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OB > Exam 1: Modules 1-3 and self paced module #1 5/12/23 > Flashcards

Exam 1: Modules 1-3 and self paced module #1 5/12/23 Flashcards

1
Q

outer uterine muscle layer

A

longitudinal - expulsion of the fetus

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2
Q

middle muscle layer

A

interlacing- constricts blood vessels

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3
Q

FSH

A

low levels of estrogen and progesterone toward end of cycle stimulates hypothalamus to secrete GnRH. FSH stimulates development of graafian follicales and their production of estrogen.

FSH surges before LH to mature a follicle, secreted by the anterior pituitary.

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4
Q

three cycles happening simultaneously

A

hypothalamus - pituitary ovary cycle
ovarian cycle - follicle maturation/ovulation, corpus luteum formation - degeneration
endometrial cycle - thickening and sloughing

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5
Q

inner muscle layer uterus

A

circular - forms sphincters at the fallopian tubes, key in maintaining cervical integrity during pregnancy/dilation in labor

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6
Q

blastocyst

A

inner mass cells (stem cells) -

become:

embryo
amnion
yolk sac

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7
Q

all or none period

A

first 2 weeks after conception - not susceptible to teratogens
damage - embryo dies or recovers and develops normally

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8
Q

implantation

A

trophoblast day 6-10
burrow into endometrium
early placenta
formation of chorionic villi - secrete hCG, maintains estrogen and progesterone (inhibits menstrual and ovarian cycles)

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9
Q

embryo’s critical development stage

A

begins 10-14 days after conception, week 3-8
3 primary germ layers develop - ectoderm, mesoderm, endoderm –> organogenesis

embryo most likely to be damaged during this time

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10
Q

trophoblast

A

outer layers
trophoblast and blastocyst formation day 4-5

become:
chorion
placenta

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11
Q

luteal stage

A

second ovarianstage - constant - 14 days

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12
Q

chorionic villi

A

important for transfer between fetus and mother
secrete hCG - maintains estrogen and progesterone - inhibits ovarian and menstrual cycles

maternal and fetal blood should not mix - nutrition, fluid, waste return - happening at the cellular level

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13
Q

cellular differentiation days 10-14

A

primary germ layers - ectoderm, endoderm, mesoderm - determine all organ systems

embryonic membranes form - chorion, amnion
amniotic fluid
yolk sac for primitive RBCs
umbilical cord

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14
Q

ectoderm

A

epidermis, hair, teeth, nose and CNS

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15
Q

mesoderm

A

dermis, muscles, bones, kidneys, CVS, lymphatic tissue, spleen

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16
Q

endoderm

A

resp & digestive tract linings, bladder, liver, pancreas

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17
Q

heart beats

A

28 days after conception (6 weeks gestational age)

able to see on US at 6 weeks,
do US at 7-8 weeks because days make a difference

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18
Q

male differentiation

A

4-6 weeks
typically not detectable on US until 16-20 weeks gestation

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19
Q

organ structures formed

A

by 8 weeks after conception - 10 weeks gestation

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20
Q

fetal breathing movements and fetal hearing

A

~16 weeks

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21
Q

youngest preterm survivor

A

21 4/7 weeks

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22
Q

ductus arteriosis

A

pulmonary artery/lung bypass
duct between pulmonary artery and descending aorta

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23
Q

foramen ovale

A

hole between right and left atria - right ventricle bypass

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24
Q

ductus venosus

A

liver bypass
umbilical vein to IVC

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25
Q

Oxytocin

A

stimulate contractions
milk letdown

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26
Q

LH

A

released by anterior pituitary - a marked surge of LH and a smaller peak of estrogen day 12 precede the expulsion of the ovum from the follicle

After ovulation, converts the empty follicle into the corpus luteum and supports this structure(which in turn supports an early pregnancy until the placenta forms)

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27
Q

Estrogen

A

dominates the follicular ovarian phase - days 1-14 (variable phase), dominates the proliferative uterine phase

moody, breast tenderness midcycle surge

stimulates the thickening of the endometrium after menstruation and before ovulation

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28
Q

ovulation

A

14 days prior to period. In a 21 day cycle it happens on day 7 for example. 28 day cycle happens on day 14

optimum time for conception - 14 days before next period, when LH, estrogen and FSH spike

begins luteal ovarian phase,

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29
Q

Progesterone

A

dominates the 2nd, luteal ovarian phase (relatively constant phase avg 14 days),

dominates the uterine secretory phase - ready for EGG, drops and lining sheds

ovarian hormone, responsible for the changes in the endometrium that occur after ovulation to prepare the uterine lining for implantation of a fertilized ovum

