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OBGYN > Normal pregnancy/ Prenatal Care > Flashcards

Normal pregnancy/ Prenatal Care Flashcards

1
Q

At how many weeks and level of bhCG will you see a gestational sac?

A

5 weeks

bhCG: 1500-2000

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2
Q

At how many weeks and level of bhCG will you see the fetal heart?

A

6 weeks

bhCG: 5000-6000

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3
Q

“Abortion” is used to describe pregnancy losses at < ____ weeks

A

<20 weeks

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4
Q

“Embryo” vs “Fetus” timeline

A

0- 8 weeks = embryo

8 weeks - birth = fetus

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5
Q

1st, 2nd, and 3rd trimester dates

A

0 to 12-14 weeks = 1st trimester
12-14 to 24-28 weeks = 2nd trimester
> 24-28 weeks = 3rd trimester

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6
Q

Viability is at >___ weeks
Term is ___ weeks
Postterm is ___ weeks

A

24 weeks
Term at 37 to 42 weeks
Post term at >42 weeks

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7
Q

Dating with US; take LMP if within __ weeks of 1st, 2nd, and 3rd trimesters

A

1 week
2 weeks
3 weeks
*the earlier the US, the more accurate

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8
Q

Record fundal heights after ____ weeks, doppler for fetal heart beat after ____

A

20 weeks

10-14 weeks

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9
Q

CV phsyiology changes in pregnancy

A
  1. CO increases 30-50%, mostly in 1st T (SV, then HR)

2. SVR decreases 2/2 progesterone

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10
Q

Pulm physiology changes in pregnancy

A
  1. Tidal volume increases
  2. TLC decreases
  3. Respiratory rate same
  4. Minute ventilation increases
  5. PaO2 increases, PaCO2 decreases
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11
Q

GI physiology changes in pregnancy

A
  1. N/V in first trimester (should resolve by 14-16 wks ow hyperemesis gravidarum)
  2. Prolonged gastric emptying/ GES tone lowered 2/2 Proges> GERD
  3. Decreased mobility of large bowel, increased H20 absorption, constipation
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12
Q

Renal physiology changes in pregnancy

A
  1. Kidneys bigger, ureters dilate > pyrelonephritis

2. GFR increases 50%, BUN and creatinine decrease

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13
Q

Heme physiology changes in pregnancy

A 
Plasma volume increases 50%
RBC mass increases 20-30%
Dilutional anemia
WBC to 10.5, platelets drop by still >100
Hypercoaguable state (PTT/INR same)
Decreased oncotic pressure
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14
Q

Risk of tocolysis with terbutaline

A

Pulmonary edema (due to decreased oncotic pressure)

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15
Q

Endocrine physiology changes in pregnancy

A

Lots of estrogen from adrenal precursors converted in placenta
hCG maintains corpus luteum in early pregnancy
human placental lactogen (HPL) ensures nutrient supply, diabetogenic
Prolactin increases
Thyroxine-binding globulin (TBG) increased by estrogen, total T3/T4 increase, fT4 same
Glucosuria common!

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16
Q

Folate recommendations

A

4 mg/ day: hx NTD, on carbamazepine, valproate, pregestational DM
400 mcg/ day: all other women

17
Q

Weight gain recommendations

A

Underweight: 25-40 lbs
Normal: 25-35 lbs
Overweight: 15-20 lbs
Obese: 11- 20 lbs

+ 300 cals/ day in pregnancy
+ 500 cals/day in breast feeding

18
Q

Antenatal Screening Recs:

A

First Trimester screen: NT, PAPP-A, bhCG @ 11-13 weeks
CVS: if concerns 9-12 wks
Quad screen: MSAFP, bhCG, estriol, inhibin A @ 15-20 wk
Amnio: if concerns >15 weeks
Anatomy Screen: US @ 18-20
Glucose Tol Test: 26 weeks

19
Q

Glucose Tolerance Testing

A

GLT: 50 g challenge, check 1 hr, >135-140 go to OGTT
OGTT: 100 g challenge, check fasting, 1, 2, 3 hr. Should be less than 95/180/155/140
6 week PP: 75g challenge, measure 2 hours >140`

20
Q

Biophysical profile (BPP)

A

Done for: High-risk pregnancy,
fetal growth problems, Rh sensitization, or high blood pressure, decreased movement of the fetus, postterm pregnancy
Started: ~32-34 weeks, repeated as needed
Includes:
1. Fetal heart rate
2. Fetal breathing movements
3. Fetal activity
4. Fetal muscle tone
5. Amount of amniotic fluid
Each of the five areas is given a score of 0 or 2 points, for a possible total of 10 points.

21
Q

What is a Doppler ultrasound exam of the umbilical artery?

A

Doppler ultrasound is used to check the blood flow in the umbilical artery, a blood vessel located in the umbilical cord. Doppler ultrasound is used with other tests when the fetus shows signs of not growing well.

22
Q

Non- stress test

A

Measures the fetal HR in response to fetal movement over time.

A belt with a sensor that measures the fetal HR is placed around pt abdomen. The fetal heart rate is recorded by a machine for 20 mins.

If two or more accelerations that are 15 bpm above baseline x 15 seconds occur within a 20-minute period, the result is considered reactive or “reassuring.”

US if worrisome

23
Q

Contraction stress test

A

Get 3 contractions in 10m, analyze FHR

If the fetal heart rate does not decrease after a contraction, the result is normal (negative). A decrease in heart rate after most contractions is a positive result. Early decels are less worrisome than late decels

24
Q

Fetal lung maturity

A

L/S ratio >2 = RDS is rare

Can also use phosphatidylglycerol, saturated phosphatydal choline, surfactant/albumin ratio, lamellar body CT

25
Q

Treatments for common pregnancy problems: Lower back pain

A

Stretching, gentle exercise, Tylenol, massage, heating pads

26
Q

Treatments for common pregnancy problems: constipation

A

water, colace, avoid laxatives in 3rd trimester (increase pre term labor?)

27
Q

Treatments for common pregnancy problems: Contractions

A

If Braxton-Hicks, drink lots of water (vasopressin > oxytoxin receptors)
If q 10 m of less, think PTL and check cervix

28
Q

Treatments for common pregnancy problems: Edema

A

Due to compressed IVC

Elevate legs, sleep on side, worry for PEC if hands/face

29
Q

Treatments for common pregnancy problems: GERD

A

Many small meals, start antacids, dont lay down right after eating; H2 blockers/PPI if persists

30
Q

Treatments for common pregnancy problems: Hemorrhoids

A

Due to IVC compression

Topical anesthetics, steroids, prevent constipation

31
Q

Treatments for common pregnancy problems: Pica

A

Stop, good nutrition instead

If poisonous, call poison control or toxicology consult

32
Q

Treatments for common pregnancy problems: Round ligament pain

A

late in 2nd tri/early in 3rd
Adnexa/lower abdomen/shoots to labia
Warm compresses or acetaminophen

33
Q

Treatments for common pregnancy problems: Urinary frequency

A

Check urine, keep up PO hydration

34
Q

Treatments for common pregnancy problems: Varicose veins

A

LE or vulva

Elevate, use compression stockings

OBGYN (32 decks)

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