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REPRODUCTIVE SYSTEM > LATE PREGNANCY (C6) > Flashcards

LATE PREGNANCY (C6) Flashcards

1
Q

Common between first and second missed menstrual pd and continue until 14-16 wks

A

Nausea & vomiting

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2
Q

Tx for mild symptoms of nausea and vomiting

A

Vit B6 along w doxylamine

Some will need phenothiazine or H1 receptor blocking anti-emetics

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3
Q

Severe vomiting that results to dehydration, electrolyte and acid-base disturbances and starvation ketosis

A

Hyperemesis gravidarum

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4
Q

May be dt steroid-induced suppression of bowel activity, compression of bowels by enlarging uterus

A

Constipation

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5
Q

In constipation, what should be avoided?

A

Enemas & strong cathartics

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6
Q

Muscular spasm and tenderness –> acute strain or fibrositis

Respond to analgesics, heat and rest

A

Backache

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7
Q

Cause: congenital predisposition abd accrue with advancing age dt increased lower extremity venous pressures

A

Varicosities

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8
Q

Venous femoral pressure in the supine pregnant is

A

8 mmHg early

to

24 mmHg at term

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9
Q

Symptoms of varicosities

A

Mild cosmetic blemishes –> severe discomfort

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10
Q

Management of varicosities

A

Periodic rest w leg elevation

Elastic stockings

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11
Q

Coexist with leg varicosities

A

Vulvar varicosities

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12
Q

Rectal vein varicosities and may first appear during pregnancy as pelvic venous pressures increase

A

Hemorrhoids

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13
Q

Relieved by topical anesthetics, warm soaks, stool softening agents

A

SMS: pain and swelling

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14
Q

caused by gastric content reflux into lower esophagus due to upward displacement and compression of stomach by uterus, combined w relaxation of lower esophageal sphincter

A

Heartburn

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15
Q

how to relieve heartburn

A

frequent feedings
avoid of bending over or lying flat
antacids

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16
Q

antacids

A

aluminum or magnesium trisilicate

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17
Q

pagophagia

A

craving ice

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18
Q

amylophagia

A

starch cravings

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19
Q

geophagia

A

craving for clay

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20
Q

triggered by severe iron def

A

pica

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21
Q

profuse salivation wc appears to follow saliv gland stimulation by starch ingestion

A

ptyalism

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22
Q

dt soporific effect of progesterone but may be compounded in the first trimester by nausea and vomiting and in the latter stages of pregnancy by general discomforts, urinary frequency and dyspnea

A

fatigue/sleeping (sis same)

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23
Q

as pregnancy advances, what happens to sleep efficiency?

A

progressively diminish

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24
Q

3rd trimester sleep situation

A

sleep disturbance and restless leg syndrome

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25
Q

more frequent early pregnancy

may be ass w hypertension in late preg

A

headache

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26
Q

increased in vaginal discharge, mostly dt mucus secretion by cervical glands in response to hyperestrogenemia in pregnancy

A

Leukorrhea

Abnormal: bacterial vaginosis, candidiasis and trichomoniasis

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27
Q

study of birth defects and their etiology

A

teratology

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28
Q

any agent (drugs, chemical, physical, envi, maternal metabolite, genetic abn and infxn – that acts during embryonic or fetal dev to produce a permanent alternation of form or fxn

basically causes STRUCTURAL ABNORMALITIES

A

Teratogen

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29
Q

after Hades - god who possessed a helmet conferring invisibility — an agent that interferes w normal maturation and fxn of an organ

A

Hadegen

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30
Q

an agent that alters growth

Hadegens and trophogens typically affect dev in fetal pd and after birth

A

Trophogen

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31
Q

these act by disturbing sp physio processes, leading to abn cellular differentiation, altered tissue growth or cell death

A

Teratogens

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32
Q

it has been linked to susceptibility to teratogenic effects ofspecific meds

A

genetic composition or fetal genome

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33
Q

more likely to develop anomalies if homozygous for a gene mutation that results in abn low lvls of epoxide hydrolase

A

hydantoin exposure

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34
Q

metabolized by microsomes to oxidative intermediates that accumulate in fetal tissues

