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NCC Exam - WHNP > Obstetrics > Flashcards

Obstetrics Flashcards

29% of exam, ~ 51 questions 1. A&P of Pregnancy 2. Prenatal Care 3. Assessment of Fetal Well Being 4. Medical & Obstetric Complications of Pregnancy (Evaluation, Diagnosis, Treatment, Referral, Counseling/Education) 5. Postpartum Care & Complications

1
Q

Define: gametogenesis

A

development of gametes: oogenesis or spermatogenesis

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2
Q

Define: oogenesis

A

development of mature human ovum - haploid # of chromosomes

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3
Q

Define: spermatogenesis

A

development of mature, functional spermatozoa - haploid # of chromosomes

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4
Q

Define: meiosis

A

two successive cell divisions that yield cells/egg/sperm that have 1/2 the number of chromosomes of somatic cells

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5
Q

Define: mitosis

A

somatic cell division in which the daughter cell contains the same number of chromosomes as the parent cell

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6
Q

Define: haploid

A

23 chromosomes, i.e. 1/2 the number of chromosomes in a typical somatic cell (46)

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7
Q

Define: fertilization

A

when the ovum and spermatazoa unite - occurs in fallopian tube usually within minutes or hours after ovulation. Typically occurs when intercourse occurs within 2 days of ovulation

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8
Q

What is a zygote?

A

a diploid cell with 46 chromosomes that results when ovum is fertilized by spermatozoan

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9
Q

What is a blastomere?

A

this is the product of mitotic cell division (cleavage) of the zygote wherein the daughter cells (blastomeres) have 46 chromosomes like the parent zygote.

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10
Q

What is a morula?

A

the solid ball of 16 or so blastomeres that enters the uterine cavity ~3 days after fertilization

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11
Q

What is a blastocyst?

A

this is when the morula has entered the uterus and fluid enters between blastomeres, converting the morula to a blastocyst. Inner cell mass @ one pole becomes embryo and the outer cell mass becomes the trophoblast.

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12
Q

Embryo

A

Between fertilized ovum and fetus, exists from weeks 2-8

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13
Q

Fetus

A

the developing conceptus after embryonic stage (i.e. after 8 weeks)

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14
Q

Conceptus

A

all tissue products of conception: fetus/embryo, fetal membranes, placenta

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15
Q

How does the blastocyst implant?

A

It adheres to the endometrial lining by eroding epithelial cells; trophoblasts burrow into endometrium; the blastocyst eventually becomes encased by the endometrium

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16
Q

When/where (typically) does implantation occur?

A

6-7 days after fertilization

upper, posterior wall of uterus

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17
Q

Implantation of the blastocyst provides…

A

maternal/embryonic physiological exchange until the placenta develops

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18
Q

What is the chorion?

A

the outer membrane that early on is the outer wall of the blastocyst. it eventually gives rise to the chorionic villi

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19
Q

What is the chorion frondosum?

A

outer chorion surface that has villi that contact the decidua basalis (the placental part of the chorion)

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20
Q

What is the chorion laeve?

A

the smooth, nonvillous portion of the chorion

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21
Q

What is the syncytiotrophoblast?

A

the outer layer of cells that cover the chorionic villi of the placenta and are in contact with the maternal blood or decidua

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22
Q

What is the cytotrophoblast?

A

the thin inner layer of the trophoblast composed of cuboidal cells

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23
Q

What is the decidua capsularias?

A

the part of the decidua that surrounds the chorionic sac.

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24
Q

What is the decidua basalis?

A

the part of the decidua that unites with the chorion to form the placenta

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25
Q

What is the decidua parientalis (vera)?

A

the endometrium during pregnancy, except the site of the implanted blastocyst

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26
Q

What is the amnion?

A

the innermost fetal membrane that holds the fetus in amniotic fluid; by end of 3rd month it fuses with the chorion forming the amniochorionic sac (bag of waters)

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27
Q

What function does the placenta serve? (3)

A

fetal lungs, liver, kidneys until birth

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28
Q

6 anatomical components of the placenta

A

trophoblasts, chorionic villi, intervillous spaces, chorion, amnion, decidual plate

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29
Q

5 steroid hormones produced by trophoblasts

A

estradiol, estriol, progesterone, aldosterone, cortisol

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30
Q

How is blood flow to the placenta regulated?

A

maternal blood transverses the placenta randomly by entering the intervillous spaces, propelled by maternal arterial pressure

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31
Q

How are oxygen and glucose transported across the placenta?

A

facilitated diffusion

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32
Q

What are the anatomical components of the umbilical cord?

A

2 arteries carry fetal deoxygenated blood to the placenta
1 vein carries oxygenated blood from the placenta to the fetus
Wharton’s jelly for protection

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33
Q

Typical umbilical cord measurements

A

0.8 - 2 cm in diameter

length ranges from 30 - 100 cm, average is 55 cm

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34
Q

What is an extremely short cord associated with?

A

abruptio placenta and uterine inversion (rare)

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35
Q

What is an abnormally long cord associated with?

A

vascular occlusion by clots and true knots

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36
Q

What produces amniotic fluid before the 2nd trimester?

A

the amniotic epithelium

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37
Q

What produces and regulates amniotic fluid starting in the 2nd trimester?

A

fetus: swallowing, urinating, inspiring

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38
Q

Define: polyhydramnios

A

AFI >/= 24 cm or maximum vertical pocket >/= 8 cm

excess of amniotic fluid

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39
Q

Incidence: polyhydramnios

A

1%

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40
Q

Etiology: polyhydramnios (7)

A 
50-60% idiopathic
fetal anomaly
fetal infection
twin-to-twin transfusion syndrome
maternal diabetes
isoimmunization
multiple gestation
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41
Q

Risks: polyhydramnios (5)

A 
fetal macrosomia
preterm labor
PPH
cord prolapse
erythroblastosis
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42
Q

Management: polyhydramnios

A

monitor w/ NST & BPP starting at 34 weeks

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43
Q

When is amniocentesis indicated for poly?

A

if AFI is >35 cm

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44
Q

Possible med tx for poly

A

indomethacin (thought to slow fluid production in utero…lungs/urine)

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45
Q

Define: oligohydramnios

A

AFI = 5 cm or max vert pocket < 2 cm

low amniotic fluid

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46
Q

Fetal conditions associated with oligo (6)

A 
chromosomal abnormalities
congenital abnormalities
growth restriction
demise
post dates
ruptured membranes or PROM
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47
Q

Placental conditions associated with oligo (2)

A

abruption

twin-twin transfusion syndrome

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48
Q

Maternal conditions associated with oligo (5)

A 
Uteroplacental insufficiency
hypertensive disorders
diabetes
drugs (ACE, prostaglandin synthesis inhibitors)
idiopathic
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49
Q

What could you do to treat oligo that results in repeated variable decels?

A

Amnioinfusion

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50
Q

When does organogenesis in the embryonic development phase begin?

A

3rd week after fertilization

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51
Q

How early can a serum and urine assay detect hCG?

A

as early as 1 week after conception

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52
Q

How long does organogenesis last in the embryonic development phase?

A

8 weeks after fertilization

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53
Q

What happens 4 weeks after fertilization?

A

heart partitioning
arm/leg buds
amnion unsheathes body stalk that becomes the umbilical cord

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54
Q

What happens 6 weeks after fertilization?

A

head larger than body
heart completely formed
finger/toes present

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55
Q

What happens by 8 weeks after fertilization?

A

All major organ systems are formed, aside from the lungs

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56
Q

When does fetal development begin?

A

8 weeks after fertilization (10 after LMP)

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57
Q

What happens @ 12 weeks?

A

uterus palpable at pubic symphysis

fetus starts making spontaneous movements

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58
Q

What happens at 16 weeks?

A

sex determinable on US by experienced observers

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59
Q

What happens at 20 weeks?

A

fetus weighs 300 g

weight now begins to increase linearly

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60
Q

What happens at 24 weeks?

A

fetus weighs 630 g
fat deposition begins
terminal sacs in the lungs are still not completely formed

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61
Q

What happens at 28 weeks?

A

fetus weighs 1000 g
papillary membrane has disappeared from the eyes
90% chance of survival with no abnormalities

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62
Q

What happens at 32 - 36 weeks?

A

fetus continues to increase in weight as more subQ fat accumulates

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63
Q

Mass and volume of normal nonpregnant uterus

A

70 g

10mL

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64
Q

@ 6 weeks, the uterus is…

A

soft, globular, asymmetric (Piskacek’s sign)

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65
Q

@ 12 weeks, the uterus is..

A

8 - 10 cm

rising out of pelvis

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66
Q

@ 14 weeks, the uterus is…

A

1/4 the way to the umbilicus

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67
Q

@ 16 weeks, the uterus is…

A

1/2 the way to the umbilicus

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68
Q

@ 20 weeks, the uterus is…

A

at the umbilicus

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69
Q

After 20 weeks, the number of cm from the pubic symphysis to the fundus is…

A

of weeks gestation, within 2 cm

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70
Q

Term pregnancy uterus mass and volume

A

1100 g

5 L

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71
Q

2 anatomical changes to the cervix during pregnancy

A

increased vascularity

thick mucus plug forms

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72
Q

What is Hegar’s sign?

A

softening of the isthmus of the cervix

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73
Q

What is Chadwick’s sign?

A

bluish color of the cervix and vagina

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74
Q

What is Goodell’s sign?

A

softening of the cervix

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75
Q

Biggest anatomic change for ovaries?

A

anovulation

maybe produce relaxin

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76
Q

How long does the corpus luteum persist? What keeps it going?

A

until 12 weeks

maintained by hCG

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77
Q

What role does the corpus luteum play?

