Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBGYN > Blueprints - 1 - Pregnancy And Prenatal Care > Flashcards

Blueprints - 1 - Pregnancy And Prenatal Care Flashcards

1
Q

How sensitive are OTC pregnancy tests?

A

Very! They will be positive around the time of the missed menstrual cycle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does a pregnant patient’s β-hCG peak, and how high does it get?

A

10 weeks gestational age

100,000 mIU/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where does β-hCG come from?

A

It is produced by the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Confirmation of a viable pregnancy - β-hCG

A

1,500 - 2,000 mIU/mL

Happens around 5 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Confirmation of a viable pregnancy - Ultrasound

A

Presence of a gestational sac as early as 5 weeks via transvaginal ultrasound.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When do you see fetal heart motion?

A

As early as 6 weeks

OR

A β-hCG of 5,000 - 6,000 mIU/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is it called an embryo?

A

From the time of fertilization until the pregnancy is 8 weeks along (10 weeks gestational age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is it called a fetus?

A

After 8 weeks of pregnancy, up until the time of birth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is it called an infant?

A

Until the first anniversary of the delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Definition - First Trimester

A

Pregnancy up to 12 weeks

Up to 14 weeks gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Definition - Second Trimester

A

From 12 - 14 to 24 - 28 weeks gestational age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Definition - Third Trimester

A

From 24 - 28 weeks until delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Definition - Previable

A

An infant delivered prior to 24 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Definition - Preterm

A

An infant delivered between 24 and 37 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Definition - Term

A

An infant delivered between 37 and 42 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Definition - Postterm

A

A pregnancy carried beyond 42 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gravidity

A

The number of times a woman has been pregnant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Parity

A

The number of pregnancies that led to a birth:

At or beyond 20 weeks GA

OR

Weighing more than 500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Nulli-
Primi-
Multi-

A

Nulli - 0
Primi - 1
Multi - >1

Remember the difference between parity and gravidity, though. A patient who is on her first ever pregnancy is primigravid and nulliparous.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Grand Multip

A

A patient whose parity ≥ 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Gestational Age

A

Number of weeks and days since the LMP.

Typically this is around 2 weeks greater than developmental age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Developmental Age

A

Number of weeks and days since fertilization.

This is also known as conceptional age or embryonic age.

Typically this is around 2 weeks less than gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is gestational age usually 2 weeks greater than developmental age?

A

Typically fertilization happens around 14 days after the LMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Nagele Rule

A

Estimated Date of Confinement (EDC) = Estimated Date of Delivery (EDD) = LMP - 3 months + 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Exact Dating

A

EDC = EDD = LMP + 280 days

OR

If date of ovulation known through Assisted Reproductive Technology (ART),

EDC = EDD = Date of ovulation + 266 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Signs of pregnancy

A

Chadwick Sign (Bluish discoloration of vagina and cervix)
Goodell Sign (Softenjng and cyanosis of the cervix at or after 4 weeks)
Ladin Sign (Softening of the uterus after 6 weeks)
Breast swelling and tenderness
Development of linea nigra (umbilicus to pubis)
Telangiectasias
Palmar erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Symptoms of pregnancy

A

Amenorrhea
Nausea and vomiting
Breast pain
Quickening - Fetal movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Chadwick Sign

A

Bluish discoloration of vagina and cervix

Indicates pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Goodell Sign

A

Softening and cyanosis of the cervix at or after 4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Ladin Sign

A

Softening of the uterus after 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How early can pregnancy signs and symptoms present?

A

A few days to a week after a missed period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Dating - How much should the ultrasound differ from LMP in each trimester?

A

First Trimester - Not more than 1 week
Second Trimester - Not more than 2 weeks
Third Trimester - Not more than 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Dating - How accurate is crown-rump length in the first half of the first trimester?

A

3 to 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Landmarks - Fetal Heart Auscultation

A

Nonelectronic Fetoscopy - 20 weeks

Doppler Ultrasound - 10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Landmarks - Quickening (Maternal awareness of fetal movement)

A

Between 16 and 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

As pregnancy progresses, what happens to the accuracy of ultrasound dating?

A

Decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Oligo-ovulatory

A

Patient ovulates beyond the usual 14th day of the cycle. 5 - 15% of women are oligo-ovulatory.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is a pitfall you can succumb to when treating an oligo-ovulatory patient?

A

Overdiagnosing prolonged pregnancy (≥ 41 weeks gestation

OR

Overdiagnosing postterm pregnancy (≥ 42 weeks gestation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How much is cardiac output increased in pregnancy?

A

30 - 50%

40
Q

At which point in pregnancy does the cardiac output increase the most?

A

First trimester. Maximum is reached between 20 and 24 weeks gestation, where it remains until delivery.

41
Q

Describe the means for increase in cardiac output during pregnancy

A

Stroke volume increases
Heart rate increases as stroke volume decreases.
By the end of the third trimester, stroke volume has decreased to near pre-pregnancy levels.

42
Q

What happens to systemic vascular resistance during pregnancy?

A

Decreases, leading to a drop in arterial BP

Likely due to elevated progesterone, which relaxes sloth muscle.

