Normal L&D Flashcards
When does beta-HCG peak?
10 weeks gestation
When can a pregnancy first be detected by ultrasound? What do you see?
TRANSVAGINAL- 5 weeks. Gestational sac but no heart until 6 weeks.
Beta-HCG level for TV U/S detection? Abdominal
1500 to 2000
Abdominal needs >6500
First trimester
up to 12 wks
Second trimester
12 wks to 24 wks
Third trimester
24 wks (or 28) to delivery
PreVIABLE delivery?
Before 24 wks
What EXACTLY does parity mean?
A pregnancy that led to a birth at or beyond 20 wks OR of an infant weighing more than 500g
Given birth to a set of twins?
G1P1 (it is considered ONE pregnancy)
The order of #s in GP….
pregnancies/#births at TERM/#births at PREterm/abortuses/living kids
What changes occur in the cardiovascular system during pregnancy?
1) CO inc by 30-50% (max at 20-24 wks then maintained)
2) Systemic vascular resistance decreases
3) BP drops and nadirs at 24 weeks then rises
Changes in pulm system during pregnancy?
1) Tidal volume inc
2) Respiratory rate UNCHANGED…therefore the combo increases MINUTE VENTILATION which inc O2 levels overall
3) Dyspnea of pregnancy
Changes in GI system in pregnancy?
Morning sickness…hyperemesis gravidarum
Prolonged gastric emptying time so GERD sx
Large bowel has dec motility so constipation
Hyperemesis gravidarum?
Severe morning sickness= WEIGHT LOSS & KETOSIS.
Renal system in pregnancy?
1) Kidneys get bigger
2) Ureters dilate
3) GFR inc by 50% early in pregnancy
4) Therefore BUN and creatinine dec
5) RAAS system inc (but sodium levels DON’T inc bc of the concomitant inc in GFR)
Hematologic changes in pregnancy?
1) Plasma volume increases more than hematocrit (RBCs) so there’s a DILUTIONAL ANEMIA
2) WBC count inc (range of 6-16 million). During stress of labor may rise to 20 million.
3) Platelets drop beta 100-150million/mL. (Greater drop INVESTIGATE IMMEDIATELY)
4) Hypercoagulability due to inc in fibrinogen, factors VII-X; clotting and bleeding TIMES don’t change
Endocrine changes in pregnancy?
1) Hyperestrogenic state
2) Alpha subunit of beta-HCG mimics LH, FSH, and TSH; peak at 10-12 wks
3) hPL inc (produced by placenta). Induces lipolysis with a concomitant inc in free fatty acids; also is insulin antagonist
4) Prolactin LEVELS inc but it doesn’t do anything until after birth of baby
5) Estrogen stims TBG, so there’s an inc in TOTAL T3 and T4 but FREE T3/T4 remain constant.
Calorie intake req during preg?
300kcal/day for preg; 500 kcal/day for breastfeeding
Weight gains
Underweight= 28-40lbs Normal= 20-30lbs Overweight= 15-25lbs
Folate req
0.4-0.8mg/day (Previous NTD or inc risk is 4mg/day)
Urinalysis in pregnancy looks for what?
Protein- preeclampsia
Glucose- diabetes
Leukocyte esterase- UTI
What are pregnant patients asked at EACH visit? What gets added after 20 weeks?
1) Vaginal bleeding
2) Vaginal discharge or leaking of fluid
3) Urinary symptoms
THEN
1) Contractions
2) Fetal movement
Components of the triple screen? Quad screen?
MSAFP (inc in NTD, dec in Down syndrome)
B-HCG
Estriol
Inhibin-A in quad screen
Second trimester visits?
- MSAFP between 15-18 wks
- Screening u/s between 18-20 wks
- Triple screen/quad screen
- Fetal heart is first heard