Midterm Flashcards
when to draw serum hCG?
9 days after conception
when to draw urine hCG?
by missed menses it will be positive
single hCG vs serial hCG?
singl hCG- confirms PG
serial hCG- it’s likely a viable PG
What’s the one thing that will tell you it’s a viable PG?
TVUS at week 6
fetal heart beat confirms viability of PG
Significance of determining due date?
- eligibility for home birth (premature not good candidate)
- timing for tests/procedures
- determine intrauterine growth restriction (IUGR)
how to estimate date of delivery (EDD)?
LMP -3 months + 7 days
vaginal bleeding during pregnancy. ascertain extent of bleeding by asking
how often are you changing pads, what size of pads?
if on your bed: how big was the circle? a small dinner plate? a large dinner plate?
how many episodes? (continued bleeding is concerning)
pain? cramping? passed any tissue?
possible causes of bleeding in early pregnancy?
Spontaneous abortion/miscarriage Ectopic pregnancy Placental bleeding/abruption/hematoma Trophoblastic disease Vaginitis, cervicitis, trauma, cancer, warts, polyps, fibroids Cervical ectropion Physiologic or implantation bleeding
suppose the bleeding is heavier and now she has cramping, she’s 7 weeks PG, would an US rule in our out a miscarriage?
Yes, they would be able to tell if it’s an inevitable
common etiol for spontaneous abortion
congenital abnormalities
chromosomal abnormalities
trauma
nagging RLQ pain, what could it be?
appendicitis, ectopic pregnancy, ovarian cyst
most common site for ectopic PG?
fallopian tubes
2 factors that increase risk of ectopic PG?
previous ectopic pregnancy, tubal surgery, DES exposure, IUD
Women who are rh negative and unsensitized should receive a Rh(D)- immune globulin (aka)
Rhogam
when does an ectopic pregnancy become apparent? when does rupture occur? is this bad?
apparent: 6-8 weeks
rupture: 6-12 weeks
bad? causes internal bleeding and necessitates aggressive treatment
imaging to dx an ectopic? labs that elude to ectopic?
imaging: US
labs: hCG doens’t double every 48 hours during first 40 days but rather rises very slowly
tx options for ectopic?
methotrexate (1st line) or surgical (2nd line)
timing of prenatal care?
first prenatal visit by 10 weeks of gestation
monthly visit until 32 weeks
biweekly 32-36 weeks
weekly 36 weeks to delivery
2 lab tests for prenatal screening?
ABO-rh
CBC
Rubella IgG
Syphilis
for gestational DM when do you screen?
24-28 weeks, don’t screen earlier because would miss GDM
wt gain recommended during PG?
30-35 lbs unless underweight in which case recommend gaining more
nutritional advice?
protein 60-75 gm/day, carbs 175 gm/day
incr cal by 340 2nd trimester, 452 cal 3rd
regular meals, prenatal vitamins, avoid deli meats, thoroughly rinse veggies and fruit
cigarettes in PG can lead to
low birth weight
placental abruption
preterm delivery
when does implantation occur?
Implantation is from the 4th-5th weeks of pregnancy or 1 week after fertilization
When there are large amounts of cell division and DNA is uncoiled, then greatest risk of damage from exposure to poisons. what stages does this occur?
- Fetus, neonate, infant, and adolescent most vulnerable
- Breast development (ductal growth and differentiation) continues until the mid 30’s during luteal phase of menstrual cycle
why are people nauseous and what’s the MOA?
incr beta HCG and progesterone, both slow peristalsis
decr gastric secretion
it resolves bc placenta take over after 1st trimester
fetal alcohol syndrome (FAS) dx
FAS: must have one from each category
1) Prenatal or postnatal delay in child’s weight or head circumference
2) Distinct physical characteristics-includes at least 2 of the following: small head, small eyes or short eye openings, a narrow lip without center groove, short upturned nose or flattened mid-facial area. Males may have abnormal testes
3) Abnormalities of CNS; signs of brain dysfunction, delays in behavioral development, and/or cognitive impairment
fetal alcohol effect (FAE) dx
1) Less severe symptoms than FAS
2) Covers wide range of problems: eye and heart defects, impairment of kidneys, lungs, and other organs, slowed growth, Musculoskeletal defects, ADD, ADHD, extreme irritability, mental retardation
herbs/homeopathy/vit to help with nausea
Sepia
Raspberry leaf tea
remedies for cranky hormonal vs weepy hormponal
cranky: sepia
weepy: pulsatilla
what’s the DDX in hyperemesis gravidum (severe intractable nausea and vomiting)?
hepatitis
cholecystitis
gastroenteritis
peptic ulcer
risks or sequelae of anemia during PG?
preterm birth
IUGR (intra uterine growth reduction)
supplements to treat iron def anemia in PG?
Nettle and yellow doc (great source of iron)
ferrous gluconate
insomnia tx during PG?
warming socks
warm bath before bed (NOT hot)
chamomile
sleepy in 1st trimester due to?
progesterone
when is oxytocin released?
low lights
when she has privacy
talking
