Exam III Flashcards
What is recommended for preconception care in a female with chronic diseases?
use the fewest medications at the lowest dosages needed to control the disease
What are the folate requirements?
- 400 mcg daily before pregnancy until 6-12 weeks postconception
- 4-55 mg folate daily 3 months before and 12 weeks after
How long should a woman wait to conceive after coming off birth control?
2-3 cycles
When should healthy changes be made prior to conception?
3 months to 1 year before conception
At what dose can caffeine reduce fertility?
more than 300 mg of caffeine per day reduces fertility by 27%
What is the MC serious disease to affect pregnancy?
diabetes
In the 1st trimester, hypothyroidism is associated with ___?
cognitive impairment in children
What is the MC neurologic disease to affect pregnant women?
seizure disorders
Mothers are more satisfied with care from which providers?
midwifes and PCPs
During what time of the pregnancy is there a heightened fetal vulnerability to teratogens?
the first 12 weeks
==>organogenesis
When is air travel safe for pregnant moms?
safe until 4 weeks before EDD
When should hot tubs and saunas be avoided?
during the first trimester
What is maternal heat exposure during early pregnancy associated with?
neural tube defects and miscarriage
What are the exercise recommendations for pregnant women?
- avoid activities that risk falls or abdominal injuries
- at least 30 min of moderate exercise
What is associated with exposure to radiation during pregnancy?
- increased risk of miscarriages
- elevated risk of childhood cancers
Lead exposure is associated with ___?
cardiovascular defects
Using wood, coal or tires for cooking or heating is associated with ___?
neural tube defects
What is one of the leading causes of neurodevelopmental deficits in children in the United States?
fetal alcohol spectrum disorder (FASD)
What is the relationship of periconception smoking and congenital heart defects?
3x increased risk of congenital heart defects
What are some risk factors associated with paternal smoking?
greater risk of developing leukemia in the childhood period
What are some risks associated with periconception smoking?
- intrauterine growth restriction
- prematurity
- SIDS
What are some contraindications of breastfeeding?
- maternal HIV infxn
- chemical dependency
- use of certain meds
How much do caloric requirements increase in pregnancy?
340 to 450 kcal per day in the 2nd and 3rd trimesters
What is the recommended weight gain in women with normal BMI?
~25-35 lbs
What is the RDI for calcium?
1000-1300 mg/day
What is associated with high vitamin A intake?
cranial-neural crest defects
What should vitamin A intake be limited to?
5000 IU per day
What is the recommended dose of vitamin D?
1000-5000 IU per day
Which artificial sweetener increases the risk of CA and can cross the placenta?
saccharin
What are some guidelines regarding caffeine consumption?
limit to 150-300 mg per day
Which herbal teas are safe in moderation?
- ginger
- citrus peel
- lemon balm
- rose hips
Which herbal teas should be avoided?
- chamomile
- licorice
- peppermint
- raspberry leaf
What are the characteristics of mild contractions?
begin 15 to 20 minutes apart and last 60 to 90 seconds
What characterizes “active labor”?
- strong contractions
- last 45 to 60 seconds
- occur 3 to 4 min apart
What is the “bloody show” and when does it happen?
days/weeks before labor, cervix softens, dilates releasing the mucus plug
What is effacement?
when contractions pull up and shorten the cervix
==>”polarity”
What does the first stage of labor consist of?
begins with the onset of regular contractions and ends with full dilation of the cervix
What is the latent first stage?
- dilates 0-3 cm
- approx. 7-10 hrs
What is the active first stage?
-dilates from 4 to 7 cm
==>about 3-5 hrs
-should be at her “birthplace”
What is “transition”?
-last phase of the first stage
-dilates from 8 to 10 cm
==>about 30-90 min
-most physically & emotionally taxing phase
What does the second stage of labor consist of?
begins with full dilation of the cervix, descent, crowning & ends with birth of the baby
==>30 min to 3+ hrs
What is “labor down”?
- natural “lull” occurs
- should rest during this time and not push
What are the mechanisms of birth?
aka: cardinal movements
- flexion
- descent
- internal rotation
- delivery of head
- restitution
- external rotation
What is the reference point for the fetal stations?
ischial spine = 0
==>above = -#
==>below = +#
What does the third stage of birth consist of?
begins with birth of baby and ends with birth of placenta
==>about 5-50 min
What can help with placental detachment?
breastfeeding
==>stimulates oxytocin which stimulates uterine contractions
What is Credes’ Method?
used to identify placental detachment
With Credes’ Methond, what does cord retraction indicate?
that the placenta has not detached yet
With Credes’ Methond, what does it mean if the cord remains lengthened?
that the placenta has detached
What is the normal amount of blood loss during birth?
