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OB > Diagnosis of Pregnancy/Prenatal Care & Nutrition > Flashcards

Diagnosis of Pregnancy/Prenatal Care & Nutrition Flashcards

1
Q

Diagnosis of Pregnancy is divided into 3 evidences:

A
  1. Presumptive Evidence of Pregnancy
  2. Probable Evidence of Pregnancy
  3. Positive Signs of Pregnancy
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2
Q

PRESUMPTIVE EVIDENCE OF PREGNANCY (SYMPTOMS)

A
  1. Nausea with or without vomiting
  2. Disturbances in urination
  3. Fatigue
  4. Perception of fetal movement
  5. Breast symptoms
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3
Q

Peculiar distaste for food, food idiosyncrasies, and other digestive tract disturbances during ________ of pregnancy.

A

first 2-3 months of pregnancy

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4
Q

Sometimes the food that she likes when she was still not pregnant, doesn’t like it anymore when in pregnancy period.

A

Peculiar distaste for food

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5
Q

She looks for foods like fruits that is not in season.

A

Food idiosyncrasies

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6
Q

→ Usually vomits every morning.

o Other patients also vomit in the afternoon and in evening.

A

Morning sickness

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7
Q

Extreme cases of nausea with or without vomiting are associated with _________.

A

hyperplacentosis as in multiple and molar pregnancies

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8
Q

It is when the nausea and vomiting is really extensive or extreme

A

Hyperemesis gravidarum

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9
Q

Hyperemesis gravidarum usually appears at _______ AOG, reaches its peak at about ________ and disappears thereafter.

A

6 weeks AOG, reaches its peak at about 60-70 days and disappears thereafter

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10
Q

Management for nausea & vomiting

A
  1. Frequent small feedings
  2. Avoidance of fatty foods
  3. Light, dry, low fat diet
  4. Ice chips
  5. Emotional support from husband and family
  6. Hydration and correction of fluids and electrolytes
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11
Q

DISTURBANCES IN URINATION is caused by?

A

Caused by direct pressure of the enlarging uterus to the urinary bladder resulting in irritability, dribbling, frequency and UTI.

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12
Q

Most of these patients are prone to develop UTI because of the shift of vaginal pH from _____ to _______.

A

from acidic to basic

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13
Q

FATIGUE is attributed to?

A

Attributed to the increased metabolism during pregnancy

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14
Q

Brisk movement in the patient’s abdomen

A

Quickening

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15
Q

PERCEPTION OF FETAL MOVEMENT is just a presumptive symptoms of pregnancy because?

A

not all patient will experience this type of fetal movement

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16
Q

Quickening occurs at around?

A

Around 18th-20th week (Primigravida); 14th-16th weeks (Multigravida)

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17
Q

May be mistaken for peristalsis or spasm of the GIT.

A

Quickening

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18
Q

Breast tenderness

A

Mastodynia

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19
Q

Mastodynia occurs during?

A

during the first few weeks of gestation

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20
Q

Mastodynia is brought about by the effects of what hormone/s?

A

Brought about by the effects of ESTROGEN which stimulate the mammary duct system; and by PROGESTERONE which stimulate the alveolar components.

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21
Q

Mastodynia is also a presumptive symptoms of pregnancy because during the time that patients who are going to menstruate, they also develop breast tenderness because of the increased in the level of _______ just before you menstruate.

A

progesterone

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22
Q

PRESUMPTIVE EVIDENCE OF PREGNANCY (SIGNS)

A
  1. Cessation of menstruation
  2. Anatomical breast changes
  3. Changes in the vaginal mucosa
  4. Skin pigmentation changes
  5. Thermal signs
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23
Q

One of the earliest sign of pregnancy.

A

CESSATION OF MENSTRUATION

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24
Q

Delay of menstruation is usually _______.

A

10 days or more

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25
Q

Cessation of menstruation is not a reliable indicator as delays may be caused by several emotional factors like:

A
  1. Emotional Stress
  2. Irregular menstrual cycle
  3. Chronic disease
  4. Drugs/Medication
  5. Endocrine disorders
  6. Lactation
  7. Certain genitourinary tumors
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26
Q

This is the bleeding on the first 4 weeks after you have a positive serum pregnancy test.

