Kestler- pregnancy Flashcards
1
Q
during weeks 1-12 after egg is fertilized, what secretes hCG
A
corpus luteum
2
Q
_____ secretes estrogen and progesterone until the placenta is fully formed
A
Corpus Luteum
3
Q
about every ____ weeks is a new trimester
A
13
4
Q
Stimulates endometrial decidualization
Promotes angiogenesis in the endometrium
Promotes endothelial dependent vasodilatory role
A
Relaxin
5
Q
2 main hormones in weeks 13-40
A
progesterone and estrogen
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
7
Q
basically preps the uterus for delivery; enhances myometrial gap junction formation and promotes breast tissue growth
A
estrogen
8
Q
near term, ____ upregulates oxytocin receptors
A
estrogen
9
Q
pulmonary changes in the pregnant mother
A
increased tidal volume
decreased FRC
increase oxygen demand/consumption
10
Q
effects of progesterone on GI during pregnancy
A
(relaxes everything)
heartburn
constipation
increase in saliva
N/V
11
Q
can still have ____ work done during pregnancy just increased irritation/pain
A
dental
12
Q
during pregnancy, there is an increase in pigmentation due to ______-stimulating hormone, estrogen, and progesterone
A
melanocyte
13
Q
Linea nigra, darkening of nipple and areola, melasma
A
increased pigmentation during pregnancy
14
Q
spider angiomas and palmar erythema due to increase in what during pregnancy
A
estrogen
15
Q
3 major cardiac changes during pregnancy
A
- systolic ejection murmurs common
- BP drops then rises in last trimester
- CO increases
16
Q
maternal blood volume ______ by 50% during pregnancy
A
increases
17
Q
the expanded maternal blood volume is mainly an increase in what
A
more plasma
18
Q
increase in _____ during pregnancy causes an increase in clotting factors
A
estrogen
19
Q
H-H ____ slightly and there is also slight thrombocytopenia
A
decrease
20
Q
renal changes during pregnancy
A
increased GFR
loss of resorptive capacity
21
Q
dilated _____ cause enlarged kidneys due to increase in glomerular size and flow
A
ureters
22
Q
decreased _____ peristalsis and increased ______ compression cause urinary stasis
A
ureteral
23
Q
urinary stasis increases risk of _____ and ______
A
asymptomatic bacteriuria
pyelonephritis
24
Q
changes in the bladder during pregnancy (4)
A
decreased tone
increase in capacity
increase urinary frequency
stress incontinence
25
endocrine changes during pregnancy (4)
thyroid changes
hyperglycemia
hypertriglyceridemia
increase in cortisol
26
specific thyroid changes during pregnancy
increase in total T4 and thyroxine-binding globulin (free T4 remains the same)
27
_____ carries oxygenated blood from the placenta to liver of fetus
umbilical vein
28
shunt that takes oxygenated blood from the umbilical cord to the inferior vena cava (bypassing the liver) and is regulated by a sphincter
Ductus venosus
29
shunts this mixed blood in the RA to the LA and is regulated by the PVR and low pulmonary flow
Foramen Ovale
30
shunts the mixed blood between the pulmonary artery and the aorta and is also regulated by the high PVR and low pulmonary blood flow
Ductus Arteriosus
31
Moms can take Tylenol but NOT ____, so shunt in fetus stays open and doesn’t shut
NSAIDs
32
_____ keeps the shunt open in certain circumstances
prostaglandin (PGE1)
33
neonate PVR _____ and SVR _____ at birth
decreases; increases
34
blood type; H&H; infection screen; UA
determine gestational age
prenatal care- first visit
35
what to assess at every visit
BP
UA
weight
36
Fetal heart tones starting between ___ wks
10-12
37
from 1-30 weeks, how often does mom go in for appointment
once a month
38
from 30-36 wks, how often does mom go for appointment
every 2 weeks
39
from 36 wks-delivery, how often does mom go in for appointment
every week
40
with a BMI <19, weight gain should be ____
28-40 lbs
41
with a BMI of 19-25, weight gain should be
15-30 lbs
42
with a BMI of >30, weight gain should be
11-20 lbs
43
can be done at 11-13 weeks to determine risk of trisomy 21
first trimester screen
44
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
cell free DNA screen
45
screens for
AFP
inhibin A
Estriol
betahCG
Quad screen (2nd trimester)
46
______in cm typically correlates to gestational age in wks (after 20 wks)
fundal height
47
in the second trimester, what are you looking for (4)