A

secretes progesterone and maintains endometrium and pregnancy until placenta takes over

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78
Q

4 anatomical changes to vagina in pregnancy

A

Chadwick’s sign
thickened mucosa
increased secretions
connective tissue loosening in preparation for birth

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79
Q

5 anatomical changes to breasts during pregnancy

A

increased size (mammary hyperplasia)
increased size and deepening pigmentation of areola
colostrum may be expressed after the first several months of pregnancy
Montgomery’s follicles
increase in vascularity

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80
Q

4 pelvic types

A

anthrpoid
android (male)
gynecoid (female)
platypelloid (rare)

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81
Q

Pregnancy changes to mouth and pharynx (3)

A

gingivitis and bleeding of gums
increased salivation
epulis (gum swelling)

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82
Q

Pregnancy changes to esophagus (2) and biggest thing it causes

A

decreased lower esophageal sphincter and tone
widening of hiatus w/ decrease in tone
heartburn!

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83
Q

Pregnancy changes to stomach (3)

A

decreased gastric emptying time
incompetence of pyloric sphincter
decreased gastric acidity and histamine output

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84
Q

Pregnancy changes to intestines (3)

A

decreased tone/motility
altered enzymatic transport across villi = increased absorption of vitamins
displacement of intestines, cecum and appendix by growing uterus

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85
Q

Pregnancy changes to gallbladder (1)

A

decreased tone/motility

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86
Q

Pregnancy changes to liver (1)

A

altered production of liver enzymes, plasma proteins, and serum lipids

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87
Q

Why are pregnant people more susceptible to UTI?

A

because of the dilation of renal calyces, pelvis and ureters

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88
Q

What happens to the bladder during pregnancy?

A

tone is decreased

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89
Q

What happens to renal blood flow during pregnancy?

A

increases 35 - 60%

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90
Q

What happens to the renal threshold for glucose, water-soluable vitamins, calcium, and hydrogen ions during pregnancy?

A

decreases

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91
Q

What happens to GFR during pregnancy?

A

increases 40 - 50%

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92
Q

What happens to the RAAS during pregnancy? What does this result in?

A

All components increase, causing retained sodium and water, resistance to pressor effect, and maintenance of normal BP

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93
Q

What role do relaxin and progesterone play on the MSK system during pregnancy?

A

they affect cartilage and connective tissue resulting in

  • the loosening of sacroiliac joint and symphysis pubis
  • the ‘characteristic gait’ of pregnancy
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94
Q

How else does pregnancy affect the MSK system?

A

lordosis

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95
Q

What happens to the diaphragm during pregnancy?

A

Rises 4 cm because of uterine size increase

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96
Q

What happens to thoracic circumference during pregnancy and residual volume during pregnancy?

A

circumference increases by 5-6 cm and volume decreases

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97
Q

What occurs because of decreased PCO2 during pregnancy?

A

mild respiratory alkalosis

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98
Q

Nasal changes during pregnancy?

A

congestion!

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99
Q

RR, TV, minute ventilatory and minute oxygen uptake changes during pregnancy?

A

RR remains the same, but all others increase

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100
Q

What do some pregnant people experience as a result of increased TV and lower PCO2?

A

dyspnea

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101
Q

How does blood volume change in pregnancy?

A

increases 30 - 50%

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102
Q

how does plasma volume change in pregnancy? what does this cause?

A

plasma volume expands leading to physiologic anemia

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103
Q

Average Hgb of pregnancy?

A

12.5

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104
Q

T/F some women require iron supplements during pregnancy

A

True

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105
Q

why is pregnancy considered a hypercoagulable state?

A

Fibrinogen (factor 1) and factors 7-10 increase

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106
Q

How is cardiac volume affected in pregnancy?

A

increases by 10%, peaks at 20 weeks

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107
Q

How does resting HR change during pregnancy?

A

increases by 10-15bpm and peaks at 28 weeks

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108
Q

Where is the slight cardiac shift?

A

up and to the left because of growing uterus

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109
Q

What percent of pregnant women develop this heart sound?

A

90%

systolic heart murmur

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110
Q

What other heart sounds are possible during pregnancy? (3)

A

exaggerated S1 split, audible S3, soft transient diastolic murmur

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111
Q

How does cardiac output change during pregnancy?

A

increased!

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112
Q

How does BP change during pregnancy? Why?

A

diastolic BP lower in first 2 trimesters
peripheral tone is relaxed by progesterone
new vascular beds are developed
both of these decrease resistance

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113
Q

Tell me 8 integumentary vascular changes that occur during pregnancy.

A

palmar erythema, spider angiomas, varicose veins/hemorrhoids, hyperpigmentation, chloasma/ freckles/nevi/recent scars darken, linea nigra, increased sweat/sebaceous activity, striae gravidarum

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114
Q

How does pregnancy affect hair growth?

A

estrogen can increase the length of growth phase of fair follicles
can also see some mild hirsutism early on

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115
Q

What are two pituitary endocrine changes during pregnancy?

A

prolactin 10x as high at term

pituitary gland doubles in size

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116
Q

Which thyroid hormone(s) cross(es) the placenta?

A

Thyroid-stimulating immunoglobulins and TRH

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117
Q

Which thyroid hormone does not cross the placenta?

A

TSH

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118
Q

What happens to thyroxin-binding globulin (TBG) during pregnancy?

A

increases because of estrogen

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119
Q

What happens to the size of the thyroid gland?

A

increases ~13%

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120
Q

What happens to the adrenal glands in pregnancy?

A

twofold increase in serum cortisol

size stays the same but the zona fasiculata increases

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121
Q

What 2 pancreatic changes do we see in pregnancy?

A

hypertrophy and hyperplasia of B cells

insulin resistance as a result of placental hormones

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122
Q

weight gain for BMI < 18.5 during pregnancy

A

28 - 40 pounds

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123
Q

weight gain for BMI 18.5 - 24.9 during pregnancy

A

25 - 35 pounds

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124
Q

weight gain for BMI 25 - 29.9 during pregnancy

A

15 - 25 pounds

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125
Q

weight gain for BMI > 30 during pregnancy

A

11 - 20 pounds

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126
Q

How is protein metabolism altered in pregnancy?

A

increases

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127
Q

How do fat deposit and storage change during pregnancy?

A

increased to prepare for breast feeding

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128
Q

How does carb metabolism change during pregnancy?

A

blood glucose levels are 10 - 20% lower

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129
Q

First trimester maternal psych alterations (1 -13 weeks)

A

focus is on physical changes and feelings
ambivalence
adjustment

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130
Q

Second trimester maternal psych alterations (14 - 26 weeks)

A

focus on fetus as a person
acceptance
period of radiant health

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131
Q

Third trimester maternal psych alterations (first part 27 - 36 weeks)

A

focus on baby’s needs
introversion
period of watchful waiting

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132
Q

9 subjective presumptive signs of pregnancy

A

amenorrhea, n/v, urinary frequency/nocturia, fatigue, breast tenderness/tingling/enlargement/color changes, vasomotor symptoms, skin changes, congestion of vaginal mucus, maternal belief of pregnancy

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133
Q

5 objective presumptive signs of pregnancy

A

continued elevated basal body temp, Chadwick’s sign, Montgomery’s tubercles or follicles, expression of colostrum, breast changes

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134
Q

10 probable signs of pregnancy

A

enlargement of abdomen, enlargement of uterus, palpation of the fettal outline, ballottment, changtes in uterine shape, Piskacek’s sign, Hegar’s sign, Goodell’s sign, palpation of Braxton Hicks contractions, + pregnancy test

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135
Q

3 positive signs of pregnancy

A

FHTs (fetoscope 18-20 weeks or doppler as early as 10 weeks), sonogram, palpation of fetal movement

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136
Q

4 differential diagnoses

A

pregnancy, leiomyoma, ovarian cyst, pseudocyesis

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137
Q

What is Naegele’s rule?

A

take the first day of the LMP, subtract 3 months, add 7 days and then add 1 year

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138
Q

When does quickening occur? what is it?

A

maternal perception of fetal movement
usually occurs 18 - 20 weeks for primaparas
14 -18 weeks for multigravidas

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139
Q

5 types of measurements that are helpful in determining GA

A

crown rump lenght, biparietal diameter, head circumference, abdominal circumference, femur length

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140
Q

how accurate is CRL in first trimester?

A

within 3 - 5 days

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141
Q

how accurate is BPD and FL in second trimester?

A

within 7 - 10 days

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142
Q

how accurate is BPD and FL in third trimester?