A

Implantation bleeding

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27
Q

In cases wherein you are about to menstruate or during the early part of pregnancy there will be breast engorgement because of the increased level of?

A

estrogen

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28
Q

Anatomical breast changes happens when?

A

Happens about 6-8 weeks after conception

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29
Q

Colostrum can be expressed as early as ______ AOG.

A

16 weeks

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30
Q

The vaginal mucosa becomes congested and violaceous, bluish and purplish in color.

A

Chadwick’s sign

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31
Q

Chadwick’s sign appears at?

A

at about 6 weeks AOG

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32
Q

Refers to darkening of the skin over the forehead, bridge of the nose and cheekbones.

A

CHLOASMA or mask of pregnancy

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33
Q

Refers to darkening of the linea alba secondary to stimulation of the melanophores by the melanocyte stimulating hormone.

A

LINEA NIGRA

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34
Q

LINEA NIGRA includes the darkening of what body parts?

A
  1. nipple
  2. areola
  3. lower midline of the abdomen
  4. axilla
  5. neck
  6. groin
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35
Q

These are caused by the separation of the underlying collagen tissue and appear as dark, irregular scars in the abdomen.

A

STRIAE GRAVIDARUM or stretch marks

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36
Q

When the patient had already delivered, the stretch marks will appear as a silvery scars and they also become discolored after ______ weeks of puerperium period.

A

4-6 weeks

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37
Q

Are vascular, stellate marks which result from high levels of circulating estrogen and which blanch when compressed;

A

SPIDER TELANGIECTASIA

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38
Q

Associated sign together with spider telangiectasia

A

palmar erythema

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39
Q

Thermal signs are perceptible elevation of temperature longer than?

A

3 weeks

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40
Q

Thermal signs are attributed to the thermogenic effect of?

A

progesterone

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41
Q

PROBABLE EVIDENCE OF PREGNANCY

A
  1. Enlargement of the abdomen
  2. Changes in the size, shape, consistency of the uterus
  3. Anatomical changes in the cervix
  4. Braxton-Hicks contractions
  5. Ballottement
  6. Physical outlining of the fetus
  7. Positive results of endocrine tests
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42
Q

ABDOMINAL ENLARGEMENT is observed at?

A

Observed from 6 weeks onwards to near term.

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43
Q

At 12th week, the fundus is at the level of?

A

symphysis pubis

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44
Q

Rapid fetal growth as the uterus rises out of the pelvis and into the abdomen.

A

16-22 weeks

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45
Q

AOG equals the fundic height

A

16-32 weeks

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46
Q

Is the softening of the uterine isthmus which is often observed by 6-8 weeks AOG.

A

HEGAR’S SIGN

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47
Q

Refers to cyanosis and softening of the cervix due to increased vascularity of the cervical tissue which occurs as early as 4 weeks.

A

GOODELL’S SIGN

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48
Q

Softening of the cervix occurs at?

A

6-8 weeks

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49
Q

Cervical mucus during pregnancy has a characteristic BEADED cellular pattern which characterizes the ________ effect on normal cervical mucus;

A

PROGESTATIONAL

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50
Q

FERNING pattern is _______ predominance seen on the first half of the cycle.

A

ESTROGEN

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51
Q

Evidence of ovulation period.

A

Ferning Pattern

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52
Q

Are painless irregular contractions which may be both palpable and visible as pregnancy progresses.

A

BRAXTON HICKS CONTRACTIONS

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53
Q

These contractions can be secondary to the contraction brought about by fetal movement or can be secondary to the hyperirritability of gastrointestinal tract.

A

BRAXTON HICKS CONTRACTIONS

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54
Q

BRAXTON HICKS CONTRACTIONS can be perceived when?

A

Can be perceived from 28 weeks onwards.

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55
Q

Bouncing back of the presenting part on the examining finger

A

BALLOTTEMENT

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56
Q

When doing the Leopold’s maneuver, the baby usually moves inside the uterus causing the examining finger to bounce back.

