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OB/GYN > Obstetrics - Normal Pregnancy + Prenatal care > Flashcards

Obstetrics - Normal Pregnancy + Prenatal care Flashcards

1
Q

Embryo vs fetus

A

< 8 weeks = embryo

> 8 weeks = fetus

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2
Q

1st vs 2nd vs 3rd trimester

A

1st - 0-12 wks

2nd - 12-28 wks

3rd - 28 - delivery

< 24 weeks - previable

24-37 weeks - preterm

> 37 weeks - term

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3
Q

Signs of pregnancy

A

Bluish discoloration of vagina and cervix (Chadwick sign)
Softening and cyanosis of the cervix at or after 4 wk (Goodell sign)
Softening of the uterus after 6 wk (Ladin sign)

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4
Q

Physio of pregnancy - CV

A

cardiac output increases by 30% to 50%.
- The increase in cardiac output is first due to an increase in stroke volume and is then maintained by an increase in heart rate as the stroke volume decreases by the end of the third trimester.

Systemic vascular resistance decreases —> decrease BP
- most likely 2/2 elevated progesterone, leading to smooth muscle relaxation.

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5
Q

Physio of pregnancy - Pulm

A

The increased minute ventilation during pregnancy causes a compensated respiratory alkalosis.

Will have dyspnea

Increase:
Tidal volume
Minute ventilation (b/c inc tidal volume but RR stays same)
INspiratory capacity

Decrease:
TLC (2/2 elevation of diaphragm)
Functional residual capacity

Constant:
RR

Plasma osmolality is decreased during pregnancy which increases the susceptibility to pulmonary edema. - Common causes of acute pulmonary edema in pregnancy include tocolytic use, cardiac disease, fluid overload and preeclampsia.

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6
Q

Physio of pregnancy - Heme

A

Increase:
Plasma volume
RBC volume (less than plasma volume)
Coagulability

Decrease:
Hct (plasma volume&raquo_space; RBC vol) —-> dilutional anemia

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7
Q

Physio of pregnancy - Endo

A

Increase:
TBG (stimulated by estrogen) —->
TOTAL T3, T4

Same:
Free T3, T4

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8
Q

Physio of pregnancy - MS

A

spider angiomata

palmar erythema secondary to increased estrogen levels

hyperpigmentation of the nipples, umbilicus, abdominal midline (the linea nigra), perineum, and face
(melasma or chloasma) secondary to increased levels of the melanocyte-stimulating hormones and the steroid hormones.

Carpal tunnel syndrome

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9
Q

Prenatal visits

- what is done?

A

Blood pressure, weight, urine dipstick, measurement of the uterus, and auscultation of the FH are performed and assessed on each follow-up prenatal care visit.

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10
Q

The FH is usually first heard during the

A

second trimester, as is the first fetal movement

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11
Q

patients who are Rh negative should receive Rho-GAM at _____ weeks.

A

28

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12
Q

Prenatal visit increments

A

Prenatal visits increase to every 2 to 3 weeks from 28 to 36 weeks and then to every week after 36 weeks.

Beyond 32 to 34 weeks, Leopold maneuvers are performed to determine fetal presentation

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13
Q

In women with latent herpes simplex virus (HSV), antiviral prophylaxis can be initiated at ____ weeks.

A

36

Active HSV would be an indication for cesarean delivery.

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14
Q

Occasional irregular contractions that do not lead to cervical change are considered

A

Braxton Hicks contractions

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15
Q

dehydration in preggers can lead to

A

uterine contractions, possibly secondary to cross-reaction of vasopressin with oxytocin receptors

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16
Q

BPP looks at five categories and gives a score of either 0 or 2 for each:

A 
amniotic fluid volume, 
fetal tone,
fetal activity, 
fetal breathing movements, 
the nonstress test (NST), which is a test of the FHR.

A BPP of 8 to 10 or better is reassuring.

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17
Q

Blood flow in the middle cerebral artery is used when evaluating for

A

fetal anemia in the setting of Rh isoimmunization

18
Q

On fetal monitoring, late FHR decelerations are concerning for

A

uteroplacental insufficiency

19
Q

At ____ weeks, screening for group B streptococcal

infection is also performed.

