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OB Block 2 Flashcards

1
Q

Define Embryo

Define Fetus

Define Fetal Viability

A

Fertilization to 8wks (10wks gestation)

> 8wks until birth (>10wks gestation)

20-24wks of gestation

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2
Q

Define Previable

Define Previable Birth

Why is gestational age two weeks older than fertilization age?

A

Infant delivered <24wks

Delivery from 20 +0/7-25+6/7 weeks of gestation

Gestational age calculated from date of LMP

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3
Q

Criteria for Preterm

Criteria for Term

Define Post-Term

A

Delivered 24-36w 6/7d,
Born <259 days

Delivered 37-41+7/7, 259-293

Delivery +42wks, 294 days

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4
Q

Define Placenta Previa

What are the 3 types and associated MC Sx

A

Placenta near/on cervical os

MC: 3rd trimester painless hemorrhage (8th mon):
Marginalis: at os margin
Partialis: covers part of os
Centralis: covers os

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5
Q

Define Abruptio Placentae

What are two RFs of Abruptio Placentae

What is the difference in presenting bleeds of an abruption?

A

Painful, premature detachment of placenta

Pre-Eclampsia
Chronic HTN

Marginal: external
Central: hemorrhage hidden

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6
Q

What layer is defected if a placenta Accreta/Increta/Percreta occurs?

Define Vasa Previa

A

A: placenta adheres to wall, deficient Nitabuch/decidua basalis
I: myometrium invasion
P: myometrium/structures penetrated

Umbilical vessels between head and cervical os; easily torn, fetal death d/t exsanguination
Common w/ multiple gestations

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7
Q

Define Velamentous Placenta

PTs presenting w/ Vasa Previa need to delivery baby via ?

A

Cord/vessels entering placenta separately

C-section at 35-37wks

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8
Q

Define Gravida

Define Parity

A

Number of pregnancy (regardless of multiples), including current (regardless of outcome)

Number of births after 20w gestation, twins= 1

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9
Q

Define Nulligravada

Define Primigravida

Define Multigravida

A

No prior pregnancy

Current first pregnancy

2 or more pregnancies including current

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10
Q

Define Nullipara

Define Primipara

Define Multipara

Define Grand Multipara

A

No births after 20wks

One birth after 20wks

+2 births after 20wks

Five+ births after 20wks

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11
Q

What’s the acronym for describing OB Hx

A 
GTPAL
Gravida- total number of pregnancy
Term: 37-40+ wks
Preterm: 20-36wks
Abortions: before 20wks
Living
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12
Q

How is Gestational Age calculated

Pregnancy trimesters are divided into equal ?

A

1st day LMP to birth
280 days, 40wks

Epochs: each 14wks

1: conception-14wks
2: 15-28wks
3: 29-42wks

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13
Q

When is a new OB appointment needed**

How long after are appointments needed?

A

10-12wks gestation

Every 4wks until 28wks
28-36wks: q2wks
+36wks: weekly

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14
Q

What screenings are checked during the first OB visit?

Which ones are done at the 15-20wk appointment

A

Cystic fibrosis
HIV
Aneuplody screen
Gonococcal

Cystic fibrosis
Aneuploidy
Neural tube defect

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15
Q

What screening is done at the 24-28wk appointment?

What screenings are done at the 29-41 wk appointments?

A

Ab screening

HepB
HIV
GBS culture
Gonococcal/Chlamydia
Syphilis
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16
Q

Clinical pelvimetry is not reliable to predict ? in labor

How is the obstetric conjugate measured

A

Cephalopelvic disproportion

Anteroposterior/Diagonal conjugate - 1.5-2cm= +10cm

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17
Q

Pelvimetry measures pelvic capacity w/ ? three measurements

What are the two pelvic shapes preferred for vaginal delivery

A

Diagonal conjugate
Interspinous diameter mid-pelvis
Intertuberous distance of pelvic outlet

Gynecoid*, Anthropoid

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18
Q

Where is the midpelvis measured at and what are they called during labor

The ? diameter is important when discussing obstructed/arrested labor

A

Ishial spine
Midpelvis + ischial= 0 station

Interspinous: 10cm

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19
Q

What is the name of the desired baby position during birth

Where is the sacrospinous ligament located

A

Occiput anterior

3 fingers between ischial spine and midline sacrum

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20
Q

The pelvic outlet is important if ? has occurred

What is the name of the device used figuring EDD and Gestational Age

A

Arrested labor

Naegles Rule:
1st day LMP - 3mon + 7 days

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21
Q

Early US is used in lieu of Naegles Rule if ?

