Midterm Flashcards
how hcg meausured and time frame
- urine (around missed period)
- serum (9d after ovulation)
- do quantitative
- if miscarriage, ectopic.. do serial
- US will tell you if viable … at 6 weeks… TVUS
heartbeat
1st tri US - for what?
- accurate due date
- know if premature, if baby is growing properly, for other testing
- if you know due date but ssx don’t make sense
if pelvic pain, abd pain, spotting/bleeding
What are the reasons to know an accurate due date?
Pre-post maturity, out of hospital birth, testing
Pt experienced vaginal bleeding.
what do you ask her?
○ how long, pad?, streak of blood when wiping, how much?
○ color?
cramping?
Vaginal Bleeding during pregnancy DDX? - What kind of bleeding is common?
Cervicitis, vaginal lesions, polyps, threatened miscarriage, ectopic pregnancy, physiologic bleeding, intercourse, etc.
- What kind of bleeding is common?
Suppose she has cramping at 7 weeks
- would US r/o or r/i spontaneous abortion?
- yes bc heart beat
- can’t find w a doppler (only at 10 wks)
Common Eti for spontaneous abortion
- abN cell divison, MC is chromosomal abN, progesterone xu
- congenital abN, trauma, exposure to teratogens, uterine abN/infx, etc. (know 1)
Low R Quadrant pain DDx
- ectopic pregnancy, ovarian cyst, appendicitis, round ligament pain, diverticulitis
Where do most Ectopic Pregn implant?
fallopian tubes
When should a pt establish prenatal care?
1st trimester
What are some labwork on the first visit? (know 2)
HIV, TSH, urine culture, PAP, GC, blood type
What increases the risk of ectopic pregnancy?
Tubal surgery, other tubal issues, DES exposure, infertility, previous PID, having IUD, previous STI infection (GC/US)
What advice regarding weight gain?
- 25-35 pounds
- 1 lb/wk
- don’t diet
ECTOPIC PREGNANCY RUPTURE when? findings?
@ 6-12 weeks
Internal bleeding, shock, death.. medical emergency
How can you Dx and r/o ectopic pregnancy?
Repeated US and serum HCG.
TX OPTIONS for ectopic pregnancy
Methotrexate and surgery.
Prenatal panel
avorh, CBC, hepatitis, antibody screen, syphilis, HIV, urine culture, pap, gonorrhea, chlamydia, blood type testing (Rh- needs RHOGAM)
Nutritional Guidelines
Increase protein to 60mg increase calories Avoid raw fish Take vitamin Heated deli meat Eat quality food Incorporate veggies
When does an implantation occur in pregn (about teratogens)?
- 4-5th wk of preg or 1 wk after fertilization
Why is smoking dangerous? (know 2)
- premature, still birth, decrease O2 supply, increased resp dz to child, etc.
Why are ppl nauseous in pregnancy?
- increased peristalsis, gastric secretions, etc.
2 vits/herbs for nausea (know 2)
b6, k c, cardamom, mint
How does nausea resolve in pregnancy on its own?
resolved bc placenta takes over making hormones
HYPEREMISIS GRAVEDERIM
- what is it?
- DDX’s?
- uncontrollable nausea vomiting, weak, dehydrated
- DDX: St flu, appendicitis, gb dz, kd infx
SOB w bad lab work indicating anemia… 2 herbs?
rhumex, nettles, teraxicum
2 risk dt anemia?
post partum hemorrhage, etc.
Teratogens… when else in life is a person vulnerable to teratogens?
wks 5-10 in fetal life during organogenesis, at newborn, adolescence, and during luteal cycle in women (breastfeeding)…
best way to faciliated oxytocin release during pregnancy
relaxed, dim lights, no talking
sleepy 1st trimester pt? hormone?
progesterone
Herbal Tx for insomnia (know 1)
scutilaria, chamomile, valerian
Fetal alc syndrome
- pre or post natal size of head cirumference delay, flattened face, upturned nose, etc.
