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EOR Women's Health > Normal pregnancy/L&D > Flashcards

Normal pregnancy/L&D Flashcards

1
Q

pregnancy: normal cardiovascular changes

A 
incr cardiac output 50%
HOTN supine, dizziness
incr pulse 10-18
incr S2 split (inspiration)
JVD
systolic ejection murmur
S3 gallop

BP should be normal, diastolic murmur NOT normal

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2
Q

pregnancy: NOT normal cardiovascular changes

A

diastolic murmur

BP should be normal

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3
Q

pregnancy: normal pulm changes

A

incr O2 demand
compensated resp alkalosis (incr ventilation)
dyspnea
mucosal hyperemia (congestion, rhinorrhea)

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4
Q

pregnancy: normal heme changes

A

incr plasma vol, RBC vol, coag factors
edema
physiologic anemia

leukocytosis
incr Fe needs (supplement 300 mg elemental Fe/day)

thromboembolism risk 2x (5.5x puerperium)
incr fibrinogen, FDP, 7, 8, 9, 10

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5
Q

pregnancy: normal renal changes

A 
incr PVR
incr bladder tone (progesterone)
decr bladder capacity
incr RAA components
urinary frequency
stress incontinence
nocturia

decr Cr, BUN
incr GFR
glucosuria NORMAL

(NOT normal: proteinuria)

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6
Q

pregnancy: normal GI changes

A

progesterone= smooth muscle relax
decr LES: GERD
decr GI motility: constipation
decr GB: stones

morning sickness, N/V- first 4-8 wks
pruritis (incr bile acid conc)
diet cravings
pica (no anemia?)
ptyalism (excess salivation, can't swallow b/c N)
olfactory aversions

ALP doubles NORMAL
incr lipids

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7
Q

ACEI category

A

D, contraindicated in preg

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8
Q

pregnancy: normal endocrine changes

A

thyroid enlarges
euthyroid

incr cortisol
incr aldosterone

incr hPL (human placental lactogen)
postprandial hyperglycemia
fasting hypoglycemia
incr insulin resistance

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9
Q

pregnancy: normal MSK changes

A

lumbar lordosis
back pain
imbalance (progesterone= ligament laxity)

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10
Q

pregnancy: normal skin changes

A 
spider angiomas
palmar erythema
striae gravidarum
**linea alba--> linea nigra
**chloasma/melasma (mask of pregnancy)
hair falling out postpartum
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11
Q

pregnancy: normal breast changes

A 
enlarge
incr areola
prominent montgomery glands
colostrum (for 2 wks)
**breast tenderness
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12
Q

pregnancy: normal ophthalmic changes

A

blurred vision (6-8 wks postpartum gone)

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13
Q

Chadwick’s sign

A

bluish vagina & cervix

pregnancy sign

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14
Q

Hagar’s sign

A

softening of cervix (b/t fundus & cervix)

pregnancy sign

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15
Q

quickening: nullipara

A

18-20 wks

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16
Q

quickening: multipara

A

14-16 wks

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17
Q

uterine growth: 12 wks

A

at symphysis pubis

fetal heart tones noted

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18
Q

uterine growth: 14-16 wks

A

midway b/t pubis & umbilicus

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19
Q

uterine growth: 20 wks

A

at umbilicus

quickening

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20
Q

uterine growth: >20 wks

A 
1 cm/wk gestation
# cm = # wks long
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21
Q

uterine growth: 38-40 wks

A

2-3 cm below below xiphoid process

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22
Q

umbilical cord contains

A

1 vein

2 arteries

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23
Q

placenta function

A

nutrients, waste elimination, gas exchange, hormone production

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24
Q

fetal kidneys functional when

A

2nd trimester (lg amniotic fluid component)

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25
Q

fetal liver functional when

A

slow
at birth, coag factors not developed
vit K at birth!

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26
Q

fetal liver developed when

A

6 wks

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27
Q

fetal IgG passive immunity gone when

A

12 wks fetus makes IgG, M, D, E

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28
Q

pregnancy sign: timing of softening and enlargement of uterus

A

6 wks after LMP

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29
Q

enlarged uterus palpated timing

A

12 wks

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30
Q

urine HCG pos when

A

4 wks after 1st day of LMP (next menses due)

best 1st AM void

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31
Q

serum HCG more sensitive vs. urine

levels?

