OB Test 4 Flashcards
An abortion is any fetal loss before ___
The third trimester
What screenings are done at the first visit?
H&H Blood type, Rh type and antibody screen HCG levels STIs (including HIV) Cervical cancer screen
What are the numbers for healthy fetal kick counts?
Up to 10/hr during 7th month… slows slightly towards 38-40 weeks (10 in 2h?)
How often are antepartum visits?
Once a month until 28 weeks.
Twice a month until 36 weeks.
Four times a month (weekly) until delivery.
What is an operculum?
Mucus plug - seals cervical canal during pregnancy.
When does quickening occur?
Primips: 18-20w
Multips: 16+ weeks
How to figure out fundal height?
Correlates with weeks of gestation (cm above pubis) between 22-34 weeks (fetal weight variations change it after that).
VOID before measuring. Same person, same position each time.
How early can colostrum be expressed?
As early as 16 weeks
Respiratory system changes
Tidal volume increases (increases hyperventilation) which causes respiratory alkalosis.
Vital capacity increases slightly; compliance and pulmonary diffusion stay the same.
Flared rib cage, increased chest circumference, thoracic breathing.
Nasal stuffiness (“rhinitis of pregnancy”)
Nosebleeds (vascular congestion/edema of nasal mucosa r/t estrogen).
True or false: pregnancy can cause a) estrogen-induced edema, b) hypersecretion of mucus, and c) vascular congestion of the nasal mucosa?
True
True or false: pregnancy can cause a) a change in white blood cell production, b) reduction in total fluid volume
False
When will shortness of breathing related to pregnancy improve?
The last few weeks, as lightening occurs.
Changes to the cardiovascular system
- Blood volume increases (plasma and erythrocytes)
- cardiac output increases
- pulse rate can increase up to 15bpm.
- blood pressure decreases. (Lowest point = 2nd trimester).
- Orthostatic hypotension d/t multiple factors (including lower albumin, increased femoral venous pressure and dependent edema
What is supine hypotensive syndrome (vena cava syndrome)?
Decrease in BP; pallor, dizziness, clamminess that occurs as a result of pregnant woman lying on back.
What is the ‘physiologic anemia of pregnancy’?
As plasma volume increases, hematocrit decreases (relative)
What happens with leukocyte production in pregnancy?
Increases - during labor and postpartum, can raise to 25k.
What happens to fibrin levels during pregnancy? Why is this a problem?
Fibrin levels increase during pregnancy.
DVT risk
What hormone causes nausea/vomiting during first trimester?
HCG
What happens to gums in pregnancy?
They can also get increased blood flow and be prone to bleeding
What are common GI symptoms in pregnancy?
- Excessive salivation
- Heartburn (d/t displacement of stomach/intestines)
- hemorrhoids
- GALLbladder stasis (gallstone formation)
- Bloating (stasis d/t progesterone = smooth muscle relaxation)
- constipation (Stasis d/t progesterone = smooth muscle relaxation)
What is the normal temp range during pregnancy?
97-99.6
What are normal urinary changes during pregnancy
Increased need to urinate in 1st and 3rd trimesters
- UTIs (increased amino acids and glucose in urine + urethral atonía + ureter stasis)
- possible glycosuria (should still check it out, but not uncommon).
What causes increased skin pigmentation?
Increased levels of estrogen and progesterone increase alpha-melanocytes.
What does relaxin and progesterone do to the joints? Which joints?
Sacroiliac, sacrococcygeal, pubic joints - relax in the later part of pregnancy. Leads to waddling gait.
Why does carpal tunnel syndrome happen in pregnancy?
Because there’s pressure/edema on peripheral nerves
What is acrothesia?
Numbness and tingling of the hands (normal in pregnancy)
Why do muscle cramps/tetany happen in pregnancy?
Low levels of calcium
What does FSH do and what produces it?
Pituitary gland: stimulates the growth of the egg in the follicle
What does LH do and what produces it?
