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Natural Childbirth I > Midterm > Flashcards

Midterm Flashcards

1
Q

Human Chorionic Gonadotropin (hCG)

A
  • Secreted into maternal circulation after implantation (5-7 days after fertilization)
  • Doubles every 29-53 hours (or 2-3 days) for 30 days after implantation
  • Serial hCG testing every 3 days
  • Not useful in determining gestational age
  • Urine test becomes positive around missed menses
  • Serum test becomes positive around 9 days after conception (more sensitive; quantitative or qualitative)
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2
Q

Basic lab tests done during pregnancy

A
  • hCG

- US

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3
Q

Lab tests done during the initial obstetrical visit

A

(around 10 weeks, ideally)

  • CBC
  • ABO-rh
  • Ab screen
  • Rubella
  • Syphilis
  • Hep B
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4
Q

Lab tests done for at-risk pregnancies

A
  • HIV
  • Varicella
  • Thyroid
  • DM
  • others if symptomatic
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5
Q

Lab tests done at standard obstetrical visits

A
  • Urine chemistry at every visit
  • Glucose screening, CBC, and Ab screen at 24-28 weeks
  • CBC, Ab screen, and GBS probe at 36 weeks
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6
Q

When/how pregnancy can be diagnosed

A
  • Serum hCG after implantation, about 9 days after conception
  • Urine hCG after first missed menses
  • TVUS at 5-6 weeks
  • Transabdominal US at 7-8 weeks
  • Fetal heart tones at 10-13 weeks
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7
Q

Indications for US in pregnancy

A
  • Irregular menses
  • Unknown LMP
  • Patients who conceive while on hormonal contraception
  • When physical findings differ from EDD based on LMP
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8
Q

Naegle’s Rule

A
  • To calculate EDD
  • LMP minus 3 months plus 7 days
    > LMP = 6/16
    > 6/16 - 3 months = 3/16 + 7 days = 3/23
    > EDD = 3/23
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9
Q

Why is an accurate due date important?

A
  • To know what medications are safe and appropriate
  • To determine if the fetus is growing appropriately
  • To determine eligibility for an out-of-hospital birth (don’t want to deliver a preemie at home)
  • To determine IUGR (intrauterine growth restriction)
  • To determine the appropriate timing for tests and procedures
    > TAB
    > Amniocentesis
    > 1st or 2nd trimester genetic tests (Down’s or chromosomal testing)
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10
Q

DDx for early bleeding

A
  • Not always pathological; most often maternal source
  • Spontaneous abortion/miscarriage
  • Ectopic pregnancy (most serious to r/o)
  • Placental bleeding/abruption/hematoma
  • Trophoblastic disease
  • Vaginitis, cervicitis, trauma, cancer, warts, polyps, fibroids
  • Cervical ectropion
  • Physiologic or implantation bleeding
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11
Q

Nausea and vomiting - mechanism

A
  • B-hCG slows peristalsis
  • Progesterone slows peristalsis and decreases HCl in stomach
  • N/V contribute to placental growth b/c low energy intake stimulates placental growth in early pregnancy
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12
Q

Nausea and vomiting - diet treatment

A
  • Dry crackers before getting out of bed
  • Foods high in B vitamins (kale, brewer’s yeast, blackstrap molasses, wheat germ)
  • Light protein snack at bedtime
  • Small frequent meals every 1-2 hours; avoid full stomach
  • Eat easily digested foods
  • Fluids are better between meals to avoid diluting HCl
  • Avoid food sensitivities
  • Almonds
  • Yogurt or kefir with added cinnamon
  • Barley or oat broth
  • Hard candies
  • 1 tsp apple cider vinegar with 8oz warm water - first thing in the morning or with meals
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13
Q

Nausea and vomiting - lifestyle treatment

A
  • Not opening eyes before getting out of bed

- Fresh air

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14
Q

Nausea and vomiting - botanical treatment

A
  • Zingiber (ginger)
  • Dioscorea villosa (wild yam)
  • Tea of raspberry leaf, peppermint, black horehound, catnip, and/or meadowsweet
  • Cardamom
  • Umboshi paste
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15
Q

Nausea and vomiting - supplment treatments

A
  • Vitamin B6
  • Vitamin K
  • Vitamin C
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16
Q

Nausea and vomiting - other treatments

A
  • Homeopathy
  • Acupuncture/acupressure
  • Reflexology
  • Hypnosis
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17
Q

Hyperemesis gravidarum - mechanism

A
  • Hormonal changes
  • Psychological and social stresses
  • Thyroid issues
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18
Q

Hyperemesis gravidarum - treatment

A
  • Homeopathy
  • Drainage
  • Counseling
  • Liver and support (silybum)
  • Acupuncture
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19
Q

Heartburn - mechanism

A
  • Progesterone relaxes the cardiac sphincter
  • Progesterone decreases gastric motility (including esophageal peristalsis)
  • Stomach is displaced up and to the right
  • Increased intragastric pressure and decreased intraesophageal pressure
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20
Q