A

initially double q 42-72 hrs

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32
Q

transvaginal US timing

A

3-4 wks

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33
Q

US timing

A

5-6 wks

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34
Q

fetal heart sounds timing

A

12 wks

doppler device/fetoscope

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35
Q

abnormal HCG from expected stage?

A

ectopic

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36
Q

HCG day 23

A

100

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37
Q

HCG day 28

A

250

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38
Q

HCG day 35

A

1000

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39
Q

gestational age

A

1st day LMP -to- estimated date of delivery

1st day LMP + 7 days - 3 mo

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40
Q

routine prenatal visit: initial

what do they perform

A

6-8 wks after LMP

pelvic exam, PAP
GC/chlamydia cultures
CBC, blood type, Rh
Hep B, syphilis, HIV, rubella, varicella
GTT if high risk (obese, PCOS, FH)
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41
Q

routine prenatal visits frequency

A

initial: 6-8 wks after LMP
8-28 wks: q 4 wks
28-36 wks: q 2-3 wks
>36 wks: q wk

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42
Q

every visit entails

A 
BP
wt (gain 4 lbs/visit)
UA (glucosuria NORMAL, proteinuria NOT normal)
fundal ht (tape measure >20 wks)
fetal HR (NORMAL 110-160)
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43
Q

options if breech

A

breech ok before 34 wks
external cephalic version (manipulate)- not if mult, uterine anomaly
Csection

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44
Q

purpose of 20 wk US

A 
confirm intrauterine
gestational age
mult gestations?
confirm cardiac activity
nuchal transparency= Down's, chromosomal abnorm- US sooner
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45
Q

1st trimester (10-13 wks)- high risk findings (old mom)

A

US nuchal transparency

plasma protein A (Downs)

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46
Q 
quad screen (special test in high risk moms, old age)
what it includes, what it means
A

decr MS-AFP
decr estriol

incr HCG
incr inhibin A

=trisomy 21 (Downs), trisomy 18 (Edwards), chromasomal abnom

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47
Q

incr MS-AFP (maternal serum) means

A

neural tube defects
spina bifida
(tetralogy of fallot, anencephaly)

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48
Q

Downs screening 1st and 2nd trimester

A

1st trimester: PAPP-A (preg assoc plasma protein A)
nuchal transparency

2nd trimester: Quad testing

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49
Q

GBS at 32-36 wks

prophylaxis?

A

PCN G IV 5, then 2.5 q 4 hrs until delivery

PCN allergy: clindamycin, erythromycin

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50
Q

LGA causes

A

incorrect assessment gest age
mult preg
lg fetus
polyhydramnios (excess amniotic fluid)

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51
Q

SGA causes

A

incorrect assessment gest age
IUGR
intrauterine fetal demise
oligohydraminios (little amniotic fluid)

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52
Q

folic acid requirement

A

0.4 mg folic acid

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53
Q

travel/flying counsel

A

fly up to 36 wks

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54
Q

sexual activity counsel

A

not limited

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55
Q

smoking in pregnancy Sx

A

IUGR
low birth wt
mortality

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56
Q

morning sickness Tx

A

crackers, lay in bed, hard candy
pyridoxine (vit B6)
antihistamines (benadryl, dramamine, doxylamine)
antiemetics (phenergan, compazine)

DON’T USE ZOFRAN!

57
Q

hyperemesis gravidarum Tx

A

corticosteroids

IVF

58
Q

GBS testing when?

A

32-36 wks

59
Q

false contractions (Braxton Hicks contractions) description

A

shorter, not as painful, not progressive, resolve with fluids/movement/analgesics

60
Q

lightening definition

A

baby’s head poked out into pelvis

61
Q

blood show definition

A

effacement, thinning cervix

62
Q

desired presentation and lie

A

longitudinal, cephalic

63
Q

effacement of cervix starts when

A

1 wk prior to delivery

64
Q

full 10 cm dilation- what do you see?

