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ENR Biweekly 2 > Kestler- pregnancy > Flashcards

Kestler- pregnancy Flashcards

1
Q

during weeks 1-12 after egg is fertilized, what secretes hCG

A

corpus luteum

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2
Q

_____ secretes estrogen and progesterone until the placenta is fully formed

A

Corpus Luteum

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3
Q

about every ____ weeks is a new trimester

A

13

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4
Q

Stimulates endometrial decidualization
Promotes angiogenesis in the endometrium
Promotes endothelial dependent vasodilatory role

A

Relaxin

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5
Q

2 main hormones in weeks 13-40

A

progesterone and estrogen

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6
Q

stimulates smooth muscle relaxation throughout the body and enhances growth of milk producing cells in the glandular tissue of the breast

A

progesterone

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7
Q

basically preps the uterus for delivery; enhances myometrial gap junction formation and promotes breast tissue growth

A

estrogen

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8
Q

near term, ____ upregulates oxytocin receptors

A

estrogen

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9
Q

pulmonary changes in the pregnant mother

A

increased tidal volume
decreased FRC
increase oxygen demand/consumption

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10
Q

effects of progesterone on GI during pregnancy

A

(relaxes everything)
heartburn
constipation
increase in saliva
N/V

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11
Q

can still have ____ work done during pregnancy just increased irritation/pain

A

dental

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12
Q

during pregnancy, there is an increase in pigmentation due to ______-stimulating hormone, estrogen, and progesterone

A

melanocyte

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13
Q

Linea nigra, darkening of nipple and areola, melasma

A

increased pigmentation during pregnancy

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14
Q

spider angiomas and palmar erythema due to increase in what during pregnancy

A

estrogen

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15
Q

3 major cardiac changes during pregnancy

A
  1. systolic ejection murmurs common
  2. BP drops then rises in last trimester
  3. CO increases
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16
Q

maternal blood volume ______ by 50% during pregnancy

A

increases

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17
Q

the expanded maternal blood volume is mainly an increase in what

A

more plasma

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18
Q

increase in _____ during pregnancy causes an increase in clotting factors

A

estrogen

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19
Q

H-H ____ slightly and there is also slight thrombocytopenia

A

decrease

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20
Q

renal changes during pregnancy

A

increased GFR
loss of resorptive capacity

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21
Q

dilated _____ cause enlarged kidneys due to increase in glomerular size and flow

A

ureters

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22
Q

decreased _____ peristalsis and increased ______ compression cause urinary stasis

A

ureteral

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23
Q

urinary stasis increases risk of _____ and ______

A

asymptomatic bacteriuria
pyelonephritis

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24
Q

changes in the bladder during pregnancy (4)

A

decreased tone
increase in capacity
increase urinary frequency
stress incontinence

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25
Q

endocrine changes during pregnancy (4)

A

thyroid changes
hyperglycemia
hypertriglyceridemia
increase in cortisol

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26
Q

specific thyroid changes during pregnancy

A

increase in total T4 and thyroxine-binding globulin (free T4 remains the same)

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27
Q

_____ carries oxygenated blood from the placenta to liver of fetus

A

umbilical vein

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28
Q

shunt that takes oxygenated blood from the umbilical cord to the inferior vena cava (bypassing the liver) and is regulated by a sphincter

A

Ductus venosus

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29
Q

shunts this mixed blood in the RA to the LA and is regulated by the PVR and low pulmonary flow

A

Foramen Ovale

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30
Q

shunts the mixed blood between the pulmonary artery and the aorta and is also regulated by the high PVR and low pulmonary blood flow

A

Ductus Arteriosus

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31
Q

Moms can take Tylenol but NOT ____, so shunt in fetus stays open and doesn’t shut

A

NSAIDs

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32
Q

_____ keeps the shunt open in certain circumstances

A

prostaglandin (PGE1)

