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ENRP Exam 1 > Normal And Abnormal Pregnancy - Dr. Moulton > Flashcards

Normal And Abnormal Pregnancy - Dr. Moulton Flashcards

1
Q

Folic Acid in pregnancy

A
  1. Should be over 0.4mg (give supp)

2. If mom has had previous NTD then make sure her level is at 4.0mg

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2
Q

G P

A 
G = number times pregnant
P = number of births (infant over 500g) = Florida P&L (F - full, P - pre, A - abortion, L - living)
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3
Q

G and P of a person with twins

A

G1 P1002 = 2 kids

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4
Q

G and P of pt with 1 term infant, 2 preterm twins, 1 miscarriage,1 ectopic , 3 living children

A

G 4 P1123

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5
Q

Signs physical that can tell you a women is pregnant 6

A
  1. Systolic murmurs, exaggerated splitting and S3
  2. Palmar erythema
  3. Spider angioma
  4. Lines nigra
  5. Striae gravidarum = stretch marks
  6. Chadwicks sign = blue color to cervix
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6
Q

Prenatal labs to do

A
  1. CBC, blood Rh type
  2. Rubella postpartum
  3. Syphilis
  4. HepB, HIV
  5. Pap : chlamydia, gonorrhea
  6. DM
  7. Urine culture
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7
Q

Plt and Factor 7-10, nd Hb hct levels during preg

A
  1. PLT : decrease
  2. Factor 7-10 increase
  3. Hb : decrease
  4. Hct: decrease
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8
Q

Gestational age

A

Last menstrual period date and delivery date

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9
Q

HCG can be seen when and how does it increase

A

7-8 days after ovulation

= increasing : doubling every 2 days for first 30 days** used for ectopic vs IUP when unsure

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10
Q

When can you do transvaginal US and see something **

A

At about 5 weeks, during Discriminatory phase when hCG is 1500-2000 (Gestational Sac seen)

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11
Q

When do you see fetal pole and when do you see cardiac activity

A
  1. Fetal pole = 6 weeks, hCG 5200

2. Cardiac activity = 7 weeks , hCG 17,500

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12
Q

Fetal pole measurement with cardiac activity

A

If fetal pole if over 5mm and no cardiac activity = fetal demise

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13
Q

Naegels rule

A

Estimate delivery date in women with 28 day cycle

= minus 3 months + 7 days

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14
Q

Gestational age can be predicted how

A

US

  1. 1st trimester (6-11 weeks): crown rump length (CRL) = off by 3-4 days
  2. 2nd trimester femur length, abd circumference : off by 10 days
  3. 3rd trimester : off by 3 weeks
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15
Q

Most common 1 chr and 3 chr causing abortion (SAB, spontaneous abortion)

A
  1. 46 XO = turner
  2. Trisomy 16
    = most common is trisomy causing SAB
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16
Q

How to dx for any genetic condition of baby

A

Chorionic villus sampling, amniocentesis

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17
Q

AR disorders to screen for

A
  1. Tay-Sachs , high in Jewish, Eastern Europe)

2. CF (North America whites, 1:25, screen all pregnant women, parents with echogenic bowel, sperm donors)

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18
Q

Sex linked disorders primary effect and 2 most common ones

A

Males , Females only carry it + NO male to male transmission

  1. Fragile X : most common inherited mental retardation , trisomy 21 is second most common
  2. DMD
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19
Q

Multifactorial Disorders 3 types

A
  1. NTD (spins bifida)
  2. Cleft lip
  3. Congenital heart defects
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20
Q

First Trimester Screening

  1. For who
  2. What you do
  3. EXs
A
  1. Not in risk
  2. Amniocentesis has higher chance of termination of pregnancy then chance of genetic problem happening = do screening (if that is elevated then to amniocentesis)
  3. Fetal Nuchal Translucency = NT thickness (back of neck)
    + [low PAPP-A + elevated B-hCG = 80% trisomy21 detection]
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21
Q

Screening for possible Down syndrome in 1st trimester

A

Elevated b-hCG, and low PAPP-A

+ nasal bone assessment absent + NT measurement thickness

22
Q

Second Trimester Screening

  1. Consists of what
  2. Sometimes consists of
A
  1. Triple screen : high b-hCG, lowestriol, high AFP markers (70% trisomy21 detection)
  2. Quadruple screen : b-hCG, estriol, AFP, Inhibin A markers (80% trisomy21 detection)
23
Q 
Cell-free fetal DNA is what 
1. Done when
2 .what is it 
3. How accurate 
4. Does not test for
A
  1. During 1st or 2nd trimester, what people use now to detect trisomy 21
  2. Test cell-free fetal DNA (from apoptosis of trophoblastic cells entering maternal circulation)
  3. 99% of T21,T18, 92% T13
  4. NTD, need to evaluate AFT or US after 15 weeks
24
Q

Positive cell-fetal dna test what to do

A

Make sure with invasive amniocentesis (16-20weeks, 0.3% miscarriage) or CVS(chorionic villi sampling = 11 weeks, 1% miscarriage)

25
Q

Teratology is what and detected mostly when

A

Abnormal fetal development

= by age 5yo (usually you don’t know exact cause)

26
Q

Teratogen

  1. Most common and what it causes
  2. When should pt avoid all drugs
A
  1. Thalidomide = phocomelia (flipper limbs, used to decrease N) (not taken any more)
  2. During organogenesis 1st trimester first 12 weeks
27
Q