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30
Q

Positive Signs of Pregnancy

A

Can’t be anything else:

Fetal Heartbeat per doppler
fetal movement
- palpated
- visualized
visualization of fetus on ultrasound
delivery

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31
Q

1st trimester

A

0-12 6/7
organogenesis, cellular hyperplasia

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32
Q

second trimester

A

13-27 6/7
cellular hyperplasia and hypertrophy

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33
Q

third trimester

A

28 weeks till delivery
cellular hypertrophy

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34
Q

ampulla

A

outer 1/3 of fallopian tube - where mature eggs meets sperm

egg survival 12-24 hours
sperm - 72 hours +

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35
Q

acrosomal reaction

A

removal of sperm’s plasma membrane allows for rxn

production of enzymes to weaken carona radiata

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36
Q

morula

A

12-16 cells - inner and outer cell mass

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37
Q

amniotic fluid

A

early pregnancy - diffusion from maternal blood
after 20 weeks - largely fetal urine

fxns:
temp stablity, prevents adherence to membranes, allows for growth and development, breathing practice, protection, keeps umbilical from crimping

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38
Q

placenta

A

part maternal (decidua), part fetal (chorion)

endocrine fxn: hPL, hCG, progesterone, estrogen production

facilitates hydostatic and osmotic pressure gradients for active/facilitated transport

fetal surface - shiny side
maternal surface - meaty

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39
Q

umbilical cord

A

2 arteries + 1 vein

arteries away from fetus, vein to fetus

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40
Q

foramen ovale

A

hole between right and left atria - right ventricle bypass

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41
Q

difference between dizygotic and monozygotic twins

A

dizygotic - two eggs, two sperm, two amnions, two chorions
monozygotic - one egg, one sperm, two amnions, one chorion

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42
Q

maternal serum/quad screen

A

trisomy 18 and 21

collected between 15 and 23 weeks (ideal b/t 16-18)

covered by most insurance
rarely used - more accurate testing options - available for patients who miss 1st trimester screen and cost preference

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43
Q

1st trimester screen

A

11-13 weeks - nuchal translucency and maternal serum

trisomy 13, 18, 21 and cardiac, neural tube defects

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44
Q

2nd trimester screen

A

2nd draw of meternal serum alphafetoprotein to screen for neural tube defects and abdominal wall defects
–> spina bifida and gastroschisis
covered by most insurance plans

45
Q

Free Fetal DNA ffDNA

A

most accurate screening option
trisomy 13, 18, 16, 29, 21 and se chromosome aneuploidies and micro-deletions

after 10 weeks
most accurate in high-risk women, advance age (>35yr)
gender!

46
Q

US 2nd or 3rd trimester

A

fetal presentation and number
AFI
placental location
presence of cardiac activity
fetal biometry
anatomy - review of systems
uterine/pelvic anatomy

detects: cranio-spinal defect, GI malformations, cardiac defects, renal malformations, skeletal

transabdominal after 12 weeks ga

47
Q

tests used to confirm chromosomal abnormality/inherited disorder

A

chorionic villus sampling - 10-12 weeks - transabd or transcervical
- does not detect neural tube defects, many risks, but allows for termination before fetal movement felt

amniocentesis - 15 - 18 weeks - needle guided aspiration of amniotic fluid

percutaneous umbilical cord blood sampling - hemophilia, hemolytic disorders, fetal infections, chromosomal

48
Q

not gaining enough weight

A

more likely to deliver low birth weight - inc risk for respiratory distress syndrome, PDA

increased lifelong risk for HTN, DM, CVD

Reasons:
Anorexia/body image disorders
Nausea, “morning sickness”
Substance abuse, smoking
Insufficient means: poverty, homelessness, etc.
Pica (filling up on non-nutritive foods)

49
Q

obesity

A

inc risk of birth defects, HTN, GDM & DM, sleep disordered breathing

inc risk of primary, rpt CS
medical induction, prolonged first stage, blood loss, prolonged operative time

neonate - macrosomia, IUGR, stillbirth, preterm

50
Q

normal BMI weight gain

A

total: 25-35lb
1st trimester: .5-3 lb
2nd/3rd: 1lb/week

or 5-10 lb by 20wks, then 1lb/week

51
Q

relaxin

A

loosening of joints (combo with estrogen and progesterone)