fundal height
fetal kicks
gestational diabetes
anatomy US
48
____ presentation around 36 weeks
fetal
49
when to get 3rd trimester labs
34-36 wks
50
third trimester labs:
H&H
infection screen
group B strep
51
prior to onset of labor, mom can experience what 3 things
baby drop
loss of mucus plug
braxton hicks contractions
52
steps of labor: (5)
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
53
what 2 things promote uterine contractions
oxytocin
prostaglandin
54
what promotes oxytocin to promote uterine contractions
estrogen
55
gradual thinning of cervix
effacement
56
gradual opening of cervix
dilation
57
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
ischial spine
58
how to document cervical exam that is "full":
10 cm, 100% effacement, station 3+
59
onset of contractions to complete dilation of cervix to 10 cm
first stage of labor
60
part of first stage of labor that has onset of contractions to 4-6 cm dilation (6-24 hours)
latent phase
61
part of first stage of labor that has rapid dilation from 4-6 cm to 10 cm (3-7 hours)
active phase
62
complete cervical dilation to delivery of fetus (1-3 hours, longer in patient’s w/ an epidural)
second stage of labor
63
delivery of infant to delivery of placenta (5-30 mins)
third stage of labor
64
most common type of C-section
low-transverse cesarean
65
Prior CS
Dystocia or failure to progress
Breech presentation
Transverse lie
Concern for fetal well-being
Uterine malformation/scars
indications for C-section
66
how long is it suggested to restrain from intercourse after giving birth
6-7 weeks (due to potential pain and getting pregnant again)
67
how long do you stay in hospital with a vaginal delivery
1-2 days
68
how long do you stay in hospital after c-section
3-4 days
69
what is discussed at post-partum visits
contraceptives
breast feeding
intercourse
mood
menses
70
Pregnancy loss before 20 wks gestation (miscarriage or spontaneous abortion)—most of the time due to a _______
chromosomal abnormality
71
Depending on _____ may use US and trend betas for confirmation of loss
gestational age
72
Medical uterine evacuation w/ ____
misoprostol
73
surgical evacuation w/ _____
D&C
74
trophoblastic tumors that contain villi and produce hCG
hydatidiform moles
75
heavy vaginal bleeding early in pregnancy, passage of grape-like clusters, hyperemesis, 1st trimester HTN, sxs of pre-e <20 wks
trophoblastic disease
76
______ is gold-standard, shows “snowstorm” and no gestational sac to diagnose trophoblastic disease
ultrasound
77
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
pregnancy test (to rule out ectopic pregnancy)
78
UPT, US, beta hCG (if >1500-2000 with an empty uterus, repeat beta and US in 2 days) to diagnose ___
ectopic pregnancy
79
to treat ectopic pregnancy
methotrexate
salpingectomy
80
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
mom being Rh- and baby being Rh+
81
what is used to prevent hemolytic disease of newborn
RhoGAM
82
anti-Rh IgG
RhoGAM
83
due to expansion of plasma volume relative to increase in RBC mass
anemia during pregnancy
84
to treat anemia in pregnancy patient
iron supplements
85
in pregnant patients is automatic hospitalization, can become septic real quick; usually due to E. coli
pyelonephritis
86
itchy palms and soles of feet (pruritis)
increase bile acids
increase AST, ALT, bilirubin
intrahepatic cholestasis of pregnancy
87
to treat intrahepatic cholestasis of pregnancy
UDCA (ursodeoxycholic acid)
88
jaundice, abd pain, N/V
Acute liver dysfxn due to fatty infiltration of liver parenchyma coagulopathy, electrolyte disturbances, multi-organ failure
acute fatty liver of pregnancy (AFLP)
89
90
to treat acute fatty liver of pregnancy
stabilize mom and deliver baby
91
PND, pedal edema, orthopnea, DOE
Dry cough, palpitations, CP, lightheadedness
JVD, displaced apical pulse, third heart sound, mitral regurg murmur
cardiomyopathy of pregnancy
92
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
cardiomyopathy of pregnancy
93
to diagnose cardiomyopathy of pregnancy:
elevated BNP
echo
94
to treat cardiomyopathy of pregnancy
beta blockers; maybe diuretics
95
Watch out for big babies, shoulder dystocia, and neonatal hypoglycemia
gestational diabetes
96
screening for gestational diabetes (in second trimester)
