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SMP - SDR > Lecture 13 - Pregnancy 101 > Flashcards

Lecture 13 - Pregnancy 101 Flashcards

1
Q

What does cramping and bleeding mean during pregnancy?

A

Together: miscarriage
Individually: normal

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2
Q

How do progesterone and estrogen levels vary during pregnancy?

A

Increase steadily throughout the whole pregnancy

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3
Q

How do hCG levels vary during pregnancy? What is this associated with?

A

Dramatic increase from week 4 to 12 and then decreases until week 24 where it stays at a steady level for the rest of the pregnancy

Associated with nausea during the first trimester due to cross-receptor reactivity with the nausea center in the brain

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4
Q

What is the main risk of the 1st trimester? Explain.

A

Miscarriage (15-50% of pregnancies), most likely due to chromosomal abnormalities

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5
Q

What are 6 initial tests done on a pregnant woman?

A
  1. Type and screen
  2. HIV
  3. STD screening
  4. Urine culture
  5. Rubella immunity
  6. Sonogram (?)
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6
Q

What is a type and screen test?

A

Both the ABO-Rh of the patient and screens for the presence of the most commonly found unexpected antibodies

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7
Q

How to date a pregnancy? What to note?

A
  1. Start with LMP = last menstrual period
  2. Sonogram to measure size confirms or refutes (1) - will be true within a few days, but less so the further along the pregnancy

Note: patient can give exact day but may be off by weeks because of bleeding associated with implantation

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8
Q

What urinary disease is more common during pregnancy?

A

UTIs and can lead to kidney infections

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9
Q

How is sized measured using a sonogram?

A

Crown-rump length (CRL) is the measurement = length of human embryos and fetuses from the top of the head (crown) to the bottom of the buttocks (rump)

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10
Q

What are the genetic tests conducted during pregnancy?

A
  1. Nuchal screening test: to detect trisomies
  2. FFDNA (free fetal DNA) screening test: genetic material which comes from embryo can be detected in the mother’s blood during pregnancy
  3. Chorionic villus sampling/Amniocentesis: diagnostic test
  4. Ancestry based screening
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11
Q

What tests are conducted during the second trimester?

A
  1. Anatomy screening sonogram at 18-20 weeks: congenital malformation screening and sex determination
  2. Maternal Serum Alpha-Fetoprotein at 15-22 weeks: marker is in relatively high concentrations in the brain/spinal fluids and spills out into maternal serum, will elevate levels in spina bifida, other neural tube defects + can add inhibin-A, estriol and bHCG to make it a quad screen to evaluate for aneuploidy
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12
Q

Is testing maternal plasma for alpha-fetoprotein a screening or diagnostic test?

A

Screening

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13
Q

Which is more common: maternal serum alpha-fetoprotein or FFDNA? Why?

A

FFDNA, because better screening test which can be done sooner

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14
Q

What is quickening? When does it occur during pregnancy?

A

When mother starts feeling the baby moving

During 2nd trimester, generally around 20 weeks (earlier if you have had babies before, parity, and know what to look for)

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15
Q

What is viability? When does it occur during pregnancy?

A

Point at which the baby could be delivered and survive

Traditionally at 24 weeks, now pushing envelop to 22-23 weeks (2nd trimester)

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16
Q

When do round ligament pains occur during the pregnancy? What to note?

A

2nd trimester

Note: worse with exercise and activity

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17
Q

What can round ligament pain be mistaken for?

A

Pre-term labor pain

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18
Q

What are fundal height check? Purpose? When are they done?

A
  1. Palpate shape of uterus to identify fundus
  2. Zero measuring tape at fundus
  3. Stretch tape over abdomen to superior border of symphysis WITH TAPE FACING DOWN to get an objective assessment

=> screening for growth abnormalities depending on week (20 weeks = 20 cm)

Done in 2nd-3rd trimesters

19
Q

Symptoms during 3rd trimester?

A
  1. Fatigue
  2. Aches, pains, and Braxton Hicks contractions vs preterm labor
  3. Dyspnea
20
Q

Frequency of doctor visits during pregnancy? Explain.

A

1st trimester: monthly

2nd trimester: monthly

3rd trimester: biweekly from week 28 to 36 and weekly from week 36 onward

Reason: pre-eclampsia screening by surveilling BP

21
Q

Symptoms during 1st trimester?

A
  1. Nausea

2. Fatigue

22
Q

What are weight gain recommendations for pregnancy?

A

From Institute of Medicine/American College of Obstetrician Gynecologists:

BMI < 18: 30-40lbs
BMI 18-25: 25-35 lbs
BMI 25-30: 15-25lbs
BMI > 30: 10-20lbs (or less)

23
Q

What 5 tests are conducted during the third trimester?

A
  1. Gestational diabetes screening
  2. Anemia screening: physiologic or iron deficiency?
  3. HIV screening (in at risk areas, like DC)
  4. GBS
  5. Rh
24
Q

What is physiologic anemia of pregnancy?

A
  1. Fetus/embryo using iron
  2. BV and plasma volume increase larger than RBC volume increase

=> so low Hb and hematocrit

25
Q

What is the GBS test? Purpose?