What is the most accurate biometric predictor of gestational age

A

Uncertain LMP
Irregular periods
OCPs

Crown Rump length, greatest accuracy during 1st trimester

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22
Q

What adjustments are made if US and LMP don’t match up

Define Double Decidual Sign

What are the TORCH microbes

A

Correspond w/ US if:
<9wks GA: >5 day difference
9-<14wks GA: >1wk difference

D Parietalis outer layer
D Capsularis inner layer

Toxoplasmosis Other Rubella CMV HSV

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23
Q

When are HIV screening conducted during pregnancy

How is this RNA Retrovirus managed

A

New OB appointments
Repeat 3rd Tri if high risk

Load <1000- vaginal delivery
Load >1000= C-section
No breast feeding

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24
Q

What two TORCH microbes can cause blueberry muffin babies?

Which trimesters are Toxoplasmosis infections dangerous?

How are Toxo infections Dx?

A

Rubella
CMV

1st: low infection, high fatality
3rd: high infection, low fatality

IgM/Placenta culture

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25
How are Toxo infections Tx When is Syphilis screened for
Mother: Spiramycin Mother and Baby: Pyrimethamine-sulfa w/ Folinic acid RPR/VDRL for all Repeat 3rd if high risk
26
How is congenital syphilis Tx How is the following Jarisch Herxheimer reaction Tx
Pen G 2.4M unit x 1, rpt 1wk later Fluid Antipyretic O2
27
When is Rubella infection dangerous How is this infection avoided?
1st trimester Avoid/Vaccine once post-partum, not c/i for breast feeding
28
What is the MC congenital viral infection Why is this Dx difficult When is acyclovir started for HSV positive mothers
CMV IgM present x 2yrs 36wks
29
Can mothers get Varicella vaccine during pregnancy? How is Varicella tx When is Hep B screened for DNA viruses RNA viruses
No, wait 28 days Infant: VZIG 96hrs and isolate Exposed mom: VZIG <6days HBsAg in all women Rescreen high risk at 3rd trimester DNA: CMV HSV Varicella HBV RNA: HIV Rubella
30
How is Hep B Tx How is Chlamydia or Gonorrhea Tx during pregnancy
Infant of +HBsAg PTs: HBIG + HBV vaccine <12hrs of birth Mothers may breast feed C: Amoxicillin 500mg TID x 7d or Azith 1000mg x 1d G: Ceftriax 250mg IM or Cefixime 400mg PO
31
What is the MC Cause of neonatal sepsis If women tests + for this, how is it Tx
GBS- Strep Agalactiae IV PCN G PCN allergy= Clindamycin
32
What is the "Screening Strategy" for GBS
Results prior to labor Screen at 35-37wks except** Tx PTs w/ + cultures Tx GBS bacteriuria this pregnancy** Tx Pts w/ previously infected infants**
33
What is the Risk Factor strategy for GBS
Tx Pts w/ risk factors for colonization Tx w/ GBS bacteriuria Tx w/ previously infected infant Intrapartum fevers +38*C 18+hrs ruptured membranes
34
When is intrapartum prophylaxis indicated
Previous infant w/ invasive GBS Dz GBS bacteriuria during current pregnancy + GBS screening culture during current pregnancy Unknown GBS status and delivery <37wks or membrane rupture +18hrs
35
When is intrapartum prophylaxis not indicated
Previous pregnancy w/ + GBS culture Planned c-section w/out labor/membrane rupture Neg vag/rectal culture in late gestation during current pregnancy
36
What is recommended for GBS Tx What is the alternative What is used for PCN allergies
Pen G 5M units IV 3M units IV q4hrs to delivery Ampicillin 2g IV 1g IV q4hrs/2g q6hrs until delivery Low anaphylaxis risk: Cefazolin 2g IV, 1g q8hrs High risk anaphylaxis- Clindamycin 900mg IV q8hrs High risk anaphylaxis and Clinda resistant- Vanc 1g IV q12hrs
37
How is bacteriuria Tx What test is required for all PTs post-ABX How are these PTs Tx if they develop pyelonephritis
Nitro Amox Ampicillin Test of cure Admit for IV therapy Prophylaxis for remainder of therapy
38
When are pregnant PTs screened for TB Conduct PPD and ? measurement is considered positive
High risk- HIV+ Lower socio-economics Minorities Immigrants from Africa Asia Cental/S America 5mm or bigger
39
What are the risks of TB to pregnant PTs and babies How are latent infections Tx How are active infections Tx
Preterm delivery Low birth weight IUGR Perinatal mortality INH 300mg PO daily w/ Pyridoxine x 9 mon RIPE w/ B6 x 2mon RI x 4mon
40
What are the Zika Sxs that may trigger need for testing What is the risk babies can be born with
Fever Rash Arthralgia Conjunctivitis HA Microcephaly Lissencephaly- no brain grooves
41
What immunizations are in a Tdap vaccine When can it be given
Tetanus Diphtheria Acellular Pertussis 27-36wks to maximize passive Abs to fetus
42
When can influenza vaccine be given? When is MMR given and is breast feeding a c/i?
Any gestational age Post-partum Safe for breast feeding
43
Air travel is safe for pregnant PTs up to ? wk Why is pregnancy itself a prothrombic/VTE risk phase
36wks High estrogen
44
How much exercise should pregnant Pts get and what should be avoided What recreation activity needs to be avoided
150min/wk Falling/abdomen trauma Extreme weather Prolonged supine No scuba: fetal decompression sickness