1 hour glucose screen
3 hour glucose tolerance test
97
to treat GDM
insulin
metformin
98
GDM controlled with diet
type A1
99
GDM that requires insulin or oral agents
type A2
100
most common meds prescribed for HTN in pregnancy
Labetalol
Nifedipine
Hydralazine
101
bp is greater than or equal to 140/90 (has preexisting HTN or began before 20 weeks gestation or persists in post partum
chronic HTN
102
initiate meds when bp becomes what in pregnant patient with chronic HTN
160/110
103
gestational HTN
104
to treat gestational HTN
ASA 81 mg (baby aspirin)
105
delivery at ____ weeks for patient with gestational HTN due to increased risk of pre-eclampsia
37 weeks
106
risk factors for pre-eclampsia
107
bp greater or equal to 140/90 after 20 weeks gestation + proteinuria or low platelets or increased Cr or ASTs/ALTs
pre-eclampsia
108
HTN after 20 weeks gestation + proteinuria
pre-eclampsia
109
criteria for severe pre-eclampsia
bp greater or equal to 160/110 after 20 weeks gestation with another lab finding (neurologic dysfunction or proteinuria)
110
to treat pre-eclampsia
delivery
111
how to manage pre-eclamptic patient
Magnesium sulfate
steroids (for fetal lung maturation at early delivery)
deliver at 37 weeks
112
used for seizure prophylaxis
Magnesium sulfate
113
difference b/t mild and severe pre-eclampsia
blood pressures
114
hemolysis
elevated liver enzymes
low platelets
can occur w/ or w/out HTN
HELLP
115
to treat HELLP
immediate delivery
116
See most commonly within 48 hours before delivering; seizure in pre-eclamptic patient
eclampsia
117
how to prevent eclampsia
magnesium sulfate
118
how to treat active seizure
MSO4
119
Oligohydramnios
120
Polyhydramnios
121
most frequent delivery style with breech
C-section
122
butt presented at the cervix instead of head
breech position
123
Normally implanted placenta that separates too early
baby loses all blood flow
Risks: HTN, cocaine!!!!!, abd trauma
placental abruption
124
Improperly implanted placenta
implants low
placenta previa
125
most common cause of third trimester bleeding
placenta previa
126
for placenta previa
127
placental villi attach directly to myometrium rather than decidua basalis
placenta accreta
128
placental villi invade the myometrium
placenta increta
129
placental vili penetrate through myometrium
placenta percreta
130
to treat placental attachment disorders
hysterectomy
131
GA < 37 wks with regular uterine contractions and progressive cervical change
preterm labor
132
purpose of giving tocolytics to patient in perterm labor
quiet uterus long enough to get steroids to the baby
133
Natural occurrence during the first stage of labor; balloon pops and all the amniotic fluid comes out
rupture of membranes
134
rupture of membranes before onset of labor
PROM (premature rupture of membranes)
135
rupture of membranes before onset of labor AND prior to 37 weeks gestation
PPROM (preterm premature rupture of membranes)
136
main complications of premature rupture of membranes
chorioamnionitis
137
infection of amniotic sac fluid that can cause neonatal infections
chorioamnionitis
138
to treat rupture of membranes without chorioamnionitis if premature
give steroids for the fetal lung development and antibiotics to decrease risk of infection and maybe tocolytics and watch
139
anytime mother develops signs of chorio (chorioamnionitis), what do you do
DELIVER
140
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
shoulder dystocia
141
Compression of cord: loss of oxygenation to baby; might pass or get cerebral palsy due to hypoxia
umbilical cord prolapse
142
cord exits the cervix before the fetal presenting part
overt
143
occurs when the cord exits the cervix with the fetal presenting part
occult
144
to treat umbilical cord prolapse
funic decompression (lift cord off baby)
145
Excessive bleeding after delivery
Even up to 6 weeks after delivery
postpartum hemorrhage (PPH)
146
most common cause of postpartum hemorrhage
atony of uterus
147
it is tired; and doesn’t want to get back to pre-pregnancy size; twins
atony of uterus
148
to treat postpartum hemorrhage
149
lasts around 2 wks after birth
self-limited mild mood disturbance
Postpartum blues
150
sx's may last for months to years after birth
Postpartum depression
151
drug of choice for PP depression
Sertraline
