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NM 702 Prenatal Care > Module 6 > Flashcards

Module 6 Flashcards

1
Q

TBG __________ in pregnancy

A

increases

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2
Q

free thyroid hormone ___________ in pregnancy

A

decreases

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3
Q

____ stimulates increase in T3 and T4

A

hCG

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4
Q

TBG level + T3 and T4 increases lead to decrease in ____, especially in weeks 8-14

A

TSH

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5
Q

thyroid __________ doesn’t change in pregnancy

A

function

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6
Q

thyroid mimics ______thyroidism in pregnancy

A

hypothyroidism

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7
Q

________________ changes support altered carbohydrate, protein and lipid metabolism and changes in basal metabolic rate.

A

thyroid hormone

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8
Q

TSH is structurally similar to _____ so it decreases in 1st trimester (8-14 weeks) when this increases

A

hCG

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9
Q

total T3 and T4 ________, the most at 10-15 weeks due to increase in TBG and hCG

A

increases

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10
Q

Free T3 and T4 ___________ in pregnancy due to increased TBG

A

decreased

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11
Q

renal iodide clearance __________ in pregnancy due to increased renal blood flow and GFR

A

increases

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12
Q

there is maternal need for ________ iodine in pregnancy to make thyroid hormones

A

increased

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13
Q

iodine uptake _________ in pregnancy

A

increases

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14
Q

pregnant and lactating women need _____ mcg of iodine per day (PNV and iodized salt)

A

250

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15
Q

______________ cells grow from 20% to 60% of the anterior pituitary

A

Prolactin-producing

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16
Q

_________ increases during pregnancy and peaks at delivery.

A

prolactin

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17
Q

increases to prepare breasts for lactation.

A

bioactive prolactin

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18
Q

Increased estrogen leads to larger ________ gland and changes in morphology

A

pituitary

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19
Q

__________ immunity is suppressed in pregnancy to protect the fetus from rejection

A

Cell-mediated

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20
Q

__________ immune response is not changed in pregnancy

A

Antibody-mediated

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21
Q

Localized _________ response along with systemic responses mediated by __________ factors protect the fetus

A

uterine; endocrine

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22
Q

Maternal immune system tolerates the fetus (it is aware of the presence of the fetus) through active mechanisms where the mother prevents the recognition of the fetus as foreign and of being rejected.
Fetal ___________ cells help in this process

A

trophoblastic

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23
Q

______________ in the fetus provide passive immunity against pathogens, epigenetic inheritance of immunity, suppression of tumor development

A

maternal IgG antibodies

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24
Q

IgG transfer increases after _______ weeks

A

20-22

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25
Q

Pregnancy stimulates an activation of the ________ system although it is delayed, but the fetus is not rejected

A

complement

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26
Q

immune system changes that begin at 11 weeks gestation and augment maternal defenses against bacterial infection

A

complement system changes

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27
Q

inhibits the maternal inflammatory response

A

PZP (pregnancy zone protein)

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28
Q

Small particles (antigens) from the __________ stimulate systemic inflammatory response

A

trophoblast

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29
Q

enhance antibody-mediated responses and cause a protective function in maternal-fetal immune relationship while decreasing maternal resistance to bacterial and viral infections

A

cytokines

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30
Q

If this system is disrupted, _____________ production increases and is increased risk for SAB, preeclampsia, PTL, and FGR

A

inflammatory cytokine

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31
Q

Maternal _____ antibodies cross the placenta in significant amounts through active transport

A

IgG

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32
Q

If the cytokine enhanced antibody-mediated response system is disrupted, inflammatory cytokine production __________ which increases risk of ______

A

increases; SAB

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33
Q

pregnant women have higher rates of fungal infections (yeast) due to effects of ________ on nutrient availability for growth

A

estrogen

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34
Q

most women do not experience increased __________ infections in pregnancy

A

bacterial

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35
Q

_______ infections are seen more frequently and more severely in pregnancy, especially in 2nd and 3rd trimesters

A

viral

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36
Q
  • Vasodilation caused by increased progesterone and
  • Proliferation of capillaries at the skin surface caused by increased estrogen

lead to…

A 
bleeding gums
vascular spiders
telangiectasias
palmar erythema
purpura
hyperemia
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37
Q

Nasal congestion (pregnancy rhinitis) occurs in many pregnant women due to the effects of:

A

estrogen

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38
Q

may occur when superficial blood vessels of the nasal mucosa break

A

Epistaxis (nose bleed)

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39
Q

This is due to swelling of the mucous membrane of the eustachian tube and changes in fluid and pressure in the middle ear. It resolves soon after birth when estrogen levels decrease.