45
What supplement excess need to be avoided What regular diet piece needs to be avoided
Iodine- congenital goiter Raw eggs- Salmonella
46
What is a homeopathic remedy used to induce labor What types of seafood need to be avoided
Raspberry leaf tea Shark Tilefish Mackerel Swordfish
47
Pregnant PTs need to limit omega-3 fats/proteins to how much? Ingestion of white/albacore tuna should be limited to /
8-12oz/wk 6oz/wk
48
Why do pregnant PTs need to avoided unpasteurized dairy/cheeses What artificial sweetener needs to be avoided
Listeria Toxoplasma Saccharin (sweet n low)- crosses placenta
49
Avoidance of raw/under cooked seafood is exercised to prevent ? infection PTs need to be careful and not exceed ? amount of prenatal vitamins
Parasites Norovirus Selenium Iron Zinc Vit A B6 C D
50
What prenatal vitamin is best pre-conception How much is recommended
Folic acid- neural tubes close by day 28 0.4-0.8mg PO daily 12wks prior 9400-800mcg)
51
When are PTs folic acid amounts increased to 4.0mg What element is a form of Omega 3s key for brain/NS development
BMI >35 Anticonvulsants- Valproate Carbamazepine T1DM Hx/FamHx neural tube defects DHA
52
What meds are c/i for pregnancy
``` Tetracyclines ACEIs Coumadin High ASA, 100mg or less ok Isotretinoin- including topicals Sulfonamides- not in late pregnancy ```
53
How much caffeine is considered a risk How much is ok?
5 cups or 500mg <300mg/day
54
Nicotine exposure leads to ? adverse fetal development What is the leading cause of preventable developmental disabilities worldwide
Low birth weight Alcohol intake
55
What are the discriminating features of FAS What are the associated features
``` Flat midface Indistinct philtrum Short nose Thin upper lip Short palpebral fissure ``` Epicanthal fold Low nasal bridge Ear abnormalities Micrognathia
56
When does sex need to be avoided during pregnancy Since dental care is recommended, how much x-ray exposure is ok?
Hx/Risk of miscarriage Placenta previa Preterm labor <5 rads not associated w/ fetal malformations
57
Why is iodinated contrast avoided in pregnancy When are domestic violence screenings conducted
Neonatal hypothyroidism 1st prenatal visit Once per trimester Post-partum visit
58
When do depression/behavioral health screenings needs to be conducted What are c/is to breast feeding?
Once during perinatal period HIV Chemical dependency Lithium Active TB
59
What are the emergent indications for pregnant PTs to return All PTs should be given ?
Contractions q3-5min Membrane rupture Vaginal bleeding 24hr phone number
60
How many weeks of leave are authorized? What are the neonatal interventions done during 2nd/3rd trimester education
12wks Circumcision Hep B Imm Vit K Conjunctival eye care
61
Why would an US be warranted during a placental abruption? When is Bacteriuria screenings conducted
Differentiate from placenta previa but aburption is clinical Dx All PTs new OB- UA and culture
62
What may be the first lab ordered during the first prenatal appointment? What labs may also be ordered during this appointment?
hCG HIV Hep Rubella G/C TSH Rh UA FT4
63
Why does prenatal care need to begin prior to pregnancy First prenatal visit is often too late to address ? risks
Organogenesis/placental development start 7d post-conception Low birth weight Obesity Birth defects- neural tube
64
``` What is the "Quick Run Down" for: 10w 18w 18-20wk 20wk 24-28wk 28w 36wk ```
10: FHTs by Doppler 18: quickening 18-20: anatomy scan 20: fundal height at umbilicus 24-28: glucose tolerance 28: Rhogam Rh- mom/Rh+ dad 36: GBS screen
65
How fast does hCG increase during the 1st mon of pregnancy How is TVUS for viability determined
Doubles q2.2days Gestational sac: 5w, 1500hCG Fetal pole: 6w, 5200 hCG Cardiac: 7w, 17500 hCG
66
All female PTs of reproductive age that present w/ abnormal vaginal bleeding need to have ? test? What are TVUS indications of demise?
hCG Gestational sac w/out yolk Absent Fetal Cardiac Motion Crown Rump Length >5mm
67
# Define Threatened abortion Define Inevitable abortion Define Incomplete abortion
Th: bleeding <20wks, os closed, <50% loss Inev: bleeding w/ dilated os, non-viable Incom: bleeding w/ dilated os and passage of tissue
68
# Define Complete abortion Define Missed abortion Define Recurrent abortion
Comp: passage of products, os closed, US to verify uterus Miss: Fetal demise retained in uterus Recurr: 3+ successive spot aborts
69
What is the MC cause of early pregnancy loss Fetus are at risk to feel mothers stresses until ? wks
Genetic abnormalities Cortisol- 22wks
70
How are threatened abortions managed? How are incomplete abortions managed? How are missed abortions managed?
Th: US and reassure Incom: Type/Cross and evacuate immediately Miss: US, reduce blood loss/pain (Misoprostol), possible D/C
71
Rhogam is given to ? PTs Where is the uterus at by wks 12, 14-16, 20, 20-38 and 38-40
Rh- PT ``` 12: palpable above pubic symphisis 14-16: midway pubic/umbilicus 20: at umbilicus 20-38: corresponds +/-2cm w/ wk of gestation 38-40: gravid uterus 3cm below xyphoid ```
72
