Module 4 Antepartum Flash Cards
The _________ a screening test is (sensitivity and specificity) the greater the ________ in unnecessary procedures
The “better” a screening test is (sensitivity and specificity) the greater the reduction in unnecessary procedures
What types of “tests” are the following?
NIPT/NIPS
1st tri- 2nd tri
Integrated, sequential
Non-treponemal (RPR, VDRL)
Mammogram
1 hour 50 gm load glucose
Pap smear
PHQ-2
TORCH antibody screen
Screening
What types of “tests” are the following?
CVS
amnio
Treponemal
Mammogram (actually a biopsy)
3 hour 100 gm load glucose
Biopsy
Colposcopy
PHQ-9
More specific tests
Diagnostic
What are the features of the inlet?
The sacral promontory and diagonal conjugate
What are the features of the midplane?
The ischial spines (interspinous diameter)
What are the features of the outlet?
The sacrococcygeal joint, ischial tuberosities and pubic arch
What are the significant diameters of the inlet?
11.5+cmx13.5+cmx12.75+cm
What are the significant diameters of the midplane?
10cmx11.5+cm
What are the significant diameters of the outlet?
11.5+cmx10cm
What is the expected fundal height at 8 weeks?
Below the symphysis pubis
What is the expected fundal height at 12 weeks?
At the symphysis pubis
What is the expected fundal height at 15/16 weeks?
Midway between the symphysis pubis and the umbilicus
What is the expected fundal height at 20 weeks?
At the Umbilicus
What is the expected fundal height after 20 weeks?
Within 2cm of gestational age from the pubic bone
At what gestation does the uterus become an abdominal organ?
After the 12 week
When is HCG detectable?
-8-10 days after ovulation
-Just before the missed period
-With implantation of the ovum
What is the expected rise of Hcg with early pregnancy?
Should double every 48-72 hours
At what gestation and level does HCG peak. What level is expected after the peak?
-Peaks at 8-11 weeks at 100,000 mIU/mL
-Then decreases and levels out at 20,000mIU/mL
What produces HCG and what is its role?
It is first produces by the blastocyst and then the placenta.
Its role is to keep the corpus luteum going until the placenta takes over.
Key Functions:
-Stimulates production of progesterone from the corpus luteum
-Stimulates thyroid production of thyroxine
-Suppresses myometrial contractions
What is the source of hPL and what is its role?
Produces by the placenta
Role:
-Increases insulin resistance
-Stimulates production of growth hormones
What is the source of progesterone and what is its role?
Source: Corpus luteum then the placenta
Role:
-Systemic vasodilation
-Prevents myometrial contractility
-Withdrawal leads to uterine contractions
-Inhibits uterine production of prostaglandins
-Supports mammary growth for lactation
What is the source of estrogen and what is its role?
Source: Ovaries, Corpus luteum, Placenta, fetus
Role:
Increases uterine blood flow
Promotes growth of the uterus and breast
Increases production of growth factors
Enhances myometrial contractility
Which estrogen is dominant in pregnancy?
E3 “Estriol”
Discuss the steps of fertilization and implantation:
Ovum (oocyte) ->zygote ->Blastocyst ->Trophoblast (placenta) ->embryo ->fetus
Define Oligohydramnios
AFI or 5.0 cm or less
Define Polyhydramnios
AFI of 24cm or more
How many arteries and veins are expected in the umbilical cord?
2 arteries and 1 vein
At what gestation is limb movement expected?
9weeks
At what gestation is leg movement expected?
14 weeks
At what gestation is hand to face movement expected?
12-13 weeks
At what gestation is limb head and torso movement expected?
12-16 weeks
At what gestation is finger sucking expected?
15 weeks
At what gestation is respiratory movement expected?
24 weeks
At what gestation are sleep-wake cycles, FHR pattern, eye movements, quiet states and active states expected?
32 weeks
What hematological changes are expected in pregnancy? When do they occur and why?
Increase in clotting factors I, II, VII, VIII, IX and decrease in protein S and C (which inhibit coagulation.
These occur primarily in the 2nd and 3rd trimesters
Purpose: to prevent PPH!
What are the expected thyroid changes in pregnancy?
hCG stimulated the thyroid and causes a decrease in TSH and increase in T4 and T3. This results in subclinical hyperthyroidism in first trimester.
In third trimester, the levels stabilize.