A

hydantoin
carbamazepine
phenobarbital

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35
Q

these have carcinogenic, mutagenic and other toxic effects that are dose related and increase w multidrug therapy

A

free oxide radicals

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36
Q

fetal neural tube defects, cardiac defects and oral clefts can be a result of

A

folic acid metabolic path disturbances

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37
Q

essential for methionine prod

wc is required for methylation —> prod CHON, lipids and myelin

A

Folates

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38
Q

It can either impair folic acid absorption or acts as folic acid antagonists

A

anticonvulsant drugs (phenytoin, carbamazepine, valproic acid and phenobarbital)

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39
Q

low periconceptional folic acid lvls in women w epilepsy may cause

A

fetal malformations

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40
Q

may increase the risk of adverse fetal outcomes dt

A

paternal exposure to drugs or environmental influences

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41
Q

proposed mechanisms:

A
  • induction of a gene mutation or chromosomal abnormality in sperm
  • during coitus, dev embryo is exposed to teratogenic agent in seminal fluid
  • occupational - inc risk for men w anomalous offspring include janitors, woodworkers, firemen, printers and painters
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42
Q

induction of a gene mutation or chromosomal abnormality in sperm

A
  • it takes 64 days for male germ cells mature into spermatogonia - drug exposure may cause gene mutation during the 2 mos before conception
  • epigenetic pathways may suppress germ-cell apoptosis or interfere w imprinting
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43
Q

exposure to these are linked to early pregnancy loss

A

mercury, lead, solvents, pesticides, anesthetic gases or hydrocarbons

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44
Q

moat freq nongenetic cause of mental retardation

A

alcohol

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45
Q

potent and prevalent teratogen

A

ethyl alcohol

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46
Q

dysmorphic facial features, pre- or postnatal growth impairment, CNS abn that may be structural, neurological or fxnal, cardiac and renal anomalies, orthpedic probs and eye and ear abn

A

fetal alcohol syndrome

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47
Q

there is an association w periconceptional alcohol use and

A

omphalocele and gastroschisis

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48
Q

valproic acid can cause

A

low IQ

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49
Q

fetotoxic and result in ACE-inhibitor fetopathy

disruption of RAS (essential for normal renal development)

A

ACE inhi

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50
Q

causes fetal hypotension and renal hypoperfusion, w subsequent ischemia and anuria

A

ACE inhi

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51
Q

reduced perf may cause fetal growth restriction rand calvarium maldevelopment, whereas oligohydramnios may result in

A

pulmonary hypoplasia and limb contractures

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52
Q

Associated w a pattern of congenital malformations resembling the autosomal recessive Antley-Bixler syndrome (at doses of 400-800mg daily) and Tetralogy of Fallot

A

Fluconazole (antifungal)

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53
Q

Abn: oral clefts, abn faces and cardiac, skull, lung, long bone and joint abnormalities

A

Antifungals

Single 150mg dose to treat vulvovaginal candidiasis doesn’t appear teratogenic

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54
Q

Inhibits prostaglandin synthesis

A

Anti-inflammatory agents

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55
Q

Not teratogenic but cab have adverse fetal effects when used in 3rd trimester

A

NSAIDs

56
Q

Cause constriction of fetal ductus arteriosus resulting in pulmonary hypertension

Also decrease fetal urine production thereby reducing amniotic volume

A

Indomethacin

57
Q

Pyrimidine synthesis inhibitor for treatment of RA

A

Leflunomide

58
Q

Animal studies showed hydrocephalus, eye anomalies, skeletal abnormalities and embryo death

A

Leflunomide

59
Q

Detectable in plasma for 2 years following discontinuation so women w childbearing potential should consider cholestyramine tx or washout

A

Leflunomide

60
Q

Nephrotoxicity and ototoxicity in preterm newborns

A

Aminoglycosides

61
Q

GBS gray

preterm infants are unable to conjugate and excrete the drug and manifested abn distention, respiratory abnormalities

A

Chloramphenicol

62
Q

Associated w four-fold increased risk for hypoplastic left heart syndrome and microphthalmia/anophthalmia

