First trimester Flashcards
(111 cards)
1
Q
What are the 3 signs of pregnancy?
A
- Presumptive
- Probale
- Positive
2
Q
is a urine test quantitative or qualitative
A
qualitative
3
Q
When is a serum HCG test done
A
when there is no urine test available or its negative and blood is going to the lab anyway
4
Q
What is the difference between a qualitative and quantitative pregnancy test?
A
- Qualitative measures the presence of HCG
2. Quantitative measures the level of pregnancy hormone in the blood
5
Q
What size is the uterus at 6 weeks gestation
A
the same size as a normal non pregnant uterus
6
Q
When does the uterus rise out of the pelvis and become an abdominal organ during pregnancy
A
at about 12 weeks
7
Q
How often/many prenatal visits does a woman having during her pregnancy?
A
- every 4 weeks until 28 weeks
- every 2 weeks until 36 weeks
- Weekly until birth
8
Q
Does pregnancy protect the female against depression?
A
- No it does not
9
Q
What is preconception care?
A
Counseling and care provided to women and their partner before becoming pregnant.
10
Q
What is the preconception period?
A
The time before or between pregnancies
11
Q
What is the typical time frame of implantation bleeding?
A
1-2 weeks after ovulation
12
Q
The clinician is talking with a person who may become pregnant about exposure to some substances that can cause pregnancy loss. The CNM/WHNP knows that substances considered to be teratogenic:
A
Must have a stage-sensitive effect depending on the time of exposure during pregnancy
13
Q
During which period is exposure to a teratogen most likely to cause PREGNANCY LOSS? (think about the all-or-nothing principle)
A
At any time during pregnancy
14
Q
After ovulation, progesterone is first produced by which structure?
A
corpus luteum
15
Q
Teratogens that affect which organ can cause damage at any time during pregnancy
A
The brain
16
Q
Which of the following hormones of pregnancy stimulates the corpus luteum to continue to function?
A
Human chorionic gonadotropin
17
Q
The neural groove is the precursor to the
A
nervous system.
18
Q
During which period is exposure to a teratogen most likely to cause PREGNANCY LOSS? (think about the all-or-nothing principle)
A
During the first 15 days after conception
19
Q
Fetal heart begins to beat at how many days
A
21
20
Q
When is hug detectable in the urine and serum when
A
7 to 9 days after ovulation
21
Q
The HCG level doubles how many hours until days 63-70
A
31 to 35 hours
22
Q
Elevated levels of HCG early in pregnancy can be indicative of what?
A
- Multiple pregnancy
- Hemolytic disease
- Hydatiform mole
- Down syndrome
23
Q
HCG that is too low indicates what or that does not double every 2 days?
A
- Impending miscarriage
2. Ectopic pregnancy
24
Q
How long does the prenatal period last?
A
from the first day of the last normal period
25
Gravida means
The total number of times a woman has been pregnant
26
Para means
the number of births
27
What does term mean
The number of term births experienced by a female 37 weeks and beyond
28
What does A stand for in GPTA
The number abortions or miscarriages
29
L stands for what in GPTAL
the number of children living
30
GPTAL stands for what
1. Gravida number of pregnancies
2. Para number of births
3. Term Number of term births 37 weeks and above
4. A stands for abortions/miscarriages
5. L stands for living
31
When is the gestational sac visible on ultrasound?
| What would the HCG levels be
1. 4.5 - 5 weeks
| 2. 1,000
32
When is a yolk sac visible on ultrasound?
5 to 5.5 weeks and the HCG should be 1,000 - 7,200
33
When is the embryonic/fetal pole visible on ultrasound?
at 5-7 weeks and the HCG levels are around 7,200 - 10,800
34
Embryonic/fetal cardiac activity is seen on ultrasound at how many weeks?
6-7 weeks and the HCG levels should be ablve 10,800
35
What are causes of bleeding in the first trimester?
1. Ectopic pregnancy
2. Molar pregnancy
3. incomplete or inevitable loss
4. STI
5. Cervical irritation
6. Implantation bleeding
7. Fibroids
8. sub-chorionic hemorrhage
36
When is ovulation bleeding most common
around 2 weeks after ovulation
37
How do you calculate due date using Nagele's rule?
1. Add 7 days to the LMP
| 2. Then subtract 3 months
38
Which molecule signals the state of the follicular phase?
GnRH secretion produces a new follicular
39
Does progesterone provide negative or positive feedback to the anterior pituitary gland?
Negative feedback to prevent secretion of FSH and LH and to prevent the release of multiple follicles
40
For pregnant women with a subchorionic hemorrhage when is the best out come with this type of hemorrhage usually seen?
