Page 1 of objectives Flashcards
Basics of hormonal regulation of menstrual cycle
- LH
- FSH
- Estrogen
- Progesterone
- LH is released from pituitary
- Surges at ovulation
- Leads to release of oocyte
Basics of hormonal regulation of menstrual cycle
- LH
- FSH
- Estrogen
- Progesterone
- FSH is released from the pituitary
- Surges at ovulation
Basics of hormonal regulation of menstrual cycle
- LH
- FSH
- Estrogen
- Progesterone
- Estrogen is released from the ovary
- Rises during follicular phase; peaks right before ovulation
- Causes thickening of endometrium of uterus
Basics of hormonal regulation of menstrual cycle
- LH
- FSH
- Estrogen
- Progesterone
- Progesterone is released from the granulosa cells of the corpus luteum that contained the oocyte
- At its lowest at ovulation; rises and peaks during luteal phase, prepping for a fertilization
- If no fertilization, levels fall and endometrial lining is shed, 14 days after ovulation
General maternal physiologic changes in pregnancy:
Hematalogic
- Hematocrit will drop due to dilution
- Also, pregnancy is a hypercoagulable state
General maternal physiologic changes in pregnancy:
Cardiovascular
- Cardiac output rises 30-50%
- Maternal heart rate rises by 15 to 20 beats/min
- Systolic and diastolic blood BP typically fall early in gestation and are about 5 to 10 mmHg below baseline in the second trimester. In the third trimester, blood pressure gradually increases and may normalize to nonpregnant values by term.
General maternal physiologic changes in pregnancy:
Respiratory
- Chronic respiratory alkalosis
- May get unilateral nasal polyp, called nasal granuloma gravidarum
How is pregnancy diagnosed?
The diagnosis of pregnancy is based on the presence of any of the following:
●Detection of human chorionic gonadotropin (hCG) in blood or urine
●Identification of pregnancy by ultrasound examination
●Identification of fetal cardiac activity by Doppler ultrasound
GTPAL system
G = number of pregnancies; twins counts as one pregnancy
T = number of term births (has reached at least 38 weeks; each twin counts as a birth)
P = number of preterm births (20 weeks to 37 weeks)
A = number of abortions/miscarriages (less than 20 weeks)
L = number of living children
Calculate estimated date of delivery (EDD) based on LMP
- EDD is 280 days from the onset of the last menstrual period (LMP) and 266 days from date of conception
- Naegele’s rule: Subtract 3 months, add 7 days to first day of LMP
What is the role of folic acid in fetal development?
What is the current recommendation regarding folic acid supplementation?
- Folic acid supplementation decreases the occurrence of neural tube defects (e.g. spina bifida, anencephaly) and is recommended for women planning pregnancy or capable of becoming pregnant
- Recommendation is supplement containing 0.4 mg to 0.8 mg of folic acid daily
What is Chadwick’s sign?
Bluish discoloration of the cervix from venous congestion, usually visible by 8-10 weeks.
What is the recommended frequency of prenatal visits?
- Every 4 weeks until 28 weeks
- Every 2 weeks from 28-36 weeks
- Every week from 36 weeks-delivery
What is the recommended weight gain during pregnancy?
Depending on weight prior to pregnancy…
…underweight (BMI < 18.5): 28-40 lbs
…normal weight (BMI 18.5-24.9): 25-35 lbs
…overweight (BMI 25-29.9): 15-25 lbs
…obese (BMI 30+): 11-20 lbs
(ACOG)
What are the screening tests (mother and fetal) of the first trimester?
- First trimester screen: u/s for fetal nuchal translucency, plus hCG and PAPP-A
- 10-14 weeks
- Asymptomatic bacteriuria
- 12-16 weeks
What are the screening tests (mother and fetal) of the second trimester?
- Quad screen (AFP, hCG, estriol, inhibin A): Down syndrome risk, trisomy 18 risk, neural tube defect risk
- 15-18 weeks
- Anatomy ultrasound
- 18-20 weeks
- Gestational diabetes (glucose tolerance test)
- 24-28 weeks
What are the screening tests of the third trimester?
- Group B strep vaginal and rectal swab
- 35-37 weeks
Amniocentesis:
- indication
- timing
Fetal genetic studies (followup to noninvasive testing): 15-17 weeks
Fetal lung maturity (infrequent; prior to semielective but medically indicated birth): 32-39 weeks
What is chorionic villus sampling?
When is it done?
Why is it done?
- small samples of the placenta are obtained for prenatal genetic diagnosis
- generally in the first trimester after 10 weeks of gestation
- Optional, but maybe advanced maternal age, genetic risk factors, anomaly seen on u/s
What are the FDA pregnancy safety categories?
When can doppler detect fetal HR?
10-12 weeks
When is fetal movement usually first detected?
The initial perception of fetal movement occurs at 18–20 weeks’ gestation in primiparous patients and as early as 14 weeks’ gestation in multiparous patients.
When is RhoGam given?
To Rh negative pregnant women whose fetus is or may be Rh positive, give RhoGam
- At 28 weeks
AND
- Whenever there is maternal hemorrhage, risk of maternal hemorrhage, or suspected maternal hemorrhage
AND
- Within 72 hours of delivery of an Rh positive infant
Fetal biophysical profile
Criteria for the biophysical profile test
- *Nonstress test:** 2 points if reactive
- *Fetal breathing movements:** 2 points if one or more episodes of rhythmic breathing movements of ≥30 seconds within a 30-minute observation period
- *Fetal tone:** 2 points if one or more episodes of extension of a fetal extremity or fetal spine with return to flexion.
- *Amniotic fluid volume:** 2 points if a single pocket of fluid is present measuring at least 2 cm by 1 cm
- *Fetal movement:** 2 points if three or more discrete body or limb movements within 30 minutes of observation
0 points are assigned for any criteria not met.
8/10 or 10/10 = good