52
Q

vena cava syndrome

A

Enlarged uterus compresses the inferior vena cava and the lower aorta when patient is supine
Reduced venous return to heart
Symptoms include decreased BP, light headedness, syncope, racing heart, sweating, fetal heart rate changes

implications for labor - keep at a tilt and monitor

53
Q

Naegle’s Rule

A

LMP + 1 year - 3 months + 7 days

not always exactly 280 days from LMP, need known LMP

54
Q

late - term
post - term

A

late - 41w0d
post - 42w0d

55
Q

preterm

A

> 37w

56
Q

give Rogam

A

Rh-negative woman:
- 28 weeks prophylactically (half-life 14 weeks)
- instances mixing suspected
- within 72 hours of delivery if baby Rh+ (via umbilical blood sample) or unknown (miscarriage/abortion)

Can omit Rogam if:
- women Rh-positive
- partner DOCUMENTED history of Rh negative

57
Q

Toxoplasmosis

A

avoid raw/undercooked meat
contact with cat feces

58
Q

Parvovirus (aka 5th’s, Coxsackie, Hand Foot Mouth)

A

check status for high exposure risks - precautions if non-immune

59
Q

Listeria

A

avoid eating unpasteurized cheese

60
Q

Rubella, Varicella

A

immunization available but not given in pregnancy (live attenuated)
check status, precautions if non-immune
immunize postpartum

rubella - isolate infants w/ rubella - 12 mo virus shedding

61
Q

hep B

A

bathe asap
baby vaccine
all family members tested/vaccinated

62
Q

Toxoplasmosis

A

cat feces, soil, uncooked meat
transplacental
highest risk of infection 3rd trimester, death 1st trimester

63
Q

Syphillis

A

all women screened
treat penicillin G

64
Q

immunizations safe to give during pregnancy

A

influenza (not nasal spray), tdap - booster 27-36wks - antibodies pass placenta, protect baby first 2 months b4 Dtap

, covid

65
Q

underweight weight gain
BMI <18.5

A

28-40 lbs

if underweight, inc risk of PTL, low birth weight

inadequate weight gain - inc risk of fetal growth restriction

66
Q

Normal weight - weight gain
BMI 18.5-24.9

A

25-35 lbs

67
Q

Overweight weight gain
BMI 25-29.9

A

15-25 lbs

68
Q

Obese weight gain
BMI >30

A

11-20 lbs

inc risk of HTN, DM/GDM, macrosomia, injury, c/s, postpartum hemorrhage, stillbirth, miscarriage

69
Q

Morbid Obesity weight gain
BMI >40

A

no weight gain

70
Q

normal symptoms during pregnancy

A

braxton-hicks
leukorrhea - estrogen
SOB - should be manageable
visual changes -
slightly elevated WBCs - look for s/s
nausea vomiting (esp 1st trim)

71
Q

nausea - which hormone?

A

hCG

72
Q

heartburn - which hormone?

A

progesterone - valve stomach esophagus softens

73
Q

constipation - which hormone?

A

progesterone - slowed gut motility

74
Q

swollen ankles/feet - which hormone?

A

estrogen, progesterone - hormones trigger fluid retention + mechanical - pelvic congestion

75
Q

Leukorrhea/mucus plug - which hormone?

A

estrogen

76
Q

bleeding gums/nosebleeds - which hormone?

A

estrogen and progesterone - capillary engorgement and swelling nasal passages
epistaxis - estrogen

77
Q

fetal heartbeat/ movement

A

SEEN on US after 6 wks
HEARD doppler 10-12 weeks (organs formed ~10 wks)
FELT 18-22 wks

78
Q

prenatal care visits

A

initial 8-12wks
visits Q4 until 28 weeks
visits Q2 weeks until 36 week
Visits Q1 week until birth

79
Q

prenatal care visits

A

initial 8-12wks
visits Q4 until 28 weeks
visits Q2 weeks until 36 week
Visits Q1 week until birth

80
Q

phyisologic anemia

A

treat:
1st & 3rd trimester hemaglobin <11g/dL
2nd trimester <10.5

fetus begins to store iron after 20 wks

81
Q

gravidity

A

any pregnancy, regardless of duration

82
Q

parity

A

of times the uterus has emptied after 20 weeks

83
Q

primipara “premip”

A

has given birth once to a fetus >20 weeks

84
Q

grand multipara

A

five or more births >20 weeks

85
Q

Nullipara “nullip”