~250 ml
Excessive bleeding after birth should be taken as a sign of ___?
retention of placental parts until proven otherwise
Which placental types have a higher risk of tearing/retention?
- circumvallate
- succenturiate
- bipartite/tripartite
- duplex
What does the fourth stage of labor consist of?
begins with placental birth and ends with the recovery of the new mother
==>about 4-6 hrs
True or False: pain relief commonly results in mother satisfaction?
False
What are some recommendations for the use of warm water baths during labor?
- wait for active labor
- maintain water at or below body temp
- limit bath time to 1-2 hrs
Is a warm water bath the same as a water birth?
no, warm water baths are typically used as an analgesic tactic
When is water birth not recommended?
- maternal herpes
- breech baby
- multiple babies
- maternal bleeding or infxn dx
- preterm labor suspected
- preeclampsia
- severe meconium
How do sterile-water injections work?
causes a burning sensation that acts as a conterirritation
==>lasts 45-90 min
What are some positives concerning opioids compared to epidurals?
- lower oxytocin augmentation rate
- shorter stages of labor
- fewer cases of malpositioning
- fewer instrument-assisted deliveries
Opioid effects on infants
- resp. depression
- dec. alertness
- inhibition of sucking
- lower neurobehavioral scores
- delay in effective feeding
What are some benefits to delayed cord clamping?
- 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
What are some symptoms that may identify serious complications of pregnancy?
- bleeding or spotting
- nausea, vomiting
- fatigue
- edema
How much does a HR increase at term?
10-30%
==>10-15 bpm
How does respiratory rate change?
increases ventilation by breathing more deeply not more frequently
What qualifies as gestational hypertension?
- systolic > 140 OR
- diastolic > 90
What qualifies as preeclampsia?
- systolic > 160 OR
- diastolic > 110
What is the MC cause of maternal death?
preeclampsia
What is the recommended weight gain for an underweight mother?
28-40 lbs
What is the recommended weight gain for an overweight mother?
15-25 lbs
What is the recommended weight gain for an obese mother?
no more than 11-20 lbs
What accounts for most of the weight gain in the 1st and 2nd trimesters?
maternal tissue
==>placenta, adipose deposits, amniotic fluid etc.
What accounts for most of the weight gained in the 3rd trimester?
fetal growth
How much weight from the total weight gained comes from fetal growth?
5-10 lbs
How much weight gain is expected in the 1st trimester?
3-6 lbs
How much weight gain is expected in the 2nd & 3rd trimester?
0.5 - 1 lbs/week
What are some maternal complications seen in obese women?
- gestational HTN/preeclampsia
- gestational diabetes
- cesarean delivery
- failure to initiate breastfeeding
When do stretch marks appear?
during the 2nd trimester
When do telangiectasias appear?
during the 2nd - 5th month
Other than skin stretching, what could be another potential cause of itching during pregnancy?
liver dysfunction resulting in ridding the body of toxins through the skin
What are the characteristics of PUPPS?
intense pruritic rash that starts on the abdomen and spares the periumbilical area as well as the face, palms and soles
What are some characteristics of Herpes Gestationis?
- rare autoimmune disorder of pregnancy
- not related to herpes virus
- intense pruritis
- palms and soles are frequently affected
What are Krukenburg Spindles?
increase in corneal epithelial pigmentation
What are some expected findings regarding the thyroid?
- enlarged thyroid due to hyperplasia of glandular tissue
- increased vascularity may result in a bruit
What are some expected findings in the eye during pregnancy?
- ptosis
- corneal thickening/edema
- greasy tears due to lysosome
- subconjunctival hemorrhages
What are some expected findings the ENT examination?
- edema and erythema in nose and pharynx
- red tympanum
- reddened, swollen gums
- epistaxis
What are some expected findings in the thorax during pregnancy?
- 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
When would dyspnea become a concern?
If it is accompanied by dizziness, lightheadedness etc.
==>CV concerns
How is the apical impulse changed?
moves up and 1-1.5 cm lateral
How much does blood volume increase?
40-50%
==>mainly due to plasma volume increase
How much does cardiac output increase?
40-50%
==>highest by 24 weeks (2nd-3rd tri)
What are some heart sound changes seen during pregnancy?
- audible splitting of S1 and S2
- S2 may be heard after 20 weeks
- grade II systolic ejection murmur
Where is the systolic ejection murmur most typically heard?
over the pulmonic area
What happens to BP during the 2nd trimester?
it decreases but returns to pre-pregnancy in the 3rd trimester
What is the best position for a pregnant mom to sleep in?
left lateral recumbent position
How early can colostrum begin?
as early as the 6th week gestation
What is Naeglele’s Rule?
add 7 days to the first day of the last normal menstrual period and count back 3 months
How is fundal height measured?