A

ear stuffiness/ mild hearing loss

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40
Q

ear stuffiness is caused by increase in:

A

estrogen

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41
Q

increased blood flow and swelling of the mouth/gums during pregnancy is caused by:

A

estrogen

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42
Q

hair is in a _________ growth phase in pregnancy

A

longer

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43
Q

the hair shaft _______ in pregnancy

A

thickens

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44
Q

growth of hair in usually male patterns

A

hirsutism

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45
Q

skin changes in pregnancy generally result from hormones of pregnancy, primarily ___________

A

estrogen

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46
Q

some skin changes __________ during the postpartum period

A

disappear

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47
Q

nail changes can occur in the ____ trimester

A

1st

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48
Q 
\_\_\_\_\_\_\_ changes in pregnancy:
brittleness
grooves
discoloration
white coloring
A

nail

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49
Q

growth phase of hair

A

anagen phase

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50
Q

___________ and ____________ blood flow to the scalp results in increased number of anagen phase hairs

A

estrogen; increased

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51
Q

when estrogen is removed after delivery, most hair will go into ____________ phase which means it will shed (PP hair loss)

A

telegen

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52
Q

extreme hair loss after pregnancy is called:

A

telegen efluvium

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53
Q

hair loss usually resolved by about ___ months PP

A

9

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54
Q

Skin pigment changes occur due to the stimulating effect of ____________ and _____________ on the melanocyte-stimulating hormone (MSH) secretion from the anterior pituitary

A

estrogen and progesterone

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55
Q

stimulates melanocytes in certain areas of the skin to darken in color

A

MSH (melanocyte-stimulating hormone)

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56
Q

The ___________ effect is seen on the nipple, areola, midline of the abdominal area (linea nigra), and, in some women as “the mask of pregnancy” (melasma)

A

skin-darkening

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57
Q

presents as brownish patches on the face and neck and is more prevalent in women with darker complexions

A

melasma

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58
Q

may persist after birth in about 1/3 of affected women and increase when a woman uses oral contraceptives

A

melasma

59
Q

Connective tissue changes are caused by increased ___________, _______________, and _______________along with stretching that occurs as the gravid uterus grows and maternal weight increase

A

estrogen, adrenocorticoids, and relaxin

60
Q

hormones of pregnancy cause collagen adhesiveness to ________ and fibers to __________

A

relax; separate

61
Q

Striae are more prevalent in _____________women in their first pregnancy

A

young caucasian

62
Q

Sebaceous and eccrine sweat glands become more active under the influence of increased __________ in pregnancy

A

androgen

63
Q

Sebaceous glands of the areola ____________(called Montgomery’s tubucles) and secrete more sebum to lubricate the nipple

A

hypertrophy

64
Q

acne may __________ during pregnancy

A

improve

65
Q

sweat glands that cover the trunk and extremeties

A

eccrine sweat glands

66
Q

increased activity of these sweat glands on the trunk and arms/legs help cool the body

A

eccrine

67
Q

Unilateral ptosis may occur in pregnancy or during labor and is thought to be caused by:

A

hormonal/fluid changes or stress

68
Q

unilateral ptosis may be a complication of ____________ in labor

A

lumbar anesthesia

69
Q

Hoarseness, deepening of the voice, and cough have been attributed to larynx changes of pregnancy and are thought to be due to the effects of:

A

estrogen and progesterone

70
Q

luekorrhea starts in the ___ trimester

A

1st

71
Q

leukorrhea is caused by:

A

increased pelvic blood flow

72
Q

_________ causes vaginal secretions to be more acidic in pregnancy to protect mother and fetus

A

estrogen

73
Q

tiny dilated blood vessels that present as small bright red spots on the trunk, arms/legs, and sometimes the face

A

spider angioma

74
Q

spider angiomas usually appear between weeks _____

A

8-20 weeks

75
Q

trauma-informed care tool in which the provider sets safe boundaries with respect to woman’s physical and emotional space

A

containment

76
Q

trauma-informed care tool in which the provider is present with her therapeutically so she feels seen and heard

A

connection

77
Q

trauma-informed care tool in which the provider

empathetically accepts her experience for what she perceives it

A

compassion

78
Q

maternal task of seeking the means to assure a safe and healthy pregnancy and childbirth for herself and her fetus/newborn