Primigravida PTs may not feel fetal movement until ? while multigravida may feel at ? What monitoring items are started and monitored during 3rd trimester
Primi: 18-20wks Multi: 16-18wks Fetal kick counts Leopolds- fetal lie, weight, presentation at 28wks
73
What are the landmarks for measuring fundal height Between weeks 20-36, how much growth is expected? If there is a discrepancy of __ or more an US is needed
Top of symphysis pubis to top of fundus in cm Weeks=height (cms) 1cm/wk >3cm
74
How much maternal weight gain is expected If mother has excessive weight gain, what are the risks?
1st timester: 3-6lbs 20wks: 1lb/wk 25-35lbs total for women w/ normal BMI 18.5-24.9 Post-partum weight retention C-section Macrosomia: >4kg
75
How much of a calorie increase is needed for 2nd, 3rd trimester and breast feeding How does maternal BP change during pregnancy and when would the lowest measurements be expected?
2/3: 300-400/day, 1lb/wk 500kcal/day while feeding Dec 2nd trimester, returns during 3rd Lowest at 26wks
76
What is the dangerous BP for pregnancy What is normal range for fetal heart tones
140/90 Doptone at 110-160bpm
77
How is edema defined in pregnancy and how much of a weight gain is a concern Why does edema occur so often in pregnancy
>+1 pitting after 12hrs bed rest 5lb gain <7days= concern Uterine compression of IVC
78
What is the purpose of counting fetal kicks after 28wks? How many is expected and what happens if it's low?
Assess fetal well being 10 kicks/hr (>10 in 30min) <10: drink sugar, re-eval <10 after 2hrs- LnD for dec fetal movement
79
How long does fetal sleep cycle last How is Rh alloimmunization screening done
20-75min, avg 23min Blood type Ab screen w/ Indirect Coombs
80
Why are Rh- pregnancies dangerous What are the end results of this issue
Rh Ag exposure causes IgM/IgG reaction IgG cross placenta, attack fetal RBCs Fetal hemolysis Anemia Hydrops fetalis
81
What agglutination result is low enough for fetal survivability When is Rhogam given?
Dilution titer below 1:16 28wks Rh-M/Rh+ or unknown Dad 72hrs post-partum Rh+ baby
82
What is the name of the quantitative test to assess if Rh- mother has had blood mixing/possible sensitization
Kleihauer Betke test- citric acid w/ pH of 3.2 dissolves maternal Hgb Eosin stains remaining HgF creating maternal ghost cells
83
How much Rhogam is given How much maternal blood does this cover
300mcg IM 30cc
84
When is prenatal genetic counseling done? Screening for fetal aneuploidy is primarily aimed at ? since it's the MC
Serum markers and 20wk US for all PTs Downs
85
What are the RFs for each trimester for the occurrence of Down's?
1: PAPP-A Age NT bhHCG ``` 2: Triple screen (AFP, hCG, unconj estriol) ``` Quad screen (better for ID, lower false +: MSAFP, Total hCG Unconjugated estriol, Inhibin A**
86
What are examples of single gene d/os Trisomy 21 Trisomy 18 Trisomy 13
CF Sickle Hgbopathies Tay-Sachs Downs Edwards Patau
87
What single gene d/o screening is offered to ALL women in US? How is Down's screened for in 1st trimester w/ the earliest screening avail? What finding indicates lower probability of Down's risk?
CF Serum marker added to US, look for nuchal translucency Visualization of nasal bone
88
When is Triple Screen for Down's conducted
2nd Trimester, optimal at 16-18wks: Total Hcg Unconjugated estriol MSAFP: inc +90% of NT defects
89
What genetic screening test result is a better positive predictive value in older PTs What are the results of the Quadruple Screening seen in 13, 18 and 21
MSAFP 13: depends x 4 18: all dec 21: dec MSAFP/Estriol, inc hCG, Inhibin
90
What are the indications to do cffDNA screening for chromosomal abnormalities
>35y/o at delivery US results of fetal aneuploidy Prior pregnancy w/ 13/18/21 Robertsonian translocation carriers (inc risk for 13 or 21) Abnormal 1st/2nd screening
91
When are amniocentesis or CVS genetic testing done?
All abnormal chromosome number >35y/o at delivery >32y/o w/ twins Abnormal US Previous affected pregnancy Couples w/ known translocation/abnormalities Women w/ + serum markers
92
What is the difference of procedure techniques and pro/cons between amniocentesis and CVS?
Amnio- 16-20wks; US guided through abdomen 2wk culture Chrom specific trisomy probes PCR for other genetic d/os ``` CVS- 10-12wks; through cervix Earlier/quicker Dx results Less precise than amnio No amniotic fluid AFPs Procedure <9wks- jaw/limg abnormalities ```
93
# Define Antenatal Unit When does antenatal testing start
Pregnancy eval for risks ER for OB +20wks gestation 'OB Triage' 32-34wks gestation q7 days High risk PTs: 26-28wks
94
How is electronic fetal monitoring interpreted What test is the first line tool for fetal surveillance
HR accelerations in response to fetal movement w/ NO deceleration "Reactive HR=norm" Non-Stress Test
95
Fetal HR monitoring is essentially ? monitoring What is a reassuring test result What is a moderate/reassuring result?
Fetal brain monitoring Norm HR110-160 Two HR accelerations in 20min, reassuring if: Inc 10bpmx10sec <32wks Inc 15bpmx15sex>32wks
96
