Midterm

Question 1

when to draw serum hCG?

Answer 1

9 days after conception

Question 2

when to draw urine hCG?

Answer 2

by missed menses it will be positive

Question 3

single hCG vs serial hCG?

Answer 3

singl hCG- confirms PG

serial hCG- it’s likely a viable PG

Question 4

What’s the one thing that will tell you it’s a viable PG?

Answer 4

TVUS at week 6

fetal heart beat confirms viability of PG

Question 5

Significance of determining due date?

Answer 5

• eligibility for home birth (premature not good candidate)
• timing for tests/procedures
• determine intrauterine growth restriction (IUGR)

Question 6

how to estimate date of delivery (EDD)?

Answer 6

LMP -3 months + 7 days

Question 7

vaginal bleeding during pregnancy. ascertain extent of bleeding by asking

Answer 7

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?

Question 8

possible causes of bleeding in early pregnancy?

Answer 8

Spontaneous abortion/miscarriage
Ectopic pregnancy
Placental bleeding/abruption/hematoma
Trophoblastic disease
Vaginitis, cervicitis, trauma, cancer, warts, polyps, fibroids
Cervical ectropion
Physiologic or implantation bleeding

Question 9

suppose the bleeding is heavier and now she has cramping, she’s 7 weeks PG, would an US rule in our out a miscarriage?

Answer 9

Yes, they would be able to tell if it’s an inevitable

Question 10

common etiol for spontaneous abortion

Answer 10

congenital abnormalities
chromosomal abnormalities
trauma

Question 11

nagging RLQ pain, what could it be?

Answer 11

appendicitis, ectopic pregnancy, ovarian cyst

Question 12

most common site for ectopic PG?

Answer 12

fallopian tubes

Question 13

2 factors that increase risk of ectopic PG?

Answer 13

previous ectopic pregnancy, tubal surgery, DES exposure, IUD

Question 14

Women who are rh negative and unsensitized should receive a Rh(D)- immune globulin (aka)

Answer 14

Rhogam

Question 15

when does an ectopic pregnancy become apparent? when does rupture occur? is this bad?

Answer 15

apparent: 6-8 weeks
rupture: 6-12 weeks
bad? causes internal bleeding and necessitates aggressive treatment

Question 16

imaging to dx an ectopic? labs that elude to ectopic?

Answer 16

imaging: US
labs: hCG doens’t double every 48 hours during first 40 days but rather rises very slowly

Question 17

tx options for ectopic?

Answer 17

methotrexate (1st line) or surgical (2nd line)

Question 18

timing of prenatal care?

Answer 18

first prenatal visit by 10 weeks of gestation
monthly visit until 32 weeks
biweekly 32-36 weeks
weekly 36 weeks to delivery

Question 19

2 lab tests for prenatal screening?

Answer 19

ABO-rh
CBC
Rubella IgG
Syphilis

Question 20

for gestational DM when do you screen?

Answer 20

24-28 weeks, don’t screen earlier because would miss GDM

Question 21

wt gain recommended during PG?

Answer 21

30-35 lbs unless underweight in which case recommend gaining more

Question 22

nutritional advice?

Answer 22

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

Question 23

cigarettes in PG can lead to

Answer 23

low birth weight
placental abruption
preterm delivery

Question 24

when does implantation occur?

Answer 24

Implantation is from the 4th-5th weeks of pregnancy or 1 week after fertilization

Question 25

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?

Answer 25

• 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

Question 26

why are people nauseous and what’s the MOA?

Answer 26

incr beta HCG and progesterone, both slow peristalsis
decr gastric secretion
it resolves bc placenta take over after 1st trimester

Question 27

fetal alcohol syndrome (FAS) dx

Answer 27

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

Question 28

fetal alcohol effect (FAE) dx

Answer 28

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

Question 29

herbs/homeopathy/vit to help with nausea

Answer 29

Sepia

Raspberry leaf tea

Question 30

remedies for cranky hormonal vs weepy hormponal

Answer 30

cranky: sepia
weepy: pulsatilla

Question 31

what’s the DDX in hyperemesis gravidum (severe intractable nausea and vomiting)?

Answer 31

hepatitis
cholecystitis
gastroenteritis
peptic ulcer

Question 32

risks or sequelae of anemia during PG?

Answer 32

preterm birth

IUGR (intra uterine growth reduction)

Question 33

supplements to treat iron def anemia in PG?

Answer 33

Nettle and yellow doc (great source of iron)

ferrous gluconate

Question 34

insomnia tx during PG?

Answer 34

warming socks
warm bath before bed (NOT hot)
chamomile

Question 35

sleepy in 1st trimester due to?

Answer 35

progesterone

Question 36

when is oxytocin released?

Answer 36

low lights
when she has privacy
talking