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Thompson Exam 4 and 5 > Exam 4: Mon.3.28.Obstetrics > Flashcards

Exam 4: Mon.3.28.Obstetrics Flashcards

1
Q

What happens with preclampsia?

A little more info than other deck

A
  • sudden ↑in BP
  • usually signals kidney damage – cause unknown, although may be pressure in placental blood vessels
  • signals need for immediate delivery
  • HELLP- a severe variant of preclampsia
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2
Q

What is HELLP?

A
  • *H** (hemolysis, which is the breaking down of red blood cells)
  • *EL** (elevated liver enzymes)
  • *LP** (low platelet count)

S/S:

  • headache
  • N&V
  • malaise
  • nonspecific viral-like symptoms
  • changes in vision
  • shoulder pain when breathing deeplyprotein in urine
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3
Q

One thing (out of many, many things) we may need to screen for if a woman complains of abdominal pain

A

ectopic pregnancy

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4
Q

Some information Dr.T added about Placental abruption

A
  • Woman may just be put on bed rest
  • Doc with react based on hormone levels, O2 going to baby, and baby’s ability to get nutrition.
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5
Q

What do you do if a preganant woman reports she is spotting?

A

Get her to her OB?GYN or PCP to get check. She may need an ultrasound to find out why she is spotting.

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6
Q

What weeks are the 1st trimester?

A

Week 1 - 12

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7
Q

What weeks are the 2nd trimester?

A

Weeks 13 - 27

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8
Q

What weeks are the 3rd trimester?

A

Weeks 28 - 40

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9
Q

Precautions for Exam and Treatment of pregnant women (7)

A
  1. Positions that involve abdominal compression in mid to late pregnancy (prone flat lying)
  2. Positions in supine for longer than a few minutes after 4th month
  3. Activities that strain the pelvic floor and abdominal muscles
  4. Positions that require rapid balance changes
  5. Vigorous stretching of hip adductors
  6. Overheating
  7. Deep heat, electrical stim over trunk
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10
Q

why are positions in supine for longer than a few minutes after 4th month a precaution?

A

supine hypotension syndrome,

pressure on inferior vena cava

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11
Q

Why is vigorous stretching of hip adductors a precaution?

A

Due to its impact on the pubic symphasis

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12
Q

Why is overheating a precaution?

A

fetal health concern with ↑ maternal core temperature

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13
Q

Which direction does a pregnant woman’s center gravity move?

A

foward and down

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14
Q

General changes that may occur post-partum that require some special consideration with physical therapy (5) PEGS-O

A
  • Pelvic floor
  • Endurance
  • Generalized ligamentous integrity
  • Strength
  • Other tissues that require special consideration
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15
Q

Special Questions to ask a pregnant patient- Table 17.4

Any complications with this pregnancy (e.g., uterine bleeding, premature contractions, incompetent cervix, pregnancy induced hypertenson, preeclampsia, or other need for special tests or bed rest)?

A

Ramifications

A positive response may alter teh rigor of the PT exam and any exercise prescription given by the PT and may necessitate monitoring of vital signs and symptoms with each visit.

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16
Q

Special Questions to ask a pregnant patient- Table 17.4

Any complications with a previous pregnancy or delivery that is placing you at high risk now? Were you considered high risk in a previous pregnancy?

A

Ramifications

For example, preterm labor in one pregnancy places a woman at risk for a similar outcome in subsequent pregnancies. Monitoring a woman for signs of preterm labor should occur with each visit.

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17
Q

Special Questions to ask a pregnant patient- Table 17.4

Did you have any of your current MSK symptoms during a previous pregnancy and, if so, what was done with them? Was the treatment successful?

A

Ramifications

This info can aid the PT in treatment planning

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18
Q

Special Questions to ask a pregnant patient- Table 17.4

What meds are currently being taken and what meds did you stop b/c of your pregnancy?

A

Ramifications

Meds such as NSAIDs, antidepressants, and migraine prescriptions that are contraindicated in pregnancy can affect symptoms of the MSK system and a patient’s pain perception and affect.

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19
Q

Special Questions to ask a pregnant patient- Table 17.4

Are you currently having any urinary or anal incontinence?

A

Ramifications

Recognition of this condition will aid the PT and patient in treatment before and after delivery.

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20
Q

Special questions to a postpartum patient- Table 17.5

Were you on bed rest during your pregnancy? If so, for how long?

A

Ramification

Debilitation may have resulted in prolonged bed rest and may necessitate treatment or modifications

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21
Q

Special questions to a postpartum patient- Table 17.5

Did any of teh following occur during delivery: regional anesthetic injection; forceps or vacuum extraction; episiotomy or tearsof the perineum; cesarean?

A

Ramifications

Debilitation may have resulted from prolonged bed rest and may necessitate treatment or midifications

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22
Q

Special questions to a postpartum patient- Table 17.5

Do you now have symptoms of urinary or anal incontinence or organ prolapse?

A

Ramifications

Referral to a PT with training in rehab of the pelvic floor would be appropriate

23
Q

Special questions to a postpartum patient- Table 17.5

Did you have your current symptoms during your pregnancy or after a previous pregnancy and, if so, was there any treatment that was successful in ameliorating these symptoms?

A

Ramifications

A positive response may assist in determining cause, interventions, and prognosis

24
Q

Pregnancy stages:

What happens at month 1? month 2? month 3?

(sounded like we don’t need to have these lists memorized- just general idea of what is going on?)

A

Month 1

  • start of first trimester
  • ovulation and conception
  • during week 4 some home pregnancy tests will detect that you have conceived
  • the embryo is just 2 cells
  • baby is most vulnerable to environmental stressors (drinking, drugs, ect.)

Month 2

  • signs of pregnancy: extreme fatigue, frequent urination, morning sickness, and hormonal fluctuations
  • The baby’s heart is beating
  • The baby’s brain is formed
  • Baby is most vulnerale to environmental stressors

Month 3

  • embryo officially becomes a fetus
  • decreased orning sickness
  • fetus is about teh size of a plum
25
Q

Pregnancy stages:

What happens at month 4? month 5? month 6?

(sounded like we don’t need to have these lists memorized- just general idea of what is going on?)

A

Month 4

  • start of the 2nd trimester
  • baby’s bones are hardening and will now show up on an x-ray
  • baby is about 5 inches long and weighs about 5 ounces
  • mom may start to show

Month 5

  • you begin to feel the baby start to kick
  • the baby’s hearing starts developing
  • Common discomforts during this month: backaches, indegestion, heart burn, headaches, water retention, dizziness, constipation

Month 6

  • This month marks the halfway mark in your pregnancy
  • at the end of teh month, the baby is almost fully formed
26
Q

Pregnancy stages:

What happens at month 7? month 8? month 9?

(sounded like we don’t need to have these lists memorized- just general idea of what is going on?)

A

Month 7

  • braxton hicks contractions possible
  • baby’s brain is beginning to process sights and sounds
  • baby is about 13 inches long

Month 8

  • the baby is fully formed and putting on weight
  • baby’s lungs are almost fully developed

Month 9

  • Common discomforts: braxton hicks contractions, pelvic pressure, difficulty sleeping
27
Q

True or false: Medications, both prescription and OTC, and herbal supplements that cross the placental barrier may be harmful to baby

A

True

28
Q

Some things a woman should think about with regards to breastfeeding

A
  • Must discuss medication use with physician
  • if a drug is allowed, should be taken 30-60 minutes after breastfeeding and 3-4 hours before next feed
  • Will need to consider diet, meds, and exercise and it’s effect on the breastmilk for as long as the woman breastfeeds
29
Q

What are the categories (just labels) for medications with pregnancy and lactation?

A

A

B

C

D

X

30
Q

What does a category A drug mean?

A

controlled stdies in human beings have demonstrated no fetal risk

(Not likely to be an RTC since preggo women are not likely to submit to this type of research)

31
Q

What does category B mean?

A

Animals studies indicate no fetal risk (no human studies are availible). It also can mean that adverse effects have occurred in some animal studdies but not in well-controlled human studies.

32
Q

What does category C mean?

A

No adequate human or animal studies, or there are no human studies to substantiate negative animal studies. Risk cannot be ruled out in humans

33
Q

What does category D mean?

A

Evidence to indicate feta risk, but benefits are thought to outweigh these risks

34
Q

What is category X?

A

drugs contraindicated in hman pregnancy. Fetal risks outweigh any potential benefits.

35
Q

Is Emetrol for nausea safe for pregnant women?

A

Yes

36
Q

Is a radiograph safe during pregnancy?

A
  • avoid plain film radiographs in 1st trimester, especially to trunk or back
  • Abdominal lead shields give some protection
37
Q

Are CT scans safe during pregnacy?

A
  • Not recommended in any trimester
  • Dr. T added caveat that if there was fear of a brain bleed then CT scan may be appropriate
38
Q

Are MRIs recommended during pregnancy?

A

considered low risk and preferential to CT

39
Q

Is Diagnostic Ultrasound recommended with pregnancy?

A
  • commonly used
  • but video display may ↑thermal effects, especially in 3rd trimester
40
Q

What is Dilutional anemia?

A
  • ↑ blood volume
  • anemia can occur even with compensatory ↑ in EPO and RBCs
  • ~10.5 gm/dL considered normal in pregnancy
  • compared to 12-16 gm/dL in normal women
  • pregnant women canusually just take an iron supplement
  • if below 10.5 gm/dL, then may need a stronger intervention
41
Q

What is Chorionic villus sampling?

A
  • early detection of genetic disorders
  • 10-13 weeks
  • 1-2% chance of miscarriage
  • Dr. T thinks due to risk a genetic counselor should be involved.
42
Q

What is Amniocentesis?

A
  • done at 16-18 weeks for genetic disorders
  • book lists 1/270 chance of miscarriage (0.004%), but most sources cite 0.5-1.0% - many factors involved (baby health, timing, high risk pregnancy)
  • Dr. T used spina bifida as an example for using amniocentesis or chorionic villus sampling. Detecting spina bifida means that possibly some repair can be done while the baby is in the uterus.
43
Q

What can cause gestational diabetes?

A
  • Hormones released by the placenta
    • human placental lactogen and human placental growth hormone
  • ↑ blood glucose and also cause insulin resistance
44
Q

Screening process fo gestational diabetes

A
  • Usual screening 24-28 weeks
  • GTT, should show fasting level of 105 mg/dL, 1 hr of 190, 2 hour of 165, 3 hour of 145
  • Screen usually determines whether full GTT is needed
  • May or may not show symptoms, thus screening is part of regular prenatal care
45
Q

What can gestational diabetes lead to?

A

Can ↑ BP during pregnancy, risk of Type 2 DM later on

46
Q

Why does gestation diabetes suck for the baby?

A
  • Hypoglycemia upon birth (corrected with feeding or glucose supplement)
  • Respiratory distress at birth
  • ↑ fetal size, extra fat
  • ↑ incidence of developmental disabilities
  • ↑ incidence of Type 2 DM
47
Q

What is “High Risk” pregnancy?

A

“High risk” is defined as any fetal or maternal condition that can adversely affect the pregnancy, usually with a premature delivery

  • 2015 preterm birthrate in the US – 9.6%
  • 2013 Infant mortality in the US – 7.4/1000 live births
  • US comes in 3rd for infant mortality for the world
48
Q

List some pre-existing maternal conditions that make a pregnancy high risk. (6)

(general terms)

A
  • heart and lung disease
  • diabetes
  • disability
  • chronic illness
  • substance abuse
  • lack of prenatal care
49
Q

Complications that make a pregnancy high risk (8)

(more specific tems)

A
  • preeclampsia
  • preterm labor
  • premature rupture of membranes
  • pregnancy-induced hypertension
  • pulmonary edema
  • hyperemesis gravidum
  • multiple gestation
  • cardiomyopathy
50
Q

Some points about bed rest for high risk pregnancy

A
  • Used 18.2% of time
  • ↓ weightbearing produces changes in every body system
  • may delay birth
51
Q

Trivia: The place Dr. Mincer was talking about in Ethiopia about the hospital that helps girls and women with fistulas

A
  • Addis Ababa Fistula Hospital
  • http://hamlinfistula.org/
  • Founded by Dr. Catherine Hamlin and her husband Dr Reginald Hamlin
  • MB would love to work here some day
52
Q

What is an incompetent cervix?

A

also called a cervical insufficiency, is a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy

Treatment:may put in some stitches at the cervix, called Cerclage, and may prescrie bedrest

53
Q

Psychosocial Complications of Pregnancy and Post-Partum Period

A
  • Psychosocial transitions cause great emotional distres
    • Influenced by hormonal and other bodily changes
    • Influenced by culture and ethnicity, expectations and belief systems surrounding the woman
    • Be observant for signs of emotional distress, low coping, perinatal depression
  • Rate of domestic violence estimated ~10%
    • Partner who does not allow the woman to speak for herself, refuses to let PT interview alone, will not leave the area, controls access
    • Physical exam – bruising, hygiene, vaginal spotting
54
Q

Common pregnancy issues include (10)

(involve mechanical compression or hormonal changes that occur in a preggo woman’s body)

A
  • Hypertension – most common, 140/90 or higher
  • Venous thromboembolism
  • Dyspnea, ↑ as pregnancy progresses
  • ↓GI motility and constipation
  • Nausea, vomiting, hyperemesis
  • GERD
  • Gallstones (cholelithiasis)
  • Urinary tract infections, cystitis, acute kidney infection (pyelonephritis), urinary incontinence due to pressure on the urogenital structures
  • Anal incontinence, 4-15%
  • Organ prolapse postpartum, such as cystocele (bladder)

Thompson Exam 4 and 5 (9 decks)

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