A

BALLOTTEMENT

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57
Q

OUTLINING OF THE FETUS dfferential diagnosis:

A

Myomas or ovarian new growths

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58
Q

hCG can be detected in the serum or urine as early as ______ days after ovulation.

A

8-9 days

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59
Q

POSITIVE SIGNS OF PREGNANCY

A
  1. Identification of fetal heart action separately and distinctly from the mother.
  2. Perception of active fetal movement by the examiner.
  3. Recognition of the embryo or fetus by ultrasound or by radiological methods.
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60
Q

Fetal heart tone (FHT) is faster than the mother’s heart beat ranging from _____ bpm

A

120-160 bpm

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61
Q

When can the FHT be heard through the stethoscope?

A

18th week

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62
Q

Fetal echocardiography and ultrasound can demonstrate FHT at?

A

10th-12th week

6-8 weeks

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63
Q

Maternal conditions that increase fetal heart tones more than 1 per minute.

A
  1. Fever
  2. drugs (tocolytic)
  3. thyrotoxicosis
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64
Q

soft blowing sound heard in Doppler

A

Funic soufflé or umbilical cord soufflé

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65
Q

Soft blowing sound under Doppler or the stethoscope and sometimes synchronous with maternal pulse,

A

Uterine soufflé

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66
Q

Uterine soufflé is heard when?

A

Usually heard in second trimester

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67
Q

Can be appreciated when examining the patient on same side

A

Maternal pulse

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68
Q

Other sounds that can be heard thru the abdominal wall other than the FHT:

A
  1. Funic soufflé or umbilical cord soufflé
  2. Uterine soufflé
  3. Sound from movement of fetus
  4. Maternal pulse
  5. Gurgling gas in mother’s GIT
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69
Q

PERCEPTION OF FETAL MOVEMENT BY THE EXAMINER is usually perceived when?

A

Usually perceived by the 20th week

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70
Q

RECOGNITION OF FETUS OR EMBRYO BY ULTRASOUND is appreciated when?

A

6-12 weeks

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71
Q

the crown rump length (CRL) measurement is predictive of gestational age at?

A

6-12 weeks

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72
Q

At 6-12 weeks, the crown rump length (CRL) measurement is predictive of gestational age and is accurate within?

A

4 days

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73
Q

Other information verified by the ultrasound:

A
  1. Presence of blighted ovum
  2. Number of fetuses
  3. Ectopic gestation
  4. Presenting part
  5. Fetal anomalies
  6. Hydramnios
  7. Detection of IUGR
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74
Q

As early as _______ weeks, most of these babies are in breech presentation and then the sonologist will tell you or recommend that we have to do a repeat ultrasound near term so that we will know what really is the cephalic or not.

A

20-28th weeks

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75
Q

You have to request an ultrasound for congenital screening as early as _____ weeks. That is the best time to request for a congenital anomaly screening especially if the patient is exposed to chemicals or underwent X-ray and if the mother is already in the elderly age.

A

18-22 weeks

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76
Q

The amount of fluid inside the uterine cavity

A

Hydramnios

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77
Q

Imaginary or spurious pregnancy

A

PSEUDOCYESIS

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78
Q

Used as confirmatory for pseudocyesis.

A

Pelvic ultrasound is used for confirmatory.

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79
Q

IDENTIFICATION OF FETAL LIFE OR DEATH is confirmed by?

A

ultrasound

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80
Q

Signs and symptoms of Fetal Death

A
  1. Uterine size has remained the same or has decreased
  2. Cessation of fetal movement
  3. Hyperemesis is not there anymore
  4. Normal blood pressure in hypertensives
  5. Loss of breast engorgement
  6. Decrease in maternal weight
  7. Soft collapsible skull felt on IE
  8. Absent FHT by Doppler or stethoscope
  9. Tobacco-stained amniotic fluid
81
Q

RADIOGRAPHIC EVIDENCE TO ESTABLISH THE DIAGBNOSIS OF FDU (FETAL DEATH-IN-UTERO)

A
  1. SPALDING’S SIGN
  2. Exaggeration of fetal spine curvature.
  3. ROBERT’S SIGN
82
Q

Significant overlapping of the skull bones

A

SPALDING’S SIGN

83
Q

Demonstration of gas bubbles in the fetus.

