LATE PREGNANCY (C6) Flashcards
1
Q
Common between first and second missed menstrual pd and continue until 14-16 wks
A
Nausea & vomiting
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
3
Q
Severe vomiting that results to dehydration, electrolyte and acid-base disturbances and starvation ketosis
A
Hyperemesis gravidarum
4
Q
May be dt steroid-induced suppression of bowel activity, compression of bowels by enlarging uterus
A
Constipation
5
Q
In constipation, what should be avoided?
A
Enemas & strong cathartics
6
Q
Muscular spasm and tenderness –> acute strain or fibrositis
Respond to analgesics, heat and rest
A
Backache
7
Q
Cause: congenital predisposition abd accrue with advancing age dt increased lower extremity venous pressures
A
Varicosities
8
Q
Venous femoral pressure in the supine pregnant is
A
8 mmHg early
to
24 mmHg at term
9
Q
Symptoms of varicosities
A
Mild cosmetic blemishes –> severe discomfort
10
Q
Management of varicosities
A
Periodic rest w leg elevation
Elastic stockings
11
Q
Coexist with leg varicosities
A
Vulvar varicosities
12
Q
Rectal vein varicosities and may first appear during pregnancy as pelvic venous pressures increase
A
Hemorrhoids
13
Q
Relieved by topical anesthetics, warm soaks, stool softening agents
A
SMS: pain and swelling
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
15
Q
how to relieve heartburn
A
frequent feedings
avoid of bending over or lying flat
antacids
16
Q
antacids
A
aluminum or magnesium trisilicate
17
Q
pagophagia
A
craving ice
18
Q
amylophagia
A
starch cravings
19
Q
geophagia
A
craving for clay
20
Q
triggered by severe iron def
A
pica
21
Q
profuse salivation wc appears to follow saliv gland stimulation by starch ingestion
A
ptyalism
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)
23
Q
as pregnancy advances, what happens to sleep efficiency?
A
progressively diminish
24
Q
3rd trimester sleep situation
A
sleep disturbance and restless leg syndrome
25
more frequent early pregnancy
| may be ass w hypertension in late preg
headache
26
increased in vaginal discharge, mostly dt mucus secretion by cervical glands in response to hyperestrogenemia in pregnancy
Leukorrhea
Abnormal: bacterial vaginosis, candidiasis and trichomoniasis
27
study of birth defects and their etiology
teratology
28
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
Teratogen
29
after Hades - god who possessed a helmet conferring invisibility --- an agent that interferes w normal maturation and fxn of an organ
Hadegen
30
an agent that alters growth
| Hadegens and trophogens typically affect dev in fetal pd and after birth
Trophogen
31
these act by disturbing sp physio processes, leading to abn cellular differentiation, altered tissue growth or cell death
Teratogens
32
it has been linked to susceptibility to teratogenic effects ofspecific meds
genetic composition or fetal genome
33
more likely to develop anomalies if homozygous for a gene mutation that results in abn low lvls of epoxide hydrolase
hydantoin exposure
34
metabolized by microsomes to oxidative intermediates that accumulate in fetal tissues
hydantoin
carbamazepine
phenobarbital
35
these have carcinogenic, mutagenic and other toxic effects that are dose related and increase w multidrug therapy
free oxide radicals
36
fetal neural tube defects, cardiac defects and oral clefts can be a result of
folic acid metabolic path disturbances
37
essential for methionine prod
| wc is required for methylation ---> prod CHON, lipids and myelin
Folates
38
It can either impair folic acid absorption or acts as folic acid antagonists
anticonvulsant drugs (phenytoin, carbamazepine, valproic acid and phenobarbital)
39
low periconceptional folic acid lvls in women w epilepsy may cause
fetal malformations
40
may increase the risk of adverse fetal outcomes dt
paternal exposure to drugs or environmental influences
41
proposed mechanisms:
- 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
42
induction of a gene mutation or chromosomal abnormality in sperm
* 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
43
exposure to these are linked to early pregnancy loss
mercury, lead, solvents, pesticides, anesthetic gases or hydrocarbons
44
moat freq nongenetic cause of mental retardation
alcohol
45
potent and prevalent teratogen
ethyl alcohol
46
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
fetal alcohol syndrome
47
there is an association w periconceptional alcohol use and
omphalocele and gastroschisis
48
valproic acid can cause
low IQ
49
fetotoxic and result in ACE-inhibitor fetopathy
| disruption of RAS (essential for normal renal development)
ACE inhi
50
causes fetal hypotension and renal hypoperfusion, w subsequent ischemia and anuria
ACE inhi
51
reduced perf may cause fetal growth restriction rand calvarium maldevelopment, whereas oligohydramnios may result in
pulmonary hypoplasia and limb contractures
52
Associated w a pattern of congenital malformations resembling the autosomal recessive Antley-Bixler syndrome (at doses of 400-800mg daily) and Tetralogy of Fallot
Fluconazole (antifungal)
53
Abn: oral clefts, abn faces and cardiac, skull, lung, long bone and joint abnormalities
Antifungals
Single 150mg dose to treat vulvovaginal candidiasis doesn't appear teratogenic
