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Women's Health > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

How to diagnose pregnancy

A 
Missed period
Nausea/vomiting
Fatigue
Frequent Urination
Breast Tenderness
Positive urine or serum pregnancy test (HCG)
Morning Sickness
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2
Q

Standard laboratory urine pregnancy tests become positive approximately _____ following the first day of the LMP (around the time of the missed period)

A

3.5–4 weeks

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3
Q

1st prenatal visit components

A 
General Medical History 
OB history
Calculate EDD/EDC
Full physical exam
Pelvic Exam, STD screen
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4
Q

CDC recommends all women should be tested for ___

ACOG recommends test high risk women (high risk entails __)

A

chlamydia

1+ sexual partner,

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5
Q

how to document GTPAL

most accurate way

A

G (gravida) = # of times pregnant
T (term) = # of full-term deliveries 37 weeks or after (36 weeks and 6 days is still preterm)
P (preterm) = # of preterm deliveries betwn 20-37 weeks
A (abortions) = # of ‘abortions’ prior to 20 weeks (SAB or TAB or ectopic)
L (living) = # of living children

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6
Q

how to document GP

A

G (gravida) P (parity)

Refers to # of pregnancies (G) and # of deliveries (P) of a fetus greater than 20 weeks gestation whether alive or stillborn

E.g. If just delivered: G2P1–>2 (2 pregnancies,1 delivery now 2)

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7
Q

TAB

SAB

A

terminated pregnancy/abortion

spontaneous abortion

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8
Q

What is the GTPAL of a woman with 2 pregnancies, 1 full term infant, 1 spontaneous abortion, and 1 living child?

A

G2T1P0A1L1

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9
Q

All prenatal care is based on the ____

A

EDD

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10
Q

how to determine EDD

A
  • a pregnancy calculator wheel based on LMP
  • use Naegele’s Rule: LMP + 7 days minus 3 months
  • *Naegele’s Rules assumes a normal 28 day cycle
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11
Q

What is the EDD of a woman whose LMP was 8/8/13?

A

LMP + 7 days - 3 months

May 15, 2014

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12
Q

does pregnancy warrant an earlier PAP to be done?

A

no

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13
Q

PE for prenatal visit consists of

A 
BP
weight and height --> BMI
Cardiac
Thyroid
Breast Exam
Pelvic exam
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14
Q

Fetal heart tones at ____ with an acoustic fetoscope (dop-tone/Doppler)

Fetal heart tones at ____ (Doppler)

A

18-20 weeks

12 weeks

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15
Q

fetal movement at ___ weeks

A

16-20 weeks

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16
Q

uterine softening and enlargment at ___ weeks

A

6+ weeks

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17
Q

Chadwick’s sign? and when does it happen

A

vaginal pallor/bluish

*at 6-8 weeks

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18
Q

Hegar/Goodell sign? and when does it happen

A

Cervical softening

*at 6-8 weeks

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19
Q

at 20 weeks where should the uterus be at

A

umbilicus

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20
Q

what labs do you get done at the 1st prenatal vistis

A

Confirmation Lab: B-HCG

Labs:
CBC (hemoglobin, hematocrit, MCV)
Blood group
Rh +/-
Antibodies (to Rh) 
Serology for syphilis 
Gonorrhea/Chlamydia
Rubella immunity
 (if mom is not immune could worry about TORCH infections)
HIV
Hepatitis B antigen testing
Urinalysis, urine culture for bacteriuria
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21
Q

Rh + =

Rh - =

A

Rh + = has antigen

Rh - = lack antigen

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22
Q

Cramping on one side at ___ weeks worry about ectopic pregnancy

A

5 weeks

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23
Q

purpose of 1st trimester us

A

Confirm Diagnosis (cardiac activity)
Estimate Gestational Age (measure crown rump length)
Evaluate uterine anomalies

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24
Q

when do you do a transvaginal US and Abdominal US

A

Transvaginal at 7-9 weeks

Abdominal at 9+ weeks

*have to wait 7 weeks before you get an US

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25
Q

cardiac activity starts around

A

6.5 weeks

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26
Q

how many pregnancies are aborted in 1st trimester

A

1:5

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27
Q

schdule of visits for prenatal care

A

Assess every 4 weeks until 32 weeks
Assess every 2 weeks between 32-36 weeks
Assess weekly after 36 weeks

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28
Q

questions to ask at every visit

A

Vaginal bleeding, N/V, dysuria, vaginal discharge, overall feeling and fetal movements (after 20 weeks)