Pituitary: stimulates the release of the egg
What does prolactin do and what produces it?
Pituitary: stimulates initial lactation
What does the corpus luteum do?
Releases progesterone to maintain the endometrial lining in case implantation occurs.
What does the posterior pituitary secrete during pregnancy
ADH/vasopressin: causes vasoconstriction and helps water balance
Oxytocin: promotes uterine contractility & letdown reflex
What is hPL and who produces it?
Human chorionic somatomamatropin…. ie human placental lactogen. Produced by the placental lining (synctiotrophoblast).
Antagonizes insulin.
Increases glucose (for fetal growth)
Increases fatty acids circulating.
p. 160
What happens to the thyroid in pregnancy?
Gets bigger and more active
T4 increases
TSH decreases.
Increases basal metabolic rate
Increases protein-bound iodine.
Returns to normal a few weeks after birth.
Endocrine changes
BMR increased
Concentration of parathyroid hormone increased
Parathyroid gland size increases
Increases removal of calcium from the bones to balance babies removal
Adrenal glands increase cortisol and aldosterone levels
Nutrition requirements during pregnancy
300 more calories per day 60g of protein per day 1.2g of calcium per day 0.4mg of folic acid per day Iron: 30-60mg supplementation last 3-4 months
How much weight should a low weight (19.8 BMI or less) mom gain during pregnancy?
28-40 lbs
How much weight should a normal weight (19.8-26.0) mom gain during pregnancy?
25-35lbs
How much weight should a high weight (26-29 BMI) mom gain during pregnancy?
25-35lbs
How much weight should an obese (29+ BMI) mom gain during pregnancy?
15+ lbs.
What are the consequences of low and high pre-pregnancy BMI?
Can increase risk for severe maternal morbidity/mortality.
Obesity: Larger babies = increased complication risk; increased risk of eclampsia, kidney failure, sepsis, hemorrhage, resp problems.
Recommendations for Nausea/Vomiting
- eat dry crackers before getting up
- small frequent meals
- drink between meals
Recommendations for urinary frequency in pregnancy
Normal during 1st & 3rd trimester
- what to look for with bladder infection
- drink min 2000L/day
- empty bladder Q2h
- get rid of fluid after dinner.
Epistaxis or rhinitis
Cool air vaporizers
Normal saline nasal sprays
(Can grow used to other sprays)
Ptyalism - what is it?
Bitter taste in mouth. Can be excessive amount of saliva.
Recommendations for heartburn
Low-sodium liquid antacid Avoid aluminum (constipation) Avoid magnesium (diarrhea) Avoid sodium (electrolyte imbalance)
If not relieved by antacids, can get a prescription for an H2 blocker.
Recommendation for varicose veins
Side-lying position during rest and sleep.
Surgery not recommended until after delivery.
Recommendations for constipation
Increase fiber in diet
Increase fluid intake
Increase exercise
If preexisting, the HCP can recommend stool softeners, laxative, suppositories.
Body mechanics for back pain
Legs 12-18” apart
Bend at knees to lift objects
Recommendations for leg cramps
Increase calcium intake
Increase phosphorus intake
Stretch
Avoid extension of foot.
Round ligament pain - recommendations
Described as a “grabbing” pain in abdomen.
Apply heating pad to the abdomen once medical complications have been ruled out.
Do you need to worry about edema in the hands and face in the morning?
Yes. Danger sign during pregnancy.
Do you need to worry about epigastric pain during pregnancy?
Yes - sign of preeclampsia and HELLP syndrome.
What are the first two uterine phases of the menstrual cycle
Menstrual phase Proliferative phase (estrogen rises)
When doe the luteal phase begin and what hormones are associated with it?
Begins after ovulation Progesterone increases (secreted by the corpus luteum)
What are the three phases that the uterus goes through during the luteal phase?