54
Inhibits prostaglandin synthesis
Anti-inflammatory agents
55
Not teratogenic but cab have adverse fetal effects when used in 3rd trimester
NSAIDs
56
Cause constriction of fetal ductus arteriosus resulting in pulmonary hypertension
Also decrease fetal urine production thereby reducing amniotic volume
Indomethacin
57
Pyrimidine synthesis inhibitor for treatment of RA
Leflunomide
58
Animal studies showed hydrocephalus, eye anomalies, skeletal abnormalities and embryo death
Leflunomide
59
Detectable in plasma for 2 years following discontinuation so women w childbearing potential should consider cholestyramine tx or washout
Leflunomide
60
Nephrotoxicity and ototoxicity in preterm newborns
Aminoglycosides
61
GBS gray
| preterm infants are unable to conjugate and excrete the drug and manifested abn distention, respiratory abnormalities
Chloramphenicol
62
Associated w four-fold increased risk for hypoplastic left heart syndrome and microphthalmia/anophthalmia
2-fold increase for clefts and atrial septal defects
Nitrofurantoin
63
ACOG: first trimester use is appropriate if no sustainable alternatives are available
Nitrofurantoin
64
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
Sulfonamides
65
Yellowish brown discoloration of deciduous teeth when used after 25 weeks
Tetracycline
66
Antineoplastic
Cyclophosphamide
Methotrexate/Aminopterin
Tamoxifen
Trastuzumab
67
Alkylating agent wc inflicts a chemical insult on developing fetal tissues and leads to cell death and heritable DNA alterations in surviving cells
Cyclophosphamide
68
Inc preg loss (HWs) and malformations include skeletal abn, limb defects, cleft palate and eye abnormalities
Cyclophosphamide
69
Folic acid antagonist, potent teratogen and abortifacient
Methotrexate/Aminopterin
70
Craniosynostosis w "clover-leaf" skull, wide nasal bridge, low-set ears, micrognathia and limb abnormalities
Fetal Methotrexate-Aminopterin syndrome
71
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
Tamoxifen
72
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
Transtuzumab
73
Causes oligohydramnios, anhydramnios and fetal renal failure ---> fetal pulmonary hypoplasia, skeletal abn and neonatal death
Trastuzumab
74
Antiviral
Ribavirin
| Efavirenz
75
Is a nucleoside analogue and a component of therapy for hepa C infxn
Malformations: skull, palate, eye, skeleton and gastrointestinal abn
Ribavirin
76
Is a nonnucleoside reverse transcriptase inhibitor used to treat HIV that causes CNS and ocular abn
Efavirenz
77
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
Bosentan and Ambrisentan
78
Sex hormones
Testosterone and Anabolic steroids
Danazol
Diethylstilbestrol
79
Causes virilization and may result in ambiguous genitalia similar to congenital adrenal hyperplasia: labioscrotal fusion w first trimester exposure and phallic enlargement
Testosterone and Anabolic steroids
80
An ethinyl testosterone derivative has weak androgenic activity that causes virilization
Clitoromegaly, fused labia and urogenital sinus malformation
Danazol
81
This exposure in utero resulted to vaginal clear cell adenocarcinoma and 2-fold increase in vaginal and cervical intraepithelial neoplasia
Diethylstilbestrol
82
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
Diethylstilbestrol
83
Genital tract in men: abn
| Epididymal cysts, microphallus, hypospadias, cryptorchidism and testicular hypoplasia
Diethylstilbestrol
84
Immunosuppressant meds
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Corticosteroids
Mycophenolate Mofetil
Radioiodine
Lead
Methyl mercury
```
85
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)
Corticosteroids
86
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
Mycophenolate Mofetil
87
Tx thyroid cancer and thyrotoxicosis; nonhodgkins lymphoma
| Radioactive iodine-131
Radioiodine
88
Contraindicated during preg bcs cross placenta and conc in fetal thyroid at 12 wks
Irreversible fetal hypothyroidism and increased risk for childhood thyroid cancer
Radioiodine
89
Prenatal exposure is associated w fetal-growth abnormalities and w childhood developmental delay and behavioral abnormalities
Lead
90
Causes disturbances in neuronal cell division and migration and leads to a range of defects from developmental delay to microcephaly and severe brain damage
Methyl mercury
91
3% risk of Ebstein anomaly
Lithium
92
Neonatal lithium toxicity from exposure near delivery:
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Hypothyroidism
DI
Cardiomegaly
Bradycardia
ECG abnormalities
Cyanosis
Hypotonia
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93
Associated w increased risk of ASD/VSD
Late preg exp is associated w persistent pulmonary hypertension of the newborn
Selective serotonin and Norepinephrine re-uptake inhibitors
94
Jitteriness, irritability, hyper- or hypo- tonia, feeding abn, vomit, hypoglycemia thermoregulatory instability and respi abn
Neonatal behavioral syndrome
95
Antipsychotic meds - abn extrapyramidal muscle movements and withdrawal symptoms
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Haloperidol
Chlorpromazine
Aripiprazole
Olanzapine
Quetiapine
Risperidone
```
96
Vit A -retinol is associated w cranial neural crest defects
-beta carotene no detects
RDA?