Heartburn - treatment

A
  • Relaxed meals eaten slowly and chewed fully
  • Avoid trigger foods (coffee, chocolate, alcohol, fats)
  • Avoid cold foods and drinks, carbonated drinks, processed foods, sugar, and cigarettes
  • Pat of butter at start of meal
  • Increase raw foods
  • 1 Tbsp apple cider vinegar 3 hrs after eating
  • Good posture, wear loose-fitting clothing
  • Raw almonds, yogurt, dry popcorn
  • Papaya or digestive enzymes, liquid calcium magnesium
  • Antacids, antisecretory antihistamines
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21
Q

Dyspepsia, flatulence, eructations - diet treatments

A
  • Consume 4+ fruits and vegetables/day, steamed instead of boiled
  • Avoid gas-forming foods
  • Avoid carbs and proteins in same meal
  • Yogurt, kefir, probiotics
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22
Q

Dyspepsia, flatulence, eructations - lifestyle treatments

A
  • Exercise

- Abdominal massage

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23
Q

Dyspepsia, flatulence, eructations - pharmaceutical/natural treatments

A
  • Simethicone
  • Homeopathy
    > Carbo veg
    > Nux vomica
  • Digestive enzymes
  • Botanicals
    > Dill
    > Ginger
    > Fennel
    > Papaya enzymes
24
Q

Constipation - mechanism

A
  • Progesterone slows peristalsis
25
Q

Constipation - diet/lifestyle treatments

A
  • Increase fruit, vegetables, and fiber in diet
  • Prunes and dried fruits
  • Fruit juice (esp prune juice)
  • Exercise
  • Decrease stress
  • Increase rest
  • 8 glasses decaffeinated fluids/day (ideally water)
  • Regular bowel habits
  • Avoid laxatives
26
Q

Constipation - medical interventions

A
  • Natural Bulk laxatives (like Metamucil or Citrucel)
  • Avoid Colace or other stool softeners unless natural alternatives were unsuccessful
  • Digestive enzymes
27
Q

Constipation - natural treatments

A 
- Homeopathy
     > Sepia
     > Nux vom
     > Calc carb
     > Sulphur
     > Pulsatilla
     > Kali-carb
     > Merc
- Botanicals
     > Yellow Dock
     > Dandelion tea
     > Psyllium seeds (1-2 tsp soaked in water)
28
Q

Ptyalism - mechanism

A
  • Excess saliva
  • Excess acidity in mouth
  • Can be stimulated by starchy foods
  • Often in cycles with nausea
29
Q

Ptyalism - treatment

A
  • Decrease starch intake
  • Avoid dairy products
  • Increase fruit intake
  • Homeopathy
    > Ipecac
    > Merc
    > Kreosotum
    > Coffea
    > Helonias
    > Kali-iodum
30
Q

Diarrhea - treatment

A
  • Increase bulk/fiber
  • Raspberry tea (esp root)
  • For infx - charcoal
31
Q

Pica - treatment

A
  • Improve diet
  • Treat nutritional deficiencies
  • Homeopathy
    > Chelendonium
    > Mag carb
    > Lyssin
    > Nitric acid
32
Q

Lab results indicating anemia

A
  • CBC - Hgb, HCT, and MCV
  • Serum B12
  • Ferritin
33
Q

Anemia - treatment

A
  • Depends on underlying cause

- Usually supplementation with nutritional support

34
Q

How to facilitate oxytocin release

A
  • Released in adequate amounts when feel safe and supported in private
  • Released pulsatilely to be effective
  • Optimal circumstances for oxytocin release
    > Dim light
    > Privacy
    > No threat or perceived danger or stress
    > Talk - use of language
35
Q

Why is smoking bad - direct effects/risks

A
  • Benzoid pyrene affects protein transport into placenta and is associated with learning disorders
  • Nicotine causes release of ACh, Epi, NE, and ADH, which lead to tachycardia, increased CO, peripheral vasoconstriction, increased BP, and changes in fat and carb metabolism
    > Leads to decreased blood flow to the placenta (for up to 15 minutes after a cigarette)
  • CO can cross placental barrier and prevent binding of oxygen to fetal blood
    > Leads to increased risk of SAB, placental abruption, placenta previa, bleeding, premature rupture of membranes, low birth weight, and fetal and neonatal death
36
Q

Why is smoking bad - maternal complications

A
  • COPD
  • Cervical cancer
  • Infertility
  • Early menopause (eggs die)
  • Ectopic pregnancy
37
Q

Why is smoking bad - effects on infants (increased risk for)

A
  • Growth and intellectual deficiencies
  • ADD/ADHD
  • Less responsive to sound
  • SIDs
  • Respiratory diseases (pneumonia, bronchitis, asthma)
  • Cancer (non-Hodgkin’s lymphoma, ALL, Wilm’s tumor)
  • Strabismus
38
Q

