Lecture 12 Flashcards
What type vaccines do you not give pregnant women?
Live virus vaccines
What is the goal of preconception counseling
Optimize a woman’s health pre-pregnancy
What is one of the first things that change with pregnancy?
Breast tenderness
When does softening and enlargement of the uterus happen?
6 weeks into pregnancy
What is when the vagina seems congested and is blueish?
Chadwick sign
WHat is the sign associated with softening of the cervix?
Hegar sign
What test is used to confirm pregnancy?
Urine or serum hCG (human chorionic gonadotropin)
The hCG beta quant should do what in early pregnancy?
Double about every day
Which is more sensitive, urine or serum hCG?
Serum
TVUS can detect pregnancy at how many weeks?
3-4 weeks gestation Beta HCG 1000-2000)
When can you visualize the fetus via abdominal US?
5-6 weeks (can see a gestational sac)
B/w what weeks is there doppler detection fo fetal haert tones?
10-12 weeks
What is EGA?
Estimated gestation age
What is EDD?
Estimated date of delivery
When is CVS performed?
> 10 weeks
When is amniocentesis usually performed?
15-20 weeks
When is cordocentesis performed?
> 20 weeks GA
What 3 tests are performed in the first timester (10-13 weeks)?
HcG (quantitative)
PAPP-A
CVS
What does a decrease in PAPP-A indicate?
Aneuploidy (abnormal chromosome number)
What makes up the triple test (what do you add for quad)?
AFP (alpha fetal protein)
Estriol
Hcg
(inhibin A- only quad)
Do values in the triple/ quad screen vary by race?
Yes
How often do you see women under 28 weeks?
Every 4 weeks
What is the normal range for fetal heart tones?
120-160 bpm
What maneuvers are used to determine fetal presentation?
Leopold maneuvers
What do you look for on urine in a normal ob exam?
Glucose
Protein (albumin)
What is external cephalic version (ECV)?
Where you turn the baby so they don’t present breech. Done at 36-38 weeks
If the fundal height is at the umbilicus, what week are they probably at?
20 weeks
What are some routine labs?
CBC RPR?FTA glucose blood type/ rH urinalysis Group B strep BMP STD: gc, chlamydia, hep B
What is associated with genetic defects and you need to get a profile on?
Rubella
At what week does the 3rd trimester start?
28 weeks
What is an indirect way to measure fetal activity?
Fetal kick counts
How many fetal kick count should there be in an hour?
4-10 kicks an hour
What is the biophysical profile
Get an NST, look at breathing movement, look for gross body movements (GSM) on US, look at fetal tone, amniotic fluid index
What is the normal range for biophysical profile
8-10
What is a concerning number for biophysical profile?
Under 6
What happens in breast in the first 8 weeks?
Nipple/ areola enlarge
Prominence montgomery tubercles
Ductal growth
Increased blood flow
When is colostrum produced?
Later in pregnancy
leakage is common
What happens to total serum calcium for the mom?
Decrease total serum calcium
What is the hormone that leads to ligament laxity and joints loosen?
Relaxin
What happens with the eyes to pregnant women?
Can have blurred vision due to cornea thickness.
Increased intraocular pressure due to fluid retention
What happens to the thyroid hormone in pregnancy?
Gets larger
What hormone becomes more prevalent in early pregnant?
free T4 (should level down after 14 weeks)
Does Mom’s TSH cross the placenta?
No
Does aldosterone synthesis increase or decrease?
Increase
Does DHEA increase or decrease?
Decrease (favor estrogen)
What is Ptyalism?
Feeling of excess saliva
Why do pregnant women have heart burn?
Decreased esophageal sphincter, increased gastric pressure and delayed gastric emptying
Why are women more constipated when pregnant?
Takes longer for food to go from stomach to cecum
What happens with a lipid profile in pregnant women?
All levels go up
What may happen with total albumin?
Serum decreases (not really decreases, just over a larger volume)
What GI conditions are pregnant women more at risk for?
Cholecystitis and gallstone
What happens with glucose levels in pregnant women?
blunted response to glucose load postprandial hyperglycemia
What increases in the CV in the first part of pregnancy?
Increased stroke volume
After increased stroke volume, what happens to the heart?
Heart rate increases (more circulating blood volume and less PVR)
How much does cardiac output increase by?
30-50%
Where does the heart shift with pregnancy?
Up and left
Women who are pregnant are in what type state hematologically?
Hyper-coagulable state w/ increased risk of DVT
in pregnancy, the dilutional affect on the RBCs leads to a decreased H and H known as what?
Physiologic anemia
What do the kidneys increase the excretion of to compensate for decreased PCO2?
Serum bicarb
Do the kidneys enlarge?
yes
What levels will decreased with renal values?
BUN
creatinine
Uric acid
GFR increases by how much in pregnancy?
50%
What 2 things will be excreted more in pregnant women?
Vitamin B12
Folic Acid
What is the only antibody going across the placenta?
IgG
What hormone does the placenta produce?
human placental lactogen (HPL)
when does fetal bone marrow begin production?
Weeks 21-22
Where does surfactant secretion begin?
Week 26
What is the name for fetal waste?
meconium
How is bilirubin eliminated in womb?
Placenta
Birth defect where infants intestines are born outside the abdominal cavity.
gastroschisis
What makes a male, male?
Gene trigger
When does the thyroid develop?
End of 1st trimester
What weeks does the 4 chamber heart form?
5-8 weeks
When are lungs able to breathe without assistance?
28 weeks
When does meconium begin to accumulate?
18 weeks
When are gonads differentiated?
6-8 weeks
When do the fetal kidneys produce urine? And how much urine do they produce
11-12 weeks; 400-1200 ml urine/day