NST is most predictive when? What can cause a non-reactive results
Normal Fetal sleep cycle Maternal sedative/opioids Cardiac/neuro abnormality Fetal hypoxemia
97
If fetus is suspected to be sleeping during NST, how are they awakened? What is the benefit to conduct a contraction stress test, although rarely ever done How is it done?
Acoustic stim NST High negative predictive value Nipple stim to release oxytocin
98
What does a + Contraction Stress test mean? Amniotic fluid is similar to ? fluid When does fetal urine production begin
High risk for fetal death, consider operative delivery Extracellular fluids 8-11wks
99
Fetal kidneys become major contributor to amniotic fluid generation by ? ? assesses amniotic fluid volume
18wks Amniotic Fluid Index- measured at deepest vertical pocket in each of 4 abdominal quadrants; Norm 2-8cm/quad w/ norm of 5-24cm Poly= >24cm Oligo= <5cm
100
What is the desired result if Single Deepest Pocket" method is used for AFI What are the 5 parts of a Biophysical Profile
2x2cm pocket NST + US: NST- HR inc Breathing, movement, tone AFI
101
What is a modified BPP that is adequately predictive
AFI + vibroacoustic NST, takes 10min (Norm BPP takes 60min)
102
What do BPP scores correlate to?
10: norm, repeat qWeek (DM, rpt twice/wk) 8 w/ normal AFI: repeat per protocol 8 w/ dec AFI: chronic asphyxia, deliver 6 w/ dec AFI- deliver 6 w/ norm AFI >36wks and favorable cervix- deliver 4, repeat same day, 6 or less= delivery 0-2: deliver, almost certain asphyxia 8-10: normal pH, reassuring unless + oligo 6: poor predictor 4 or less: not reassuring, consider delivery
103
When are Doppler US of umbilical artery done? What is considered normal?
IUGRestrictions Dec resistance as gestational age inc
104
What lab result is used as an indicator for giving steroids in preterm situations to prep for delivery? What are the 1st Trimester precautions
Syst/Diastolic ratio from umbilical artery Doppler Bleeding Abdominal pain UTI Sxs
105
Folic acid supplementation is how much? When are neural tube defects screened for?
400-800ug/day 1st: nuchal translucent US 2nd: MSAFP during Triple/Quad screening
106
Where is MSAFP synthesized? How is this protein linked to NT defects?
Yolk sac Fetal GI tract/liver Defected fetal integument allows AFP to leak into amnionic fluids
107
MSAFP can help detect what two issues occurring during development? What is the Dx test of choice for NTDs?
Anencephaly Spina bifida MSAFP w/ Sonography/US
108
When are women screened for Trisomy 21 What type of genetic defect is Cystic Fibrosis
Prenatal care <20wks EGA 1st: Fetal NT 2nd: Triple/Quad screens Auto Recessive on CFTR Chrom 7, defected Cl channel protein
109
What type of genetic defect is Tay-Scahs How are high risk ethnicity tested? How are low risk ethnicity tested?
Auto Recessive, progressive neurodegeneration/early death High: molecular DNA base mutation Low: Hexosaminidase A serum level
110
What happens if a baby w/ Tay-Sachs is given milk What do babies present w/?
Unmetabolized sugars build up, damage liver, eyes, kidneys and brain Brain/kidney damage Cataracts Jaundice Large liver
111
Amniocentesis is used to detect fetal genetic d/os and ? What test is done to analyze getal karyotype?
Fetal lung maturity assessment CVS
112
Fetal blood sampling is AKA What is the MC and other indications to do this test
Cordocentesis Percutaneous UBS MC: Fetal anemia assessment Other: platelet alloimmunization, fetal karyotype
113
Amenorrhea is not a reliable S/Sx of pregnancy until ? During 1st month of pregnancy, uterine bleeding can be from ?
+10 days after expected menses Blastocyst implantation
114
# Define Goodells Define Hegars Define Chadwicks
a b c
115
What is the 'mask of pregnancy'? What is a common early sign?
Chloasma Fatigue
116
What is the purpose of the hcG during early pregnancy When do these levels peak and plateau
Prevents involution of corpus luteum 60-70 days
117
What is the qualitative and quantitative method to test for pregnancy What are 3 rare but possible causes of false-pos tests?
Qual: urine Quant: blood Exogenous/tumor making hCG Renal failure
118
When will gestational sac, fetal pole and heart beat be detectable by TVUS? What is the difference between a non and pregnant uterus
Sac: 21 days post-fertilization Pole: 6wks HR: 6-7wks Non: 70gm Preg: 1100gm, 1000x greater capacity by delivery
119
What is the total volume of contents in a pregnant uterus By __wk, uterus is too big to fit in pelvis and as it ascends it rotates ?
Avg 5L Can be +20L 13wks Right
120
What supports a pregnant uterus when Pt is standing or laying Define Braxton Hicks contractions
Up: Ant pressure on muscle wall, midline CT Supine: vertebral columns, adjacent great vessels Non-rhythmic, 5-25mmHg contraction w/out cervical changes
121
Uterine contractions do ? to uterine flow? Maternal placental blood flow ? during gestation by means of ?
Dec Inc, vasodilation due to estradiol
122
What is the difference between preg and non-preg cervix What are the contents of the mucus plug and it's function