The outcome is better if they occur before the 20 weeks or early in the pregnancy because the clot is small and usually resolves spontaneously and is reabsorbed
41
What is the treatment for sub-chorionic hemorrhage
1. Pelvic rest for several weeks and reassurance this condition often resolves spontaneously
42
For pregnancy loss up to 10-13 weeks ACOG recommends using the term what?
Early pregnancy loss
43
Women without complete abortion can take time to consider their options preferably if their condition is?
Stable
44
Spontaneous expulsion in expectant management declines in what time frame and can take up to how long
1 week
| a month
45
Heavy bleeding is defined as
soaking through 2 pads in 2 hours
46
A medication that is safe to give for an abortion that does not start on its own is (1) as long as the pregnancy is 13 weeks or less
misoprostol
47
What is the time frame for misoprostol to evacuate the uterus?
4 to 16 hours
48
What is the normal dosing for misoprostol?
Misoprostol can be give orally in doses of 600 mg or 400 mg sublingual.
Oral treatment can be repeated twice within a 3 hour interval, the dosing can be space 6 to 12 hours for those experiencing side effects
49
What is the dosing for intra-vaginal misoprostol
800 mg repeating the dose between 3 hours and 7 days after administration
50
`Is fever a side effect of misoprostol
yes
51
To improve the health of women of reproductive age before conception thereby improving pregnancy related outcomes. A set of interventions to identify and modify biomedical, behavioral, and social risk to a womans health or pregnancy outcomes through prevention and management.
ACNM preconception care definition.
52
What are findings that are suggestive of early pregnancy loss?
1. crown-rump length < 7 mm without a heart beat
2. Mean sac diameter of 16–24 mm without embryo;
3. Absence of embryo with heart beat 7–13 days after ultrasound that showed a gestational sac without a yolk sac or 7–10 days after an ultrasound that showed a gestational sac with yolk sac
4. empty amnion; enlarged yolk sac > 7 mm; small gestational sac in relation to size of embryo; absence of embryo for ≥ 6 weeks after last menstrual period.
53
Describe symptoms of a woman having experiencing an ectopic pregnancy?
1. Spotting
2. bleeding or no bleeding
3. The cul-de-sac may be full of blood, causing the posterior vaginal fornix to bulge outward.
4. Pain in the neck or shoulder, especially on inspiration, may be present as a result of diaphragmatic irritation from blood in the peritoneal cavity.
54
If surgical intervention is not needed for an ectopic pregnancy what medication can be given to dissolve the pregnancy?
Methotrexate
55
Describe what an abdominal pregnancy is?
An abdominal pregnancy is a pregnancy that began as a tubal pregnancy and ruptured into the peritoneal cavity early enough so that the ovum remains viable and implants in the abdomen
56
What are symptoms of an abdominal pregnancy
1. Signs and symptoms include an inability to outline the uterus
2. the sensation that fetal parts are just “under the skin” of the woman.
3. The woman may have severe gastrointestinal symptoms that do not resolve with standard management.
4. Ultrasound examination does not always suffice for making the diagnosis, especially later in pregnancy
57
Why is abdominal pregnancy dangerous?
Abdominal pregnancy is a life-threatening condition due to adverse effects of placental implantation on abdominal organs such as the liver.
58
How is an abdominal pregnancy handled?
Birth must be by cesarean, and requires a tertiary setting wherein multiple subspecialists in maternal–fetal medicine and surgery are involved.
59
What is pregnancy of unknown origin?
The fetus is not seen on ultrasound and can not be found
60
What is the management of pregnancy of unknown origin
1. expectant management
2. medical
3. exploratory d and c
61
What are the complications of expectant management of a spontaneous abortion
incomplete abortion and retained POC
62
What is a prudent waiting period before offering intervention in a woman who has chosen expectant management of spontaneous abortion
2 week waiting period
63
What is the success rate of misoprostol
The success of misoprostol is 80% to 90% within 7 days
64
If a woman has had 3 or more miscarriage's what is the next step in her management
genetic counseling and an endocrine evaluation should be considered
65
What is standard evaluation for a woman with repeated miscarriages?
1. ultrasound to rule out congenital abnormalities of the genital tract
2. genetic testing
3. coagulation disorders
4. autoimmune disorders
5. Thyroid disorders
66
What is the term for bleeding that occurs between the chorion and myometrium
sub chorionic hemorrhage
67
What is the most common Gestational trophoblastic disease
hydatidiform mole
68
How does a hydatidiform mole arise
conditions that develop from abnormal placental
69
How do gestational trophoblastic neoplasms arise
from gestational trophoblastic disease
70
Besides hydatidiform mole what other types of gestational trophoblastic disease is there?
1. gestational choriocarcinoma
2. invasive moles
3. placental site trophoblastic tumor.
