COPR AREA 6 Flashcards
(6.1.q) Describe the roles of follicle stimualting hormone (FSH), luteinizing hormone (LH), and progesterone in ovulation and menstruation
- FSH stimulates up to 20 follicles to induce maturation of an oocyte into an ovum per cycle, although only one usually fully matures and is released (the other die via atresia).
- LH triggers ovulation, wherein a mature ovum is released. The remaining follicular cells form the corpus luteum, which releases…
- Progesterone triggers the secretory phase of the menstrual cycle, leading to maturation of the endometrium
(6.1.q) List up to 6 functions of the placenta during fetal development
- Respiratory Gas Exchange
- Transport of Nutrients
- Excretion of Wastes
- Transfer of Heat
- Hormone Production (HcG)
- Formation of a Barrier (between maternal and fetal circulation)
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(6.1.q) At what gestational age is a pregnancy considered “full-term”
37-42 weeks
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(6.1.q) Which maternal organ undergoes the greatest physiologic change during pregnancy?
The uterus
(goes from 2g and 10mL fluid capacity to 1kg and 5L fluid capacity!)
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(6.1.q) How can one approximate the appropriate height of the fundus based on gestational age, and what would a low-lying fundus indicate?
the top of the fundus should sit the same number of cms above the symphysis pubis as the gestational age (i.e. 32wks = 32cm above the pubis). A low fundus could indicate developmental complications or breech positioning.
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(6.1.q) Defien the terms “gravid” and “para”
- gravid refers to the total number of pregnancies, of any duration
- para refers to pregnancies carried to 28 or more weeks gestation (regardless of whether there was a live delivery)
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(6.1.q) What is considered typical blood loss during vaginal delivery?
up to 500mL
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(6.1.q) Describe hematologic and cardiovascular changes during pregnancy
- Blood volume and cardiac output increase by 40-50%
- Increase in WBC and RBC count (hence the higher risk for anemia during pregnancy)
- HR increases by 15-20bpm
- Orthostatic effects on hemodynamics become more pronounced
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(6.1.q) Should pregnant patients be intubated with larger, small, or the same size endotracheal tubes as non-pregnant patients?
Smaller!
Pregnancy causes edema in the respiratory and oral vasculature.
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(6.1.q) A 36YO pregnant patient at 26wks gestation presents with polydypsia, polyuria, and polyphagia. You should be immediately concerned for:
GDM (Gestational diabetes Mellitus)
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(6.1.q) Blood pressure usually (increases/decreases) during pregnancy
Decreases! (especially diastolic)
Blood volume increases, but not pressure during healthy pregnancies
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(6.1.q) What are risk factors for preeclampsia
- Maternal Age: either less than 20yrs or advance maternal age
- Multiple pregnancies
- Pre-existing HTN, renal disease, and diabetes
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(6.1.q) What is the classic triad of findings in preeclampsia? (not including hypertension)
- edema
- gradual onset of HTN
- proteinuria
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(6.1.q) Describe the pathophysiology of Rh desus of the fetus
- Occurs when Rh-negative mother is pregnant with Rh-positive (inherited from father) fetus
- RBCs from fetus may stimulate maternal production of anti-Rh antibodies, which go on to attack the fetal RBCs
- Normally only a problem in subsequent pregnancies, not first ones (mother not yet sensitized)
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(6.1.q) What is the preferred agent for treatment of maternal seizures?
Magnesium sulfate (bencodiazepines cross the placental barrier and may cause fetal harm)
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(6.1.q) A pregnant patient presents with RUQ pain, severe itching of hands and feet, dark urine, and light-colored stools. What is the most likely diagnosis?
Cholestasis
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(6.1.q) Third-trimester bleeding should (never/sometimes/always) be seen as a dire medical emergency
ALWAYS
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(6.1.q) What are the three most common causes of third-trimester bleeding?
- abruptio placentae
- placenta previa (most common)
- uterine rupture
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(6.1.q) Define the gestational age ranges for each of the three trimesters
- First trimester: 1-13 wks
- Second Trimester: 14-27 wks
- Third Trimester: 28-40 wks
(6.1.q) What are common causes of placental abruption?
- Hypertension (most common)
- Trauma
- Infection
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(6.1.q) What are classic signs/symptoms of placental abruption?
- Sudden-onset severe abdominal pain
- Signs of shock (often out of proportion to blood loss)
- Vaginal bleeding may or may not be present
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(6.1.q) What is the classic presentation of placenta previa?
Painless third-trimester bleeding. Blood is usually bright red. Increased risk with increasing maternal and gestational age. (relatively low risk to mother and fetus if found early)
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(6.1.q) Describe the classic presentation of uterine rupture
- Always occurs during labour
- Intially very strong and painful contractions followed by sudden cessation of contractions, with or without bleeding
- Signs of shock
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(6.1.q) Describe the management of third-trimester bleeding (beyond standard management of hemmhorage or shock)
- Place patient in left-lateral decubitus position
- Use loosely-placed trauma pads over the vagina to attempt to stop blood flow (do NOT pack the vagina)
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(6.1.q) Define hyperemesis gravidarum and describe routine prehospital treatment
- severe nausea/vomiting during pregnancy which continues beyond the first several weeks of pregnancy.
- May lead to severe dehydration
- Routine management involves transport, fluid replacement, and dimenhydrinate
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(6.1.q) Describe the classic presentation of ectopic pregnancy
- severe abdominal pain and signs of shock in a woman of reproductive age
- Pt. may or may not be aware of pregnancy
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(6.1.q) Distinguish between primigravida, primipara (primip), multigravida, multipara (multip), grand multipara, and nullipara
- primigravida: pregnant for first time
- primipara (primip): has delivered only one baby
- multigravida: has had 2+ pregnancies
- multipara (multip): has delivered 2+ babies
- grand multipara: has delivered 5+ babies
- nullipara: has never delivered a baby (a mother who is pregnant for the first time is primigravid and nulliparous)
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