiviral prophylaxis at 36 weeks
C section
36 weeks, IV penicillin at labor to protect baby
Where do we find hyperpigmentation in the pregnant lady and what is it called in specific places?
Nippled, umbilicus, abdominal midline (linea nigra), perineum, and face (melasma)
What is responsible for constipation in pregnancy?
Elevated progesterone
What are the 5 categories of the biophysical profile? What is a good score?
Amniotic fluid, fetal tone, fetal activity, fetal breathing, non stress test.
8-10
What is considered a reactive non stress test?
2 accelerations in 20 minutes, 15 beats above baselines for 15 seconds
What is a good oxytocin challenge test?
3 contractions over 10 minutes with same criteria. 2 accelerations, 15 above baseline for 15 seconds each.
What is a good predictor of fetal lung maturity?
Lethicin to sphingomyelin ratio. Should increase as pregnancy progresses because L goes up and S goes down.
What is the G TPAL designation?
Number of pregnancies Term babies Pre term Abortions Living children
Where is most of the estrogen produced during pregnancy?
How is it produced?
What produces HCG and what does HCG maintain?
Big cause of progesterone?
What two changes occur with the thyroid?
Placenta, a little by ovaries
Precursors produced by maternal adrenal glands
Placenta to maintain corpus luteum, which produces pro to maintain progesterone.
Smooth muscle relaxation
Estrogen increases TBG which increases total t3 and t4, but free is constant
HCG stimulates thyroid because of its similar structure to TSH, so t3 and t4 a little up and TSH a little down, but euthyroid
What is nuchal translucency?
Collection of fluid under the skin behind the neck
First trimester screening for aneuploidy?
NT and serum markers, PAPPA, and beta HCG
Two second trimester tests for prenatal care?
US and triple or quad screen
4 common third trimester screenings?
Hematocrit, syphilis, GLT, and group b strep
What is the specific test to do if mom has SLE? What screening to do if mom is PPD+? Mom has thyroid disease? Graves? Diabetes? African American?
Anti rho or anti la, can cause fetal heart block Chest x ray after 16 weeks TSH, free t4 TSI A1c Sickle cell.
Why constipation during pregnancy?
Elevated progesterone increases transit time and more water is absorbed
Why edema in pregnancy?
Compression of IVC and pelvic veins increases hydrostatic pressure.
Why GERD?
How to treat?
Lower esophageal sphincter relaxation and increased transit time in stomach.
Antacids and small meals, don’t lay down after meal
Origin and insertion of round ligament?
Uterine horns, through the deep inguinal rings, down the inguinal canal and onto labia majora
What are some of the causes of increased urinary frequency?
Vascular volume is up, GFR is up, compression of bladder or growing uterus, and UTIs
Two ways we can screen for fetal karyotype and genetics?
Amniocentesis
Chorionic villus sampling
The non stress test is a test of what?
FHR
What is PUBS and why would we do it?
Percutaneous umbillical blood sampling
Nee to know baby’s hematocrit, RH, anemia or hydrops