A

all measurements less accurate after 26 weeks

within 14 - 21 days

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143
Q

define: fertility rate

A

live births/1000 females ages 15 - 44 years

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144
Q

define: birth rate

A

births/total population in the given year(s)

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145
Q

define: live birth

A

the birth of an infant showing any signs of life (spontaneous breathing, beating heart, pulsation of the cord, movement of voluntary muscles) no matter gestational age

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146
Q

define: neonatal period

A

28 completed days after birth

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147
Q

define: perinatal period

A

from the end of 22 weeks to 7 days after birth
OR
births weighing 500 g or more and ending 28 completed days after birth

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148
Q

define: fetal death

A

spontaneous intrauterine death of a fetus at any time during the pregnancy

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149
Q

define stillbirth:

A

fetal death at 20 weeks or more

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150
Q

define: stillbirth rate

A

ratio of fetal deaths divided by the sum of births (including live births and fetal deaths in any given year)

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151
Q

define neonatal death

A

early neonatal death is death during first 7 days after birth
late neonatal death is during first 7 to 28 days after birth

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152
Q

define: neonatal mortality rate

A

the number of neonates dying before reaching 28 days of age per 1000 live births in a given year

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153
Q

define: perinatal mortality

A

number of stillbirths and deaths in the first week of life

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154
Q

define perinatal mortality rate

A

number of stillbirths and perinatal deaths (first week of life) per 1000 total births

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155
Q

define: infant mortality

A

death of an infant in the first 12 months

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156
Q

define infant mortality rate

A

number of infant deaths in the first 12 months per 1000 live births

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157
Q

define: maternal morbidity

A

illness or disease associated with childbearing

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158
Q

define: maternal mortality ratio

A

number of maternal deaths that result from the reproductive process per 100,000 live births

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159
Q

define:abortus

A

fetus or embryo removed or expelled from the uterus during the first half of gestation (20 weeks or less) weighing less than 500 g

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160
Q

define: late preterm infant

A

34 0/7 - 36 6/7

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161
Q

define early term infant

A

37 0/7 - 38 6/7

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162
Q

define term infant

A

infant born after 37 completed weeks gestation up until 42 completed weeks gestation

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163
Q

define: post-term infant

A

infant born anytime after completion of 42nd week gestation

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164
Q

define: direct maternal death

A

death of the mother resulting from obstetric complications of pregnancy, labor, or the puerperium and from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors

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165
Q

define: gravida

A

of times a patient has been pregnant regardless of outcome

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166
Q

define: para

A

number of pregnancies carried to 20th week or beyond OR delivery of an infant weighing more than 500 g

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167
Q

define: nulligravida

A

never pregnant

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168
Q

define nullipara

A

never carried pregnancy to 20 weeks or 500 g

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169
Q

define primigravida

A

patient who is pregnant for the first time

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170
Q

define primipara

A

patient who has carried a pregnancy past the 20th week or who is currently pregnant for the firwstw time and is carrying past the 20th week

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171
Q

define multigravida

A

patient who has been pregnant 2 or more times

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172
Q

define multipara

A

patient who has carried 2 or more pregnancies past the 20th week of gestation or who has delivered an infant weighing more than 500 g more than once

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173
Q

define grand multipara

A

patient who has given birth 7 times or more

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174
Q

define TPAL

A

term >/= 37 weeks or 2500 g
premature 20 - 36 6/7; 500 - 2499 g
abortions < 20 weeks and 500 g
living children

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175
Q

how do we measure fundal height

A

in cm from pubic symphysis to fundus

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176
Q

what are Leopold’s maneuvers and what do they tell us?

A

4 abdominal palpation maneuvers that tell us the lie, presentation, position, attitude, variety (?) and estimated fetal weight

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177
Q

Components of lab testing at initial prenatal visit (18)

A 
1 blood type
2 Rh factor
3 antibody screen
4 CBC
5 RPR or VDRL
6 rubella titer
7 hep B surface antigen (HBsAg)
8 urine culture/screen
9 HIV (option to decline)
10 GC
11 CT
12 wet mount
13 TSH
14 Hgb A1C
15 Pap
16 PPD skin test
17 Hgb electrophoresis
18 genetic screening
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178
Q

what are the two main types of prenatal genetic tests?

A

screening and diagnostic

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179
Q

screening tests tell us…

A

risk for certain genetic disorders

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180
Q

diagnostic tests tell us…

A

confirmatory information using cells from the fetus or placenta

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181
Q

what are the two types of prenatal screening tests?

A 
carrier screening (mom or dad gets serologic or tissue testing to see if they are carriers)
prenatal genetic screening (serologic testing combined with USG performed during pregnancy to screen for aneuploidy, spine and brain defects
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182
Q

when is first-trimester screening performed?

A

between 10 and 13 weeks

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183
Q

what is involved with 1st trimester screening?

A

serologic testing for PAPP-A (pregnancy-associated plasma protein) and hCG, US to measure nuchal translucency. mother’s age
used to calculate risk for trisomies 18 and 21

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184
Q

when is second trimester screening performed?

A

between 15 and 22 weeks

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185
Q

what is involved with 2nd trimester screening?

A

quad screening
serologic blood test to detect NTDs and trisomies 18 and 21
serologic testing looking at MSFAP, estriol, inhibin Am and hCG
can also do US 18 - 20 weeks to ID anatomic fetal defects

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186
Q

what is cell-free DNA testing?

A

can be performed as early as 10 weeks

serologic testing of mother’s blood for aneuploidu (trisomies 13, 18, 21)

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187
Q

what would follow a positive result from cell-free DNA testing?

A

possibly CVS or amniocentesis to diagnose

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188
Q

when should we screen for gestation DM?

A

24 - 28 weeks

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189
Q

if a patient is Rh-, what follows?

A

repeat antibody screen at 26 - 28 weeks

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190
Q

can repeat which labs in third trimester if indicated by history, exam findings, risk factors?

A

CBC/crit, RPR/VDRL, CT/GC, HIV, hep B

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191
Q

when do we screen for group B strep?

A

35 - 37 weeks

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192
Q

how frequently should prenatal visits occur?

A

Q4weeks up to 28 or 32 weeks
then until 36 weeks, Q2weeks
from 36 weeks to 41 weeks, weekly visit

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193
Q

genetic risk factors for pregnancy (4)

A

age >/=35
previous chromosomal abnormality
fam hx of birth defects or mental retardation
ethic/racial origins (african SS, Med/east asian B thalassemia, Jewish tay sachs)

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194
Q

other risks factors for pregnancy (4)

A

multiple pregnancy losses/previous stillbirth
psych/mental health disorders
history of IUGR
preterm birth(s)

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195
Q

11 risks factors for current pregnancy

A 
abnormal multiple marker screening
exposure to possible teratogens
IUGR
oligo/poly
diabetes
HTN
multiple gestation
PROM
postdates
decreased fetal movement
Rh isoimmunization
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196
Q

4 types of possible teratogen exposure during preganncy

A

radiation
alcohol/meds/substances
occupational exposures
infections

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197
Q

7 risk increasing infections during pregnancy

A

toxo, rubella, CMV, herpes, HIV, syph, Zika

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198
Q

CDP (common discomforts of pregnancy): incidence of N/V

A

50% of pregnant women are affected, 25% affected by nausea only, 25% unaffected; 1st trimester

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199
Q

when should patients start taking a prenatal vitamin before trying to conceive?

A

3 months prior - can help reduce need for tx for N/V

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200
Q

what are some nutrition adjustments to manage N/V during pregnancy?

A

eat small, frequent meals Q1-2 hours
avoid spicy/fatty foods
eat protein
bland/dry foods before getting out of bed

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201
Q

other adjustments (non-food) for N/V?

A 
avoid triggers (odors)
stop prenatal and iron, but continue folic acid until resolution
acupuncture/pressure (?)
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202
Q

3 comfort measures for breast tenderness during pregnancy

A

supportive bra
careful intercourse
reassurance that it will pass

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203
Q

possible differentials to consider when a pregnant patient presents with backache (5)

A

strain, sciatica, sacroiliac joint problem, preterm labor, UTI

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204
Q

interventions for backache related to pregnancy (9)

A

massage, ice/heat, hydrotherapy, pelvic rock, counseling on good body mechanics, pillow in lumbar area when sitting or between legs when laying on side, pregnancy support/girdle, supportive bra, supportive low-heeled shoes

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205
Q

what could you suggest for sacroiliac joint problems in a pregnant patient with backache?

A

appropriate exercises, nonelastic sacroiliac belt, trochanteric belt worn below abdomen at femoral heads to increase stability

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206
Q

interventions for fatigue related to pregnancy (6)

A

reassurance that it will pass (normal in 1st trimester)
mild exercise
good nutrition
planned rest periods
decrease activities
less fluid before bed to decrease nocturia

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207
Q

non-pharm/supplement interventions for heartburn during pregnancy? (3)

A

small, frequent meals
less fluid with meals - drink fluids in between meals
elevate head of bed 10 - 30 degrees

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208
Q

pharm/supplement interventions for heartburn during pregnancy (4)

A

papaya, slippery elm bark throat lozenges, antacids, PPIs and H2 blockers (preg cat B)

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209
Q

interventions for constipation during pregnancy (4)

A

increased fluids and fiber, prune juice or warm beverage in the morning, encourage exercise, stool softeners

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210
Q

interventions for hemorrhoids during pregnancy (7)

A

avoid constipation/BM straining, elevate hips with pillow or knee-chest position, sitz baths, witch hazel or epsom salt compress, reinsert hemorrhoid with lubed finger, Kegels, topical anesthetics (Preg cat C if combined with steroid)

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211
Q

interventions for varicosities related to pregnancy (4)

A

support stockings to be worn before getting out of bed
avoid restrictive clothing
perineal pad if vaginal varicosities
rest periods with elevated legs, avoid crossing legs

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212
Q

interventions for leg cramps related to pregnancy (7)

A

decrease phosphate (no more than 2 glasses of milk/day)
massage
no pointing toes - flex ankle to stretch calf
keep legs warm
walk, exercise
Ca tablets
Mg tablets

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213
Q

interventions for presyncopal episodes during pregnancy (3)

A

change positions slowly, push fluids and encourage regular caloric/glucose intake, avoid lying flat on back and avoid prolonged standing/sitting

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214
Q

important to do what when a pregnant patient presents with headache?

A

rule out migraine or other pathologic causes of headache

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215
Q

interventions for headaches in pregnancy (10)

A

massage, acupressure, hot/cold compress, rest, good sleep hygiene, warm baths, meditation/biofeedback, aromatherapy, smaller/more frequent meals, mild analgesic

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216
Q

important to do what when a pregnant patient presents with leukorrhea?

A

r/o vaginitis, STI

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217
Q

interventions for leukorrhea during pregnancy? (4)

A

good perineal hygiene, cotton undies and change frequently, unscented pantyliners, avoid douching and sprays

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218
Q

important to do what when a pregnant patient presents with urinary frequency?

A

r/o UTI

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219
Q

interventions for urinary frequency?

A

decrease fluids in evening to avoid nocturia

avoid caffeine

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220
Q

interventions for insomnia?