A

ROBERT’S SIGN

84
Q

Is a planned program of medical evaluation and management, observation and education of the pregnant women directed toward making pregnancy, labor, delivery, and the postpartum recovery a safe and satisfying experience.

A

PRENATAL CARE

85
Q

is a woman who has been delivered only once of a fetus or fetuses which reached viability.

A

PRIMIPARA

86
Q

is a woman who has completed 2 or more pregnancies to viability.

A

MULTIPARA

87
Q

is a woman who is not now and never has been pregnant.

A

NULLIGRAVIDA

88
Q

is a woman who is or has been pregnant irrespective of the pregnancy outcome.

A

GRAVIDA

89
Q

pertains to pregnancy

A

GRAVIDA

90
Q

means that the patient has already delivered.

A

PARA

91
Q

woman of her first pregnancy.

A

PRIMIGRAVIDA

92
Q

multiple pregnancies.

A

MULTIGRAVIDA

93
Q

is a woman who has never completed a pregnancy beyond the stage of viability or beyond and abortion.

A

NULLIPARA

94
Q

is a woman in labor.

A

PATURIENT

95
Q

is a woman who had just given birth.

A

PUERPERA

96
Q

period within 6 weeks after delivery

A

PUERPERIUM

97
Q

G

A

number of pregnancies

Even if the pregnancy has not reached viability, as long as the pregnancy test is positive it is already to be counted.

98
Q

P

A

number of deliveries

99
Q

1st 0

A

number of full-term deliveries

100
Q

2nd 0

A

number of preterm deliveries

101
Q

3rd 0

A

number of abortions or miscarriages including H-mole and ectopic pregnancies

102
Q

4th 0

A

number of living children

103
Q

currently pregnant woman

A

G1P0 (0000)

104
Q

woman who delivered with her 1 child in full term

A

G1P1 (1001)

105
Q

woman who delivered preterm

A

G1P1 (0101)

106
Q

woman who had an abortion/1st miscarriage

A

G1P0 (0010)

107
Q

the child died at full term

A

G1P1 (1000)

108
Q

twin pregnancy at full term

A

G1P1 (2002)

109
Q

twin pregnancy that is preterm

A

G1P1 (0202)

110
Q

twin pregnancy and end up in abortion

A

G1P0 (0020)

111
Q

ectopic/miscarriage/abortion

A

G1P0 (0010)

112
Q

Is a method of estimating the date of confinement

A

NAEGELE’S RULE

113
Q

NAEGELE’S RULE formula

A

From the 1st day of the last menstrual period, add 7 days, then subtract 3 months and add 1 year.

(-3/ +7/ +1)

114
Q

TIMING FROM OVULATION

A

Add 267 days from the woman’s date of last ovulation. This is only true for women with 28-day cycle.

115
Q

maternal perception of fetal movement is perceived initially at _____ weeks in multigravidas and ________ weeks in primigravidas.

A

16-18 weeks in multigravidas and 18-20 weeks in primigravidas.

116
Q

12 weeks

A

at level of symphysis pubis

117
Q

16 weeks

A

halfway between umbilicus and symphysis pubis

118
Q

20 weeks

A

at level of umbilicus

119
Q

36 weeks

A

is below the ensiform cartilage

120
Q

Transvaginal ultrasound can detect a pregnancy at 4-5 weeks’ gestation corresponding to the serum B-hCG concentration of _______ miu/ml.

A

1500-2000miu/ml.

121
Q

Transvaginal ultrasound is used during early pregnancy because?

A

Transvaginal ultrasound is used during early pregnancy because the transducer of the ultrasound has direct contact with the cervix giving accurate crown rump length and AOG.

122
Q

1 trimester is equal to how many weeks?

A

13 weeks

123
Q

What age of patients are labeled as highly threatened/high risk?

A

<20 and >40 years old

124
Q

Leopold’s maneuver is best done when?