A

35-37 weeks

Patients who have a positive culture should be treated with intravenous penicillin when they present in labor to prevent potential neonatal group B streptococcal infection

20
Q

Gestational diabetes - risks

A

Intrauterine growth restriction is typically seen in women with pre-existing diabetes and not with gestational diabetes.

Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios and fetal macrosomia are all associated risks of gestational diabetes

21
Q

Accurate GA dating is made by

A

Certain LMP c/w first or second trimester US

dating by 3rd trimester US or unsure LMP is more suspect

22
Q

How do you get a di-di pregnacy?

A

Separation of ovum prior to differentiation of trophoblast

will get 2 amnions and 2 chorions

23
Q

How do you get mono-di pregnancy?

A

Separation of ovum after trophoblast differentiation adn before amnion formation

will get 1 chorion adn 2 amnions

24
Q

How do you get mono-mono pregnancy?

A

Separation of ovum after trophoblast differentiation and after amnion formation

1 chorion
1 amnion

25
Q

Division of cells beyond what day will give you singleton fetus?

A

15-16 days

26
Q

GBS screening

Tx

A

35-37 weeks

Cx of vagina and rectum

Tx w/ IV penicillin G at time of labor or ROM

  • If status unknown and labor prior to 37 wks GA or ROM > 18 hrs –> tx with PXN G
  • also can use cefazolin (ancef) if PCN allergic
  • Vanco for GBS resistant to clinda or unknown susceptibility
27
Q

Screen for gonorrhea

A

1st prenatal visit and 3rd trimester

28
Q

Screening for syphilis

A

VDRL or RPR

If +

  • send titer
  • confirm with FTA-Abs to r/o false + (SLE, antiphosphlipid ab syndrome)
29
Q

Morning sickness resolves by week

A

16

30
Q

Patients who desire non-invasive assessment of their risk for aneuploidy can have

A

first trimester screen (a fetal nuchal translucency (NT) measurement and a maternal serum PAPP-A)
- if +, can have detailed fetal US and echo at 19-20 weeks to r/p anomalies if doesn’t want an amnio or CVS

a second trimester quadruple screen.

31
Q

Ibuprofen is safe to take until around

A

32 weeks gestation, when premature closure of the ductus arteriosis is a risk

32
Q

Progesterone in pregnancy

A

> 25 ng/ml suggests healthy pregnancy

33
Q

bHCG levels in pregnancy

A

Should rise by at least 50% every 48 hours until the pregnancy is 42 days old

after that time, the rise in level may not follow the curve

34
Q

Nonstress test

A

assessment of fetal well-being that measures the fetal heart rate response to fetal movement.

nl = two fetal heart rate accelerations of 15 beats/minute for 15 seconds within 20 minutes.

Vibroacoustic stimulation is not indicated unless the NST is non-reactive.

35
Q

Contraction stress test

A

assesses uteroplacental insufficiency and looks for persistent late decelerations after contractions (3/10 minutes)

36
Q

Methods to date a pregnancy - best methods

1st trimester

A

1st trimester

- US measurement of crown-rump length is best

37
Q

Chorionic villus sampling vs amniocentesis

A

Chorionic villus sampling (CVS)

  • performed between 10 and 12 weeks gestation
  • use FISH to analyze cells
  • increased risk fetal death and limb reduction defects
  • limb reduction defects occurs when procedure carried out before 9-10 wks GA

Amniocentesis
- performed after 15 weeks

38
Q

Gold standard to eval cervix for incompetence in pregnancy

A

Transvaginal US

length < 10th % for GA is short cervix

39
Q

Exercise contraindicated in pregnancies with…

A 
Amniotic fluid leak
Cervical incompetence
Mult gestation
Placenta abruption
Placenta previa
Premature labor
Preeclampsia
Gestational HTN
Severe heart or lung dz
40
Q

Nl amniotic fluid pH

A

neutral 7-7.5

41
Q

Cause of low back pain in third trimester pregnancy

A

Increase in lumbar lordosis

Relaxation of ligaments supporting joints of pelvic girdle

OB/GYN (7 decks)

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