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33
Q

neonate PVR _____ and SVR _____ at birth

A

decreases; increases

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34
Q

blood type; H&H; infection screen; UA
determine gestational age

A

prenatal care- first visit

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35
Q

what to assess at every visit

A

BP
UA
weight

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36
Q

Fetal heart tones starting between ___ wks

A

10-12

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37
Q

from 1-30 weeks, how often does mom go in for appointment

A

once a month

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38
Q

from 30-36 wks, how often does mom go for appointment

A

every 2 weeks

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39
Q

from 36 wks-delivery, how often does mom go in for appointment

A

every week

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40
Q

with a BMI <19, weight gain should be ____

A

28-40 lbs

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41
Q

with a BMI of 19-25, weight gain should be

A

15-30 lbs

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42
Q

with a BMI of >30, weight gain should be

A

11-20 lbs

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43
Q

can be done at 11-13 weeks to determine risk of trisomy 21

A

first trimester screen

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44
Q

can be done at 10-35 weeks; it pulls fetal DNA from mom’s blood and screens for trisomy 13, trisomy 18, and trisomy 21

A

cell free DNA screen

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45
Q

screens for
AFP
inhibin A
Estriol
betahCG

A

Quad screen (2nd trimester)

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46
Q

______in cm typically correlates to gestational age in wks (after 20 wks)

A

fundal height

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47
Q

in the second trimester, what are you looking for (4)

A

fundal height
fetal kicks
gestational diabetes
anatomy US

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48
Q

____ presentation around 36 weeks

A

fetal

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49
Q

when to get 3rd trimester labs

A

34-36 wks

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50
Q

third trimester labs:

A

H&H
infection screen
group B strep

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51
Q

prior to onset of labor, mom can experience what 3 things

A

baby drop
loss of mucus plug
braxton hicks contractions

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52
Q

steps of labor: (5)

A
  1. head of fetus pushes against cervix
  2. nerve impulses from cervix transmitted to brain
  3. brain stimulates pituitary gland to secrete oxytocin
  4. oxytocin carried in bloodstream to uterus
  5. oxytocin stimulates uterine contractions and pushes fetus toward cervix
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53
Q

what 2 things promote uterine contractions

A

oxytocin
prostaglandin

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54
Q

what promotes oxytocin to promote uterine contractions

A

estrogen

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55
Q

gradual thinning of cervix

A

effacement

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56
Q

gradual opening of cervix

A

dilation

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57
Q

if provider can feel baby’s head when finger is inserted into vagina and cervix, then they have descended below _______ and are in a positive station

A

ischial spine

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58
Q

how to document cervical exam that is “full”:

A

10 cm, 100% effacement, station 3+

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59
Q

onset of contractions to complete dilation of cervix to 10 cm

A

first stage of labor

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60
Q

part of first stage of labor that has onset of contractions to 4-6 cm dilation (6-24 hours)

A

latent phase

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61
Q

part of first stage of labor that has rapid dilation from 4-6 cm to 10 cm (3-7 hours)

A

active phase

62
Q

complete cervical dilation to delivery of fetus (1-3 hours, longer in patient’s w/ an epidural)

A

second stage of labor

63
Q

delivery of infant to delivery of placenta (5-30 mins)

A

third stage of labor

64
Q

most common type of C-section

A

low-transverse cesarean

65
Q

Prior CS
Dystocia or failure to progress
Breech presentation
Transverse lie
Concern for fetal well-being
Uterine malformation/scars

A

indications for C-section

66
Q

how long is it suggested to restrain from intercourse after giving birth

A

6-7 weeks (due to potential pain and getting pregnant again)

67
Q

how long do you stay in hospital with a vaginal delivery

A

1-2 days

68
Q

how long do you stay in hospital after c-section

A

3-4 days

69
Q

what is discussed at post-partum visits

A

contraceptives
breast feeding
intercourse
mood
menses

70
Q

Pregnancy loss before 20 wks gestation (miscarriage or spontaneous abortion)—most of the time due to a _______

A

chromosomal abnormality

71
Q

Depending on _____ may use US and trend betas for confirmation of loss

A

gestational age

72
Q

Medical uterine evacuation w/ ____

A

misoprostol

73
Q

surgical evacuation w/ _____

A

D&C

74
Q

trophoblastic tumors that contain villi and produce hCG

A

hydatidiform moles

75
Q

heavy vaginal bleeding early in pregnancy, passage of grape-like clusters, hyperemesis, 1st trimester HTN, sxs of pre-e <20 wks