Preg has inc water content ImmGlobulins/Cytokines to prevent infections
123
Progesterone causes cervical mucus to ? Define Theca-Lutein Cysts
Thicken, no ferning/poor crystalization ``` Inc hCG due to: Gestational trophoblastic dz Pre-eclampsia Hyperthryoid Placentomegaly- multi fetal pregnancy + DM ```
124
Where is relaxin released from What changes does it cause in the body
Corpus luteum Decidua Placenta CT remodeling, not peripheral joint laxity Renal hemodynamics Dec serum osmolality Inc arterial compliance
125
Why are pregnant PTs more vulnerable to vaginal candidiasis What do estrogen and progesterone stimulate on the breasts during pregnancy
Inc lactic acid= pH 3.5-6, inc glycogen stores E: adipose deposition, duct growth P: ampullary hypertrophy, secretory maturation
126
What part of the maternal endocrine system is not needed for pregnancy maintenance? When does the part of the system reach peak size
Pituitary- serum Prl parallel pituitary size First few days post-partum, possible chiasm compression Normal by 6mon
127
? part of the thyroid correlates to expanding blood volume What does progesterone do to the body during pregnancy
Thyroxine binding globulin Dec smooth muscle tone Relaxes uterus= inc tocolytic
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# Define Diastasis Recti Define Striae gravidarum and the RFs for them
Seperated rectus muscles at midline Stretch marks: weight gain, younger age, FamHx
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# Define Linea Nigra Define Chloasma Skin changes during pregnancy can be mimicked it PTs is on ?
Pigmented dark brown skin Melasma gravidarum- irregular brown patches on face/neck OCPs
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# Define Angiomas What causes palmar erythema
Vascular spiders Inc estrogen and cutaneous blood flow from heat released by inc metabolism
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Basal metabolic rate inc by ?? by 3rd trimester What is average weight gain for a pregnancy
20% 27.5lbs/12/5kgs
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What is water retention normal during pregnancy What can predispose PTs to late pregnancy edema
Dec plasma osmolality Dec interstitial colloid osmotic pressure
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Protein metabolism increases by ? during pregnancy What are normal carbohydrate metabolism findings during pregnancy
1000g Mild fasting hypoglycemia Postprandial hyperglycemia Hyperinsulinemia
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Pregnant PTs who fast for prolonged periods will develop ? metabolic state Leptin holds a key role in body fat/energy expenditure regulation so a deficiency can be associated w/?
Ketonemia Anovulation Infertility
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During pregnancy, inc insulin resistance and estrogen stimulation causes maternal ? When do leptin levels peak?
Hyperlipidemia 2nd trimester
136
What happens to thyroid hormones during pregnancy What vitamin facilitates Ca absorption by the mother for fetal use?
Inc maternal T4 to maintain euthyroid Fetal thyroid production in 2nd half req's inc iodide Vit D3
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What happens to blood volume and Hgb/Hct during pregnancy How much blood loss is expected during pregnancy?
Inc volume, dec Hgb/Hct Vaginal; 500-600mL C-Section: 1L
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Metabolic increases during pregnancy Early pregnancy is a ___inflammation state while mid pregnancy is a ___ inflammation state
Fe WBC- d/t Estorgen/cortisol Thromboembolism risk IgA/IgG Early: pro-inflammatory Mid: anti-inflammatory, improvement of autoimmune dzs
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? much Fe is needed during pregnancy ? WBC is elevated during pregnancy Inflammatory markers are useless during pregnancy, what is used for indicators?
1000mg, 1mL RBC= 1.1mg Fe Leukocyte Procalcitonin
140
What are the cardiovascular changes during pregnancy by each week?
``` 5w: inc CO= Dec SVR + Inc HR 6-7w: dec BPs, inc HR 10-20: inc pre-load LAD on EKG Exaggerated S1 split w/ inc loudness ```
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What is the best position for pregnant PTs to lay down? What is the change and significance of prostaglandins during pregnancy
LLR Inc during, control vascular tone, BP and Na balance
142
What ratio has been considered an important pre-eclampsia pathogenesis What other CV finding in high levels have a role in eclampsia?
PGI2:thromboxane ratio Endothelin
143
When does morning sickness arise and disappear? How can it be managed/Tx?
4-8wks, gone by 16wks Small meals Pyridoxine w/ Doxylamine or Phenothiazine
144
What meds are used w/ B6 or Ginger to help manage N/V during pregnancy What Cat B or Cat C anti-emetics may be considered?
Doxlamine Meclizine Diphenhydramine Metoclopramide B: Ondansetron; long QT, serotonin syndrome C: Promethazine, Prochlorperazine, Chlorpromazine
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# Define Pyogenic Granuloma Stomach and intestines are displaced ? by enlarging uterus