Secretory phase (epithelial cells plump up and secrete endometrial fluid)
Ischemic phase (if not fertilized, corpus luteum degenerates, estrogen and progesterone fall)
Menstrual phase
What OTC medications for headache can you take in pregnancy?
Acetaminophen
(NOT aspirin or ibuprofen).
When do you take the OGTT and if you have to repeat it, what are the criteria for a diagnosis?
24-28 weeks
For 3h OGTT, two or more of the following:
- fasting 95+
- 1h 180+
- 2h 155+
- 3h 140+
What pharmaceutical treatments for diabetes are used during pregnancy
Insulin or glyburide
When do you perform ultrasounds for diabetic moms.
Week 24 and every 4 weeks after.
When do you perform Non-Stress Tests for diabetic moms?
At 28 weeks and every week afterwards.
What are some newborn complications of gestational diabetes
Hypoglycemia LGA Large head/shoulders Premature births Polyhydramnios Decreased surfactant / resp distress Meconium - poop in the soup Placental insufficiency to fetus
In TORCH, what does the “o” encompass?
Other: hepatitis B, syphilis, herpes zoster
What is the Kleihauer-Betke test for?
Done after trauma to see how much fetal blood is in maternal circulation.
(Can also assess for pre-term labor)
Do all women who get help have preeclampsia?
No - they may not have BP problems or proteinuria.
What are the criteria for preeclampsia?
BP over 140/90 + proteinuria.
When do you start doing kick counts?
After 27 weeks
What does NIPT test for and at how many weeks?
Tests for trisomy disorders (and gender) at 10-20 weeks.
Guidelines for fetal kick counts
Lie on L side
20-30m each time
You want 10 fetal movements in 3 hours
(If you have less than 8, tell provider)
What is percutaneous umbilical blood sampling for?
To determine genetic anomalies. Can do after 18 weeks gestation.
What is chorionic villi sampling for and when can you do it?
Take a small sample of cells from where the placenta attaches to the uterus. Can be done after 9 weeks. Detects genetic diseases and some birth defects.
What are the rules for getting an abdominal ultrasound done?
Have 1-2Q of fluid to drink beforehand so you have a full bladder.
Wedge under the right hip, leaning to the left.
What does ultrasound screen for?
Nuchal translucency of 3mm or greater (trisomy 13, 18, 21)
Can help guide needle for chorionic villus sampling.
At how many weeks does a NST switch from 10/10 to 15/15
At 32 weeks.
What does the biophysical profile entail?
NST (2pt) Fetal breathing (2pt) Fetal tone (2pt) Fetal movements (2pt) Amniotic fluid (2pt). 8-10= normal. Less than 6, notify provider.
How to set up contraction stress test?
Obtain 15m baseline on FHR
Then, Pitocin or nipple stim
Want 3 contractions that last for 40-60s in 10m.
If late decels (50% or more), Positive result. Can’t withstand stress of labor.
If non-persistent late decels, Equivocal result. Might need BPP.
If negative, baby is good to go.
Amniocentesis procedures
Consent
Give RhoGAM (if Rh -)
Empty bladder (dont’ want to puncture it)
Monitor VS and FHR
Tell mom to notify if she feels decreased fetal movement, uterine contractions, fever/chills.
Take more fluids over the next 24h and rest.
What does amniocentesis do?
Extracts amniotic fluid for genetic testing. (Diagnoses Down syndrome, can diagnose fetal lung maturity). 99% accurate.
What is AFP?
Alpha feto protein. Produced by the placenta until 6w, then by the fetal liver after 6w.
Can show up in amniotic fluid or maternal blood (15-20w).
High AFP can signify
Neural tube defects
Omphalocele (organs outside of belly button)
Anencephaly (born without parts of brain)
Multiples
Low AFP can signify
Down’s syndrome
Hydatidiform mole
What does the Quad Screen contain
-AFP test (neural tube defects (H), Down syndrome (L), hydatidiform mole (L))
-hCG (molar pregnancy)
-Unconjugated estriol (tests for multiple anomalies)
-Diameric Inhibin A (Down’s syndrome marker)
Just a blood test (15-20w).