A

trophoblastic disease

76
Q

______ is gold-standard, shows “snowstorm” and no gestational sac to diagnose trophoblastic disease

A

ultrasound

77
Q

every time a reproductive age female comes in w/ R or L lower quadrant pain, get a ________; maybe some vaginal bleeding——-do not miss this b/c it can kill the mom

A

pregnancy test (to rule out ectopic pregnancy)

78
Q

UPT, US, beta hCG (if >1500-2000 with an empty uterus, repeat beta and US in 2 days) to diagnose ___

A

ectopic pregnancy

79
Q

to treat ectopic pregnancy

A

methotrexate
salpingectomy

80
Q

This can cause mom to become sensitized and create anti-D antibodies that can cross the placenta and attack her baby’s RBC  hemolytic disease of the newborn

A

mom being Rh- and baby being Rh+

81
Q

what is used to prevent hemolytic disease of newborn

A

RhoGAM

82
Q

anti-Rh IgG

A

RhoGAM

83
Q

due to expansion of plasma volume relative to increase in RBC mass

A

anemia during pregnancy

84
Q

to treat anemia in pregnancy patient

A

iron supplements

85
Q

in pregnant patients is automatic hospitalization, can become septic real quick; usually due to E. coli

A

pyelonephritis

86
Q

itchy palms and soles of feet (pruritis)
increase bile acids
increase AST, ALT, bilirubin

A

intrahepatic cholestasis of pregnancy

87
Q

to treat intrahepatic cholestasis of pregnancy

A

UDCA (ursodeoxycholic acid)

88
Q

jaundice, abd pain, N/V
Acute liver dysfxn due to fatty infiltration of liver parenchyma  coagulopathy, electrolyte disturbances, multi-organ failure

A

acute fatty liver of pregnancy (AFLP)

89
Q
A
90
Q

to treat acute fatty liver of pregnancy

A

stabilize mom and deliver baby

91
Q

PND, pedal edema, orthopnea, DOE
Dry cough, palpitations, CP, lightheadedness
JVD, displaced apical pulse, third heart sound, mitral regurg murmur

A

cardiomyopathy of pregnancy

92
Q

Occurs during late pregnancy or early postpartum period
Risk factors: age > 40, pregnancy-related HTN disorders, multiparty, multiple gestations, obesity, CHTN, prolonged use of tocolytics, African descent, anemia

A

cardiomyopathy of pregnancy

93
Q

to diagnose cardiomyopathy of pregnancy:

A

elevated BNP
echo

94
Q

to treat cardiomyopathy of pregnancy

A

beta blockers; maybe diuretics

95
Q

Watch out for big babies, shoulder dystocia, and neonatal hypoglycemia

A

gestational diabetes

96
Q

screening for gestational diabetes (in second trimester)

A

1 hour glucose screen
3 hour glucose tolerance test

97
Q

to treat GDM

A

insulin
metformin

98
Q

GDM controlled with diet

A

type A1

99
Q

GDM that requires insulin or oral agents

A

type A2

100
Q

most common meds prescribed for HTN in pregnancy

A

Labetalol
Nifedipine
Hydralazine

101
Q

bp is greater than or equal to 140/90 (has preexisting HTN or began before 20 weeks gestation or persists in post partum

A

chronic HTN

102
Q

initiate meds when bp becomes what in pregnant patient with chronic HTN

A

160/110

103
Q
A

gestational HTN

104
Q

to treat gestational HTN

A

ASA 81 mg (baby aspirin)

105
Q

delivery at ____ weeks for patient with gestational HTN due to increased risk of pre-eclampsia

A

37 weeks

106
Q
A

risk factors for pre-eclampsia

107
Q

bp greater or equal to 140/90 after 20 weeks gestation + proteinuria or low platelets or increased Cr or ASTs/ALTs