Epulis gravidarum, highly vascular swelling of gums Cephalad
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Gastric emptying is not changed during pregnancy except for ? Why do PTs need to urinate more during pregnancy?
Labor Hypervolemia induced hemodilution: dec protein/oncotic pressure increases renal blood flow
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What neuro decline is noted during the 3rd trimester? Define Krukenberg spindles
Memory, dec verbal recall/processing speeds Brown/red opacities on posterior cornea surgace due to hormone changes
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What is the MC form of Pica and other forms seen in pregnant PTs This condition is usually triggered by ?
*Amylophagia- starch Pagophagia- ice Geophagia- clay Fe deficient
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What is the first line medication for pregnancy GERD? What can be used for constipation?
TUMS Colace
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What causes varicosities to develop? How are vulvar varicosities Tx
Uterus inc LE venous pressure Special hose/belt
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# Define Round Ligament pain and when/where is it seen How is this Tx
Sharp groin pain early 2nd semester, R>L Reassurance, modified activities
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How is pregnancy induced back pain managed? What is the best way to manage?
Acetaminophen No NSAIDs Cyclobenzaprine/Baclofen Education Exercise PT/Chiropractor
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Criteria for Low Birth Weight Criteria for Very Low Birth Weight Criteria for Extremely Low Birth Weight
1.5-2.5kg 1-1.49kg 0.5-0.99
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What is the criteria for advanced maternal age? Criteria for adolescent pregnancy
>35y/o at delivery <20y/o at delivery
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What is the MC 1st trimester surgical procedure? What monitoring is done for procedures?
Laparascopy for Dx/management FHT before and after
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What pregnancy change leads to inc insulin risks What is the trifecta of metabolic syndrome during pregnancy
Adipokines DM2 Dyslipidemia HTN
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How much weight gain is recommended for PTs that are overweight? How much gain is recommended for PTs that are obese?
BMI 25-29.9: 15-25lbs BMI 30 or higher: 11-20lbs
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How is asthma managed? Steroid stress does is considered if PTs have been using steroids for longer than ?
SABAs and inhaled CCS >3wks
159
What is the leading cause of pregnancy related deaths? What scoring method is not validated during pregnancy?
PEs Wells, inc D-Dimer are not rliable
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What anticoagulants are used in pregnant PTs What is not used due to it's ability to cross placenta
Lovenox, LMWH Coumadin
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What is the leading cause of septic shock during pregnancy How are pregnancy related UTis Tx
Pyelonephritis Empirically
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What is the goal of diabetes control during pregnancy When is screening conducted?
Euglycemia during organogenesis 24-28wks EGA
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What are the two steps of screening for gestational diabetes
1: 50g glucose challenge- Plasma glucose 1hr after + = 140mg or higher, order tolerance test 2: 100g glucose tolerance, overnight fast then drink 100g Two or more levels at/above threshold= dx
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Ranges for Gestational Diabetes D When is f/u/repeat testing done
Fasting 92-126 at any gestational age >126= overt diabetes 6-12wks post-partum Q3yrs
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How is GDM managed What is the maternal risk for developing GDM
Insulin if fasting levels >95 PO sulfonylureas: Glyburide; Metformin= 1st line 50% chance of developing over DM in next 20yrs
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# Define Superfetation Define Superfecundation
Two embryos at different ages in same uterus Fertilization of two ova w/in same menstrual cycle, not same coitus/same male
167
Define TTT
Twin Twin Transfusion Donor twin transfuses blood to recipient Donor= polyhydra, anemic, restricted growth Recipient: oligohydra, polycythemic, overloaded
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Majority of early pregnancy losses occur w/in ? Spontaneous abortions will have what possible 4 findings on sonogram
12wks CRL +7mm, no HR MSD >25mm, no embryo 11 days w/ gestational sac w/ yold, no embryo/heart beat 14 days w/ gestational sac w/out yolk, no embryo/heart beat
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How are spontaneous abortions evaluated if VUS is unclear MC site of ectopic pregnancy