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29
Q

exam and labs done at ALL visits

A

BP
Weight
Edema
Urine glucose/protein

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30
Q

LE edema is common due to

A

inferior vena cava syndrome

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31
Q

how much weight should you gain in pregnancy

A

25-30 lbs
Normal BMI 20-26

Up to 40# if underweight
Up to 15# if overweight

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32
Q

what numbers suggest hypertension

A

Systolic change >30mm Hg (over baseline, not 1st trimester BP), diastolic change >15 mm

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33
Q

Leopold’s maneuvers

A

a common and systematic way to determine the position of a fetus inside the woman’s uterus

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34
Q

Between ______, the fundal height approximates the weeks of gestation

A

20-36 weeks

*measure with cm measuring tape

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35
Q

when/how do you test for nuchal translucency

A

10-13 weeks u/s with blood test (1st trimester screening)

  • Measure crown rump lenght greater than 2.5mm worry about trisomy
  • Rule out Trisomy 21, 13, and 18
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36
Q

Maternal blood draw detecting multiple fetal aneuploidies including

A

Trisomy 21, 13, 18 (some Turner Syndrome and all detect GENDER)-99% accurate

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37
Q

NIPT (noninvasive prenatal genetic testing) can be drawn as early as

A

10 weeks
(1st trimester screening)

*Trade Names: Maternity 21/Harmony/Verifi/Panorama

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38
Q

when is Quad screening done and what does it screen for

A

15-20 weeks (2nd trimester screening)
*older test- only if other this are not done (If they come in late

AFP, hCG, estriol, and inhibin-A

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39
Q

AFP (Alpha-FetoProtein) Test alone often done at ____ weeks for ___

A

15-20 weeks

Spina Bifida detection in conjunction with NT test (high= spina bifida)

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40
Q

hormone produced within the placenta

A

hCG

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41
Q

protein produced by fetus

A

AFP

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42
Q

produced by fetus and placenta

A

Estriol

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43
Q

protein produced by the placenta and ovaries

A

Inhibin-A

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44
Q

Low levels of AFP and abnormal levels of hCG and estriol may indicate that the developing baby has

A

Trisomy 21 (Down syndrome), Trisomy 18 (Edwards Syndrome) or another type of chromosome abnormality

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45
Q

____ if patient is at high risk/qualifies for insurance coverage

A

NIPT

46
Q

Invasive Prenatal Tests

A

CVS (chorionic villus sampling)

Amniocentesis

47
Q

when is CVS and amniocentesis done

A

CVS at 10-15 weeks
Amniocentesis at 15 -+ weeks

*both have ~1% risk of miscarriage

48
Q

Sample of placental cells taken to perform genetic testing

>99% detection via karyotype

A

CVS-Chorionic Villus Sampling

49
Q

Sample of amniotic fluid taken to perform genetic testing

>99% detection via karyotype

A

amniocentesis

50
Q

what prenatal tests are done at 19-20 weeks

A

Routine ultrasound

Check EDD, fetal development

51
Q

what prenatal tests are done at 24-28 weeks

A

Screen for Gestational Diabetes- Glucose tolerance test and 3 hour GTT (if GTT is high)
Rhogam for Rh- mothers

52
Q

what prenatal tests are done at 32-36 weeks

A

Screen for Group B Strep
Recheck:
Hemoglobin and hematocrit levels
STIs if continued risk or new risk factor

53
Q

of movements in 1 hour
Average movements in a time period
Several assessments/day

A

fetal kick count

54
Q

Fetal heart rate to fetal movement
Mother notes fetal movement in a 20 minute period
Reactive (reassuring) if 2+ accelerations occur in 20 minutes
Nonreactive – no heart accelerations in 40 minutes

A

Non-stress test fetal assessment

55
Q

Measurement of blood flow velocities in the umbilical artery, umbilical vein, uterine artery with U/S

A

Doppler velocimetry

56
Q

Spontaneous or oxytocin-induced contractions compared to fetus heart rate
Measures the response of the fetal heart rate to the stress of a uterine contraction

A

contaction stress test

57
Q

Five assessments –> NST, presence of fetal breathing, fetal movement of body or limbs, fetal tone (flexed extremities), adequate amniotic fluid volume