A

1 cause of neonatal sepsis and if levels are high, penicillin treatment during labor can significantly decrease rates of neonatal sepsis

Group B streptococcus = normally occurring flora in adults, with 30-40% of women colonized in rectovaginal area

GBS culture collected 35-36 weeks to figure out who needs treatment

26
Q

Describe the gestational diabetes screening test.

A
  • 50g sugar, nonfasting, blood glucose 1hr later - if abnormal, then do:
  • 100g sugar, fasting, blood at 0 (fasting), 1hr, 2hr, 3hr - need to have 2 or more abnormal values to fail
27
Q

Describe Rb testing in the third trimester. Treatment?

A

15% of mothers are Rh negative, and so if they have a baby who is Rh positive (if father is), sometimes a tiny bit of fetal RBCs spill into the maternal circulation (especially during 3rd trimester) => mother will create antibodies against baby’s blood cells => immune hydrops fetalis where baby gets swollen, anemic, and dies without intervention (especially if it’s second pregnancy with Rh positive baby)

Treatment: Rhogam, purified antibody against Rh positive at 28 weeks and at birth (stays for 12 weeks) that binds Rh parts of fetal RBCs that passes the placenta and targets them for destruction so that maternal immune surveillance does not get involve

28
Q

Describe dyspnea in the third trimester.

A
  1. Shortness of breath in pregnancy
  2. Reduced lung volume
  3. Increased oxygen demand
  4. Decreased preload
  5. Increased peripheral edema
29
Q

What is presentation? How to determinate it?

A

Technique to tell what position the baby is in done:

  1. Leopold maneuver (achieves diagnosis most of the time)
  2. Sonography is gold standard
30
Q

Best presentation? Bad? %?

A
  1. Head down, vertex, cephalic is best: 90%

2. Breech is problematic: general recommendation except in rare situations is cesarean delivery: 10%

31
Q

3 types of breeches?

A
  1. Complete
  2. Incomplete
  3. Frank
32
Q

Definition of labor?

A

Regular contractions
PLUS
Cervical change

33
Q

What are the 3 stages of labor?

A
  1. 1st – dilation up to 10cm (fully dilated): 2 phases =>
    - Latent phase – first half, (up to 5ish cm) less painful?, slower dilation (lasts up to a day)
    - Active phase – second half (5ish-10cm), more painful, (faster dilation generally about 1cm change per hour)
  2. 2nd – pushing (up to 4-5hrs)
  3. 3rd – placenta delivery (<30 minutes)
34
Q

What is the Friedman curve for normal labor?

A

Time vs cervical dilation

Used during labor to tell whether or not there is a need for intervention

35
Q

Describe fetal heart rate monitoring in labor. What to note?

A

Continuous fetal heart monitoring does a decent job of determining fetal risk for acidosis, as acidemia during labor is associated with long term brain damage and cerebral palsy

Our ability to discern acidemia is limited, however, and critics of continuous monitoring accurately point out that interventions (c/section, operative vaginal delivery) have increased without associated decrease in anoxic brain injuries

36
Q

3 delivery methods? Describe each.

A
  1. Vaginal: optimal outcome, compared to operative delivery less blood loss, lower risk of peripartum infection, easier next delivery
  2. Operative vaginal: forceps or vacuum indicated for prolonged 2nd stage or nonreassuring fetal heart tones
  3. Cesarean: indicated for breech/malpresentation, nonreassuring FHT, cephalopelvic disproportion (big baby), active herpes infection, abnormal placentation, poorly controlled HIV, multiples (twins/triplets), and MORE
37
Q

3 immediate postpartum activities?

A
  1. Initiate breastfeeding to promote bonding, milk supply and uterine contractions
  2. Uterus contracts down dramatically to reduce bleeding (stimulated by nipple stimulation => oxytocin)
  3. Vaginal laceration repair occurs at this time
38
Q

Are vaginal lacerations expected during most first pregnancies? Locations?

A

YUP

Locations: periurethral, labial, and most common perineal

39
Q

Uterus CO during delivery?

A

25%

40
Q

Hormonal changes during pregnancy?

A
  1. Prolactin peaks at birth and then peaks during each breast feeding session with pretty high basal levels that decrease little by little overtime
  2. Progesterone/estrogen peak at birth and then decrease back to normal post-partum because placenta is delivered
  3. Oxytocin surge at birth and then during each breast feeding session with 0 basal levels
41
Q

When does breast milk production start?

A

Colostrum in first 3 days and then big increase

42
Q

Grading of perineal lacerations?

A

Graded by severity:
1st degree– mucosa only (quite rare)
2nd degree– mucosa and superficial musculature (strong majority)
3rd degree– involves anal sphincter musculature
4th degree– tear from base of the vagina through to anal sphincter including muscle and anal mucosa

43
Q

Effect of breastfeeding on female reproductive system? What to note?

A

Breastfeeding => elevated prolactin => suppresses estrogen/progesterone => suppresses ovulation

Exclusive breastfeeders can rely on cycle suppression for 3 months (sometimes longer) => natural form of pregnancy spacing

Low estrogen causes:
1. Mood disturbance: postpartum depression vs. baby blues
2. Vasomotor symptoms: night sweats
3. Vaginal dryness
=> similar to menopause

SMP - SDR (23 decks)

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