Fetal Alcohol Syndrome

A
  • Must have at least one feature from each of the following three categories:
  • Prenatal or postnatal delay in child’s weight or head circumference
  • Distinct physical characteristics, at least 2 of the following:
    > Small head, small eyes or short eye openings, narrow lip w/o center groove, short upturned nose or flattened mid-facial area, abnormal testes in males
  • Abnormalities of CNS, signs of brain dysfunction, delays in behavioral development, and/or cognitive impairment
39
Q

When most susceptible to teratogens

A
  • Fetus is most susceptible during organogenesis (weeks 5-10)
40
Q

Other things to avoid during pregnancy

A
  • Ibuprofen
  • Aspirin
  • Decongestants
  • Vitamin A
41
Q

Goal of prenatal care

A
  • Healthy parent and child
42
Q

Components of prenatal care

A
  • Early accurate estimation of gestational age
  • Identification of patients at risk for complications
  • Ongoing health status evaluation of both parent and fetus
  • Anticipation of problems and intervention to prevent or minimize morbidity
  • Patient education and communication
43
Q

Timing of prenatal care

A
  • Patients interview in first trimester
  • First prenatal appt by ten weeks of gestations
  • Prenatal visits monthly until 32 weeks
  • Prenatal visits biweekly from 32-36 weeks
  • Prenatal visits are weekly from 36 weeks - delivery
44
Q

Initial prenatal visit

A
  • Prenatal history
  • Establish EDD
  • PE
  • Lab testing
45
Q

Standard prenatal visit

A
  • History
  • PE
  • Lab testing
46
Q

Prenatal patient education

A
  • Travel
  • Seat belts
  • Nutrition
  • Food choices
  • Weight gain
  • Vitamins
  • Vices
  • Exercise
  • Recreation
47
Q

Ectopic pregnancy

A 
- Occurs when a developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity
     > Sites of implantation
          -> Fallopian tube (MC)
          -> Ovary
          -> Abdomen/pelvic region
          -> Cervix
48
Q

Risks of ectopic pregnancy

A
  • Risk of rupture leading to hemorrhage and maternal shock and potentially death
  • Leading cause of pregnancy-related maternal death in the 1st trimester
  • Accounts for 4-10% of all pregnancy-related maternal death
  • Untreated ectopic pregnancies are often fatal
49
Q

High risk factors for ectopic pregnancy

A
  • Previous ectopic pregnancy
  • Previous tubal ligation
  • Tubal pathology
  • In utero DES exposure
  • Current IUD use (worse w/ Mirena vs Paraguard)
50
Q

Moderate risk factors for ectopic pregnancy

A
  • Infertility
  • Previous cervicitis (GC/CT)
  • History of PID
  • Multiple sexual partners
  • Smoking
51
Q

Low risk factors for ectopic pregnancy

A
  • Previous pelvic/abdominal surgery
  • Vaginal douching
  • Early intercourse (<18 yo)
52
Q

Clinical manifestations of ectopic pregnancy

A
  • Typically appear 6-8 weeks after LMP, but can occur later
    > Majority of ruptures occur by 6-12 weeks
  • Normal pregnancy symptoms
  • Abdominal pain (99%), may present as acute abdomen
    > More likely to be one-sided
    > Achey, pressure, sharp, nagging
    > Likely to be constant pain
  • Amenorrhea (74%)
  • Vaginal bleeding (56%)
  • Should be suspected of any patient of reproductive age with these symptoms
53
Q

PE for ectopic pregnancy

A
  • Vitals
  • Low grade fever
  • Adnexal, CMT, and/or abdominal tenderness
  • Adnexal mass
  • May be unremarkable
54
Q

Spontaneous abortion

A
  • Miscarriage
  • Pregnancy that ends before the fetus has reached 20 weeks (after 20 weeks is a still birth)
  • Subcategories
    > Threatened miscarriage
    > Inevitable miscarriage
    > Complete miscarriage
    > Incomplete miscarriage
    > Missed abortion
55
Q

Risk factors for SAB

A
  • Advancing maternal age
  • Previous SAB (risk increases proportional to number of SABs)
  • Smoking > 10 cigarettes/day
  • Cocaine
  • NSAIDs, excluding acetaminophen
  • Low or high maternal BMI
  • Celiac disease (if eating gluten)
56
Q

Etiology of SAB

A
  • Chromosomal abnormalities (50%)
  • Congenital anomalies
    > Genetic or chromosomal abnormalities
    > Extrinsic factors
    > Exposure to teratogens
  • Trauma or invasive procedures
  • Host factors
    > Uterine abnormalities
    > Maternal infection
    > Endocrinopathies
    > Acquired thrombophillias and abnormalities of immune system
    > Unexplained
57
Q

Clinical presentations/history of SAB

A
  • Amenorrhea
  • Vaginal bleeding
  • Pelvic pain

Natural Childbirth I (2 decks)

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