A

Biopysical profile

58
Q

prenatal vitamins

A

extra iron

folic acid

59
Q

exercise during pregnancy

A 
Moderate exercise (HR less than 140) is okay daily 
Avoid risky exercise (no hot yoga)
60
Q

travel guidelines for pregnancy

A

Avoid distant travel in 8th month

Most airlines won’t allow past 36 weeks
Cruise lines prohibit travel at 25th week

61
Q

medications during pregnancy

A

Class A/B- generally safe
Class C/D benefits must outweigh risk
Class x- Contraindicated

62
Q

what happens to cardiac output with pregnancy and why?
Initially due to _____
Later, due to _____

A

Increased cardiac output 30-50%

increased blood volume

increase heart rate (by 10-20 bpm)

63
Q

Cardiac Ausculatory changes in pregnancy:

A
  • Systolic ejection murmurs are common
  • Accentuated split S2

*Diastolic murmurs are NOT normal in pregnancy!!

64
Q

vascular changes in pregnancy

A
  • Decreased peripheral vascular resistance-progesterone
  • Decreased BP in the beginning of pregnancy (1st half)

*Don’t care 1st trimester BP to 3rd trimester BP

65
Q

Ineffective shunting of blood through the paravertebral circulation due to the enlarging uterus compressing on the inferior vena cava

A

“Inferior Vena Cava Syndrome”
or
Supine hypotensive syndrome

66
Q

sx:
Light-headed
Increased heart rate
Syncope

relieved by:

A

Supine hypotensive syndrome

Relieved by lying on the left side
lay on left side after 20 weeks!! (do not lay on their back)

67
Q

hematologic changes associated with plasma volume and RBC mass

A

increase by 50%

RBC mass increases by 20-30% if taking iron supplements
15-20% if not taking iron supplements

68
Q

Need increased blood volume for:

A

the loss of blood during delivery

69
Q
  • Dilution due to a greater increase in intravascular volume compared to RBC mass.
  • Decrease in hemoglobin and hematocrit
  • Better placental diffusion with lower cardiac output
  • Iron preferentially goes to the fetus
A

“Physiologic Anemia” or “dilutional anemia”

70
Q

Vascular Changes w/ pregnancy

A
  1. Hypercoagulable State (Helpful to prevent mother from hemorrhaging during delivery)
  2. edema (due to increased plasma volume)
  3. blurred vision (Fluid retention–> thickening of the cornea)
71
Q

Respiratory Changes

A
  1. nasal congestion/secretions and epistaxis
  2. Diaphragm rises up by 4 cm
  3. Chest diameter increases 2+ cm –> “barrel chested”
  4. Increase in oxygen demand by 20%
  5. Maternal arterial PCO2 decreases/arterial PO2 increases**
72
Q

why do you get nasal congestion/secretions and epistaxis

A

Increased blood flow/mucosal hyperemia- more flowy
Due to increased estrogen level

*unresponsive to meds

73
Q

why does Maternal arterial PCO2 decreases/arterial PO2 increases

A

Facilitates carbon dioxide transfer from fetus to mother

*Hyperventilation is secondary to progesterone

74
Q

Gastrointestinal Changes

A
  1. Major effect is on gastrointestinal motility (decreases)- due to progesterone
  2. Increase in gingivitis
  3. Nausea/vomiting
  4. Gastroesophageal reflux (heartburn)–> secondary to lower esophageal sphincter (LES) tone/pressure decreases
  5. Gallbladder dysfunction
  6. constipation/bloating
  7. hemorrhoids
75
Q

why do you get morning sickness

A

Due to progesterone, HCG

*esp 1st trimester (4-8 weeks)

76
Q

pica- cravings for ice, clay

A

think iron deficiency

77
Q

cuase of gallbadder dysfunction

A

Decreased emptying
Secondary to progesterone and estrogen

*Increased risk of gallstones

78
Q

cuases of constipation/bloating

A

Progesterone-mediated smooth muscle relaxation
Slower transit times
Intestinal water absorption from intestine
Increasing uterus size affects intestinal function

79
Q

causes of hemorrhoids

A

Due to increase pelvic blood flow
Enlarging uterus impedes venous return
Constipation contributes treat with Metamucil and increased dietary fiber if drinking enough water

80
Q

bladder and urinary changes

A
  1. Urinary stasis and predisposition for ureteral reflux

2. Decreased bladder capacity due to enlarging uterus

81
Q

Urinary stasis and predisposition for ureteral reflux due to:

A
  • Ureteral dilation (Secondary to progesterone)
  • Decreased bladder tone–> retention of urine(Secondary to progesterone)
  • To prevent pyelonephritis, even asymptomatic bacteruria is treated
  • Glomerular filtration rate (GFR) increases right away! (Kidneys have to filtrate more blood volume)
82
Q

kidney changes

A
  1. increase in renal blood flow
  2. Increased glomerular filtration rate (GFR) – 50%
  3. increase renal excretion of bicarbonate
83
Q

Increased glomerular filtration rate (GFR) might present with:

A

increased Increased urinary glucose excretion

“Trace” glucose on dipstick is normal

84
Q

why is there an increase in renal excretion of bicarbonate

A
  • Compensation for respiratory changes (respiratory alkalosis)
  • Keeps maternal arterial pH normal
85
Q

endocrine changes

A
  1. glucose metabolism/Increased tissue insulin resistance
  2. increase in lipids (Provide maternal fuel so fetus can have glucose)
  3. increase in cortisol levels (via estrogen)
  4. increase in oxytocin
  5. increase in water retention of 3 L
  6. Euthyroid state
  7. Thyroid levels don’t fluctuate much
86
Q

Triglycerides increase by ___%, cholesterol increase by __%

A

300%

50%

87
Q

why is there an increase in water retention of 3 L

A

Secondary to the increase in the renin-angiotensin-aldoserone system due to decreased vascular resistance

88
Q

breast changes

A
  1. Increase in size up to 50%
  2. Darker pigmentation of areola
  3. Enlargement of Montgomery Tubercles-sebaceous glands of areola
  4. breast tenderness (due to progesterone)
  5. increased blood flow
  6. colostrum
89
Q

Brown papules/glands on the Areola –>hypertrophied sebaceous glands

A

montgomery tubercles

90
Q

may be expressed at the end of pregnancy

-yellow thick fluid from nipples

A

colostrum

91
Q

vaginal changes

A

Vaginal discharge
Increased shedding of vaginal epithelium

*Leukorrhea of pregnancy (WBC discharge)

92
Q

cervix changes

A

Endocervix everts further

mucus plug formation (comes out over several days)

93
Q

uterus changes

A

Uterine myometrium (muscular wall) hypertrophies

94
Q

skin changes

A
  1. Hyperpigmentation (mask of pregnancy, Linea nigra, Darkening around the areola, axillae, genitalia, neck, anus)
  2. acne (sebum production)
  3. vascular spiders
  4. varicsoe veins
  5. stretch marks
  6. pruritus (scalp, anus, vulva, abdominal wall)
95
Q

what causes hyperpigmentation

A

Due to estrogen, progesterone, HCG

96
Q
  • melasma/chloasma

Sometimes doesn’t go away (use sunscreen)

A

“mask of pregnancy”

97
Q

Softening of the cervix

A

Goodell’s sign

98
Q

Bluish/purple discoloration of the vagina –> increased blood flow –> sign of pregnancy on exam

A

(Chadwick sign)

99
Q

growth phase, less in telogen phase so very little hair shedding

A

anagen phase

100
Q

pathophysiology:
Dilation and proliferation of blood vessels secondary to increase in estrogen
Red lesions with branches extending out

A

vascular spiders

101
Q

Increase blood volume and venous pressure on veins from uterus
Do not usually regress

A

varicose veins

102
Q

striae gravidarum

A

stretch marks

*Fade postpartum but will not disappear
No true way to prevent them
Genetics play a huge role

103
Q

hair and nail changes

A
  1. increased hair volume
  2. nails grow faster

*More follicles in anagen (growth) phase
Reverses 2-4 months post-partum =hair loss

104
Q

___ is any condition in which the flow of bile from the liver is blocked

A

cholestasis

105
Q

musculoskeletal changes

A
  1. ligament laxity
  2. lumbar lordosis
  3. hernias (umbilical and abdominal)
  4. increased bone turnover
106
Q

cuase of ligament laxity

A

Progesterone and relaxin

Uterus tips forward

107
Q

Bone turnover via _____ but no loss of bone density as calcitonin is high and kidneys compensate.

A

increase parathyroid hormone

108
Q

____ is the most important substrate

A

Glucose

109
Q

fetal physiology:

survive on low oxygen saturation due to

A

High cardiac output

High fetal hemoglobin

110
Q

produced by fetal urine and from placenta

A

amniotic fluid

111
Q

Passive immunity from mom to fetus

A

IgG

*crosses the placenta

Women's Health (3 decks)

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