- empty bladder
- supine
- from upper part of pubic symphysis to superior fundus
- recorded in cm
When is the fundal height most accurate?
between 20-30 weeks
What is the expected fundal growth?
1 cm per week
Where would the 40 week fundal measurement fall?
at the 36 week due to the baby dropping
What is a hydatidiform mole?
tissues that aren’t differentiating but are multiplying
What is the MC presenting symptom in a complete hydatidiform mole?
vaginal bleeding
What are some other findings in a complete hydatidiform mole?
- hypermesis
- preeclampsia
- large for date uterus
- hyperthyroidism
What is a serious complication of a hydatidiform mole?
cancer transformation
==>mets MC to local tissues, lung or brain
What is a follow up test done with a hydatidiform mole?
bHCG tested monthly for 6-12 months
What classifies as a spontaneous abortion?
pregnancy loss at less than 20 weeks gestation
What is a “threatened abortion”?
a pregnancy complicated by bleeding before 20 weeks gestation
What is an “inevitable abortion”?
cervix has dilated but products of conception have not been expelled
What accounts for the majority of spontaneous abortions?
chromosomal abnormality (49%)
What finding decreases the likelihood of a spontaneous abortion?
fetal heartbeat identification decreases risk from 50% to 3%
What is the likely cause of vaginal bleeding in the 2nd or 3rd trimester accompanied by no pain?
placenta previa
What is the MC cause of an abruptio placentae?
HTN
What is the 2nd MC cause of an abruptio placentae?
trauma
What is abruptio placentae?
separation of the placenta after the 20th week of gestation
What is the presentation of an abruptio placentae?
- vaginal bleeding
- abdominal or back pain w/ uterine tenderness
- fetal distress
- abnormal uterine contractions
- premature labor
What is polyhydramnios?
abnormally high level of amniotic fluid
==> >2000 mL
What is the MC presentation of preeclampsia?
HTN and proteinuria
What are some paternal specific risk factors?
- first-time father
- previously fathered a preeclamptic pregnancy
What may be given during labor in preeclamptic patients?
magnesium sulfate
==>prevent seizures
==>can also slow labor
What does HELLP stand for?
- Hemolysis
- Elevated Liver enzymes
- Low Platelet count
What is eclampsia?
sever complication of preeclampsia
==>new onset of seizures in a woman with preeclampsia
What are the 4 major things a mom can do to prevent gestational diabetes?
- don’t smoke/non-smoker
- physical activity
- healthy eating
- pre-pregnancy BMI <25
When is the initial screening for gestational diabetes done?
at 24-28 weeks
==>50g, 1 hr glucose challenge test
What is normal for the gestational diabetes screening?
<130/140 mg/dL
What is the recommended diet for gestational diabetes?
meets pregnancy needs but restricts carbs to 35-40% of daily Cal
What is involution?
process where the uterus is transformed form pregnant to non-pregnant state
What is puerperium?
time after birth to about a few weeks after (~6 weeks)
What are the 3 types of lochia?
-lochia rubra (1-3 weeks) ==>red -lochia serosa ==>brownish red -lochia alba ==>yellow
What is the MC type of lochia?
type 1
==>prolonged breastfeeding
What does type 2 lochia consist of?
- prolonged rubra phase
- short or no breastfeeding
What does type 3 lochia consist of?
- two rubra phases
- variant of type 2
When does thyrotoxicosis typically occur?
1-4 months postpartum
When does hypothyroidism typically occur?
4-8 months postpartum
What are some lab test findings associated with thyrotoxicosis?
decreased TSH
What are some lab test findings associated with hyppthyroidism?
increased TSH
What effects does progesterone have the the MSK system?
- alters vascular supply
- decreases smooth muscle tone
What effects does estrogen have the the MSK system?
relaxes joint capsule
What effects does relaxin have the the MSK system?
allows pelvis to open
“Morning sickenss” should be evaluated further if it begins when?
after 9 weeks of gestation
Which hormone may be linked to LBP?
progestin
Pain with IN ilium
- opposite glut medius
- inguinal pain
- anterior thigh pain
Pain with EX ilium
- ipsi glut medius
- medial knee
- back of thigh
What should you adjust if you have a P sacrum accompanied by either an AS, IN or ASIN?
adjust sacrum
What should you adjust if you have a P sacrum accompanied by either a PI, EX or PIEX?
adjust ilium