A

on the 20th week age of gestation. Earlier than that, you cannot appreciate Leopold’s maneuver.

125
Q

2 gloved and lubricated fingers are inserted into the vagina while the other hand gently compresses the lower abdomen to check the size, shape and position of the uterus.

A

Bimanual examination

126
Q

ROUTINE ANTEPARTAL TESTS

A
  1. CBC, blood typing, Rh typing
  2. Urinalysis, urine culture and sensitivity
  3. Serologic test for syphilis (RPR, VDRL)
  4. Hepatitis B surface antigen
  5. Rubella titer
  6. Cervical cytology (Pap smear)
127
Q

PRENATAL INTRUCTIONS

A
  1. Inform the patient of any problems and discuss management.
  2. Antepartum education program.
  3. Explain future visits
  4. Discuss the economic aspect of pregnancy
  5. Give instruction about diet, relaxation and sleep, bowel habits, exercise, bathing, taking recreation, sexual intercourse, smoking, drug and alcohol ingestion.
  6. Emphasize danger signals such as vaginal bleeding, persistent vomiting, chills and fever, sudden escape of fluid from vagina, abdominal pain, swelling of face, blurring of vision, and continuous headache.
128
Q

FREQUENCY OF VISITS:

0-28 weeks

A

every 4 weeks

129
Q

FREQUENCY OF VISITS:

28-36 weeks

A

every 2 weeks

130
Q

FREQUENCY OF VISITS:

36-40 weeks

A

every week

131
Q

internal exam, check if cervix is dilated

A

38 weeks

132
Q

request for RT-PCR testing if mother will deliver in the hospital, because they can get it for free in any molecular laboratories in Iloilo as long as they have a PhilHealth.

A

37 weeks

133
Q

WHO recommendation # of visits

A

4 visits or more

134
Q

maternal serum alpha feto-protein screening

A

15-20 weeks

135
Q

gestational diabetes screening

A

24-28 weeks

136
Q

test D-negative women for antibodies

A

28 weeks

137
Q

In L1, L2, and L3 – you are facing the mother ______.

A

cephalad

138
Q

FUNDAL GRIP

A

L1

139
Q

While facing the woman, palpate the woman’s upper abdomen with both hands.

A

L1

140
Q

To know what part of baby occupies the fundus

A

L1

141
Q

The fetal _____ is hard, round, and moves independently of the trunk

A

head

142
Q

_______ feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk.

A

buttocks

143
Q

UMBILICAL GRIP

A

L2

144
Q

Both the examiner’s hand is on the side

A

L2

145
Q

To determine the location of the fetal back

A

L2

146
Q

While facing the patient, the examiner palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman’s uterus. This is then repeated using the opposite side and hands.

A

L2

147
Q

The fetal ______ will feel firm and smooth while fetal extremities should feel like small irregularities and protrusions or nodulations.

A

back

148
Q

PAWLICK’S GRIP

A

L3

149
Q

To determine what fetal part is lying above the inlet, or lower abdomen.

A

L3

150
Q

To know if the presenting part is engaged or still floating.

A

L3

151
Q

Grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand.

A

L3

152
Q

PELVIC GRIP

A

L4

153
Q

To locate the fetus’ brow

A

L4

154
Q

The fingers of both hands are moved gently down the sides of the uterus toward the pubis.

A

L4

155
Q

The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the ______ is located.

A

brow

156
Q

If the fetal head is extended though, the _____ is instead felt and is located on the same side of the back.

A

occiput

157
Q

MATERNAL EVALUATION

A
  1. Blood pressure, actual and extent of change.
  2. Weight, actual and amount of change.
  3. Symptoms: headache, nausea, vomiting, bleeding, dysuria, bleeding from vagina.
  4. Fundic height
  5. Leopold’s maneuver
  6. Vaginal examination at first visit and at term
158
Q

FETAL EVALUATION

A
  1. Fetal heart rate
  2. Size of fetus, actual and rate of change (through fundic height)
  3. Presenting part and station
  4. Fetal activity
159
Q

CBC

A

Should be repeated at 28-32 weeks.

