Normal Pregnancy, Prenatal care, and Lab changes (Moulton) Flashcards
What is Gravidity?
What is Parity?
What is acronym for Parity?
1) Number of times a woman has been pregnant
2) Number of pregnancies led to a birth at or beyond 20 weeks or an infant weighing more than 500 grams
FPAL
What does G1P1002 mean?
What does G4P1123 mean?
1) A woman who has given birth to 1 set of twins at term and both are living
2) A woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriages and 1 ectopic pregnancy. She has 3 living children.
1) What do Rh Negative patients get?
2) When?
3) FPAL Length
1) Rhogam
2) 28 weeks and anytime sensitization occurs
3)
Full term 37-42 weeks
Preterm 20-36+6
Abortion: <20 weeks
What should you vaccinate against postpartum if not already immune?
With a prenatal visit, what should you screen for if the patient presents as obese?
Rubella
Diabetes
Gestational age is the number of weeks that have elapsed between when?
1) First day of the last menstrual period
2) The date of delivery
hCG can be first detected in serum when after ovulation?
6 to 8 days
hCG less than ____ IU/L is negative.
Level above ____ IU/L considered positive.
A level of about ____ IU/L is reached by time of expected menses.
1) 5
2) 25
3) 100
In the first 30 days of a normal pregnancy hCG __1__ every 2.2 days.
This is used to evaluate for early intrauterine pregnancy vs __2__.
1) Doubles
2) Ectopic pregnancy
With a transvaginal ultrasound, what is seen around 5 weeks.
What is seen at 6 weeks.
What is seen at 7 weeks.
1) Gestational sac
2) Fetal pole
3) Cardiac activity
When estimating gestation age/due date, what is Naegele’s rule based on?
How is it calculated
1) Regular 28 day menstrual cycle
2) Last menstrual period - 3 months + 7 days + 1 year
At 6-11 weeks how can due date be determined within 7 days?
Crown Rump Length
How can Fetal demise be calculated?
Crown Rump Length >5mm
With Absence of Fetal Cardiac Activity
Child born to women that are 35 yrs and older are at increased risk of?
The autosomal trisomies (13, 18 or 21)
Downs Syndrome cases are due to meiotic nondisjunction events leading to __1__ chromosomes with an extra copy of chromosome __2__.
1) 47
2) 21
1) What is the most common class of spontaneous abortions?
2) What is the most common one?
3) What is the most common SINGLE chromosomal abnormality found in spontaneous abortions is?
1) Autosomal trisomies
2) Trisomy 16
3) Turner 45XO
*Can also use Chorionic Villi sampling and amniocentesis
With autosomal dominant disorders, the affected individual has a ____ chance of passing the gene and disorder to the offspring.
50%
Consanguineous couples are at an increased risk of what?
What is important for CF screening?
Child homozygous for recessive gene
Genetic Counseling
1) High Risk populations have higher frequency of what compared to general population?
2) Tay-Sachs should be screened in Who?
1) Heterozygotes
2) Eastern European Jewish
1) Sex linked disorders primarily affect which sex?
2) Which sex are usually the unaffected carriers?
3) What is the most common form of inherited mental retardation?
4) How are sex linked disorders diagnosed?
5) When can they be performed?
6) When is the risk of this diagnosis method?
1) Males
2) Females
3) Fragile X syndrome
4) Chorionic Villus sampling: 11 weeks
Amniocentesis: 16-20 weeks
6) Miscarriage
Cleft lip or palate, congenital heart defects, pyloric stenosis and neural tube defects are all examples of birth defects inherited in what fashion.
Multifactorially (both genetic and environmental factors)
Why should women with an affected child for neural tube defect take 4 mg of folic acid in subsequent pregnancies before conception?
Since neural tube closure is complete at 28 days post conception
What is Fetal Nuchal Translucency thickness associated with?
Chromosomal and congenital abnormalities
What does first trimester screening include? (Week 1-12)
What is seen with Down syndrome?
1) Maternal Age
2) Nuchal Translucency
3) b-hCG
4) Pregnancy Associated Plasma Protein-A (PAPP-A)
Elevated b-hCG and Low PAPP-A
*BNPM (Barnes and Noble in the PM) during first trimester
1) What is Second Trimester Screen (13-26)
2) What is added to make it Quadruple Screen?