A

warm bath
hot drink - warm milk, chamomile tea
quiet/relaxing activities
avoid daytime naps

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221
Q

important to do what when a pregnant patient presents with round ligament pain?

A

r/o other abdominal pain causes like appendicitis, ovarian cyst, placental separation, inguinal hernia

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222
Q

interventions for round ligament pain (6)

A

warm/ice compress, hydrotherapy, avoid sudden or twisting movement, flex knees to abdomen/pelvic tilt, support uterus with pillow when lying down, maternity abdominal support/girdle

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223
Q

interventions for skin rash

A

ice, oatmeal bath, diphenhydramine 25 mg Q4 hrs PRN, derm referral PRN

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224
Q

interventions for carpal tunnel syndrome

A

good posture, lying down, rest/elevate affected hand(s), ice/wrist splints, mild analgesic

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225
Q

what is the recommended daily caloric intake during pregnancy?

A

2500

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226
Q

what is the recommended daily protein intake during pregnancy?

A

60 g

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227
Q

underweight BMI recommended weight gain during pregnancy?

A

28-40#

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228
Q

normal BMI recommended weight gain during pregnancy?

A

25-35#

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229
Q

overweight BMI recommended weight gain during pregnancy?

A

15-25#

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230
Q

obese BMI recommended weight gain during pregnancy?

A

11-20#

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231
Q

risk factors associated with low gestational weight gain (5)

A

low fam income, black race, young age, unmarried, low education

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232
Q

low gestational weight gain is associated with…

A

growth-restricted infants

fetal and infant mortality

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233
Q

high gestational weight gain is associated with…

A 
large infant weight which can cause:
fetopelvic disproportion
operative delivery
birth trauma
asphyxia
PPH
mortality
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234
Q

what replaced the FDA risk factor category labelling on medications?

A

the PLLR which gives a more comprehensive narrative/description (pregnancy and lactation labeling final rule)

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235
Q

what were the previous FDA risk factor categories for meds during pregnancy?

A 
A - safe (folic acid, levothyroxine)
B - probably safe, Zofran, amoxacillin
C - not great, sertraline, fluconazole
D - risky, phenytoin, lithium
X - contraindicated!!!! methotrexate, warfarin
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236
Q

are live vaccines considered safe during pregnancy?

A

nope

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237
Q

when can you give a live vaccine in relation to pregnancy?

A

4 weeks prior or during the PP period

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238
Q

which two specific vaccines are contraindicated during pregnancy?

A

Varicella and Rubella

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239
Q

Which vaccine is recommended every pregnancy?

A

Tdap

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240
Q

Which vaccine is recommended for high-risk patients who are antigen and antibody negative?

A

Hep B

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241
Q

Which vaccine is possibly indicated for maternal trauma?

A

Tetanus

242
Q

Which vaccine is recommended during flu season?

A

TIV (the inactivated influenza vaccine)

243
Q

When is amniocentesis typically performed, and why?

A

usually 14 -1 6 weeks for genetic evaluation or to assess NTDs

244
Q

why might amniocentesis be used later in pregnancy?

A

assessing lung maturity, r/o amnionitis or fetal hemolytic disease

245
Q

risks associated with amniocentesis (5)

A

infection, bleeding, preterm labor, PROM, fetal loss

246
Q

what is a special precaution that needs to be taken with amniocentesis?

A

if the patient is Rh- and at risk for isoimmunization, you gotta give RhoGAM with the procedure

247
Q

What is CVS and what is it used for?

A

sampling of the chorionic villi from the placenta (outer trophoblastic layer has the same genetic make up as the fetus) to look at genetic stuff

248
Q

when is CVS typically performed?

A

between 10 and 13 weeks

249
Q

risks with CVS (3)

A

infection, bleeding, miscarriage

250
Q

can you do CVS in the case of maternal blood group sensitization?

A

nope, contraindicated

251
Q

What is a nonstress test?

A

it’s when we can look at fetal well-being by watching the FHR response to fetal movement

252
Q

Why might an NST be indicated?

A 
decreased fetal movement
post-term
DM
HTN
IUGR
253
Q

What is a reactive NST result?

A

2+ accels of 15 or more bpm lasting 15 or more seconds within a 15 -20 min period for > 32 weeks
2+ accels of 10 or more bpm lasting 10 or more seconds within a 15 - 20 min period for 28 - 32 weeks

254
Q

What is a nonreactive NST result?

A

Criteria unmet within 40 minutes; need further eval (could be repeat, BPP, or CST)

255
Q

What is an inconclusive/unsatisfactory NST result?

A

can’t tell, gotta repeat

256
Q

what are 5 factors that can affect an NST result?

A

fetal sleep, smoking within 30 minutes before test, maternal intake of medications, fetal central nervous system anomalies, fetal hypoxia or acidosis

257
Q

What is AFV?

A

amniotic fluid volume measurements

258
Q

Expected range for single deepest pocket in an AFV measurement?

A

2 - 8 cm

259
Q

What is AFI?

A

a way to measure AFV wherein you divide the uterus into 4 quads and and measure deepest verticle pocket in each and then sum them
normal is 5 - 24 cm

260
Q

What are the five components of a BPP?

A 
NST
muscle tone
breathing movements
gross body movements
AFV
261
Q

how does BPP scoring work?

A 
each variable gets a score from 0 (abnormal) to 2 (normal)
total it
8 - 10 = normal
6 is equivocal (repeat)
4 or less is abnormal
262
Q

what do you need to see in each category within what timeframe?

A 
30 minutes (after NST)
breathing = 1 or more episode(s)
body movement = 3 or more discrete movements
tone = 1 or more episodes of extension with return to flexion
AFV = 1 or more pocket  >2 cm
NST = reactive
263
Q

maternal effects related to consuming alcohol while pregnant (6)

A 
preeclampsia
placental abruption
placenta previa
spontaneous abortion
ectopic pregnancy
PROM
264
Q

infant effects related to maternal consumption of alcohol while pregnant (4)

A

FASD (fetal alcohol spectrum disorders): physical, behavioral, intellectual disabilities that last a lifetime
also: low birth weight/growth
heart, kidney problems
brain damage

265
Q

What are two screening tools we can use for alcohol misuse?

A

CAGE & TWEAK

266
Q

What does the CAGE screening tool stand for?

A

ever felt the need to Cut down on drinking?
ever been Annoyed by people criticizing your drinking?
ever felt Guilty about drinking?
ever had drink first thing in the AM (eye opener?)

267
Q

What does the TWEAK screening tool stand for?

A 
Tolerance
Worried
Eye-openers
Amnesia
Cut down
268
Q

Risks associated with nicotine use during pregnancy?

A

higher stillbirth risk
maternal: preeclampsia, placental abruption, placental previa, SA, ectopic, PROM
infant effects: IUGR, premature birth, small for GA

269
Q

OB complications associated with drug use

A 
NAS
birth defects
low birth weigh
premature birth
small head circumference
SIDS
270
Q

Symptoms of NAS

A

up to 14 days after birth
blotchy skin, diarrhea, CRYING, abnormal suckling reflex, fever, hyperactive reflexes, increased muscle tone, irritability, poor feeding, rapid breathing, seizures, sleep problem, slow weight gain, nasal congestion and sneezing, sweating, trembling, vomiting

271
Q

What are the most common infections during pregnancy associated with congenital disease?

A 
TORCH infx:
Toxoplasmosis
Other (syph, varicella-zoster, parvovirus B19)
Rubella
CMV
Herpes
272
Q

How to prevent Toxo

A 
cook meat to 145 and poultry to 160
no unpasteurized milk or cheese
avoid kitty litter
avoid untreated water
good handwashing or glove use when gardening
273
Q

Preventing Varicella-Zoster (Herpes virus)

A

vaccinate 4 weeks prior to conception or PP

VZIG for exposure

274
Q

Preventing fifth disease (parvovirus)

A

handwashing, avoid contact with sick people, avoid touching mouth/eyes/nose

275
Q

Prevention of rubella

A

vaccinate preconception or PP

276
Q

which is the most common congenital infection?

A

CMV

277
Q

CMV infant mortality rate?

A

30%

278
Q

Prevention of CMV

A

handwashing, avoid contact with sick people, avoid touching mouth/eyes/nose

279
Q

what type of HIV screening occurs for pregnant patients?

A

opt-out screening

280
Q

biggest predictor for vertical transmission of HIV?

A

viral load

281
Q

when would a c be indicated for a patient with HIV?

A

if viral load is > 1000; C at 38 weeks

282
Q

is breastfeeding okay for a patient with HIV?

A

not recommended

283
Q

Prevention for Zika?

A

avoid travel to areas with Zika
condom use for anyone with Zika or possibly exposed
protect against mosquito bites

284
Q

types of IUGR

A

symmetric and asymmetric

285
Q

when does symmetric IUGR occur?

A

early in pregnancy

286
Q

what can cause symmetric IUGR? (3)

A

congenital infection
chromosomal abnormality
maternal drug use

287
Q

when does asymmetric IUGR occur?

A

later in pregnancy

288
Q

what are the 2 main etiologic pathways of asymmetrical IUGR?

A

reduced nutrition to fetus

abnormal uteroplacental perfusion (head-sparing appearance)

289
Q

maternal causes of asymmetric IUGR (4)

A

HTN, anemia, collagen disease, insulin-dependent DM

290
Q

placental causes of asymmetric IUGR (4)

A

previa, abruption, malformations, infarctions

291
Q

fetal causes of asymmetric IUGR (2)

A

multiple gestation, anomalies

292
Q

definition of macrosomia

A

> 4000 g at birth or more than 90th percentile in weight for GA

293
Q

dizygotic twins

A

2 separate ova fertilized by 2 separate sperm

294
Q

monozygotic twins

A

splitting of a single fertilized egg

295
Q

when do dichorionic diamniotic twins split?