A

safe passage

79
Q

maternal task of letting go of old ways of being to make way for the new ways of being by reflecting on her current life, on past relationships, and aspirations for mothering

A

acceptance by others

80
Q

maternal task of establishing a direct form of experience between mother and her fetus/infant

A

binding-in

81
Q

maternal task that is the most complex and demanding in which the mother embraces the changes willingly and sees their purpose in giving to her child for the child’s benefit and well-being

A

giving of oneself

82
Q

seeking elements of mothering that are valued to incorporate into her vision of mothering

A

replication

83
Q

trying on different aspects of mothering through mental contemplation

A

fantasy

84
Q

synthesizing elements of replication and fantasy work into a single role of mother

A

dedifferentiation

85
Q

melasma is more common in _______ women

A

Asian, Latina, and African

86
Q

_____ is the most sensitive index for thyroid function in pregnancy

A

TSH

87
Q

slightly __________ thyroid is normal in pregnancy

A

enlarged

88
Q

healthy pregnant woman will have __________ fasting glucose levels than nonpregnant women

A

lower

89
Q

some _____ antibodies are harmful to the fetus such as, the antibodies a Rh- mother produces in response to antigens in Rh+ RBC of the fetus

A

IgG

90
Q

________ antibodies against can cross the placenta and attack fetal RBC causing severe hemolytic disease of the fetus

A

IgG

91
Q

RhoGAM prevents maternal ___________ production resulting in __________ immunity

A

antibody; passive

92
Q

consists of the reformation and change of the woman’s view of self

A

maternal tasks of pregnancy

93
Q

evaluation of the woman’s relationship with her own mother occurs in the ____ trimester

A

2nd

94
Q

bound thyroid hormones are not ___________ during pregnancy

A

bioavailable

95
Q

during pregnancy, total body iodine pool is decreased due to :

A

decreased iodide absorption in the small intestines

96
Q

The U.S. is _____ iodine deficient that Europe and SE Asia

A

more

97
Q

maternal chemotaxis is NOT _________ in pregnancy

A

increased

98
Q

foreign tissue from the same species but different antigenetic make-up

A

semiallograft

99
Q

the phase of pregnancy with the most marked inflammation at the maternal-placental interface

A

embryonic

100
Q

immune factors that protect the fetus from rejection also:

A

protect mother from viruses and bacteria

101
Q

concerning skin conditions in pregnancy

A

eczema
prurigo
pruritic folliculitis

102
Q

“prickly heat” feeling is caused by

A

increased eccrine sweat gland activity

103
Q

HPA function __________ during pregnancy

A

increases

104
Q

HPA function changes in pregnancy is mediated primarily by:

A 
placental hormones (ACTH, GH, CRH)
alterations in liver function
alteration in kidney function
105
Q

What lab test would you use to screen for altered thyroid function in pregnancy?

A

TSH

106
Q

has structure similar to thyroid-stimulating hormone (TSH), so stimulates increased T3 and T4 leading to negative feedback to the pituitary gland and a decrease in TSH

A

hCG

107
Q

What happens during pregnancy to decrease the iodine pool?

A
  • increased renal iodide clearance
  • increased iodine needed to make thyroid hormones
  • increased loss of renal iodide due to increased renal blood flow, increased GFR, and placental transfer of iodine to the fetus
108
Q

Of the total thyroid hormone in the body in pregnancy, where is most of the thyroid hormone found?

A

bound to TBGs

109
Q

Why does the free thyroid hormones remain within normal limits while total thyroid hormone levels increase in pregnancy?

A

because most of the thyroid hormone is bound to TBGs

110
Q

____________ levels increase and peak at term to prepare for breastfeeding

A

prolactin

111
Q

T3 and T4 levels peak at __ - __ weeks gestation

A

10-15

112
Q

T3 and T4 levels plateau at ___ - ____% higher than nonpregnant values (and most are bound to TBGs)

A

40-100%

113
Q

How are thyroid hormones (T3 and T4) transported through the body?