43
Q

By how much does blood pressure drop during pregnancy?

A

Systolic - 5 to 10 mmHg
Diastolic - 10 to 15 mmHg

This drop bottoms out at week 24. From that point, the blood pressure slowly creeps back up to pre-pregnancy levels. Should never exceed them, though.

44
Q

What happens to tidal volume during pregnancy?

A

Increases 30 - 40%

45
Q

What happens to total lung capacity during pregnancy?

A

Decreases 5% due to elevation of the diaphragm

46
Q

What happens to the expiratory reserve volume during pregnancy?

A

Decreases by about 20% due to the increase in tidal volume

47
Q

What happens to minute ventilation during pregnancy?

A

Increases 30 - 40% due to tidal volume increase.

This leads to an increase in PaO2 and a decrease in PaCO2.

48
Q

What happens to PaCO2 in pregnancy?

A

Decreases to ~30 mmHg (~40 mmHg is normal)

Likely caused by increased progesterone levels (this either increases responsiveness of respiratory system to CO2 or it acts as a primary stimulant, itself)

Leads to increased CO2 gradient between mother and fetus

49
Q

What dies the CO2 gradient between mother and fetus do?

A

Facilitates oxygen delivery and carbon dioxide removal to and from the fetus.

50
Q

Dyspnea of pregnancy

A

Occurs in 60 - 70% of patients

Possibly secondary to decreased PaCO2, increased tidal volume, or decreased total lung capacity.

51
Q

“Morning Sickness”

A

Nausea and vomiting occur in more than 70% of pregnancies and can happen at any point in the day.

Oft attributed to elevated estrogen, progesterone and hCG.

Also may be due to hypoglycemia (treat with frequent snacking)

52
Q

When should nausea and vomiting in pregnancy typically resolve?

A

14 to 16 weeks gestation

53
Q

Hyperemesis Gravidarium

A

Severe “morning sickness” associated with:

Weight loss (≥5% of pre-pregnancy weight)
Ketosis
54
Q

Pregnancy’s effects on stomach and esophagus

A

Gastric emptying time prolongs
Gastroesophageal sphincter tone decreases.

Leads to reflux
Possibly combines with decreased esophageal tone to cause ptyalism (hypersalivation/spitting)

55
Q

Pregnancy’s effects on the intestines

A

Large bowel has decreased motility.

This increases water absorption.

Leads to constipation.

56
Q

Pregnancy - Gross effect on kidneys

A

Kidneys increase in size and ureters dilate.

Increases rates of pyelonephritis.

57
Q

Pregnancy’s effect on GFR

A

Increases by 50% early on and is maintained until delivery.

58
Q

Pregnancy’s effect on BUN and Creatinine

A

Both decrease by 25%

59
Q

Pregnancy’s effect on the Renin-Angiotensin system.

A

Increased activity
Increased aldosterone levels
Increased sodium resorption

Plasma levels of sodium do not increase, though, due to the simultaneous increase in GFR.

60
Q

Pregnancy’s effect on plasma volume, RBC volume and hematocrit

A

Plasma volume increases by 50%
RBC volume increases by 20 - 30%
Hematocrit decreases (dilutional anemia)

61
Q

Pregnancy’s effect on WBC count

A

Increases to anywhere from 6 million to 16 million.
Mean level ~10.5 million/mL

During labor, this level may reach 20 million/mL due to stress.

62
Q

Pregnancy’s effect on platelets

A

Slightly decreased platelet count.

Probably secondary to increased plasma volume and increased peripheral destruction.

63
Q

A platelet count below 100 million/mL over a short time during pregnancy

A

Not normal. Investigate NOW.

64
Q

Coagulation status of pregnancy

A

Hypercoagulable state
Increased number of thromboembolic events

May be due to elevations in:
Fibrinogen
Factor VII
Factor VIII
Factor IX
Factor X

May also be due to other elements in the Virchow triad (increased venous stasis and vessel endothelial damage)

Clotting/bleeding times do not change.

65
Q

Pregnancy and estrogen

A

Hyperestrogenic

Increased estrogen primarily produced by the placenta
Ovaries contribute some, but less

66
Q

Normal estrogen production in the ovaries

A

Ovarian theca cells produce estrogen precursors.

Precursors are transferred over to ovarian granulosa cells.

67
Q

Estrogen production by the placenta

A

Plasma-borne precursors are produced by the maternal adrenal glands.
Placenta converts precursors to estrogen.