A

days 0 - 3

296
Q

when do monochorionic diamniotic twins split?

A

days 4 - 8

297
Q

when do monochorionic monoamniotic twins split?

A

days 9 - 12

298
Q

what happens after day 13 to MZ twins that haven’t split?

A

conjoined twins

299
Q

what is the definition of a postdates pregnancy?

A

pregnancy that continues beyond 42 weeks gestation

300
Q

complications associated with postdates pregnancy

A 
shoulder dystocia (macrosomia)
oligohydramnios
uteroplacental insufficiency
neonatal meconium aspiration
stillbirth
301
Q

what do we begin at 41 weeks for possible postdates management?

A

biweekly NST/AFI or BPP

302
Q

expectant management and delivery for postdates

A 
consider induction when cervix is ripe
prostaglandins to promote cervical ripening
inducing labor
deliver if fetal compromise or oligo
possible meconium staining of fluid
303
Q

antepartum management of obesity in pregnancy (5)

A 
US 18 - 24 weeks to detect anomalies and soft markers for aneuploidy
US Q 4-6 weeks to monitor fetal growth
weekly NSTs starting at 32 weeks
prior OSA needs specialty evaluation
early GDM screening with GTT
304
Q

postpartum management of obesity in pregnancy

A

higher risk for VTE (meds a

nd non-pharm interventions)

305
Q

define: hyperemesis graviadrum

A

persistent vomiting during pregnancy without another cause

306
Q

incidence of HG

A

0.3 - 3% of pregnancies

307
Q

theoretical considerations for etiology (3)

A 
hCG correlation (peak of hCG often coinceds with severe symptoms
estrogen correlation (lower levels of estrogen associated with lower incidence of n/v in pregnancy
evolutionary adaptation to avoid certain foods that could be dangerous
308
Q

risk factors for HG (4)

A

hx of HG in previous pregnancy, fam hx of HG, motion sickness, migraines

309
Q

typical dx criteria for HG (4)

A

severe/intractable vomiting with unknown etiology
weight loss of at least 5% ofpre-pregnancy weight
ketonuria
electrolyte imbalance (thyroid/liver lab abnormalities)

310
Q

what is the assessment tool we use for n/v during pregnancy? and what does it ask about? (3)

A

PUQE
length of nausea symptoms during a given day
# of times vomiting during a given day
# of times retching/dry heaving during a given day

311
Q

what are the score break downs for the PUQE assessment tool

A

mild =6
moderate 7-12
severe >/=13

312
Q

nonpharm options for HG (7)

A 
multivitamins
frequent small meals
avoid spicy or fatty foods
bland foods before getting out of bed
avoiding triggering odors or other stimuli
ginger 1 g per day divided doses
acupressure/acupuncture
313
Q

pharm options for HG (5)

A 
Pyridoxine (B6) 10 - 25 mg QUID/TID PO
Diclegis (pyridoxine + doxylamine 10mg/10mg PO) for moderate 2 tabs before bed, for severe 4 tabs (morning, afternoon, 2 before bed)
metoclopramide 5 - 10 mg Q6-8h PO
Promethazine 25 mg Q4h rectal supp
Zofran (sketchy)
314
Q

if HG unresponsive to medical therapy or weight unmaintainable, what could we do?

A

enteral tube feeds

315
Q

if liquids intolerable and outpatient treatment not working for HG, what could we do?

A

hospitalize for IV rehydration, antiemetic therapy and nutritional support

316
Q

define 1st trimester bleeding

A

bleeding that occurs within the first 12 weeks of pregnancy

317
Q

differentials for 1st trimester bleeding (9)

A

implantation bleeding, threatened abortion, ectopic pregnancy, cervicitis, cervical polyps, vaginitis, trauma/intercourse, disappearing twin, autoantibody/autoimmune disorder

318
Q

When is serum hCG positive after fertilization?

A

8 - 9 days

319
Q

how does beta hCG increase with a normal pregnancy?

A

doubles every 2 days

320
Q

according to the rule of 10, what is beta hCG at missed period? at 10 weeks? at term?

A

100, 100,000, 10,000

321
Q

90% of ectopic pregnancies have less than ____ beta hCG?

A

6500

322
Q

define spontaneous abortion

A

occurs without apparent cause

323
Q

define threatened abortion

A

signs/symptoms of possible loss of fetus

324
Q

define inevitable abortion

A

cervix is dilating and the uterus will be emptied

325
Q

define incomplete abortion

A

part of the products of conception are retained in the uterus

326
Q

define complete abortion

A

all products of conception have been expelled

327
Q

define missed abortion

A

fetus died prior to 20 weeks, but contents were retained for 2 or more weeks

328
Q

define recurrent pregnancy loss

A

3 or more consecutive abortions

329
Q

etiology of abortion?

A

fetal chromosomal abnormalitiy (common)

maternal parity, short interpregnancy interval, maternal/paternal age

330
Q

when should an IUP be visualized transabdominally? transvaginally?

A

hCG 6500, 2000

331
Q

in general, how do we manage abortion?

A

blood type, baseline beta hCG and repeat in 48 hrs, US, RhoGAM for unsensitized Rh- patients

332
Q

options for managing an inevitable or incomplete abortion?

A

D & C (surgical or chemical)
expectant management
emotional support/anticipatory guidance

333
Q

options for managing a threatened abortion or disappearing twin?

A

pelvic rest

emotional support/anticipatory guidance

334
Q

define ectopic pregnancy

A

implantation of the blastocyst anywhere other than the endometrium

335
Q

risk factors for ectopic pregnancy (7)

A

STI, therapeutic abortion followed by infection, endometriosis, previous pelvic surgery, failed bilateral tubal, scarring of tubes, hormonal alteration of tubal motility/menstural reflux (functional)

336
Q

symptoms of ectopic pregnancy (3)

A

amenorrhea with frequent vaginal spotting
lower pelvic/abdominal pain (unilateral)
unilateral tender adnexal mass

337
Q

components of the clinical picture for an ectopic pregnancy (6)

A 
severe abdominal pain
CMT
free fluid on US
cul-de-sac fullness
should pain s/t diaphragmatic irritation
vertigo/fainting
338
Q

how to manage an ectopic pregnancy?

A

transfer to medical management (goal is to preserve the tube)
methotrexate
RhoGAM for Rh- patients

339
Q

how does hydatiform mole or trophoblastic disease manifest? (6)

A 
AUB
size/dates discrepancy
lack of fetal activity
HG
gestation HTN
passage of vesicular tissue
340
Q

management of mole?

A

evacuate the uterus by suction curettage
close surveillance for persistent trophoblastic proliferation or malignant changes
rec avoid pregnancy for 1 year
serial beta hCG levels Q2 weeks until normal, then once a month for 6 mos, then Q2mos for 1 year

341
Q

possible causes of mid-trimester SA (4)

A

autoimmune, cocaine, anatomic/physiologic factors, infection of cervix/vagina

342
Q

symptoms of cervical insufficiency (4)

A

painless dilation, bloody show, spontaneous ROM, vaginal/pelvic pressure

343
Q

risk factors for cervical insufficiency (3)

A

previous mid-trimester loss, cervical surgery, DES

344
Q

treatment for cervical insufficiency

A

consultation
cerclage after 12 - 14 weeks
monitor cervical length with TV US

345
Q

risks of cerclage

A

ROM and infection

346
Q

incidence of low-lying placenta in 1st trimester

A

1/3

347
Q

what are the three locations for placental abruption?

A

subchorionic (between placenta and membranes)
retroplacental (between placenta and myometrium, worse prognosis)
preplacental (between placenta and amniotic fluid)

348
Q

what is predictive of fetal survival in association with abruption?

A

the size of the hemorrhage

349
Q

when should you NEVER perform a digital vaginal exam on a pregnant patient?

A

3rd trimester bleeding UNLESS you know for sure there is no placenta previa

350
Q

what is placenta previa?

A

when the placenta is located over or next to the internal oss

351
Q

what are the degrees of previa?

A

partial, marginal, complete

352
Q

risk factors for previa (3)

A

multiparity
previous C or uterine surgery
smoking

353
Q

PRIMARY symptom of placenta previa?

A

PAINLESS vaginal bleeding

354
Q

secondary symptom of previa?

A

unengaged fetal presentation and/or malpresentation

355
Q

management of complete previa

A

medical management and C

356
Q

management of partial, marginal previa?

A

observant until delivery
hospitalize if bleeding
possible tocolytic therapy
possible to deliver vaginally, will need immediate access to C

357
Q

what is placental abruption?

A

the premature sepaation of the placenta from the uterus (can be partial or complete)

358
Q

risk factors for abruption (6)

A

HTN, trauma, smoking, cocaine, multiparity, uterine anomalies or tumors

359
Q

symptoms of abruption (4)

A

vaginal bleeding
uterine tenderness and rigidity
contractions or uterine irritability/tone
fetal tachy or brady

360
Q

complications from abruption (3)

A

DIC
shock
fetal compromise/death

361
Q

management of abruption (4)

A

COLLAB
monitor clotting studies and crit/hgb, platelets
stabilize mother
delivery as indicated by fetal or maternal condition

362
Q

what is placenta accreta?

A

when the placenta invades the myometrium of the uterine wall

363
Q

risk factors for accreta (6)

A 
AMA
previous C
multiparity
prior uterine surgery
Asherman's
previa
364
Q

symptoms of accreta?

A

often none

sometimes vaginal bleeding

365
Q

management of accreta

A

COLLAB
early dx
delivery where hemorrhage can be managed

366
Q

possible risks/effects of epilepsy for a pregnant patient (8)

A 
increase in seizure frequency and severity
increase in maternal mortality
preeclampsia
preterm labor
stillbirth
increased risk of C
increased risk of miscarriage
PPH
367
Q

possible risks to fetus of epilepsy during pregnancy (2)

A

growth restriction/LBW

birth defects because of medication

368
Q

how do we manage epilepsy in pregnancy?