Pregnancy and Lactation Labeling Rule

  1. Is what
  2. 3 parts of it
A
  1. Risk of taking a drug vs not in a pregnant pt

2. Describes safety of pregnancy, lactation, Female and male reproductive potential

28
Q

Factor that effect how safe a drug is when taken during pregnancy

A
  1. Dose and how many a day
  2. Other factors that cause fetus to be susceptible
  3. Timing : day 17-56 post conception , organogenesis
  4. If combined with other agent
29
Q

Most common teratogen and 2 others

A
  1. Alcohol (microcephaly, low ears, flat midface)
  2. Antianxiety medication (meprobamate, chlordiazepoxide) = use FLUOXETINE
  3. Antineoplastic (aminopterinm methotrexate)
  4. Anticoagulants (Coumadin) use HEPARIN or lovnox
  5. Anticonvulsants (Diphenyldantoin = fetal hydantoin syndrome, cardio and growth restriction)
30
Q

Anticonvulsants what cause problems in pregnancies

A
  1. Valproic Acid : spina bifida, cardiac, skeletal
  2. Carbamazepine (spina bifida, craniofacial)
  3. Phenobarbital with others drugs
31
Q

2 Hormones that can cause fetal problems

A
  1. Estrogen/Progesterone OCP : masculinization of female external genitalia)
  2. DES : cervical cancer, vaginal Cancer, testicular abnormalities, T-heaped uterus
32
Q

Retinoid and preg

A

Avoid

50% chance abortion, cardio and cranial and CNS problems

33
Q
  1. Tobacco
  2. Drugs illicit
  3. Infections
    Can do what
A
  1. Short weight and growth
  2. Fetal drug dependence
  3. Congenital problems, growth and mental problems (bulging eyes, depressed nose, triangle mouth = CMV at 1st trimester)
34
Q

Radiation effect

  1. Problem
  2. No problem
  3. How much
A
  1. 2 -6 weeks : problems
  2. Before 2 weeks : nothing or miscarriage nothing inbetween ( so if no miscarriage then all is fine)
  3. 5 rads of exposure = no risk
35
Q

When do you have the most preg sx

A

100,000 hCG at 10 weeks

N, V, avoid greasy foods, small meals, salt crackers, room temp soda, zofran, phenergan, VitB6

36
Q

What causes this in pregnancy:

  1. Heartburn
  2. Constipation
  3. Hemorrhoids
  4. Leg cramps
  5. Backache
A
  1. High P, esophageal sphincter relaxes
  2. Low colonic activity
  3. Venous P in rectum increased (elevate legs, stool softeners)
  4. Last half of preg, at night, massage and stretch
  5. Weight is central front (belts, pillow, massage, heat)
37
Q

How often do you meet with preg pt

A
  1. Every 4 weeks until 28weeks
  2. Every 2 weeks until 36 weeks
  3. every week until delivery
38
Q

BMI recommend weight gain + urine Protein used for

A
  1. Under 19 = 28-40lb
  2. 19-25 = 25-35lb
  3. Over 25 = 15-25lb

= urine protein test for preeclampsia

39
Q

Uterus size means

A

Amount of cm top of fundus to pubic bone = weeks pregnant

40
Q

Fetal HR heard with

A
  1. After 12 weeks = Doppler device **

2. 18-20weeks = Fetoscope

41
Q
  1. Fetal movement felt when

2. Near term what you looks for

A
  1. Quickening, around 20 weeks

2. Fetal lies how + position (vertex, breech)

42
Q

What to do at :

  1. 20 weeks
  2. 28 weeks
  3. 36 weeks
A
  1. 20 weeks = fetal survey US (check all things)
  2. 28 weeks = gestational DM, Hb and hct recheck, RH = rhogam injection if RH-, Tdp injection
  3. 36 weeks = screen group B strep with vaginal culture (treat AB)
43
Q

How much should baby move when healthy and when

A

At 28 weeks baby moves 10 times in 2 hours, 9:00pm-1:00am most active)

44
Q

Nonstress Test

  1. Used for what
  2. And how to do it
A
  1. Not feeling baby move
  2. REACTIVE = 2 accelerations of 15 or more beats above baseline for 15sec or more (in 20min)
    NONREACTIVE = not 2 accelerations in 20 min
45
Q

Contraction Stress Test :
1. Done when
2 how

A
  1. When Nonstress test is nonreactive
  2. Give oxytocin to make 3 contractions (in 10min) = nipple stimulation OR pitocin
    = assess Deceleration in fetal HR (if most are late then its bad sign, move to delivery)
46
Q

On graph of nonstress test how much in dark line to dark line

A

1 min

47
Q

LAte Deceleration (late decel)

A

Deceleration of fetal HR in contraction stress test happens late right after contraction peak

48
Q

Biophysical profile

  1. Is done when
  2. How is it done
A
  1. After nonstress test and contraction stress test done

2. 8-10 points means good, 6 = deliver if pt is at term, 4 or less = nonreassuring

49
Q

Biophysical profile points come from

A

2 points each

  1. Nonstress test
  2. Fetal breathing (1 breath per 30sec for 30min)
  3. Fetal movement = 3 in 30min
  4. Fetal tone = 1 extr extension with return to flexion in 30min
  5. Amniotic fluid volume = 2cm fluid in 2 planes, with US
50
Q

Best antepartum test

A

Contraction stress test ,then biophysical profile, then nonstress test (however still all pretty good)

ENRP Exam 1 (13 decks)

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