160
Q

Serum alpha feto-protein

A

16-18 weeks (for neural tube defects)

161
Q

Screening for glucose intolerance

A

24-28 weeks

162
Q

HBsAg

A

last trimester

163
Q

RT-PCR test

A

for COVID 19 at 37 weeks

164
Q

recommended weight gain during the entire pregnancy.

A

10-12 kg

165
Q

CALORIES:

Should have additional _______ kcal/day be allowed during the 2nd and 3rd trimester.

A

300 kcal/day

166
Q

PROTEIN:

Recommended ____ grams/day during the entire pregnancy

A

9 grams/day

167
Q

Are the main source of energy during pregnancy

A

CARBOHYDRATES

168
Q

Account for an average of 74% of total energy intake

A

CARBOHYDRATES

169
Q

CARBOHYDRATES:

Recommended intake is _____ grams/day.

A

150-225 grams/day

170
Q

Are the most concentrated sources of energy

A

FATS

171
Q

Adds palatability and satiety value to diet; are sparer’s of proteins

A

FATS

172
Q

FATS:

Daily minimum intake should be _____ grams.

A

15-25 grams

173
Q

Promotes normal bowel functions

A

DIETARY FIBER

174
Q

CALCIUM:

Recommended intake is _____ mg/dl.

A

900 mg/dl

175
Q

for lactose intolerance, take ________.

A

500mg tablet twice per day

176
Q

Essential for the calcification of bones and teeth.

A

PHOSPHORUS

177
Q

Increased need is during the 2nd and 3rd trimester.

A

IRON

178
Q

Average requirement of Iron is ___ mg/dl for the whole duration of pregnancy.

A

41 mg/dl

179
Q

2nd most abundant trace element in the body.

A

ZINC

180
Q

Essential for the activity of most enzymes.

A

ZINC

181
Q

Is required for normal growth and sexual maturation, brain development and function, and immune function.

A

ZINC

182
Q

Recommended intake of Zinc is ___ mg/dl.

A

12 mg/dl

183
Q

Recommended intake of Iodine is _____ ug/dl.

A

125 ug/dl.

184
Q

Deficiency leads to megaloblastic anemia

A

FOLATE or FOLIC ACID

185
Q

Folic acid recommendation is _____ ug/dl

A

350 ug/dl

186
Q

Is required for vision, growth, cellular differentiation and proliferation reproduction and integrity of the immune system.

A

VITAMIN A

187
Q

Recommendation of Vitamin A is ______ RE (retinol equivalent).

A

475 RE (retinol equivalent)

188
Q

Also known as aneuria or antineuretic factor.

A

VITAMIN B1 or THIAMINE

189
Q

Recommended daily allowance of Vitamin B1 is _____ mg/dl.

A

1.3 mg/dl.

190
Q

Most important because it alleviates the nausea and vomiting during the 1st trimester.

A

VITAMIN B2 or RIBOFLAVIN

191
Q

Exerts an important controlling influence on body influences.

A

VITAMIN B2 or RIBOFLAVIN

192
Q

Signs of Riboflavin deficiency:

A

Angular Stomatitis, Glossitis, Cheilosis, and Seborrheic dermatitis.

193
Q

RDA of Vitamin B2 is _____ mg/dl.

A

0.6 to 1 mg/dl

194
Q

RDA of Vitamin B6 (Pyridoxine) is ___ mg/dl

A

2 mg/dl

195
Q

Occurs naturally only in foods of animal origin

A

VITAMIN B12

196
Q

RDA of Vitamin C is ___ mg/day

A

70 mg/day

197
Q

Pregnant women can travel up to ___ weeks AOG.

A

34 weeks

198
Q

COMMON COMPLAINTS DURING PREGNANCY

A
  1. Nausea and vomiting
  2. Back pain
  3. Varicosities
  4. Hemorrhoids
  5. Heartburn
  6. Pica
  7. Ptyalism
  8. Fatigue
  9. Headache
199
Q

Leukorrhea

A

→ Trichomonas vaginalis
→ Monilia
→ Gardnerella

OB (1 decks)

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