Serial hCG: Inc, no sac/embryo= ectopic Dec, no sac/emryo= complete SAB Ampulla d/t abnormal anatomy
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What is the classic triad of ectopic pregnancy How are ectopic pregnancies Dx when hCG is above threshold?
Amenorrhea Abdominal pain Vaginal bleeding TVUS
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As soon as an unruptured ectopic pregnancy is identified, what is the immediate/urgent next step Define Heterotopic Pregnancy
Laparotomy removal Coexisting intra-uterine and ectopic pregnancy
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What drug is used to remove ectopic pregnancies in healthy PTs Difference salpingostomy and salpinectomy
Methotrexate Removal of unruptured tubal pregnancy Excision of tube for un/ruptured pregnancy
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What are the two types of Gestational Trophoblastic Dz Define GTD complete molar pregnancy What will be seen on lab work if this is present
Hydatidiform: + villi Nonmolar malignant neoplasm; - villi Empty ovum- all chromosomes are paternal >100K hCG, hyperemesis gravidum
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Define GTD Partial Molar
Fertilized ovum w/ extra paternal haploid set: 69XXX or 69XXY Non viable fetus developing w/ cluster of grapes
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Define Grestational Trophoblastic Neoplasia types and risks
Invasive: MC GTN following hydatidiform moles Choriocarcinoma: MC following SAB/pregnancy, most malignant Placental site trophoblastic tumor: rare, chemo resistant Epitheloid trophoblastic tumor: low hCG, chemo resistant, common metastatic Dz
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What is the MC presentation of Gestational Trophoblastic Neoplasia What clinical presentation is pathognemonic for molar pregnancy
Irregular bleeding w/ uterine subinvolution (failure to return to normal size) Pre/eclampsia w/out chronic HTN/occurring prior to 20wks gestation
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How are hydatidiform moles Tx How are GTN Tx
D/C Serial hCG q2wks until not detected (complete 9wks, partial 7wks) qMon surveillance x 6mon Chemo alone Hysterectomy if Dz is chemo resistant
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Complete hydatidiform mole fact MC cause of fetal hematologic anemia
Snowstorm appearance on US w/ extremely high hCG, empty ovum 9 week serial hCG monitoring RBC alloimmunization- maternal Abs cross placenta, destroy fetal RBCs
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How is fetal anemia detected Hydrops fetalis is defined as ?
Fetal blood sample Doppler eval of middle cerebral artery during systole Two or more effusion: pleural, pericardial, ascites or One effusion and anasarca Along w/ enlarged placenta
180
Nearly half of non-immune hydrops occurs in ? population What is the most common infection cause
45XO Parvovirus B19
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How is Hydrops Fetalis evaluated for?
Indirect Coombs- alloimmunization Sonograph: anatomy, MCA doppler, fetal echo Amniocentesis- keryotype Kleihauer Betke A-thalassemia/inborn erros
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AFI criteria for mild/mod/sev polyhydramnios This can indicate an issue ? in the fetus
Mild: 25-29.9cm Mod: 30-34.9cm Sev: 35 or more Tracheo/Esphageal fistula
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Dx criteria for oligohydramnios Presentation after midpregnancy can be associated with ?
AFI <5cm or Deepest pocket <2cm Growth restriction Pre-eclampsia Vascular dz
184
How are cases of oligohydramnios Tx What are the 3 phases of fetal growth
Maternal hydration Intrapartum amnioinfusion if FHR decelerations are present 1: 5g/day x 16wks 2: 15-20g/day (wk 17-32) 3: fetal fat/glyogen accumulation
185
Difference between Fetal Growth Restriction and Intrauterine Growth Restriction If IUGR occurs early in pregnancy what will be seen? What will be seen if it occurs later in pregnancy?
IUGR- pathological cause preventing growth Symmetric- dec cell size and number from chemicals, viral or cellular agenesis Asymmetric- placental insufficiency from maternal HTN; leads to brain sparing development
186
What affect does IUGR have on lung development What is the criteria for macrosomia
Accelerated maturation +4500g at birth
187
What is the most common sub-unit of hCG? What is the MC form of pregnancy induced hyperthyroidism How is it Dx
TSH HyperThyroid: Graves Dec TSH, Inc FT4 thyroxine
188
How is pregnancy induced hyperthyroid Tx What is the MC form of pregnancy induced hypothyroidism
Propylthiouracil in 1st Trimester Methimazole- 2nd trimester Hashimotos High TSH, Dec FT$ Tx w/ Levothyroxine
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How are PTs w/ seizure d/os Tx PTs w/ ? Sx signal a poor fetal outcome
Lowest dose of monotherapy Folic Acid Vit K Hyperthermia
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How is an acute seizure managed in a PTs w/ no seizure Hx?
MgSulfate
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