A

pre-eclampsia

108
Q

HTN after 20 weeks gestation + proteinuria

A

pre-eclampsia

109
Q

criteria for severe pre-eclampsia

A

bp greater or equal to 160/110 after 20 weeks gestation with another lab finding (neurologic dysfunction or proteinuria)

110
Q

to treat pre-eclampsia

A

delivery

111
Q

how to manage pre-eclamptic patient

A

Magnesium sulfate
steroids (for fetal lung maturation at early delivery)
deliver at 37 weeks

112
Q

used for seizure prophylaxis

A

Magnesium sulfate

113
Q

difference b/t mild and severe pre-eclampsia

A

blood pressures

114
Q

hemolysis
elevated liver enzymes
low platelets
can occur w/ or w/out HTN

A

HELLP

115
Q

to treat HELLP

A

immediate delivery

116
Q

See most commonly within 48 hours before delivering; seizure in pre-eclamptic patient

A

eclampsia

117
Q

how to prevent eclampsia

A

magnesium sulfate

118
Q

how to treat active seizure

A

MSO4

119
Q
A

Oligohydramnios

120
Q
A

Polyhydramnios

121
Q

most frequent delivery style with breech

A

C-section

122
Q

butt presented at the cervix instead of head

A

breech position

123
Q

Normally implanted placenta that separates too early
baby loses all blood flow
Risks: HTN, cocaine!!!!!, abd trauma

A

placental abruption

124
Q

Improperly implanted placenta
implants low

A

placenta previa

125
Q

most common cause of third trimester bleeding

A

placenta previa

126
Q
A

for placenta previa

127
Q

placental villi attach directly to myometrium rather than decidua basalis

A

placenta accreta

128
Q

placental villi invade the myometrium

A

placenta increta

129
Q

placental vili penetrate through myometrium

A

placenta percreta

130
Q

to treat placental attachment disorders

A

hysterectomy

131
Q

GA < 37 wks with regular uterine contractions and progressive cervical change

A

preterm labor

132
Q

purpose of giving tocolytics to patient in perterm labor

A

quiet uterus long enough to get steroids to the baby

133
Q

Natural occurrence during the first stage of labor; balloon pops and all the amniotic fluid comes out

A

rupture of membranes

134
Q

rupture of membranes before onset of labor

A

PROM (premature rupture of membranes)

135
Q

rupture of membranes before onset of labor AND prior to 37 weeks gestation

A

PPROM (preterm premature rupture of membranes)

136
Q

main complications of premature rupture of membranes

A

chorioamnionitis

137
Q

infection of amniotic sac fluid that can cause neonatal infections

A

chorioamnionitis

138
Q

to treat rupture of membranes without chorioamnionitis if premature

A

give steroids for the fetal lung development and antibiotics to decrease risk of infection and maybe tocolytics and watch

139
Q

anytime mother develops signs of chorio (chorioamnionitis), what do you do

A

DELIVER

140
Q

baby gets stuck during delivery underneath pubic symphysis; the longer the baby is stuck, increased risk of brachial injury (wont be able to use that arm); fracture; fetal death

A

shoulder dystocia

141
Q

Compression of cord: loss of oxygenation to baby; might pass or get cerebral palsy due to hypoxia

A

umbilical cord prolapse

142
Q

cord exits the cervix before the fetal presenting part

A

overt

143
Q

occurs when the cord exits the cervix with the fetal presenting part

A

occult

144
Q

to treat umbilical cord prolapse

A

funic decompression (lift cord off baby)

145
Q

Excessive bleeding after delivery

Even up to 6 weeks after delivery

A

postpartum hemorrhage (PPH)

146
Q

most common cause of postpartum hemorrhage

A

atony of uterus

147
Q

it is tired; and doesn’t want to get back to pre-pregnancy size; twins

A

atony of uterus

148
Q
A

to treat postpartum hemorrhage

149
Q

lasts around 2 wks after birth
self-limited mild mood disturbance

A

Postpartum blues

150
Q

sx’s may last for months to years after birth

A

Postpartum depression

151
Q

drug of choice for PP depression

A

Sertraline

ENR Biweekly 2 (11 decks)

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