A

membrane starting to come through

65
Q

fetal stations definition

A

baby’s head vs. ischial spines and pelvis

66
Q

station 0 (where, dilation, effacement)

A

at level of spines
3-4 cm dilated
70% effacement
aka “engagement”

67
Q

dilation of cervix starts when

A

days before delivery

68
Q

movements of labor

A
  1. engagement (station 0) days-wks before delivery
  2. head flex
  3. descent
  4. internal rotation, face down
  5. extension of neck, head delivered
  6. external rotation, face up
  7. expulsion
69
Q

fetal monitoring during labor

A
  • intermittent doppler monitor (1st stage q 30 min, 2nd stage q 15 min)
  • electronic fetal monitoring
70
Q

2nd stage of labor aka

A

“pushing” stage
bear down
full cervical dilation

71
Q

length of 2nd stage of labor

A

primigravid: 30min-3hrs
multiparous: 5-30 min

72
Q

modified ritgen maneuver when?

A

2nd stage of labor
prevent tears
push up against infant chin

73
Q

perineal tearing 1st degree

A

vaginal laceration

perineal skin torn

74
Q

perineal tearing 2nd degree

A

vaginal laceration
perineal skin torn
+perineal muscle torn

75
Q

perineal tearing 3rd degree

A

vaginal laceration
perineal skin torn
perineal muscle torn
+external anal sphincter torn

76
Q

perineal tearing 4th degree

A 
vaginal laceration
perineal skin torn
perineal muscle torn
external anal sphincter torn
\+complete external anal sphincter torn
\+rectal mucosa torn
ALL THE WAY
77
Q

2 normal NB head findings

A

molding (shift cranial bones)
caput succedaneum (edema scalp)
-resolve in 24 hrs

78
Q

3 classic signs of placenta separation

A
  • uterus rises in abdomen
  • gush of blood
  • lengthening umbilical cord
79
Q

3rd stage of labor definition

A

placenta delivery, within 30 min infant delivery

80
Q

risks postpartum uterine hemorrhage

A

rapid/protracted labor
enlarged uterus (polyhydramnios, lg fetus, mult gest)
chorioamnionitis (inflamm membr)

81
Q

4th stage of labor definition

A

2hrs postpartum

82
Q

labor induction drugs

A

oxytocin: stim contractions
misoprostol (prostaglandin): cervical ripening
rupture membranes

83
Q

indications for C section

A 
placenta previa
abruptio placentae
prolapse of umbilical cord
uterine rupture
breech
84
Q

relative contraindications for vaginal birth after C section (5)

A
  • Hx high/classic C section
  • previous uterine rupture
  • OB complications
  • 2 prior uterine scars + no vaginal deliveries
  • no vaginal birth at home after C section
85
Q

indications for no resuscitation in NB

A

full term, CLEAR AMNIOTIC FLUID (no meconium), spontaneous breathing/crying, good muscle tone

86
Q

Apgar signs (5)

A 
Appearance (color)
Pulse (HR)
Grimace (reflex activity response to stim)
Activity (muscle tone)
Respirations
87
Q

Apgar: color 0, 1, 2

A

blue/pale, acrocyanotic, pink

88
Q

Apgar: HR 0, 1, 2

A

absent, 100

89
Q

Apgar: reflex activity response to stim 0, 1, 2

A

none, grimace, cry/active WD

90
Q

Apgar: muscle tone 0, 1, 2

A

limp, some flexion, active motion

91
Q

Apgar: respirations 0, 1, 2

A

none, weak cry/hypoventilation, good crying

92
Q

meds given within 1 hr delivery to NB

A

erythromycin (gonococcal ophthalmia)

vit K1 0.5-1 mg (prevent hemorrhagic dz of NB)

93
Q

puerperium period

A

6-8 wks after birth

94
Q

initial postpartum exam time

A

4-6 wks after

95
Q

lochia

A

sloughed off endometrium, clots expelled, discharge
heavy 1st few days
resolves over several wks

96
Q

cervix back to 1 cm when?

A

1 wk

97
Q

ovarian function returns when?

A

nonlactating 3 wks

lactating 6 mo

98
Q

uterus normal size (involution) when?

A

6 wks

99
Q

cardiovascular system postpartum

A

incr HR resolves in 1 hr

incr plasma vol normal in 2-3 wks

100
Q

renal system postpartum

A

incr GFR normal in several wks
urinary retention (edema around urethra)
stress incontinence normal in 3 mo

101
Q

highest risk for postpartum hemorrhage when?

A

1st 24 hrs

102
Q

pt mgmt postpartum

A
  • ambulation encouraged
  • breast engorgement uncomfortable, will resolve
  • mastitis
  • stool softeners
  • perineum care: oral analgesics, local anesthetics (benzocaine spray), sitz baths
103
Q

wt loss postpartum

A

2 lb/mo

104
Q

sexual activity postpartum

A

in ~2wks

105
Q

oral contraception while lactating?