A

attached to TBGs

114
Q

consequences of iodine deficiency in pregnancy

A

preventable mental retardation
increased risk of spontaneous abortion
increased risk of stillbirths

115
Q

immune system alteration that is responsible for pregnant women being more at risk for viral, bacterial and fungal infections (especially viruses + opportunistic pathogens)

A

suppression of cell-mediated immunity

116
Q

these enhance the antibody-mediated response which protects the fetus and delays the maternal response to infection

A

cytokines

117
Q

Reasons why IgG is _________ in pregnancy:
hemodilution of pregnancy
enhanced loss of IgG in the urine
transfer of maternal IgG to the fetus in 3rd trimester

A

IgG is decreased

118
Q

maternal antibody that provide passive immunity to the fetus/neonate (e.g. against tetanus, diphtheria, polio, measles, mumps, GBS, E Coli, HBV)

A

IgG

119
Q

a critical component of cervical changes in preparation for parturition and labor onset

A

3rd trimester inflammatory processes

120
Q

may delay maternal response to infection

A

chemotaxis

121
Q

Faster _________ helps protect the mother from having a cell-mediated response to fetal cells in her circulation, thus preventing her from recognizing fetal cells as foreign and attacking them.

A

phagocytosis

122
Q

Localized _________ response along with systemic responses mediated by endocrine factors protect the fetus

A

uterine

123
Q

Fetal ____________ cells help in the process and help maternal immune systems not reject it

A

trophoblastic

124
Q

changes that occur with the initial contact between the embryonic trophoblast and maternal tissues during implantation and the remodeling of maternal blood vessels

A

the inflammatory process at implantation

125
Q

Immunologic factors that may cause _____________:
•Activation of an immune response secondary to microbial infection (chlamydia, listeria, parvo, toxoplasmosis),
-Exaggerated maternal immune response to trophoblastic invasion,
-Cytokine-induced failure of the ovary to produce sufficient progesterone,
-Presence of autoimmune antibodies such as antiphospholipid antibodies that interfere with placentation.

A

spontaneous abortion

126
Q

treatment for molloscum fibrosum gravidarum

A

may regress or clear spontaneously following delivery, although many remain
Remaining skin tags can be excised

127
Q

gradual increase in ______________ activity may be due to increased thyroid activity, increased body weight, and metabolic activity.

A

eccrine sweat gland

128
Q

Eccrine glands are important in ______________ at the skin surface. Increased activity reflects dissipation of excess heat from increased metabolic activity of woman and fetus.

A

thermoregulation

129
Q

increased eccrine sweat gland activity leads to increased:

A

sweating

130
Q

Disruption of lacrimal acinar cells can lead to:

A

dry eyes

131
Q

Reasons for __________ in pregnancy:
Mild corneal edema and thickening (worse in 3rd trimester can change eye topography and alter refractory power of the eye.
Corneal hyposensitivity may develop due to increased thickness and fluid retention.

A

dry eyes

132
Q

Modifications in fluid dynamics and vascular permeability, increased protein synthesis, vasomotor alterations of the autonomic nervous system, increased vascularity, hormonal influences (especially estrogen) influences lead to:

A

nasal stuffiness

133
Q

hearing changes in pregnancy

A

transient/mild hearing loss

increased risk of serous effusion (infection)

134
Q

reasons for ear stuffiness in pregnancy

A

changes in mucous membranes of the eustachian tube
edema of the nasopharynx
alterations in fluid dynamics/pressures of the middle ear

135
Q

May develop around 20 weeks; fine new hairs disappear by 6 wk pp, coarser hairs may remain

A

hirsutism

136
Q

occurs most often in primiparous women, usually during the last month of pregnancy or immediate postpartum.

A

PUPPs

137
Q

abrupt appearance of intensely pruritic urticarial papules and plaques usually on trunk and extremities- rarely involve the face, palms, or soles that usually resolves within 7-10 days postpartum.

A

PUPPs

138
Q

rare pruritic specific dermatosis usually presents with sudden onset pruritus in late second or third trimester, usually on palms and soles of feet.
-Evaluate for elevated liver enzymes and bile acids.

A

ICP (Intrahepatic Cholecystitis of Pregnancy)

139
Q

three self-systems described by Rubin

A

ideal self
actual self
body-image self

140
Q

four absolute contraindications to sexual intercourse in pregnancy

A

vaginal bleeding
placenta previa
Premature cervical dilation
PROM

141
Q

Seeking safe passage
Acceptance by others
Binding in
Giving of Oneself

A

maternal tasks of pregnancy

142
Q

factors that threaten prenatal attachment

A

substance abuse
anxiety
depression

143
Q

N/V in pregnancy has been correlated with alterations in ____________ hormones

A

thyroid

NM 702 Prenatal Care (8 decks)

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