EXAM 1 Flashcards
1st trimester urinary frequency normal or not?
Yes, and will recur in 3rd trimester. If it happens in 2nd trimester then possible UTI
What is quickening, when does it occur?
Slight fluttering movements of the fetus felt by the mother, usually between 16-20 weeks gestation.
Mom has hep B, what are we giving?
Hep B & immune globulin within 12 hours after birth
Facial edema indications?
(will give s/s, know which is abnormal during 1st trimester)
Pre eclampsia
Pt doesn’t have rubella vaccine, when is the best time to administer?
AFTER birth because it’s a live vaccine and can harm the fetus
Pt in 1st trimester having second thoughts, what’s your therapeutic response?
Second guessing is called ambivalence, normal during 1st trimester
Supplement to prevent neural tube defects?
Folic acid
Is it ok to exercise during pregnancy?
Yes just avoid hot tubs, sauna, and increase hydration
Know BMI, what’s the right weight gain?
Healthy BMI: 25-35 lbs
First trimester: 3.5-5 lbs
Second & third trimester: 1lb/week
GTPAL:
Gravity: number of pregnancies
Term births: number born at > 37 weeks
Preterm births: pregnancy delivered 20th-36th weeks
Abortion: counts with gravity, twins & triplets count as ONE
Living: current
Nagele’s rule:
Date of LMP minus 3 months plus 7 days plus 1 year = EDD
What is lordosis? Is it normal?
Yes because fetus pulls pelvic forward
Normal skin changes during pregnancy: this will be SATA
Striae gravidarum: stretch marks in abdomen, breast, hips, may be itchy
Chloasma: “mask of pregnancy” brownish hyperpigmentation of the cheeks, nose, forehead
Linea nigra: black line on belly
Know about contraceptives, most reliable
Behavioral methods: abstinence, fertility awareness (cervical mucus ovulation method, basal body temp, symptothermal method, standard days method), withdrawal (pull out), lactational amenorrhea method (breastfeeding)
Barrier methods: condoms, diaphragm, cervical cap, contraceptive sponge Hormonal methods: oral, injectables, transdermal, vaginal rings, implantable, IUD, emergency
Sterilization: tubal ligation (cut fallopian tubes), vasectomy (cutting vas deferens, which carries sperm)
Abortion: surgical or medical (methotrexate + misoprostol, mifepristone + misoprostol)
Tx for positive Chlamydia:
1 dose of Azithromycin
What mineral needs to be doubled during pregnancy?
Iron
Vaccines ok to give during pregnancy:
TDAP, flu, Covid
Where would the fundus be located at 20 weeks gestation?
At the umbilicus
Contraindications with oral contraceptives:
DVT, smoking, > 35 years
12 weeks heartburn reasoning:
High progesterone, it slows down gastric emptying
Presumptive sign: (think mom, subjective)
amenorrhea, breast enlargement and soreness, nausea, vomiting, quickening (when a mother feels the movement of the fetus in the uterus)
Probable sign (think doctor):
Abdominal enlargement, Hegar’s sign (softening and compressibility of lower uterus), Chadwick’s sign (violet bluish color of cervix and vaginal mucosa), Goodell’s sign (softening of cervical tip), Ballottement (rebound of unengaged fetus, think BALL), braxton hicks contractions, positive pregnancy test
Positive sign (think baby, objective):
the baby is seen (4-6 weeks), heard (10-12 weeks), and felt (20 weeks). Heard fetal heart tones, felt fetal movement by the provider, seen by an ultrasound
Implantation cycle:
Conception occur in the FALLOPIAN TUBES
Fertilized ovum gets IMPLANTED in the uterus between 6-10 days Implantation occurs 6-10 days
Sperm survives 24-48 hours
During implantation, you can have some bleeding
Nutrition during pregnancy (which will need further teaching):
Folic acid: prevent neural tube defects
Protein: needed for tissue growth
Omega 3’s: needed for brain development for the growing fetus
Iron: to supply fetus with iron
Calcium: 1000 mg/day
Fluids: 8-10 glasses (2.3L)
AVOID unpasteurized milk, unwashed fruits/veggies, liver, raw fish/meat, high mercury, alcohol
Advanced maternal age >35 year/ is at risk for:
Down syndrome baby trisomy 21
Umbilical cord contains:
2 Arteries, 1 Vein
STI counseling:
Ask about past exposures
What does smoking during pregnancy do to fetus?
Fetus will be at risk due to decreased blood flow to placenta, placental abruption, preterm delivery
know probable signs of pregnancy, which comes first?
Abdominal enlargement
Hegar’s sign (softening and compressibility of lower uterus)
Chadwick’s sign (violet bluish color of cervix and vaginal mucosa)
Goodell’s sign (softening of cervical tip)
Ballottement (rebound of unengaged fetus, think BALL)
braxton hicks contractions
positive pregnancy test
What is leukorrhea, is this normal?