3,000 IU/day
97
Most potent human teratogen: isotretinoin, acitretin and bexarotene
Inhi neural crest cell migration during embryogenesis---> retinoic acid embryopathy (CNS, face, heart, thymus)
Vit A derivatives
98
Causes venticulomegaly
Maldevelopment of facial bones or cranium, microtia or anotia, micrognathia, cleft palate, conotruncal heart defects and thymic aplasia or hypoplasia
Vit A derivatives
99
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
Isotretinoin
100
Severe psoriasis tx
Metabolized to Etretinate
Should delay conception for at least 3 yrs following therapy discontinuation
Acitretin
101
Used to treat cutaneous T-cell lymphoma--> cause eye and ear abn, cleft palate and incomplete ossification
Bexarotene
102
Tretinoin and Tazarotene --> possible neural crest defects
Topical retinoids
103
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
Thalidomide
104
An absence of one or more long bones which results in hands and feet being attached to the trunk by a smol rudimentary bone
Phocomelia
105
Analogue of thalidomide used to treat types of myelodysplastic syndrome and multiple myeloma
Lenalidomide
106
Exposure of warfarin between 6-9th wks
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
Warfarin used in first trimester
Agenesis of corpus callosum, cerebellar vermian agenesis -- Dandy Walker malformation, microphthalmia and optic atrophy
107
Warfarin used in first trimester
Agenesis of corpus callosum, cerebellar vermian agenesis -- Dandy Walker malformation, microphthalmia and optic atrophy
108
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
Tobacco
109
Fetal growth restriction and behavioral abn in infancy and early childhood
Amphetamines
110
Vasoconstrictive and hypertensive effects: cerebrovascular hemorrhage, myocardial damage and placental abruption and preterm delivery
Coke jk cocaine
111
Preterm birth
Placental abruption
Fetal growth restriction or death
Opioids-Narcotics Heroin
112
Not associated w fetal anomalies hmmmm
MJ 🍃
113
Theoretically premature closure of ductus arteriosus
Aspirin
114
Not associated w increased risk of anomalies
Acetaminophen
115
Not known teratogen but possibility of fetal bradycardia
Local anesthesia
116
Not teratogen anticoagulant
Heparin
117
Can cause embryopathy
Coumarin derivatives
118
Anti-emetics
Phenothiazine - no known terato
| Ondansetron HCl - no human studies
119
Antihypertensive
No known teratogenic effects w methyldopa, hydralazine, diuretics
Beta-adrenergic agonists - possible fetal growth restriction, neonatal hypoglycemia
Calcium channel blockers - possible limb defects
120
Antimicrobials
Penicillin - safest
Erythromycin
Nitrofurantoin
Quinolones - fluoroquinolones - arthropathy and cartilage erosion in animals
Antifungals: nystatin, clotrimazole, miconazole - no anomalies
121
Herbal remedies
Black cohosh - abortifacient
Garlic/Ginger/Gingko biloba/Ginseng - risk of bleeding
Yohimbe/Ephedra - hypertension, arrhythmias
122
Fluid secretion that contains essentially the same conc of proteins and lactose as milk but almost no fat
Colostrum
123
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
Estrogen and progesterone loss
124
Hormones that contribute to milk prod
GH
Cortisol
Parathyroid hormone
Insulin
125
Hormones are necessary to provide what that is required for milk formation
AA
FA
Glucose
Ca
126
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
Sucking
127
It usually can be expressed from the nipples by the 2nd postpartum day
Colostrum
128
Secretion of colostrum persists for about how many dayz?
5 daze w gradual conversion to mature milk in the ensuing 4 wks
129
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
Human meellkkk
130
IL what are in large amt in colostrum and human milk
IL 2
131
May be absorbed orally and promote growth and maturation of intestinal mucosa
EGF epidermal growth factor
132
All vitamins are found in human melk EXCEPT???????
K
Vit K ok okay kkk
133
10 steps to successful breastfeeding (WHO/UNICEF)
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
Strong evidences shows that human milk feeding decreases the incidence and severity of
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Diarrhea
Lower respiratory infxn
Otitis media
Bacteremia
Bacterial meningitis
Botulism
UTI
Necrotizing enterocolitis
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