What is the first endocrine gland to appear in the fetus?
the Thyroid!!
Note: it does not produce thyroid hormones until 18-20weeks
What is T4 critical for during pregnancy?
brain and bone growth
What is the recommended daily intake of iodine in pregnancy?
220 mcg/day
What TSH level is expected in normal pregnancy?
0.1-4.0
What TSH level is expected in overt hyperthyroidism in pregnancy?
Undetectable TSH
What TSH level is expected in overt hypothyroidism in pregnancy?
> 4.0
Why is the fetus an allograft?
So the pregnant persons immune system doesnt attack it!
-trophoblastic tissue does NOT express cell membrane proteins!
-downregulation of maternal adaptive immunity
Define fetal lie.
Long axis of the fetus to the long axis of the pregnant person
Longitudinal, Transverse or Oblique
Define fetal position
Position (3 letter notation)
Left or Right: references the pregnant person’s pelvis
Denominator: Occiput, Sacrum, or Mentum
Where in the pelvis does the denominator lie?
Anterior, transverse or posterior
Define Presentation
Presentation (vertex, breech or shoulder)
Subdivided: vertex, sinciput, brow or face
Define attitude
Attitude (flexed, face, brow)
How are these conditions genetically passed down?
-Neurofibromatosis
-Marfan’s Syndrome
-Huntington Disease
-Achondroplasia (dwarfism)
Autosomal Dominant
Key: There is no carrier state
How are these conditions genetically passed down?
-Sickle Cell Disease
-Cystic Fibrosis
-Alpha-thalassemia
-Tay-Sachs
-Beta-thalassemia
Autosomal recessive
How are these conditions genetically passed down?
-Duchenne muscular dystrophy
-Hemophilia A
Sex-linked
How are these conditions passed down?
-Neural Tube Defects (spina bifida, anencephaly)
-Heart Defects
-Pyloric stenosis
-Cleft lip
-Club foot
Multifactoral Inheritence
What is an aneuploidy?
What is a moosomy?
What is a trisomy?
How can we test for chromosomal disorders?
cell free DNA
What are the different sex chromosome abnormalities?
-Turner Syndrome (x) F: weblike neck
-Klinefelter syndrome (XXY) M: tall, feminine
-Trisomy X (XXX) F: epicanthal folds, wide-spaced eyes, curved pinky
What can the maternal condition-CMV cause in the fetus?
cognitive deficit, microcephaly
What can the maternal condition-rubella cause in the fetus?
Deafness, cataracts, heart defects, cognitive deficit
What can the maternal condition-syphillis cause in the fetus?
Abnormal teeth and bones, cognitive deficits
What can the maternal condition-toxoplasmosis cause in the fetus?
Hydrocephaly, blindness, cognitive deficit
What can the maternal condition-varicella cause in the fetus?
Limb reduction, skin scarring, muscle atrophy, chorioretinitis
What can the maternal condition-zika cause in the fetus?
Microcephaly, decreased brain tissue, dec ROM in joints, eye damage
What can the maternal condition-alcoholism cause in the fetus?
Miscarriage, fetal alcohol syndrome, FGR, developmental delay
What can the maternal condition-DM cause in the fetus?
heart Defects, microcephaly, NTDs, skeletal defects, GU, GI & reproductive system defects
What can the maternal condition-fever cause in the fetus?
NTD’s, heart & abdominal wall defects, oral cleft
What can the maternal condition-seizure disorder cause in the fetus?
Cleft lip, cleft palate, heart defects
What can the maternal condition-lupus disorder cause in the fetus?
MAB, stillbirth, congenital heart block, FGR, prematurity
Currently, it is recommended that both screening & dx testing be offered to ___________ pregnant people ___________ age or risk factors present.
Currently, it is recommended that both screening & dx testing be offered to all pregnant people regardless of age or risk factors present
When can the NIPT/NIPS/cell free DNA be done, what does it test for an how accurate is it?
After 10weeks until delivery
99% accurate!
blood test: Karyotyping-checks for chormosomal aneuploidies only
When can the 1st trimester screen be done, what does it test for an how accurate is it?
10-14wks
90% accurate
blood test + NT U/S to check for chromosomal aneuploidies
When can the 2nd trimester screen be done, what does it test for an how accurate is it?
15-18weeks
83% accurate
Blood test + anatomy U/S: checks for chromosomal aneuploidies and NTDs