A

med therapy is key but not always effective (mono is best if possible)
adjust dose bc pharmokinetic metabolism changes in pregnancy
it’s helpful to know/monitor prior to pregnancy (9-12 mos w/o seizures is promising)
don’t use valproate
folic acid!!!

369
Q

definition/range of thrombocytopenia?

A

low platelets, usually <150

370
Q

managing thrombocytopenia?

A

draw platelets at each prenatal visit and 1-3 months PP

consider consult if warranted

371
Q

managing idiopathic thrombocytopenic purpura (ITP)?

A

corticosteroids and IV immunoglobulins may be required

372
Q

is GERD common in pregnancy?

A

you bet, 40 - 80% of pregnancies are affected

373
Q

what is GERD?

A

the movement of gastric contents into the esophagus

374
Q

what causes GERD in pregnancy?

A

estrogen and progesterone impact the lower esophageal sphincter
enlarging uterus too
all of this increases thoracic pressure

375
Q

risk factors for GERD in pregnancy (4)

A

certain foods/beverages
medications
overeating or eating quickly
lying down after eating

376
Q

2 important differentials for GERD in pregnancy?

A

HELLP and preeclampsia

377
Q

symptoms of GERD (4)

A

burning/pain
sleep disturbance
n/v
cough/hoarseness

378
Q

med management of GERD (3)

A

Mg hydroxide or trisilicate
Histamine-2 receptor agaonists (ranitidine)
avoid sodium carbonate antacids

379
Q

important symptoms associated with GERD to report despite medication (5)

A 
interrupted sleep
difficulty swallowing
weight loss
blood in sputum/vomit
black stools
380
Q

what are the physical and anatomical changes associated with pregnancy that increase VTE risk? (5)

A 
hypercoaguability
increased venous stasis
decreased venous outflow
compression of the vena cava &amp; pelvic veins from enlarging uterus
decreased maternal mobility
381
Q

types of VTE

A

DVT most common

PE (starts as DVT and moves to lungs)

382
Q

risk factors for VTE (15)

A 
pregnancy/PP
hx/fam hx of VTE
inheritied thrombophilia
sickle cell
autoimmune disorders
DM
HTN/preeclampsia
heart disease
BMI > 30
AMA
varicose veins
smoking
multiple gestation
C
hospitalization
383
Q

effects of VTE (5) both maternal and fetal

A 
recurrent thrombosis
ulceration
post-thrombotic syndrom
maternal death
fetal compromise or death
384
Q

how to medically manage VTE (tx or prophylaxis)

A

HEPARIN no warfarin

385
Q

what are the two main types of fetal malpresentation?

A

breech and shoulder

386
Q

what are the types and descriptions of breech position?

A

Breech - buttocks in the lower pole
Frank = legs extended up over abdomen and chest
Complete = legs are flexed at hips and knees
Footling = one or both feet or knees are lowermost

387
Q

etiology for breech (5)

A 
uterine septum
fetal anomaly
fetal attitude
previa
conditions that result in abnormal fetal movement or muscle tone
388
Q

risks associated with breech (3)

A

labor dystocia, cord prolapse, fetal head entrapment

389
Q

management options for breech (4)

A

external cephalic version
moxibustion
C?
webster maneuvers

390
Q

criteria for external cephalic version

A

normal AFI
reactive NST
EFW 2500 - 4000 g

391
Q

can a should presentation with transverse lie be a candidate for a vaginal birth?

A

No

392
Q

etiology of shoulder presentation (4)

A

multiparity
previa
poly
uterine anomalies

393
Q

management of shoulder presentation

A

similar to breech - ECV, moxi, C?, webster

394
Q

define: chronic htn

A

bp over 140/90 diagnosed before pregnany, before 20 weeks, or after 12 weeks pp

395
Q

define: GHTN

A

new-onset high BP after 20 weeks gestation without proteinuria

396
Q

define: chronic HTN with superimposed preeclampsia

A

1) chronic htn with new onset proteinura at more than 300 mg in 24 hrs but no proteinuria before 20 weeks
OR
2) a sudden increase in proteinuria or BP or a platelet count of less than 100.000 in women with htn and proteinuria before 20 weeks

397
Q

define: preeclampsia

A

pregnancy-specific htn disorder associated with headaches, visual disturbances, epigastric pain, rapid edema development
dx: 2 BP measurements that are >/= 140/90 on 2 separate occasions at least 4 hrs apart after 20 weeks gestation
OR
BP over 160/100 a previousl normotensive woman and proteinuria >/= 300 per 24 hr urine or protein/creatinie ratio >/= 0.3
OR
outside of other quantitiative measures, dipstick 2+
OR
without proteinuria, new onset HTN with new onset:
<100,000 platelets
serum creatinie >1.1 or doubled w/o renal disease
doubling of normal liver enzymes
pulmonary edema
cerebral or visual symptoms

398
Q

what is HELLP syndrome?

A

hemolytic anemia
elevated liver enzymes
low platelet count
*can be ante or post partum

399
Q

define: eclampsia

A

seizures that cannot be attributed to other causes in a woman with preeclampsia

400
Q

maintenance goal for pregnant patient with preexisting htn on antihypertensive med(s)?

A

120/80-160/105

401
Q

recommendation for pregnant patient with chronic hypertension and who is at great risk for adverse outcomes?

A

low-dose aspirin 60 - 80 mg, PO daily, starting in late first trimester

402
Q

if a pt with chronic htn has no other maternal or fetal complications, when is delivery indicated?

A

not before 38 weeks

403
Q

first choice antihypertensives for those who require them during pregnany?

A

labetolol, nifedipine, methyldopa

404
Q

how to manage preeclampsia without severe features?

A

assessing maternal symptoms
daily fetal movement counts
2xweekly BP checks
weekly liver and platelet checks

405
Q

additional rec for management of preeclampsia with severe features?

A

MgSO4 to prevent eclampsia is recommended in the intra/post partum period

406
Q

8 risk factors for hypertensive disorders of pregnancy

A 
nulliparity
adolescent or AMA
multiple gestation
fam hx of pree or eclampsia
obesity/insulin resistance
chronic htn
limited exposure to the father's sperm
antiphospholipid antibody syndrome/thrombophilia
407
Q

7 theories as to the cause of hypertensive disorders of pregnancy

A 
abnormal trophoblast invasion
coagulation abnormalities
vascular endothelial damage
cardiovascular maladaptation
immunologic phenomena
genetic predisposition
dietary deficiencies or excesses
408
Q

antepartum management of hypertensive disorders of pregnancy

A

diet assessment
adequate fluids
mayyyybe restrict activities
monitor: BP. proteinuria, edema, weight, intake/output, DTRs, subjective symptoms

409
Q

6 lab tests associated with hypertensive disorders of pregnancy

A 
creatinine
Hgb/Hct
platelets
LFTs
24 hr urine
creatinine clearance
410
Q

assessing the fetus in a patient with a hypertensive disorder of pregnancy

A

daily movement counts
NST
AFI/BPP
US to monitor growth

411
Q

main goal of intra and postpartum management of hypertensive disorders of pregnancy?

A

prevent seizures

412
Q

main anticonvulsant used during intra/postpartum hyptersensive management?

A

IV mag

413
Q

side effects of MgSO4?

A

flushing, somnolence

414
Q

MgSO4 overdose signs

A

loss of patellar reflex
muscular paralysis
respiratory arrest
aggravated by decreased UO bc mag is excreted by kidneys

415
Q

antidote to Mag?

A

calcium gluconate

416
Q

when BP exceeds 160/100 intra or postpartum, how do we manage?

A

IV labetolol or hydralazine OR IR PO nifedipine (if no IV access)

417
Q

what BP drug reserved for resistant HTN?

A

Na nitroprusside

418
Q

what is not recommended for hypertensive disorders of pregnancy?

A

diuretics bc we are already volume depleted

419
Q

incidence of HELLP syndrome

A

10% of patients with preeclampsia with severe features

420
Q

5 diagnostics for HELLP

A 
hemolysis
abnormal peripheral blood smear
increased bili >/= 1.2
elevated liver enzymes (ALT, AST, LDH)
platelets less than 100,000
421
Q

6 treatment/management pieces for HELLP

A 
mag
bed rest
crystalloids
albumin 5 - 25%
delivery as indicated
plasma volume expansion
422
Q

eclampsia is basically…

A

preeclampsia with seizures

423
Q

how to manage eclampsia? (4)

A

mag
O2
safety
stabilize and deliver

424
Q

prevention of pregnancy-induced HTN? (2)

A

vit d and calcium if at risk and low dietary intake

low dose aspirin can be considered in high-risk pregnancy

425
Q

define diabetes

A

endocrine disorder where you have abnormal carb metabolism resulting in inadequate production/utilization of insulin

426
Q

incidence of diabetes in pregnancy?

A

7%…86% are GDM

427
Q

what is the diabetogenic effect of pregnancy?

A

human placental lactogen acting like an insulin antagonist, and also maybe estrogen and progesterone acting the same way

428
Q

what do we do w/ regards to DM in pregnancy at the FIRST prenatal visit?

A

risk assessment

429
Q

12 high risk factors

A 
overweight/obese
physical inactivity
hx of GDM
prior babe over 9# (LGA)
>25 years old
fam hx of T2DM
AA, hispanic, american indian, alaska native, native hawaiian or pacific islander
HTN and/or hx of CVD
high HDL and triglycerides
PCOS/other insulin resistance conditions
A1C > 5.7%
being treated for HIV
430
Q

6 low risk factors

A 
<25 years
normal weight prior to pregnancy
ethnic group of low dm prevalence
no DM in first degree relatives
no hx of abnormal glucose tolerance
no hx of poor obstetric outcome
431
Q

when do we screen all pregnant women for DM, regardless of risk?