Why does hyperemesis gravidarum cause ketonuria
If not enough nutrients, body will break down muscle/fat.
Will dehydration lead to acidosis or alkalosis
Acidosis
With a molar pregnancy, will the fundus be higher or lower?
Higher
Why is anemia a risk of molar pregnancies?
D/t bleeding.
What’s the benefit of a progesterone injection if you have a short cervix?
Can decrease the risk fo preterm labor by 1/3
If pre-term labor is likely, how long to you want steroids to be in the system? How much earlier can you give them?
Want steroids in the system for 48h prior to delivery
Can be up to 7 days earlier.
What is fetal fibronectin test for? Is it accurate?
It’s to determine the likelihood of labor. Swab of tissue at cervix.
If negative, good chance mom won’t deliver in 2w.
If positive, doesn’t really mean much.
Why would you want an ultrasound to measure cervical length?
To see the risk for preterm labor (shorter cervix - more likely labor)
Aside from fetal lung maturity, what else do corticosteroid injections help with? When would you want to give them?
Intraventricular hemorrhage, necrotizing enterocolitis, and respiratory distress syndrome.
Give if PPROM at < 32w.
Actively in preterm labor
delivery is anticipated in 7d and mom is 24-34w.
What are some tocolytics we mentioned?
Cox inhibitors
Calcium channel blockers (nifedipine)
Calcium antagonists (mag sulfate) in conjunction with something else
Terbutaline (oral or subQ)
What other benefit does mag sulfate have in a premature delivery?
Can reduce the risk of cerebral palsy.
How do insulin needs vary in pregnancy if a person has type 2 diabetes?
Insulin needs decrease in the 1st trimester
Increase in the 3rd trimester
Decrease after placental delivery
Is Trichomonas a bacteria, parasite or virus?
Parasite. Spread by sex.
Is vaginosis d/t a parasite, virus, or bacteria?
A bacteria
What are the paternal stages?
Announcement (excitement)
Moratorium (doesn’t feel real, on hold)
Focusing (can see, feel baby move)
What are adolescent moms more at risk for?
Anemia
Preeclampsia
Gestational diabetes
How long should sperm be in the body before ovulation?
9-12 hours, ideally.
What are the s/s if chlamydia is symptomatic?
Pain: urination, abdominal, during sex.
Discharge: anal, penile, vaginal
Swollen testes
Bleeding.
What are the medications for chlamydia?
Ezithromycin, Doxycycline. Treat in pregnancy.
What can chlamydia and gonorrhea cause (later complications)
PID
Infertility
Chronic joint pain
Ectopic pregnancy
What are the s/s if gonorrhea is symptomatic?
Pain: urination, abdomen, pooping.
discharge (yellow, white, green)
Bleeding
Cluster of fluid-filled blisters
What are the medications for gonorrhea?
1 shot of ceftriaxone, 1 dose of oral ezithromycin
What conditions can chlamydia cause in newborns
Conjunctivitis
Pneumonia
What conditions can gonorrhea cause in newborns?
Ophthalmia neonatorium (reason for eye ointment)
Syphilis, s/s early
Chancre @ entry site, 1st 4 weeks.
- weight loss
- malaise
- Slight fever
Syphilis s/s late
Wart-like plaques (infectious), rash on palms
What problems can result from syphilis (baby?
Miscarriage, stillbirth, neuro issues, birth defects, infant death.
How is an HSV CNS infection diagnosed?
PCR assay
When do you start to get HIV symptoms?
About 2-4 weeks after infection (feverish, achy, sick)
Unlikely to show up until after 18m if baby
Can you deliver vaginally with HIV?
Yes, if viral load is undetectable. C/s if detectable viral load.