2-fold increase for clefts and atrial septal defects

A

Nitrofurantoin

63
Q

ACOG: first trimester use is appropriate if no sustainable alternatives are available

A

Nitrofurantoin

64
Q

3-fold risk inc risk anencephaly and left ventricular outflow tract obstruction

8-fold inc risk of choanal atresia and 2-fold inc risk of diaphragmatic hernia

A

Sulfonamides

65
Q

Yellowish brown discoloration of deciduous teeth when used after 25 weeks

A

Tetracycline

66
Q

Antineoplastic

A

Cyclophosphamide
Methotrexate/Aminopterin
Tamoxifen
Trastuzumab

67
Q

Alkylating agent wc inflicts a chemical insult on developing fetal tissues and leads to cell death and heritable DNA alterations in surviving cells

A

Cyclophosphamide

68
Q

Inc preg loss (HWs) and malformations include skeletal abn, limb defects, cleft palate and eye abnormalities

A

Cyclophosphamide

69
Q

Folic acid antagonist, potent teratogen and abortifacient

A

Methotrexate/Aminopterin

70
Q

Craniosynostosis w “clover-leaf” skull, wide nasal bridge, low-set ears, micrognathia and limb abnormalities

A

Fetal Methotrexate-Aminopterin syndrome

71
Q

A nonsteroidal selective estrogen-receptor modulator (SERM) used as an adjunct to treat breast cancer that causes malformations similar to those cb DES (diethylstilbestrol) exposure

A

Tamoxifen

72
Q

A recombinant monoclonal Ab directed to the human epidermal growth factor receptor-2 (HER-2) protein

Used to treat breast cancer that over express HER2 CHON

A

Transtuzumab

73
Q

Causes oligohydramnios, anhydramnios and fetal renal failure —> fetal pulmonary hypoplasia, skeletal abn and neonatal death

A

Trastuzumab

74
Q

Antiviral

A

Ribavirin

Efavirenz

75
Q

Is a nucleoside analogue and a component of therapy for hepa C infxn

Malformations: skull, palate, eye, skeleton and gastrointestinal abn

A

Ribavirin

76
Q

Is a nonnucleoside reverse transcriptase inhibitor used to treat HIV that causes CNS and ocular abn

A

Efavirenz

77
Q

An endothelin-receptor antagonist
Used to treat pulmonary arterial hypertension: no human studies and teratogenic concerns arise from mice deficient in endo receptor develop abn of head, face and large BV

A

Bosentan and Ambrisentan

78
Q

Sex hormones

A

Testosterone and Anabolic steroids
Danazol
Diethylstilbestrol

79
Q

Causes virilization and may result in ambiguous genitalia similar to congenital adrenal hyperplasia: labioscrotal fusion w first trimester exposure and phallic enlargement

A

Testosterone and Anabolic steroids

80
Q

An ethinyl testosterone derivative has weak androgenic activity that causes virilization
Clitoromegaly, fused labia and urogenital sinus malformation

A

Danazol

81
Q

This exposure in utero resulted to vaginal clear cell adenocarcinoma and 2-fold increase in vaginal and cervical intraepithelial neoplasia

A

Diethylstilbestrol

82
Q

Genital tract abn in women: hypoplastic, T shaped uterine cavity, cervical collars, hood, septa and coxcombs and withered fallopian tubes, early menopause and testicular hypoplasia

A

Diethylstilbestrol

83
Q

Genital tract in men: abn

Epididymal cysts, microphallus, hypospadias, cryptorchidism and testicular hypoplasia

A

Diethylstilbestrol

84
Q

Immunosuppressant meds

A 
Corticosteroids
Mycophenolate Mofetil
Radioiodine
Lead
Methyl mercury
85
Q

Includes glucocorticoids and mineralocorticoids wc have antiinflammatory and immunosuppressive actions (used to treat asthma and autoimmune dse

3-fold increase in clefts (3 per 1000 exposed fetus)

A

Corticosteroids

86
Q

An inosine monophosphate dehydrogenase inhibitor that is a potent immunosuppressant used to prevent rejection in organ-transplant recipients, and lupus nephritis