A

24-28 weeks

432
Q

when should we screen for DM in high risk pregnant patients?

A

ASAP

433
Q

describe the 2 step screening approach for DM

A

start with 1 hour 50 g glucose tolerance test
if 130 or more (or 140 or more..??), perform diagnostic 100 g 3 hr test on another day after 8 hours of fasting
need 2 or more abnormals on that test to dx

434
Q

describe the 1 step screening approach for DM

A 
75 g 2 hr test after 8 hrs fasting
measure fasting, 1, 2 hrs
you can dx if any one of these values is abnormal:
fasting >/=95
1 hr >/=180
2 hr >/= 155
435
Q

what 6 risk factors, if at least 3 of which are present, increased maternal mortality?

A 
uncontrolled hyperglycemia
ketonuria, n/v
GHTN, edema, proteinuria
pyelonephritis
lack of care compliance
AMA
436
Q

main objective of managing diabetes?

A

strict glucose levels

437
Q

how many cals/kilo of body weight/ideal body weight?

A

30

438
Q

calorie breakdown percentages by meal for DM management

A

b-25
l-30
d-30
snack-15

439
Q

sources of calories percentage breakdown

A

p-20
f-30-35
c-45-50

440
Q

first line treatment of GMD and why?

A

insulin, doesn’t cross placenta

441
Q

possible alternative to insulin?

A

metformin but crosses placenta

442
Q

how do insulin requirements change during pregnancy? why?

A

decreased need during first trimester
increased need during second trimester
linked to HPL levels

443
Q

what are fetal risks associated with non-gestational diabetes?

A

NTDs and cardiac anomolies

444
Q

what do we monitor on US in diabetes?

A

IUGR, macrosomia, polyhdramnios

445
Q

what do we begin at 28 weeks in diabetes management?

A

FMCs

446
Q

if nutritional adjustments and glucose monitoring are effective, what antenatal testing is indicated?

A

none

447
Q

if DM is poorly controlled or medically managed, when do we begin antenatal testing? and what?

A

32 weeks, BPP & NST

448
Q

what happens pp to insulin requirements?

A

usually decrease 24 - 48 hrs after placenta is delivered

449
Q

screening postpartum for dm?

A

75 g 2 hr test 6-12 weeks pp

450
Q

what are the 4 most common thyroid diseases in pregnancy?

A

non-toxic goiter
hyper and hypo
thyroiditis

451
Q

how signficant is the impact of pregnancy on maternal thyroid physiology?

A

GREAT!!

452
Q

why does the thyroid enlarge during pregnancy?

A

hyperplasia

increased vascularity

453
Q

are TSH and T4 affected during pregnancy?

A

no, no change

454
Q

how do total serum thyroxine and triiodothyronine concnetrations change in pregnancy?

A

both increase

455
Q

symptoms of throtoxicosis or hyperthyroidism in pregnancy?

A

tachy. thyromegaly, exophthalmos, failure to gain weight

456
Q

how do we diagnose thyrotoxicosis or hyperthroidism in pregnancy?

A

elevated free T4, low TSH

457
Q

risks for untreated thyroid problems during pregnancy? (5)

A

preeclampsia, stillbirth, IUGR, HF, preterm birth

458
Q

treatment for thyroid probs during pregnancy?

A

thioamide drug: prophylthiouracil or methimazole

459
Q

levels for Fe-deficiency anemia during pregnancy?

A

1st trim: Hgb < 11.0
2nd trim: Hgb < 10.5
3rd and PP: < 11.0

460
Q

talk about the etioogy of iron deficiency anemia during pregnancy?

A

poor nutrition and a consequence of expanding blood volume without proper expansion of hgb

461
Q

risks associated with iron-def anemia

A

LBW, premature delivery, perinatal mortality

462
Q

how do we manage Fe-deficiency anemia?

A

correct hgb mass deficit and rebuild iron stores
iron replacement therapy with vit c and folic acid
3 mo iron therapy after anemia is corrected

463
Q

what can cause anemia from acute blood loss during pregnancy? (7)

A 
abortion
ectopic pregnancy
hydatiform mole
placenta previa
abruptio placenta
placenta implantation abnormalities
pp hemorrhage
464
Q

etiology of megaloblastic anemia

A

usually folic acid deficiency

465
Q

signs of megaloblastic anemia

A

n/v, anorexia

466
Q

fetal risks of megaloblastic anemia

A

NTDs

467
Q

prevention of megaloblastic anemia

A

folic acid 0.4mg daily normally

4 mg daily prior to and during pregnancy for women with a hx of previous infant with NTD

468
Q

how to manage ss anemia in pregnancy?

A

fetal surveillance after 32-34 weeks

monitor and manage pain crises

469
Q

definition of post partum period?

A

6 weeks initially after delivery

470
Q

reviewing patient history pp: 7 pertinent diagnostic tests to know about

A 
blood type/Rh
rubella titer status
hep b status
HIV status
RPR
genetic testing
group b strep
471
Q

PP assessment (normal vs abnormal): tired but happy

A

normal

472
Q

PP assessment (normal vs abnormal): unhappy, dissatisfied

A

abnormal

473
Q

PP assessment (normal vs abnormal): 98.6-100.4 degrees

A

normal

474
Q

PP assessment (normal vs abnormal): temp greater than 100.4

A

abnormal, consider infx, PE

475
Q

PP assessment (normal vs abnormal): pulse 65-80

A

normal

476
Q

PP assessment (normal vs abnormal): pulse >80 or < 65

A

abnormal, consider infx, blood loss, PE

477
Q

PP assessment (normal vs abnormal): RR 12-16

A

normal

478
Q

PP assessment (normal vs abnormal): RR < 12

A

abnormal, consider OD narcotics, atelactesis, pneumonia

479
Q

PP assessment (normal vs abnormal): RR >16

A

abnormal, consider anxiety, pain

480
Q

is it normal for there to be a transient increase in BP after delivery?

A

yes, by 5% for up to 4 days

481
Q

PP assessment (normal vs abnormal): BP > 140/90

A

abnormal, evaluate for pp hypertensive disorder

482
Q

PP assessment (normal vs abnormal): BP < 90/60

A

abnorma, consider blood loss, med reaction

483
Q

PP assessment (normal vs abnormal): A&O x 3

A

normal

484
Q

PP assessment (normal vs abnormal): disoriented, excessive sedation

A

abnormal

485
Q

PP assessment (normal vs abnormal): no chest pain, regular HR and rhythm

A

normal

486
Q

PP assessment (normal vs abnormal): chest pain, tachy, palpitations

A

abnormal

487
Q

PP assessment (normal vs abnormal): no SOB, clear lung fields, breathe w/o difficulty

A

normal

488
Q

PP assessment (normal vs abnormal): SOB, adventitious breath sounds

A

abnormal

489
Q

PP assessment (normal vs abnormal): sore nipples

A

normal

490
Q

PP assessment (normal vs abnormal): colostrum and breast fullness for 3-5 days

A

normal

491
Q

PP assessment (normal vs abnormal): painful, cracked, bruised, bleedings nipples

A

abnormal

492
Q

PP assessment (normal vs abnormal): no breast filling by day 5

A

abnormal

493
Q

PP assessment (normal vs abnormal): BM 2-3 PP

A

normal

494
Q

PP assessment (normal vs abnormal): decreased abdominal muscle tone

A

normal

495
Q

PP assessment (normal vs abnormal): diastasis recti

A

normal

496
Q

PP assessment (normal vs abnormal): fundus is midline and firm

A

normal

497
Q

PP assessment (normal vs abnormal): n/v, diarrhea, constipation, abdominal pain

A

abnormal

498
Q

PP assessment (normal vs abnormal): distended abdomen

A

abnormal

499
Q

PP assessment (normal vs abnormal): unable to palpate uterus

A

abnormal

500
Q

PP assessment (normal vs abnormal): non-midline fundal height, height is increasing out of line of PP day

A

abnormal

501
Q

PP assessment (normal vs abnormal): signs of infection on surgical scar, not well approximated

A

abnormal

502
Q

PP assessment (normal vs abnormal): diuresis

A

normal

503
Q

PP assessment (normal vs abnormal): burning, retention, incontinence, lack of sensation or urge to void

A

normal (first 2 days)

504
Q

PP assessment (normal vs abnormal): dysuria, persistent retention/incontinence, bladder distention, CVA tenderness

A

abnormal

505
Q

PP assessment (normal vs abnormal): mild erythema, bruising, edema of the perineum

A

normal

506
Q

PP assessment (normal vs abnormal): worsening perineal symptoms

A

abnormal

507
Q

PP assessment (normal vs abnormal): perineal hematoma

A

abnormal

508
Q

PP assessment (normal vs abnormal): episiotomy/lac repair showing signs of separation

A

abnormal

509
Q

PP assessment (normal vs abnormal): malodorous lochia or excessive amounts of lochia with clots

A

abnormal

510
Q

PP assessment (normal vs abnormal): pink hemorrhoids

A

normal

511
Q

PP assessment (normal vs abnormal): deep blue or purple hemorrhoids

A

abnormal

512
Q

PP assessment (normal vs abnormal): sore muscles in lower extremeties

A

normal

513
Q

PP assessment (normal vs abnormal): bilateral, symmetric edema of lower extremeties

A

normal

514
Q

PP assessment (normal vs abnormal): unilateral leg pain

A

abnormal

515
Q

PP assessment (normal vs abnormal): unilateral calf tenderness

A

abnormal

516
Q

PP assessment (normal vs abnormal): one leg more edematous than the other

A

abnormal

517
Q

what. isinvolution

A

the process of the uterus returning to th epre-pregnant state

518
Q

3 steps of involution?

