L&D Flashcards
How can you measure gestational age using ultrasonography?
Measure crown-rump length (CRL) at 6-12 weeks
Measure biparietal diameter (BPD), femur length, and abdominal circumference from 13 weeks
When is ultrasound most reliable for measuring gestational age?
During first trimester
When are fetal heart tones detected?
17-18 weeks at the earliest
What is the main difference between urine and serum B-hcg?
Serum B-hcg is more sensitive and preferred if menstrual period is <1 week late
Where is B-hcg produced and at what level does it peak?
Produced by the placenta; peaks at 100,000 mIU/ml by 10 weeks GA
Describe the levels of B-hcg throughout pregnancy
Peaks at 10 weeks, decreases during the second trimester and levels off during the third trimester
Approximately how long should you expect B-hcg to double in a normal pregnancy?
every 48 hours
Describe the stages of labor.
Stage I: 0-10cm. separated into latent and active. Latent is 0-6cm and active is >6-10cm
Stage II: 10cm to delivery
Stage III: post deliver to placental delivery
What is the most common cause of low back pain during the third trimester?
increased pressure from uterus and laxity of muscles and joints
Pregnancy causes a hypercoagulable state. What level of Fibrinogen should you expect?
Fibrinogen should be elevated in pregnancy. If it is “normal”, suspect DIC!
What are the appropriate weight gains per BMI? Underweight, BMI<19.8 Acceptable, BMI 19.8-26.0 Overweight, BMI 26.1-29.0 Severely overweight, BMI>29.0
Underweight, BMI<19.8 - 12-18kg
Acceptable, BMI 19.8-26.0 - 11-16kg
Overweight, BMI 26.1-29.0 - 7-11kg
Severely overweight, BMI>29.0 - 5-9kg
Which Immunoglobulins cross the placenta?
IgG
Name 9 organisms that cross the placenta?
Toxoplasma gondii Rubella HIV Varicella-zoster virus CMV Enteroviruses Treponema pallidum Listeria monocytogenes Parvovirus B19
How often should prenatal visits be per gestational age?
Weeks 0-28: q4wks
Weeks 29-35: q2wks
Weeks 36-birth: q1wk
TORCHeS pathogens
Toxoplasmosis Other (parvovirus, varicella, Listeria, TB, malaria, fungi) Rubella CMV Herpes simplex virus Syphilis
What fetal defects are associated with ACEIs?
fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, IUGR, lack of cranial ossification
What fetal defects are associated with Alcohol?
Fetal alcohol syndrome (growth restriction before and after birth, mental retardation, mid facial hypoplasia, smooth philtrum, renal and cardiac defects)
What fetal defects are associated with Amphetamines
Preterm delivery, placental abruption, preeclampsia, IUGR, fetal demise
What fetal defects are associated with Androgens
Virilization of female fetus; advanced genital development of male fetus.
What fetal defects are associated with Carbamazepine
Neural tube defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR
What fetal defects are associated with Cocaine
Bowel atresia, congenital malformations of the heart, limbs, face and GU tract; microcephaly; IUGR; cerebral infarctions
What fetal defects are associated with DES
Clear cell adenocarcinoma of the vagina or cervix, vaginal adenosine, abnormalities of the cervix and uterus or testes, possible infertility
What fetal defects are associated with Lead
Increased SAB rate, stillbirth
