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obstetric - gynecol STEP 2 > first signs of pregnancy > Flashcards

first signs of pregnancy Flashcards

1
Q

Most common first symptom of pregnancy

A

amenorrhea - in women with regular menstruation (may be missed in women with irregular menses)

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2
Q

other early symptoms of pregnancy (beside amenorrhea) (and mechanism)

A
  1. breast tenderness
  2. nausea + vomiting (esp morning) (until 12 - 14th wk)
    - due to a surge in estrogen, progesteron, β-HCG
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3
Q

time for embryo, fetus + infant

A

embryo: fertilization - 8 wks gestation
fetus: 8 wks gestation - birth
infant: birth - 1 yr old

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4
Q

developmental age (DA) vs gestational age (GA)

A

DA: number of days since fertilization
GA: number of days/wks since lust period
GA=DA+2wks

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5
Q

Nagele rule (and example)

A

estimation of the day of delivery:
Last menstrual period - 3 months + 7 days
ex: if LMP at 1 oct 2015 –> july 8, 2016

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6
Q

pregnancy - trimester breakdown (dates)

A

1st: fertilization untl 12 wks DA (or 14 GA)
2nd: 12 wks - 24 wks DA
3rd: 24 wks DA until delivery

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7
Q

genitalia have men or female characteristics - when

A

10 wks DA

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8
Q

pregnancy - term lengths fetus (dates)

A
  1. pre viable: fetus born before 24 wks GA
  2. preterm: fetus born between 25-37 wks (GA)
  3. Term: a. ealy = 37wks - 38 + 6days
    b. full = 39 - 40 + 6days c. late = 41 - 41 + 6 days
  4. Late term: fetus born after 42 wks GA
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9
Q

Gravididy vs parity according to definitions

A

Gravididy: the number of times a patient has been pregnant
Parity: what happens to the pregnancy (Full term births –> preterm –> abortions –> living children)

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10
Q

Parity - characterstics in order

A
  1. Full term births
  2. preterm
  3. abortions (spontaneous or induced)
    living children
  4. living children (if multiple gestation pregnancy –> 1 birth results in more than 1 living children
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11
Q

Gravididy / parity example: 35 yrs old woman present for her 6th pregnancy. She had 2 abortions, 2 children born at term, and a set of twins born preterm

A

G 6 P 2 1 2 4

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12
Q

signs of pregnancy (only the names)

A
  1. Goodell sign
  2. Ladin sign
  3. Chadwick sign
  4. Telangiectasias/palmar erythema
  5. Chloasma
  6. Linea nigra
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13
Q

signs of pregnancy - names and time from conception

A
  1. Goodell sign (4 wks, 1st trimester)
  2. Ladin sign (6 wks, 1st trimester)
  3. Chadwick sign (6-8 wks, 1st trimester)
  4. Telangiectasias/palmar erythema (1st trimester)
  5. Chloasma (16 wks (2nd trimester)
  6. Linea nigra (2nd trimester)
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14
Q

Goodell sign - findings and time from conception

A

4 wks, 1st trimester

Softening of the cervix

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15
Q

Ladin sign - findings and time from conception

A

6 wks, 1st trimester

softening of the midline of the uterus

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16
Q

Chadwick sign - findings and time from conception

A

6-8 wks, 1st trimester

blue discoloration of vagina and cervix

17
Q

telangiectasia / palmar erythema - findings and time from conception

A

1st trimester

small blood vessels/reddening of the palms

18
Q

chloasma - findings and time from conception

A

2nd trimester
the mask of pregnancy: hyperpigmentation of face (MC forehead, nose, cheeks)
WORSEN IN SUN

19
Q

linea nigra - findings and time from conception

A

2nd trimester

a line of hyperpigmentation than can extend from xiphoid process to pubic symphisis

20
Q

Diagnostic evaluation of pregnancy

A
  • both urine and serum testing are based on β-HCG (Highly sensitive)
  • Ultrasound to confirm an intrauterine pregnancy
21
Q

β-HCG course in pregnancy

A

produced (by placenta) rapidly in 1st trimester, doubling every 48 hours for the first 4 weeks. At 10 weeks of gestation it peaks, and levels will typically drop in the 2nd trimester. In the 3rd t rimeter the levels increase slowly again to 20-30.000 IU/ml

22
Q

gestational sac appears on US - when

A

5 weeks or β-HCG 1000-1500 IU/ml

23
Q

physiologic changes in pregnancy - cardiology

A
  • increased CO, increased preload, decreased afteload, increased HR
  • slightly lower BP (lowest at 24-28 wks)
24
Q

physiologic changes in pregnancy - renal

A
  1. increase in size of kidney + uteres –> increased risk of pyelonephritis from compression of the ureters
  2. Increase in GFR (secondary to a 50% increase in plasma volume)
  3. decrease in BUN + Cr
  4. mild hyponatremia (due to increase ADH)
    due to increased cardiac output and renal blood flow due to progesterone with increased renal extraction
25
Q

physiologic changes in pregnancy - hematology

A
  1. anemia (2ry to increase 50% of plasma volume)
  2. hypercoagulation state
    - not increase PT, PTT or INR
    - increase in fibrinogen
    - decrease in protein S activity
    - increase in resistance to activated pr C
    Virchow triad occur –> venous stasis
26
Q

physiologic changes in pregnancy - respiratory

A

hyperventilation to eliminate fetal CO2

progesterone directly stimulates central resp center to increase tidal volume and minute ventilation

obstetric - gynecol STEP 2 (22 decks)

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