A

1) contraction of uterus
2) autolysis of myometrial cells
3) regeneration of the epithelium

519
Q

is involution the result of a reduction in cell number or cell size?

A

CELL SIZE

520
Q

how much the fundus descends each day

A

1 cm

521
Q

what might a fundus that is not midline indicate?

A

subinvolution, probably because of a full bladder

522
Q

where is the uterus immediately after delivery? what size is it?

A

1/2 way between the umbilicus and symphysis pubis and it is the size of a grapefruit

523
Q

where is the uterus 12 hours post delivery?

A

@ level of umbilicus

524
Q

by what time after delivery should the uterus/fundus not be able to be palpated?

A

2 weeks

525
Q

what happens by 6 weeks post delivery to the uterus?

A

returns to slightly larger than pre-pregnant size

526
Q

what are the 3 components of lochia?

A

eschar, decidual cells, myometrial placental bed

527
Q

what are the 3 stages of lochia?

A

rubra, serosa, alba

528
Q

when do we see rubra?

A

first 3-7 days

529
Q

when do we see serosa?

A

day 14-21

530
Q

when do we see alba?

A

until cessation of flow 4-6 weeks post partrum

531
Q

color of rubra, serosa, alba?

A

red/red-brown
pinkish-brown
yellow/white

532
Q

content of rubra?

A

decidua, lanugo, meconium, necrotic placental remains, cellular remains from vernix

533
Q

content of serosa?

A

blood, mucus, erythrocytes, leukocytes, decidual tissues

534
Q

when is colostrum produced?

A

upon birth, sometimes even in 3rd trimester

535
Q

when does engorgement occur?

A

approx. 72 hours after birth

536
Q

where does human milk production begin and then where does it go from there?

A

upper-outer glands, then fills medially and inferiorly

537
Q

when does let-down reflex develop (milk ejection)?

A

first 1-2 weeks

538
Q

3 positive reactions to childbearing?

A

achievement, empowerment/strength, new baby thrill

539
Q

4 negative reactions associated with childbearing?

A

frustration with breastfeeding if challenging
disappointment if l/d didn’t go as planned
body mistrust if birth was premature or birth process wasn’t completed as hoped
loss for individual self

540
Q

what is bonding?

A

mother to infant connection, it is affective/behavior/chemical

541
Q

how can we facilitate bonding?

A

skin to skin immediately after delivery and avoiding separation in the early/immediate pp period

542
Q

what is attachment?

A

mother to infant interaction (face to face, skin to skin) how mother responds to infant’s needs

543
Q

timeline for pp blues

A

within 3-5 days of birth up to 1-2 weeks pp

544
Q

etiology of pp blues

A

profound shifts in hormones

545
Q

pp depression timeline

A

occurs anytime within 4 weeks after childbirth or 3, 6, 8, 12 months after childbirth

546
Q

symptoms of pp depression (5)

A

sleep disturbance, feeling overwhelmed, anxiety, irritability, unable to perform ADLs

547
Q

one of the differences between pp blues and pp depression (progression)

A

blues usually improve

depression symptoms do not improve over time…likely to worsen

548
Q

how do we screen for PP depression

A

EPDS

549
Q

what are other (4) things we should rule out with pp depression symptoms

A

pp thyroiditis
anemia
infection
sleep deprivation

550
Q

prevalence of blues, depression, psychosis

A

up to 80%
6.5-12%
1-2/1000 births

551
Q

dx pp depression

A

DSM 5 criteria

552
Q

tx pp depresssion, 1st line

A

SSRIs, usually oaky with breast feeding

553
Q

4 symptoms of pp psychosis

A

hallucinations (auditory/visual disturbances), disorganized thinking, bizarre speech/behavior, delusions

554
Q

when is it typical for ovulation to return for a patient who is non-breast feeding?

A

around 39 days pp

555
Q

typical recommendation for return to sexual activity?

A

pelvic rest for 4-6 weeks, many return to intercourse earlier than that.

556
Q

how long do pregnant patients continue to be ina hypercoagulable state after delivery? why?

A

3-4 weeks, physiologic adaptive mechanism to prevent hemorrhage

557
Q

what should be avoided during this 3-4 weeks of hypercoaguability after birth?

A

estrogen

558
Q

impact of hormonal contraception on lactation is _____

A

contraversial

559
Q

can a patient be fitted/use a cap/diaphgrahm right away after birth?

A

no, must wait until involution is complete

560
Q

what are the 3 criteria for the lactation amenorrhea method to be used?

A

no menses
infant is < 6 mos
breastfeeding Q4hrs during the day, Q6hrs at night, no solid food subs yet

561
Q

old guidelines for pp folllow-up?

A

6 weeks after delivery, now ACOG suggests sooner

562
Q

if the patient is high risk, when do we follow-up pp?

A

1-2 weeks after delivery

563
Q

you have a patient who plans to breastfeed, wants long acting reversible contraception as soon as possible, and just delivered the placenta < 10 minutes ago. what BC option is best?

A

Cu-IUD

564
Q

you have a patient who does not plan to breastfeed, wants long acting reversible contraception as soon as possible, and just delivered the placenta < 10 minutes ago. what BC option is best?

A

LNG-IUD

565
Q

absolute contraindication to any IUD?

A

post partum sepsis

566
Q

absolute contraindication to COCs?

A

<21 days PP and either breastfeeding or not

567
Q

how do we diagnose urinary retention post-partum? (4)

A

can’t void spontaneous 6-8 hrs after birth or after removal of cath
residual > 150 ml
palpable bladder
fundus displaced/not midline

568
Q

5 risk factors for PP urinary retention

A 
epidural
operative vaginal delivery
episiotomy or lac
LGA
primiparity
569
Q

how might we manage urinary retention?

A

cath, referral to urology

570
Q

define pospartum fever/infection

A

> /= 100.4 x2 during pp days 2-10

571
Q

3 differentials for pp fever (3 common, 3 less common)

A 
endometritis
wound infection
UTI
transfusion reaction
drug raction
septic pelvic thrombophlebitis
572
Q

gold standard tx choice for uterine infection/endometritis

A

clindamycin and gentamycin

can add vanc if staph is suspected

573
Q

what is the leading cause of maternal mortality worldwide?

A

PPH

574
Q

PPH is defined as…(ACOG)

A

EBL 1000mL regardless of delivery route

blood loss accompanied by signs/symptoms of hypovolemia within 24 hrs of birth

575
Q

traditional definition of PPH

A

EBL 500 vaginal

EBL 1000 c

576
Q

8 risk factors for PPH

A 
prolonged labor/prolonged use of oxytocin
chorioamnionitis
high parity
twins. multiple gestation
polyhydramnios
macrosomia
operative vaginal delivery
precipitous delivery
577
Q

7 primary etiologies for PPH

A 
uterine atony
obstetrical trauma
lacs
retained placenta
placenta accreta
coagulation defects
inversion of the uterus
578
Q

what part of the breast supports the shape?

A

cooper’s ligaments

579
Q

how many milk ducts are in each breast? where do they converge?

A

4-18, at the nipple

580
Q

describe a basic glandular unit

A

contains 4-18 lobules, each with alveoli responsible for milk ejection

581
Q

which part of the breast is located in the areola and are sebaceous glands that provide protective secretion/lubrication to the nipple?

A

Montgomery tubercles

582
Q

when does lactogenesis 1 occur?

A

early pregnancy to 3rd day postpartum

583
Q

what occurs during lactogenesis 1?

A

small amounts of colostrum are secreted

100ml breastmilk produced on postpartum day 1

584
Q

what is contained in the fluid produced during lactogenesis 1?

A

immunoglobulins, lactoferrin, oligosaccharides

585
Q

when does lactogenesis. 2occur?

A

pp days 2-4

586
Q

what is lactogenesis 2 initiated by? (3)

A

delivery of placenta
decrease in progestin
increase in prolactin

587
Q

how much milk is produced during lactogenesis 2 on day 4

A

500 ml

588
Q

which stage of milk production do patients typically refer to their milk coming in?

A

lactogenesis 2

589
Q

when does lactogenesis 3 occur?

A

between days 7 and 14 pp

590
Q

characterize lactogenesis 3 (4)

A

mature milk
maintenance of milk
supply-demand

591
Q

discuss the supple-demand relationship with regards to lactation

A

suckling stimulates nipple/areola
hypothalamus receives message to secrete prolactin and oxytocin
prolactin stimulates milk production
oxytocin stimulates let-down (contraction of myoepithelial cells)

592
Q

contraindications to breastfeeding (3)

A

maternal infection
illicit drug use
meds

593
Q

maternal infections contraindicated for breast feeding (5)

A

HIV
herpes, active lesion on nipples and breasts
flu
untreated TB
varicella developed 5 days prior to birth to 2 days after delivery

594
Q

medicaitons contraindicated for breastfeeding (6)

A 
antiretrovirals
anticonvulsants
chemo
radiation
retinoids
statins
595
Q

interventions (5) for breast engorgement?

A 
acupuncture
hot/warm before feed, cold after
cabbage leaves
breast massage
hand expression
596
Q

2 possible meds for insufficient milk supply?

A

domperidone

metoclopramide

597
Q

diagnostic criteria for mastitis (3)

A

erythematous/edematous wedge-shaped area in the breast, unilateral
fever >/= 101.3
flu-like symptoms

598
Q

first line treatment for mastitis

A

dicloxacillin or flucloxacillin 500 mg PO QID x 10-14 days
cephalexin 500 mg QID X 10-14 days
clindamycin 300 mg QID or erthromycin 250 mg or 500 mg QID X 10-14 days if allergic to penicillin

599
Q

what is abreast abcess?

A

a collection of pus in the breast, surrounded by inflammation

600
Q

how do we diagnose and treat an abscess?

A

exam & US for dx
surgical drainage, needle aspiration
antibiotics

NCC Exam - WHNP (6 decks)

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