Yes, normal during pregnancy
Foods for iron deficiency:
Lean meats, eggs, cheese, milk, nuts, legumes, green leafy veggies
Pt dx with genital herpes, which will indicate further teaching:
there’s no cure, but acyclovir can suppress
What to assess with a biophysical profile?
BPP is a non invasive test that combines NST and fetal ultrasound to assess fetal movements, fetal breathing, muscle tone, amniotic fluid, and NST (you want this reactive)
When is a baby’s heart audible with a Doppler?
10-12 weeks
Who would doctor order maternal serum alpha-fetoprotein/MSAFP?
All patients
Why do we order MSAFP?
Screening occurs between 15-22 weeks, used to rule out down syndrome and neural tube defects.
Condom teaching:
Place condom on erect penis, leaving an empty space at the tip for sperm reservoir
Following ejaculation, withdraw penis from vagina while holding the rim of the condom to prevent semen spillage
Can use in conjunction with spermicidal gel to increase effectiveness
Check expiration date prior to use
Latex and polyurethane condoms protect against STI
Only water soluble lubricants should be used with latex condoms to avoid condom breakage
Amniocentesis:
Done after 14 weeks to test for genetic disorders, congenital anomalies (neural tube defects), and assessment of fetal lung maturity (for amniocentesis)
RhoGAM should be administered to Rh negative mother, this covers any chance of blood mixing
Complications for mom: infection, hemorrhage, placental abruption
Complications for baby: infection, injury from the needle
VEAL CHOP MINE:
Veal- FHR pattern
Chop- Cause
Mine- management
FHR pattern:
Variable deceleration
Early deceleration
Acceleration
Late deceleration
Cause:
Cord compression
Head compression
Okay
Placental insufficiency
Management:
Maternal repositioning
Identify labor progress
No interventions
Execute interventions
Hyperemesis gravidarum:
Excessive vomiting
Monitor I&O, electrolytes, weight
Give antiemetics; zofran & reglan
GONORRHEA:
2nd most common infection in USA, highly contagious and reportable to CDPH NEONATAL CONJUNCTIVITIS IF WOMAN GIVES BIRTH
Caused by -> AEROBIC GRAM NEGATIVE INTRACELLULAR DIPLOCOCCI
Site of infection -> Columnar epithelium of endocervix
Tx -> antibiotics
Manifestations -> most asymptomatic, abnormal vag discharge and bleeding, dysuria, cervicitis, bartholin abscess, PID
GENITAL HERPES SIMPLEX
Recurrent lifelong viral infection
Transmission via contact with mucous membranes or breaks in skin with visible or non visible lesions (kissing, sexual contact, vaginal delivery)
No cure only antiretroviral therapy to reduce symptoms, shedding, and recurrent episodes
Primary episode -> most severe and prolonged; multiple painful vesicular lesions, mucopurulent discharges, superinfection with candida, fever, chills, malaise, dysuria, HA, genital irritation, inguinal tenderness, lymphadenopathy Recurrent infection -> more localized and quicker resolution; tingling, itching, pain, unilateral genital lesions
Dx -> confirmed via viral culture of fluid from vesicle
SYPHILIS:
Curable bacterial infection caused by SPIROCHETE TREPONEMA PALLIDUM Serious systemic disease
Meds -> Benzathine PCN G IM, Doxycycline if allergic to PCN. Then reevaluate with serologic testing
Test -> VDRL and RPR, FTA-ABS, TPPA, TPHA
HIV:
Manage with Highly Active Antiretroviral Therapy (HAART), Zidovudine given during labor
HEP A, HEP B:
A- GI tract
B- Bodily fluids
Prevention through immunization
HPV:
Most asymptomatic or visible genital warts Test -> pap smear, HPV test
ECTOPARASITIC INFECTIONS:
Scabies: intense pruritic dermatitis with lesions
Pubic lice: pruritus with lice or nits
Tx -> permethrin cream, lindane shampoo, decontamination of bedding and clothing, tx of family members and sexual partners, education
Goal -> ERADICATE INFESTATION, REMOVE NITS, PREVENT SPREAD
BACTERIAL VAGINOSIS:
Most prevalent cause of vaginal discharge, 50% of women asymptomatic
Risk factors -> multiple sex partners, douching, lack of lactobacilli, STALE FISHY ODOR
Management -> avoid sex and alcohol
PELVIC INFLAMMATORY DISEASE:
Results of ascending polymicrobial infection of upper female reproductive tract, frequently from untreated chlamydia or gonorrhea
Management -> empiric broad spectrum antibiotics, oral fluids, bed rest, pain management
First trimester:
1-13 weeks (3 months)
Second trimester:
14-26 weeks (4-6 months)
Third trimester:
> 27 weeks