A

yes. progesterone only (minipill)
- exclusively breastfeeding: start in 6 wks
- partially breastfeeding: start in 3 wks

106
Q

breastfeeding benefits

A
  • decr AOM, resp infections
  • decr diarrhea
  • decr SIDS
  • decr atopic/allergic dz
  • decr juvenile diabetes
  • decr hospital admissions
107
Q

breastfeeding contraindications

A

HIV, chemo, illegal drugs

Li, tetracycline, methotrexate, radioactive

108
Q

hormones released in breastfeeding

A

oxytocin, prolactin

109
Q

colostrum when?

A

first 5 days lactation

110
Q

mother’s minimum calorie requirement (breastfeeding)

A

1800 calories/day

111
Q

RF for PPD and postpartum psychosis

A

younger, Hx mental disorders, DEPRESSION DURING PREGNANCY

112
Q

postpartum blues definition, onset, duration, Tx

A

sad/anxious/angry/insomnia/tearful
starts 2-4 days, for 1-2 wks
no Tx

113
Q

PPD Tx

A

antidepressant, psychotherapy

114
Q

postpartum psychosis Tx

A

antidepressant, antipsychotics

115
Q

when to start checking fundal ht

A

20 wks

116
Q

when to start checking fetal heart tones

A

10 wks

117
Q

normal fetal HR

A

120-160 bpm

118
Q

1st trimester screening

A
  • preg-assoc plasma protein A (PAPP-A) (low= trisomy 21)
  • free beta-HCG (high= trisomy 21)
  • US: EDC, mult gestations
  • nuchal translucency screening at 10-13 wks (pos= trisomy, Turners)
  • chorionic villus sampling at 10-13 wks
119
Q

US fetal heart activity detected when

A

5-6 wks after LMP

120
Q

indications for nuchal translucency / chorionic villus sampling / amniocentesis

A

> 35 y/o, Hx chromosomal abnorm child/parent/FH, abnorm 1st/2nd trimester mom screening

-neural tube defect risk- amniocentesis

121
Q

2nd trimester screening

A

estriol, AFP, inhibin A, US, amniocentesis

122
Q

trisomy 21

A

low estriol, low AFP, low preg-assoc plasma protein A (PAPP-A)
high inhibin A, high free beta-HCG, pos nuchal translucency

123
Q

estriol, AFP, inhibin A in trisomy 21

A

low estriol, low AFP, high inhibin A

124
Q

US purposes

A
  • fetal viability
  • growth vs. gestational age
  • placenta status/location
  • amniotic fluid level
  • lethal malformations
  • f/u abnorm blood screening tests
125
Q

amniocentesis when?

A

15-18 wks

126
Q

3rd trimester screening

A
  • gestational diabetes
  • Rh repeat Ab titers
  • vaginal culture for GBS
  • H/H
  • NST (non-stress test)
  • US
  • biophysical profile
127
Q

GBS vaginal-rectal culture when?

A

35 wks

128
Q

gestational diabetes screening when?

A

24-28 wks

129
Q

H/H pregnancy screening when?

A

35 wks

130
Q

CVS (chorionic villus sampling) when?

A

10-13 wks (1st trimester screening)

131
Q

nuchal translucency when?

A

10-13 wks (1st trimester screening)

132
Q

how to monitor fetal well-being

A

nonstress test (NST): doppler monitor, external stress gauge for uterine contractions

133
Q

normal NST

A

reactive

  • 2 accelerations of fetal HR in 20 minutes (incr 15 bpm baseline HR for 15 sec)
  • absence of decelerations
134
Q

decelerations definition

A

decr fetal HR 15 bpm OR 15 sec OR slow return to baseline

135
Q

accelerations definition

A

incr fetal HR 15 bpm for 15 sec

136
Q

bad sign in fetal HR

A

late decelerations

137
Q

biophysical profile (BPP)- 5 parameters

A

NST, amniotic fluid level, gross fetal movement, fetal tone, fetal breathing

-each parameter 2 points, total of 10 points

138
Q

biophysical profile when, purpose

A
  • late in pregnancy

- monitor fetal well-being

139
Q

GBS test when

A

32-36 wks

EOR Women's Health (4 decks)

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