Half of exposed preg resulted in spontaneous abortion and 1/5 of surviving infants had malformations- ear abnormalities

A

Mycophenolate Mofetil

87
Q

Tx thyroid cancer and thyrotoxicosis; nonhodgkins lymphoma

Radioactive iodine-131

A

Radioiodine

88
Q

Contraindicated during preg bcs cross placenta and conc in fetal thyroid at 12 wks

Irreversible fetal hypothyroidism and increased risk for childhood thyroid cancer

A

Radioiodine

89
Q

Prenatal exposure is associated w fetal-growth abnormalities and w childhood developmental delay and behavioral abnormalities

A

Lead

90
Q

Causes disturbances in neuronal cell division and migration and leads to a range of defects from developmental delay to microcephaly and severe brain damage

A

Methyl mercury

91
Q

3% risk of Ebstein anomaly

A

Lithium

92
Q

Neonatal lithium toxicity from exposure near delivery:

A 
Hypothyroidism
DI
Cardiomegaly
Bradycardia
ECG abnormalities
Cyanosis 
Hypotonia
93
Q

Associated w increased risk of ASD/VSD

Late preg exp is associated w persistent pulmonary hypertension of the newborn

A

Selective serotonin and Norepinephrine re-uptake inhibitors

94
Q

Jitteriness, irritability, hyper- or hypo- tonia, feeding abn, vomit, hypoglycemia thermoregulatory instability and respi abn

A

Neonatal behavioral syndrome

95
Q

Antipsychotic meds - abn extrapyramidal muscle movements and withdrawal symptoms

A 
Haloperidol
Chlorpromazine
Aripiprazole
Olanzapine
Quetiapine
Risperidone
96
Q

Vit A -retinol is associated w cranial neural crest defects
-beta carotene no detects

RDA?

A

3,000 IU/day

97
Q

Most potent human teratogen: isotretinoin, acitretin and bexarotene

Inhi neural crest cell migration during embryogenesis—> retinoic acid embryopathy (CNS, face, heart, thymus)

A

Vit A derivatives

98
Q

Causes venticulomegaly
Maldevelopment of facial bones or cranium, microtia or anotia, micrognathia, cleft palate, conotruncal heart defects and thymic aplasia or hypoplasia

A

Vit A derivatives

99
Q

13-cis-retinoic acid

Cell differentiation and used for cystic nodular acne

First trim exposure – high rate of pregnancy loss and malformations in 1/3 of fetus loss

A

Isotretinoin

100
Q

Severe psoriasis tx

Metabolized to Etretinate

Should delay conception for at least 3 yrs following therapy discontinuation

A

Acitretin

101
Q

Used to treat cutaneous T-cell lymphoma–> cause eye and ear abn, cleft palate and incomplete ossification

A

Bexarotene

102
Q

Tretinoin and Tazarotene –> possible neural crest defects

A

Topical retinoids

103
Q

Most notorious human teratogen

Used to treat leprosy and multiple myeloma

34-50 days mens age -> phocomelia

Causes cardiac malf, GI abn, limb redxn defects

A

Thalidomide

104
Q

An absence of one or more long bones which results in hands and feet being attached to the trunk by a smol rudimentary bone

A

Phocomelia

105
Q

Analogue of thalidomide used to treat types of myelodysplastic syndrome and multiple myeloma

A

Lenalidomide

106
Q

Exposure of warfarin between 6-9th wks

A

Stippling of the vertebrae and femoral epiphysis and by nasal hypoplasia w depression of nasal bridge; some may have choanal atresia resulting in respiratory distress

107
Q

Warfarin used in first trimester

A

Agenesis of corpus callosum, cerebellar vermian agenesis – Dandy Walker malformation, microphthalmia and optic atrophy

107
Q

Warfarin used in first trimester

A

Agenesis of corpus callosum, cerebellar vermian agenesis – Dandy Walker malformation, microphthalmia and optic atrophy

108
Q

Poland sequence (interruption in vascular supply to one side of fetal chest and ipsilateral arm), cardiac anomalies, hydrocephaly, microcephaly, omphalocele, gastroschisis, cleft lip and palate and hand abn