68
Q

Low estrogen levels - Effect on fetus

A

Fetal death

Anencephaly

69
Q

hCG - Structure

A

Two dissimilar subunits (alpha & beta)

70
Q

α-hCG

A

Identical to the α subunits of:
Luteinizing Hormone (LH)
Follicle-Stimulating Hormone (FSH)
Thyroid Stimulating Hormone (TSH)

71
Q

hCG levels in pregnancy

A

Double every 48 hours (early pregnancy)
Peaks at 10 - 12 weeks
Declines gradually
Reaches steady state after week 15

72
Q

hCG is made by

A

The placenta

73
Q

hCG’s function

A

To maintain the corpus luteum in early pregnancy

74
Q

Corpus Luteum’s function

A

Produces progesterone (to maintain the endometrium)

Once the placenta begins to produce progesterone instead, the corpus luteum degrades into the corpus albicans

75
Q

Progesterone level in pregnancy

A

Increases over the course of pregnancy

Causes smooth muscle relaxation (affects GI, cardiovascular and GU systems)

76
Q

hPL - Production and Function

A

Human Placental Lactogen
Aka
Human Chorionic Somatomammotropin (hCS)

Produced by the placenta

Helps ensure constant nutrient supply to fetus

77
Q

hPL - Mechanism

A

Insulin antagonist
(Diabetogenic effects)

Induces lipolysis
(Concomitant increase in circulating free fatty acids)

78
Q

Insulin level in pregnancy

A

Increased due to hPL’s insulin antagonist effects. Body is trying to compensate.

79
Q

Prolactin level in pregnancy

A

Markedly increased
Decreases after delivery
Later increases in response to suckling

80
Q

Pregnancy’s effect on thyroid hormones

A

Ultimately, pregnancy is a euthyroid state. Slight changes explained below.

Estrogen stimulates Thyroid Binding Globulin, leading to:

TBG increases
Total T3 and T4 increase
Free T3 and T4 remain constant

hCG weakly stimulates the thyroid, since α-hCG resembles the α-subunit of TSH:

T3 and T4 slightly increase
TSH slightly decreases

81
Q

Musculoskeletal changes in pregnancy

A

Center of gravity shifts.

Leads to postural changes and lower back strain, worsening particularly in the 3rd trimester.

Sometimes pregnancy is associated with self-limited bouts of carpal tunnel.

82
Q

Dermatologic changes during pregnancy

A

Increased Estrogen:
Spider angiomata
Palmar erythema

Increased melanocyte-stimulating hormones and steroid hormones:
Hyperpigmentation of nipples
Hyperpigmentation of umbilicus
Hyperpigmentation of abdominal midline (linea nigra)
Hyperpigmentation of perineum
Hyperpigmentation of the face (melasma or chloasma)

83
Q

When you’re pregnant, you’re eating for two, right?

A

No. You’re eating for 1.15.

Caloric requirement is increased by 300 kCal per day when pregnant, and 500 kCal per day when breastfeeding.

84
Q

Average caloric requirements of a non-pregnant woman

A

2,000 to 2,500 kCal per day

85
Q

Recommended weight gain during pregnancy

A

20 - 30 lbs

15 - 25 lbs (if overweight)

28 - 40 lbs (if underweight)

86
Q

Do most women gain the recommended amount of weight during pregnancy?

A

No. Most gain more. This leads to:

Complications in pregnancy
Postpartum weight retention
Downstream obesity

87
Q

Increased nutritional requirements in pregnancy (non-caloric)

A 
Protein
Iron
Folate
Calcium
Other vitamins/minerals
88
Q

Protein requirement in pregnancy

A

70 - 75g per day

Normally it is 60g

89
Q

Calcium requirement in pregnancy

A

1.5 g per day

90
Q

Why do many patients develop iron deficiency anemia in pregnancy?

A

Increased hematopoietic demands from both the mother and the fetus.

91
Q

Folate requirement in pregnancy

A

0.8 mg per day
(Normal is 0.4 mg)

Important for preventing neural tube defects

92
Q

What is recommended for a patient whose hematocrit falls during pregnancy?

A

Increase iron intake with oral supplements

93
Q

Initial Prenatal Visit - Overview

A

History
Physical Exam
Diagnostic Evaluation

94
Q

Initial Prenatal Visit - History

A

Include:

Present Pregnancy:
LMP
Symptoms during pregnancy

Obstetric History of Prior Pregnancies:
Date

Outcome - 
Spontaneous Abortion (SAB)
Therapeutic Abortion (TAB)
Ectopic Pregnancy
Term Delivery

Mode of Delivery
Length of Time in Labor and Second Stage
Birth Weight
Complications

Complete Medical History
Complete Surgical History
Complete Family History
Complete Social History

95
Q

Initial Prenatal Visit - Physical

A

Complete physical exam
Keep prior medical/surgical history in mind

Pelvic exam w/pap smear unless one was done in the past 6 months

Culture for gonorrhea and chlamydia

Bimanual exam - size of uterus should be consistent with Gestational Age from the LMP

Ultrasound for dating if the patient is unsure of LMP. Accurate dating is CRUCIAL.

96
Q

Initial Prenatal Visit - Diagnostic Evaluation

A 
CBC
Hematocrit
Blood Type
Ab Screen/RPR/VDRL for syphillis
Gonorrhea and Chlamydia Culture
Rubella Ab Screen
HBsAg
Urinalysis
Urine Culture
VZV titers (if no history of chicken pox)
PPD for TB in high risk patients
Urine pregnancy test (if patient is unsure)
Serum β-hCG (if bleeding or cramping)
Toxoplasma Titers
Offer HIV test
Early screening for aneuploidy:
NT (ultrasound)
Serum markers

OBGYN (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions