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ObPeds > Exam III > Flashcards

Exam III Flashcards

1
Q

What is recommended for preconception care in a female with chronic diseases?

A

use the fewest medications at the lowest dosages needed to control the disease

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2
Q

What are the folate requirements?

A
  • 400 mcg daily before pregnancy until 6-12 weeks postconception
  • 4-55 mg folate daily 3 months before and 12 weeks after
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3
Q

How long should a woman wait to conceive after coming off birth control?

A

2-3 cycles

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4
Q

When should healthy changes be made prior to conception?

A

3 months to 1 year before conception

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5
Q

At what dose can caffeine reduce fertility?

A

more than 300 mg of caffeine per day reduces fertility by 27%

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6
Q

What is the MC serious disease to affect pregnancy?

A

diabetes

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7
Q

In the 1st trimester, hypothyroidism is associated with ___?

A

cognitive impairment in children

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8
Q

What is the MC neurologic disease to affect pregnant women?

A

seizure disorders

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9
Q

Mothers are more satisfied with care from which providers?

A

midwifes and PCPs

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10
Q

During what time of the pregnancy is there a heightened fetal vulnerability to teratogens?

A

the first 12 weeks

==>organogenesis

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11
Q

When is air travel safe for pregnant moms?

A

safe until 4 weeks before EDD

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12
Q

When should hot tubs and saunas be avoided?

A

during the first trimester

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13
Q

What is maternal heat exposure during early pregnancy associated with?

A

neural tube defects and miscarriage

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14
Q

What are the exercise recommendations for pregnant women?

A
  • avoid activities that risk falls or abdominal injuries

- at least 30 min of moderate exercise

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15
Q

What is associated with exposure to radiation during pregnancy?

A
  • increased risk of miscarriages

- elevated risk of childhood cancers

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16
Q

Lead exposure is associated with ___?

A

cardiovascular defects

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17
Q

Using wood, coal or tires for cooking or heating is associated with ___?

A

neural tube defects

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18
Q

What is one of the leading causes of neurodevelopmental deficits in children in the United States?

A

fetal alcohol spectrum disorder (FASD)

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19
Q

What is the relationship of periconception smoking and congenital heart defects?

A

3x increased risk of congenital heart defects

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20
Q

What are some risk factors associated with paternal smoking?

A

greater risk of developing leukemia in the childhood period

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21
Q

What are some risks associated with periconception smoking?

A
  • intrauterine growth restriction
  • prematurity
  • SIDS
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22
Q

What are some contraindications of breastfeeding?

A
  • maternal HIV infxn
  • chemical dependency
  • use of certain meds
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23
Q

How much do caloric requirements increase in pregnancy?

A

340 to 450 kcal per day in the 2nd and 3rd trimesters

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24
Q

What is the recommended weight gain in women with normal BMI?

A

~25-35 lbs

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25
Q

What is the RDI for calcium?

A

1000-1300 mg/day

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26
Q

What is associated with high vitamin A intake?

A

cranial-neural crest defects

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27
Q

What should vitamin A intake be limited to?

A

5000 IU per day

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28
Q

What is the recommended dose of vitamin D?

A

1000-5000 IU per day

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29
Q

Which artificial sweetener increases the risk of CA and can cross the placenta?

A

saccharin

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30
Q

What are some guidelines regarding caffeine consumption?

A

limit to 150-300 mg per day

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31
Q

Which herbal teas are safe in moderation?

A
  • ginger
  • citrus peel
  • lemon balm
  • rose hips
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32
Q

Which herbal teas should be avoided?

A
  • chamomile
  • licorice
  • peppermint
  • raspberry leaf
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33
Q

What are the characteristics of mild contractions?

A

begin 15 to 20 minutes apart and last 60 to 90 seconds

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34
Q

What characterizes “active labor”?

A
  • strong contractions
  • last 45 to 60 seconds
  • occur 3 to 4 min apart
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35
Q

What is the “bloody show” and when does it happen?

A

days/weeks before labor, cervix softens, dilates releasing the mucus plug

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36
Q

What is effacement?

A

when contractions pull up and shorten the cervix

==>”polarity”

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37
Q

What does the first stage of labor consist of?

A

begins with the onset of regular contractions and ends with full dilation of the cervix

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38
Q

What is the latent first stage?

A
  • dilates 0-3 cm

- approx. 7-10 hrs

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39
Q

What is the active first stage?

A

-dilates from 4 to 7 cm
==>about 3-5 hrs
-should be at her “birthplace”

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40
Q

What is “transition”?

A

-last phase of the first stage
-dilates from 8 to 10 cm
==>about 30-90 min
-most physically & emotionally taxing phase

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41
Q

What does the second stage of labor consist of?

A

begins with full dilation of the cervix, descent, crowning & ends with birth of the baby
==>30 min to 3+ hrs

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42
Q

What is “labor down”?

A
  • natural “lull” occurs

- should rest during this time and not push

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43
Q

What are the mechanisms of birth?

A

aka: cardinal movements
- flexion
- descent
- internal rotation
- delivery of head
- restitution
- external rotation

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44
Q

What is the reference point for the fetal stations?

A

ischial spine = 0
==>above = -#
==>below = +#

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45
Q

What does the third stage of birth consist of?

A

begins with birth of baby and ends with birth of placenta

==>about 5-50 min

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46
Q

What can help with placental detachment?

A

breastfeeding

==>stimulates oxytocin which stimulates uterine contractions

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47
Q

What is Credes’ Method?

A

used to identify placental detachment

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48
Q

With Credes’ Methond, what does cord retraction indicate?

A

that the placenta has not detached yet

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49
Q

With Credes’ Methond, what does it mean if the cord remains lengthened?

A

that the placenta has detached

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50
Q

What is the normal amount of blood loss during birth?

A

~250 ml

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51
Q

Excessive bleeding after birth should be taken as a sign of ___?

A

retention of placental parts until proven otherwise

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52
Q

Which placental types have a higher risk of tearing/retention?

A
  • circumvallate
  • succenturiate
  • bipartite/tripartite
  • duplex
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53
Q

What does the fourth stage of labor consist of?

A

begins with placental birth and ends with the recovery of the new mother
==>about 4-6 hrs

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54
Q

True or False: pain relief commonly results in mother satisfaction?

A

False

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55
Q

What are some recommendations for the use of warm water baths during labor?

A
  • wait for active labor
  • maintain water at or below body temp
  • limit bath time to 1-2 hrs
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56
Q

Is a warm water bath the same as a water birth?

A

no, warm water baths are typically used as an analgesic tactic

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57
Q

When is water birth not recommended?

A
  • maternal herpes
  • breech baby
  • multiple babies
  • maternal bleeding or infxn dx
  • preterm labor suspected
  • preeclampsia
  • severe meconium
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58
Q

How do sterile-water injections work?

A

causes a burning sensation that acts as a conterirritation

==>lasts 45-90 min

59
Q

What are some positives concerning opioids compared to epidurals?

A
  • lower oxytocin augmentation rate
  • shorter stages of labor
  • fewer cases of malpositioning
  • fewer instrument-assisted deliveries
60
Q

Opioid effects on infants

A
  • resp. depression
  • dec. alertness
  • inhibition of sucking
  • lower neurobehavioral scores
  • delay in effective feeding
61
Q

What are some benefits to delayed cord clamping?

A
  • increased blood volume
  • reduced need for blood transfusion
  • decreased incidence of intracranial hemorrhage in preterm infants
  • lower frequency of iron def. anemia in term infants
62
Q

What are some symptoms that may identify serious complications of pregnancy?

A
  • bleeding or spotting
  • nausea, vomiting
  • fatigue
  • edema
63
Q

How much does a HR increase at term?

A

10-30%

==>10-15 bpm

64
Q

How does respiratory rate change?

A

increases ventilation by breathing more deeply not more frequently

65
Q

What qualifies as gestational hypertension?

A
  • systolic > 140 OR

- diastolic > 90

66
Q

What qualifies as preeclampsia?

A
  • systolic > 160 OR

- diastolic > 110

67
Q

What is the MC cause of maternal death?

A

preeclampsia

68
Q

What is the recommended weight gain for an underweight mother?

A

28-40 lbs

69
Q

What is the recommended weight gain for an overweight mother?

A

15-25 lbs

70
Q

What is the recommended weight gain for an obese mother?

A

no more than 11-20 lbs

71
Q

What accounts for most of the weight gain in the 1st and 2nd trimesters?

A

maternal tissue

==>placenta, adipose deposits, amniotic fluid etc.

72
Q

What accounts for most of the weight gained in the 3rd trimester?

A

fetal growth

73
Q

How much weight from the total weight gained comes from fetal growth?

A

5-10 lbs

74
Q

How much weight gain is expected in the 1st trimester?

A

3-6 lbs

75
Q

How much weight gain is expected in the 2nd & 3rd trimester?

A

0.5 - 1 lbs/week

76
Q

What are some maternal complications seen in obese women?

A
  • gestational HTN/preeclampsia
  • gestational diabetes
  • cesarean delivery
  • failure to initiate breastfeeding
77
Q

When do stretch marks appear?

A

during the 2nd trimester

78
Q

When do telangiectasias appear?

A

during the 2nd - 5th month

79
Q

Other than skin stretching, what could be another potential cause of itching during pregnancy?

A

liver dysfunction resulting in ridding the body of toxins through the skin

80
Q

What are the characteristics of PUPPS?

A

intense pruritic rash that starts on the abdomen and spares the periumbilical area as well as the face, palms and soles

81
Q

What are some characteristics of Herpes Gestationis?

A
  • rare autoimmune disorder of pregnancy
  • not related to herpes virus
  • intense pruritis
  • palms and soles are frequently affected
82
Q

What are Krukenburg Spindles?

A

increase in corneal epithelial pigmentation

83
Q

What are some expected findings regarding the thyroid?

A
  • enlarged thyroid due to hyperplasia of glandular tissue

- increased vascularity may result in a bruit

84
Q

What are some expected findings in the eye during pregnancy?

A
  • ptosis
  • corneal thickening/edema
  • greasy tears due to lysosome
  • subconjunctival hemorrhages
85
Q

What are some expected findings the ENT examination?

A
  • edema and erythema in nose and pharynx
  • red tympanum
  • reddened, swollen gums
  • epistaxis
86
Q

What are some expected findings in the thorax during pregnancy?

A
  • diaphragm rises as much as 4 cm
  • lower ribs flare
  • transverse diameter increases 2 cm
  • chest circumference increases 5-7 cm
  • costal angle >103 degrees
87
Q

When would dyspnea become a concern?

A

If it is accompanied by dizziness, lightheadedness etc.

==>CV concerns

88
Q

How is the apical impulse changed?

A

moves up and 1-1.5 cm lateral

89
Q

How much does blood volume increase?

A

40-50%

==>mainly due to plasma volume increase

90
Q

How much does cardiac output increase?

A

40-50%

==>highest by 24 weeks (2nd-3rd tri)

91
Q

What are some heart sound changes seen during pregnancy?

A
  • audible splitting of S1 and S2
  • S2 may be heard after 20 weeks
  • grade II systolic ejection murmur
92
Q

Where is the systolic ejection murmur most typically heard?

A

over the pulmonic area

93
Q

What happens to BP during the 2nd trimester?

A

it decreases but returns to pre-pregnancy in the 3rd trimester

94
Q

What is the best position for a pregnant mom to sleep in?

A

left lateral recumbent position

95
Q

How early can colostrum begin?

A

as early as the 6th week gestation

96
Q

What is Naeglele’s Rule?

A

add 7 days to the first day of the last normal menstrual period and count back 3 months

97
Q

How is fundal height measured?

A
  • empty bladder
  • supine
  • from upper part of pubic symphysis to superior fundus
  • recorded in cm
98
Q

When is the fundal height most accurate?

A

between 20-30 weeks

99
Q

What is the expected fundal growth?

A

1 cm per week

100
Q

Where would the 40 week fundal measurement fall?

A

at the 36 week due to the baby dropping

101
Q

What is a hydatidiform mole?

A

tissues that aren’t differentiating but are multiplying

102
Q

What is the MC presenting symptom in a complete hydatidiform mole?

A

vaginal bleeding

103
Q

What are some other findings in a complete hydatidiform mole?

A
  • hypermesis
  • preeclampsia
  • large for date uterus
  • hyperthyroidism
104
Q

What is a serious complication of a hydatidiform mole?

A

cancer transformation

==>mets MC to local tissues, lung or brain

105
Q

What is a follow up test done with a hydatidiform mole?

A

bHCG tested monthly for 6-12 months

106
Q

What classifies as a spontaneous abortion?

A

pregnancy loss at less than 20 weeks gestation

107
Q

What is a “threatened abortion”?

A

a pregnancy complicated by bleeding before 20 weeks gestation

108
Q

What is an “inevitable abortion”?

A

cervix has dilated but products of conception have not been expelled

109
Q

What accounts for the majority of spontaneous abortions?

A

chromosomal abnormality (49%)

110
Q

What finding decreases the likelihood of a spontaneous abortion?

A

fetal heartbeat identification decreases risk from 50% to 3%

111
Q

What is the likely cause of vaginal bleeding in the 2nd or 3rd trimester accompanied by no pain?

A

placenta previa

112
Q

What is the MC cause of an abruptio placentae?

A

HTN

113
Q

What is the 2nd MC cause of an abruptio placentae?

A

trauma

114
Q

What is abruptio placentae?

A

separation of the placenta after the 20th week of gestation

115
Q

What is the presentation of an abruptio placentae?

A
  • vaginal bleeding
  • abdominal or back pain w/ uterine tenderness
  • fetal distress
  • abnormal uterine contractions
  • premature labor
116
Q

What is polyhydramnios?

A

abnormally high level of amniotic fluid

==> >2000 mL

117
Q

What is the MC presentation of preeclampsia?

A

HTN and proteinuria

118
Q

What are some paternal specific risk factors?

A
  • first-time father

- previously fathered a preeclamptic pregnancy

119
Q

What may be given during labor in preeclamptic patients?

A

magnesium sulfate
==>prevent seizures
==>can also slow labor

120
Q

What does HELLP stand for?

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelet count
121
Q

What is eclampsia?

A

sever complication of preeclampsia

==>new onset of seizures in a woman with preeclampsia

122
Q

What are the 4 major things a mom can do to prevent gestational diabetes?

A
  • don’t smoke/non-smoker
  • physical activity
  • healthy eating
  • pre-pregnancy BMI <25
123
Q

When is the initial screening for gestational diabetes done?

A

at 24-28 weeks

==>50g, 1 hr glucose challenge test

124
Q

What is normal for the gestational diabetes screening?

A

<130/140 mg/dL

125
Q

What is the recommended diet for gestational diabetes?

A

meets pregnancy needs but restricts carbs to 35-40% of daily Cal

126
Q

What is involution?

A

process where the uterus is transformed form pregnant to non-pregnant state

127
Q

What is puerperium?

A

time after birth to about a few weeks after (~6 weeks)

128
Q

What are the 3 types of lochia?

A 
-lochia rubra (1-3 weeks)
 ==>red
-lochia serosa
 ==>brownish red
-lochia alba
 ==>yellow
129
Q

What is the MC type of lochia?

A

type 1

==>prolonged breastfeeding

130
Q

What does type 2 lochia consist of?

A
  • prolonged rubra phase

- short or no breastfeeding

131
Q

What does type 3 lochia consist of?

A
  • two rubra phases

- variant of type 2

132
Q

When does thyrotoxicosis typically occur?

A

1-4 months postpartum

133
Q

When does hypothyroidism typically occur?

A

4-8 months postpartum

134
Q

What are some lab test findings associated with thyrotoxicosis?

A

decreased TSH

135
Q

What are some lab test findings associated with hyppthyroidism?

A

increased TSH

136
Q

What effects does progesterone have the the MSK system?

A
  • alters vascular supply

- decreases smooth muscle tone

137
Q

What effects does estrogen have the the MSK system?

A

relaxes joint capsule

138
Q

What effects does relaxin have the the MSK system?

A

allows pelvis to open

139
Q

“Morning sickenss” should be evaluated further if it begins when?

A

after 9 weeks of gestation

140
Q

Which hormone may be linked to LBP?

A

progestin

141
Q

Pain with IN ilium

A
  • opposite glut medius
  • inguinal pain
  • anterior thigh pain
142
Q

Pain with EX ilium

A
  • ipsi glut medius
  • medial knee
  • back of thigh
143
Q

What should you adjust if you have a P sacrum accompanied by either an AS, IN or ASIN?

A

adjust sacrum

144
Q

What should you adjust if you have a P sacrum accompanied by either a PI, EX or PIEX?

A

adjust ilium

ObPeds (3 decks)

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