A

never given birth to a fetus >20 wks

86
Q

primigravida

A

pregnant for the first time

87
Q

5 digit system

A

G - number of pregnancies of any length
P- TPAL
T - term births >37 wks, regardless outcome
P - preterm - # of births 20 wks - 37 wks
A - loss of pregnancy <20wks
L - number of currently living children

88
Q

Stage 1 Early Phase

A

0-5cm
contractions q5-10min 30-60 seconds

other symptoms: loose stools, backache

support:
encourage alternative rest/activity. Distraction, hydrate, light meals, shower
empty bladder q2

89
Q

Stage 1 Active Phase

A

6-10cm
contractions - stronger, more regular q3-5 min 60 seconds
late active 8-9 cm q1-3 min 90 seconds

apprehensive, engrossed in contractions

other sx: inc bloody show, inc pelvic pressure

support: active support with position changes, breathing, massage, focus
empty bladder q2

90
Q

false labor

A

no rupture of membranes
irregular contractions, space out when lying down
no cervical changes

91
Q

true labor

A

↑ in U/C
Frequency
Duration
Intensity (strength)
Progressive cervical dilation, effacement & descent of presenting part
Rupture of membranes

92
Q

lie

A

relationship of long axis of fetus to long axis of mother
-longitudinal
- transvers

93
Q

Presentation

A

what part enters pelvis 1st
-cephalic (vertex)
-breech
-shoulder

94
Q

attitude

A

relationship of the fetal parts to one another
flexed, military, brow, face

95
Q

Position

A
96
Q

probable signs pregnancy

A

Objective
Those things the provider can observe/measure

eg. linea negra, palpation fetal outline, positive pregnancy test
Goodell’s, Hegar’s sign - changes to the uterus
Chadwick’s sign - cervix becomes blue
Braxton Hicks - false contractions (lower back pain, pelvic pain)
Uterine souffle - wooshing maternal pulse
Linea nigra -
Abdominal striae - stretch marks
Ballottement - bimanual cervical check reveals firmness (could be fibroids)
Palpation of fetal outline - fibroids
Abdominal enlargement - weight gain, ascites
Positive pregnancy test - can be false, rare Hcg secreting ovarian tumors

97
Q

Presumptive signs pregnancy

A

Subjective
Those things the woman experiences and reports

eg. amenorrhea, nausea, vomiting
all have other possible causes

amenorrhea (can also be caused by birth control,
nausea
vomiting
urinary frequency
breast tenderness
darkened areola
quickening - feeling fetus move
weight gain
fatigue

98
Q

engagement

A

baby at 0 station - presenting part is at ischial spine

above this is negative number, below is positive number (-5 - +5)

99
Q

caput

A

natural generalized swelling of soft tissue - cone head

100
Q

molding

A

overriding of the bones without damage to the brain

101
Q

prevent hemorrhage - active mgmt 3rd stage

A

(after delivery of anterior shoulder or cord clamped)
Pitocin 10-40 U in IV 500-1000 ml LR fast
Pitocin 10 Units IM - not ideal - last resort

patients with placenta accreta:
Tranexamic Acid (TXA) after cord clamped

fundal massage AFTER the placenta is out (before can cause partial separation -> postpartum hemorrhage)

102
Q

> 1000 mls blood loss

A

hemorrhage

pitocin
methergine 0.2 mg IM
cytotec (misoprostol) 800-1000mcg sublingual or rectally
hemabate 250 mcg IM, intracervical, intrauterine
TXA 1g in 100 ml NS IV of 10 minutes - first 3 hrs

urinary catheter to empty bladder

103
Q

lacerations degrees -1st

A

vaginal mucosa and perineal skin

104
Q

lacerations degrees - 2nd

A

1st degree + bulbocavernosus muscle, transverse & deep transverse muscles & fascia

105
Q

lacerations degrees - 3rd

A

1st + 2nd + anterior anal sphincter

106
Q

lacerations degrees - 4th

A

1st + 2nd + 3rd + anterior rectal mucosa

Lacerations heal as well or better than episiotomies

107
Q

Chlamydia gonorhea

A

1st and 2nd most common
ophthalmic neonatorum

chlamydia –> pneumonia

e-mycin ointment asap postpartum

108
Q

HSV

A

50-60% mortality w/ exposure to primary lesion - neuro complications, sepsis

prophylactic antiviral beginning wks 35-36, if 2-3 outbreaks during pregnancy
c-section of active lesions (vag safe if no active lesions 7 days)

OB (2 decks)

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