A

Tobacco

109
Q

Fetal growth restriction and behavioral abn in infancy and early childhood

A

Amphetamines

110
Q

Vasoconstrictive and hypertensive effects: cerebrovascular hemorrhage, myocardial damage and placental abruption and preterm delivery

A

Coke jk cocaine

111
Q

Preterm birth
Placental abruption
Fetal growth restriction or death

A

Opioids-Narcotics Heroin

112
Q

Not associated w fetal anomalies hmmmm

A

MJ 🍃

113
Q

Theoretically premature closure of ductus arteriosus

A

Aspirin

114
Q

Not associated w increased risk of anomalies

A

Acetaminophen

115
Q

Not known teratogen but possibility of fetal bradycardia

A

Local anesthesia

116
Q

Not teratogen anticoagulant

A

Heparin

117
Q

Can cause embryopathy

A

Coumarin derivatives

118
Q

Anti-emetics

A

Phenothiazine - no known terato

Ondansetron HCl - no human studies

119
Q

Antihypertensive

A

No known teratogenic effects w methyldopa, hydralazine, diuretics

Beta-adrenergic agonists - possible fetal growth restriction, neonatal hypoglycemia

Calcium channel blockers - possible limb defects

120
Q

Antimicrobials

A

Penicillin - safest
Erythromycin
Nitrofurantoin
Quinolones - fluoroquinolones - arthropathy and cartilage erosion in animals

Antifungals: nystatin, clotrimazole, miconazole - no anomalies

121
Q

Herbal remedies

A

Black cohosh - abortifacient
Garlic/Ginger/Gingko biloba/Ginseng - risk of bleeding
Yohimbe/Ephedra - hypertension, arrhythmias

122
Q

Fluid secretion that contains essentially the same conc of proteins and lactose as milk but almost no fat

A

Colostrum

123
Q

What allows lactogenic effect of prolactin to assume its milk promoting role, and over 1-7 days, breasts begin to secrete copious amounts of milk instead of colostrum

A

Estrogen and progesterone loss

124
Q

Hormones that contribute to milk prod

A

GH
Cortisol
Parathyroid hormone
Insulin

125
Q

Hormones are necessary to provide what that is required for milk formation

A

AA
FA
Glucose
Ca

126
Q

Stimulates release of oxytocin from Neurohypophysis, which stimulates milk ejection from the milk ducts (let-down reflex) by causing contract of myoepithelial cells –> expressing milk from alveoli into ducts

A

Sucking

127
Q

It usually can be expressed from the nipples by the 2nd postpartum day

A

Colostrum

128
Q

Secretion of colostrum persists for about how many dayz?

A

5 daze w gradual conversion to mature milk in the ensuing 4 wks

129
Q

Suspension of fat and protein in a carbohydrate-mineral soln

Vol prod by nursing mom: 600mL/day

Isotonic w plasma

Most milk proteins are unique and aren’t found elsewhere

A

Human meellkkk

130
Q

IL what are in large amt in colostrum and human milk

A

IL 2

131
Q

May be absorbed orally and promote growth and maturation of intestinal mucosa

A

EGF epidermal growth factor

132
Q

All vitamins are found in human melk EXCEPT???????

A

K

Vit K ok okay kkk

133
Q

10 steps to successful breastfeeding (WHO/UNICEF)

A
  1. BF policy
  2. Train all HC staff necessary to implement policy
  3. Inform preggy on benefits and mgmt of BF
  4. Initiate BF within first 30 mins after birth whoawhoa
  5. How to BF and maintain lactation even in separation
  6. NB infants no milk feeds or water other than Breast MELK
  7. Practice rooming in
  8. Encourage BF on demand
  9. No to artificial treats or dummies to beeastfed infacts
  10. Foster est of BF support grps and refer moms to them on discharge from hospi or clinic
134
Q

Strong evidences shows that human milk feeding decreases the incidence and severity of

A 
Diarrhea
Lower respiratory infxn
Otitis media
Bacteremia
Bacterial meningitis
Botulism
UTI
Necrotizing enterocolitis

REPRODUCTIVE SYSTEM (8 decks)

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