3) What can it help detect?
1) b-hCG, estriol, and maternal serum alpha fetoprotein
2) Inhibin A
BEM(i)
3) Down syndrome
1) The non invasive prenatal tests what?
2) Derived from where that enters where?
3) It has high detection rates for what?
4) What does it not test for?
1) Free fetal DNA
2) Apoptosis of trophoblastic cells that entered maternal circulation
2) Trisomy 13, 18, 21
3) Neural tube Defects
Cell free fetal DNA tests should only be ordered in high risk patients, including one or more of the following:
1) History of Trisomy pregnancy
2) Old Age
3) FH of Chromosomal abnormalities
4) Fetal US showing Aneuploidy
HOFF
__1__ is defined as any agent or factor that can cause abnormalities of form or function in an exposed fetus.
For example, ____ which was used in the 50s caused phocomelia (short limbs).
What is the most Vulnerable time of teratogenesis?
What occurs during this period?
1) Teratogen
2) Thalidomide
3) First trimester
4) Organogenesis
1) What is the most common teratogen to which a fetus is exposed?
2) What is the drug of choice for anxiety and depression during pregnancy.
3) Why are the antineoplastic methotrexate and aminopterin teratogen?
1) Alcohol
2) Fluoxetine
3) They are folic Acid Antagonist
What teratogen causes a syndrome of
- growth restriction
- Low set ear
- Smooth philtrum
- Thin upper lip
- Microcephaly
- Mental retardation?
Alcohol (Fetal alcohol syndrome)
Which of the following alkylating agents, busulfan, chlorambucil, and cyclophosphamide are not teratogenic agents?
They all are
What anticoagulant crosses the placenta and cause spontaneous abortion, intrauterine growth restriction, and central nervous system defects like mental retardation?
Which anticoagulant is the drug of choice because it does not cross the placenta?
1) Coumadin
2) Heparin
Which anticonvulsant causes a syndrome of
- Craniofacial abnormalities
- Limb reduction defects
- Prenatal onset growth restriction
- Mental deficiency
- Cardiovascular anomalies?
Diphenylhydantoin
Which does Valproic and Carbamazepine cause?
Spina Bifida
Exposure to what hormone causes an increased risk for vaginal cell cancer and can cause a T shaped uterus?
Diethylstilbestrol (DES)
What drug can cause spontaneous abortion or congenital malformation for severe acne in first trimester?
Isotretinoin
What interferes with fetal growth- weight, length, and head circumference?
Tobacco smoking
Exposure to what infectious agent in early pregnancy can result in
- Proptosis (displacement of eye)
- Depressed nasal bridge
- Triangular mouth?
CMV
When is the critical period for lethal effect from radiation exposure?
2 and 6 weeks
What drug induces Heartburn in pregnancies?
What other GI complaint is a common unpleasant symptom of pregnancy?
Progesterone
2) Constipation and Hemorrhoids
What MSK complaint is a common unpleasant symptom of pregnancy especially at night?
What MSK complaint is common especially in late pregnancy?
1) Leg cramps
2) Back pain
BMI < 19 recommended weight gain is ____ lbs.
BMI 19-25 recommended weight gain is ____ lbs.
BMI > 25 recommended weight gain is ____ lbs.
1) 28-40
2) 25-35
3) 15-25
The first sensation of movement is known as what and occurs when?
1) Quickening
2) 20 weeks
What routine screening should be performed at 20 weeks?
Fetal survey ultrasound
What routine screening/procedures should be performed at 28 weeks?
1) Gestational diabetes
2) Rhogam injection to Rh negative patients
3) Tdap
28 is GRT
What routine screening should be performed at 36 weeks?
Screening for group B strep
GBS=36
Reactive Non-Stress Tests shows what normally?
2 acceleations
15 beats above baseline
Lasting 15 seconds
1) What do you give with Contraction stress test
2) Why?
3) What should happen if late decelerations are noted?
1) Oxytocin
2) To give at least 3 contractions in 10 minutes
3) Delivery
