Pregnancy Flashcards
What is the presentation of placenta abruption
- sudden onset of vaginal bleeding
- uterine contractions
What are risk factors for placenta abruption
- Previous abruption is the strongest risk factor
- hypertension
- preeclampsia
- smoking
- trauma
- cocaine use
What is placenta previa
-placenta impants too low on either the top of the cervix or the cervical isthmus
What are sx suggestive of a placenta previa
- bright red vaginal bleeding
- painless bleeding
What is the presentation of the severe pre-eclampsia
-sudden onset of severe recurrent headache
-visual abnormalities
-pitting edema (edema on face, eyes and fingers)
-rapid weight gain
-right upper quadrant pain
-BP >140/90
-Proteinuria
-Oliguria
-
What is HELLP
- hemolysis
- elevated liver enzymes
- low platelets
What are the findings in HELLP syndrome?
- RUQ pain
- N/V
- Malaise
Lab abnormalities:
- Elevates in AST, ALT, LD
- Decrease in Platelets
WBC count is ____ throughout pregnancy especially in the 3rd trimester, can be as high has _____
elevated; 10,500
What lab values are elevated in pregnancy
ALP, lipid profile, Total T3, WBC, GFR, ESR, TSH
How are hemoglobin and hematocrit values different in pregnancy
Both are reduced in pregnancy
What is the use of serum alpha-fetoprotein
-biochemical marker used to estimate a pregnant woman’s risk fo having a fetus/infant with down syndrome
If you have an abnormal alpha-fetoprotien what do you then order
triple or quad screen to evaluate for trisomy 21
If you have a high alpha-fetoprotein what are concerns
- neural tube defects
- omphalocele
- gastroschisis
- multiple gestation
- pregnancy dating error
What is the triple marker screen test composed of
- AFP
- beta HCG
- estriol serum level values
What is the quad marker screen test composed of
-combination of the triple screen (AFP, beta HCG, estriol) and inhibin-Aq
Tay-Sachs is common in
Jewish descents
Cystic Fibrosis is common in
whites
Sickle cell anemia is common in
African American
______ is an important indicator of the viability of pregnancy and useful in the _____ trimester
Doubling time; 1st
What is a normal HCG patter in a viable pregnancy
HCG doubles every 48 hours for the 1st 12 weeks
Screen for _____ in pregnancy
HBsAg, HIV, gonorrhea, chlamydia, syphilis, HSV, check rubella/varicella titres
What antibiotic is okay in 1st and 2nd trimester but contraindicated in 3rd trimester and why
Macrobid
-b/c of increased risk of hemolytic anemia
What macrolide is category C and should be avoided
Clarithromycin
What is the risk of pseudoephedrine in pregnancy
-increased risk of gastrochisis
What is the risk of sulfa drugs in pregnancy
- cause hemolytic anemia
- hyperbiliruminemia
What health education should you provide in pregnancy
- take 400mcg of folic acid prenatally
- avoid soft cheeses, undercooked meats, raw milk
- avoid cat litter
- do not eat raw shellfish or oysters
- no cold cuts, hot dogs, deli meat
- no ETOH or smoking
- regular coffee 8oz/d is okay
- no excessive heat
Weight gain in pregnancy
- Normal: 25-35 lbs
- Underweight patients: 28-40 lbs
- Obese patients: 11-20 lbs
Women >35 years have higher risk of
- chromosomal abnormalities
- pre-eclampsia
- low birth weight infants
- miscarriage
- premature birth
- complications during delivery
What are positive signs of pregnancy
- palpation of the fetus
- ultrasound and visualization of the fetus
- fetal heart tones
What are probable signs of pregnancy
- goodell’s sign (cervical softening @ 4 weeks)
- Chadwicks (blue coloration at 6-8 weeks)
- Hegars (softening of hte uterin isthum at 6-8 weeks)
- enlarged uterus
- ballottement
- urine or blood pregnancy test
What are presumptive signs of pregnancy
- amenorrhea
- N/V
- Breast changes
- fatigue
- urinary frequency
- slight increase in body temperature
- quickening (at 16 weeks)
At 12 weeks the uterine fundus rises above the
symphysis pubis
At 16 weeks the uterine fundus is
between symphysis pubis and umbilicus
At 20 weeks the uterine fundus is
At the umbilicus
Fundal height between 20-35 weeks should
equal the number of weeks in cm +/- 2 cm
What are physiologic changes of pregnancy
- HR increases by 15-20 bpm
- S3 is common, wide split of S1 or S2 split
- May hear systolic ejection murmur
- Cardiac output increases by 50%
- physiologic anemia of pregnancy
- preload increases
- hypercoagulable state
- mild edema
- total lung capacity drops to 4L
- degreased peristalsis
- kidney size increases
Cholasma/melasma is related to
high estrogen
What is naegele’s rule
Used to estimate EDD
LMP - 3 months + 7 days or
LMP + 9 months + 7 days
If you use methydopa in pregnancy what should you check or monitor
baseline LFTs contraindicated in active liver disease
Uterine involution takes
6 weeks
What is oligohydramnios
-AFI <5cm
What is a normal AFI
5-25cm
What are risk with oligohydramnios
- fetal malformation
- pulmonary hypoplasia
- umbilical cord compression
- fetal or neonatal death
What is rhogam
immunoglobin that helps prevent maternal isoimmunization
If rhoGAM is not givne to an RH-negative women this will result in
fetal hemolysis and fetal anemia in future pregnancies
What is the dose of rhogam
300mcg IM at 28 weeks and 72 hours post delivery
What test detects the presence of Rh antibodies
Coombs test
What are risk factors for GDM
- previous GDM
- Obesity
- Ethnicity (asia, american indian, pacific islander, african american, hispanic_
- macrosomic infant
- age >35
What is the preferred test for GDM
75g OGTT
What is the diagnostic criteria for 75g OGTT in GDM
- Fasting 92mg/dL +
- 1 hour 180mg/dL +
- 2 hour 153mg/dL +
First line treatment for GDM is
Lifestyle modifications
75g OGTT is the ____ however if a 50g OGTT is performed and positive what is required
screening and diagnostic test;
a 100g follow up
In individuals with GDM check for diabetes at
4-12 weeks postpartum
In a pregnant adult a count of ____ is considered a UTI
10^3
A threated abortion
vaginal bleeding but os remains closed
inevitable abortion
cervix is dilated