71
Where does the term hydatidiform mole come from?
Greek
hydatisia means drop of water
and the Latin word mola, which means “false conception.
72
How does a hydatidiform mole develop
A hydatidiform mole is a process in which a sperm fertilizes an ovum but only sperm DNA is present no embryonic tissue develops
73
How are molar pregnancies classified
1. complete
| 2. incomplete
74
The public health service in 1989 and 2005 recommended what schedule of visits for pregnant women?
8 visits for nulliparous
6 visits for mulitparous
with additional visits at 41 weeks for women with post date pregnancies
75
what are the two ways clinicians date pregnancy
1. LMP
| 2. ultrasound
76
Why would an estimated due date need to be changed
If there is a discrepancy between the LMP and U/S dating of fetal age of more than 5 days
77
LMP/US DATING EXAMPLE 1: For a patient whose ultrasound-based gestational age assessment is 7 2/7 weeks, if the menstrual-based EDB is 1/20/21 and the ultrasound-based EDB is 1/30/21 (those are different by more 5 days and the person is less than 8 6/7 weeks),
There LMP due date is 10/20/21 and the U/S due date is 1/30/21 go with the U/S
78
8 5/7 weeks.
| What does this mean
8 weeks
| 5 days
79
Which phase in pregnancy marks the beginning of the antepartum period?
The start of labor
80
What does G3 P2002 stand for
A woman who is currently pregnant with her 3rd baby she gave birth to a full term baby with each prior pregnancy
81
What does G2 P0101 stand for
A woman currently pregnant she gave birth to one preterm infant and has one live child
82
G3P1103 stands for
A woman currently pregnant with her 3rd pregnancy she gave birth to one full term infant and preterm twins all 3 alive
83
What is the mean menstrual age for pregnancy
283 to 284 days
84
By what week of pregnancy is organogenesis completed
at the end of 12 weeks
85
the second trimester was 13 to 28 weeks what was the reason
28 weeks was the limit of viability prior to the introduction of modern neonatal techniques
86
the first trimester last from
1 to 12 weeks
87
when does the 2nd trimester begin
13-28 weeks
88
when does the 3rd trimester begin
28 to 40 weeks
89
What are the 3 components of the diagnosis of pregnancy
1. confirm the pregnancy
2. establish gestational age
3. determine viability
90
What are the two positive signs of pregnancy
1. ultrasound visualization
| 2. fetal heart tones
91
During pregnancy what hormone is responsible for the softening of the cartilage, joint and ligament laxity
Progesterone on cartilage and joints
| estrogen and relaxin for ligament laxity
92
What causes hyperpigmentation during pregnancy?
Estrogen and progesterone and melanocyte-stimulating hormone induce melanocytes to make and deposit pigment
93
What creates stretch marks during pregnancy?
Elastin fibers at the dermal epidermal junction stretch and shift from perpendicular to parallel
94
Why might some pregnant woman experience protein in the urine?
Protein reabsorption is not as efficient as it is in the non-pregnant state
95
Why are pregnant women at increased risk for UTI during pregnancy
The ureters, urethra and bladder dilate under the influence of progesterone
96
Are urinary tract infections associated with preterm labor
yes
97
What is the first endocrine gland to appear in the fetus
Thyroid
98
When does the fetus begin to secrete TSH
18 to 20 weeks
99
The basal metabolic rate increases in pregnancy by what percentage
20 to 25
100
What thyroid hormones should the clinician assess during during pregnancy
Tsh
free t4
total t4
101
Why is oral care important during pregnancy
mothers can pass oral bacteria onto their babies
102
What laboratory test are recommended for pregnant women
```
Rh-D
CBC
HBsAg
HIV
Rubella titer
Syphilis
Varicella
Urinalysis
Urine culture
Chlamydia
Gonorrhea
```
103
When is the Rh D Rhogam given to pregnant women who lack allo-antibodies
28 weeks
104
What are pregnancy diagnosis
1. Pregnancy unknown location
2. Viable intrauterine pregnancy
3. Threatened spontaneous abortion
105
When are women tested for diabetes during pregnancy
First trimester
| 2nd trimester 24-28 weeks
106
When is a 3 hour GTT obtained
a 3 hour GTT is obtained if the BG following a 50-g load is greater than 130 or 140
107
What is alloimmunization
Rh (D)-positive cells when exposed to Rh (D)-positive blood—a phenomenon called alloimmunization.
108
Group B strep is a gram positive bacteria that is normally found were
Gastrointestinal and genital tract
109
When are women screened for group B strep
between 35 to 37 weeks
110
If GBS is identified in a urine culture at any time during a pregnancy, it is a sign of
heavy colonization
111
What is the treatment given to women who are GBS +
PCN during active labor or after rupture of membranes
