Pregnancy

Question 1

promotes endometrial growth that supports the early embryo. It appears to stimulate marked enlargement of the pituitary gland (by up to 135%) and increased prolactin output from its anterior lobe, which readies breast tissue for lactation.
-also contributes to the hypercoagulable state that puts pregnant women at four to five times higher risk for thromboembolic events, primarily in the venous system.

Answer 1

Estrogen

Question 2

-increase throughout pregnancy, leading to increased tidal volume and alveolar minute ventilation, though respiratory rate remains constant; respiratory alkalosis and subjective shortness of breath result from these changes.
- Decreased gastrointestinal motility from progesterone contributes to gastroesophageal reflux, constipation, and biliary diseases in pregnancy (such as cholelithiasis and cholestasis).
-relaxes tone in the ureters and bladder, causing hydronephrosis (in the right ureter more than the left) and an increased risk of bacteriuria

Answer 2

Progesterone level

Question 3

has five variant subtypes. Two are crucial to maintaining the pregnancy, one produced by the corpus luteum in early pregnancy to stabilize the endometrium and prevent loss of the early embryo.
-The other is produced by the placenta throughout gestation, supporting progesterone synthesis. Serum and urine pregnancy assays test primarily for the two pregnancy-related hCG variants
-the other three isoforms are produced by different cancers and the pituitary gland.

Answer 3

Human chorionic gonadotropin (hCG)

Question 4

influences fetal growth and the development of preeclampsia.
-Human placental lactogen (related to the placental growth hormone family) and other hormones contribute to insulin resistance during pregnancy and the development of gestational diabetes (GDM), which carries a lifetime risk of progressing to type 2 diabetes of up to 60%.

Answer 4

Placental growth hormone

Question 5

-changes include an increase in thyroid-binding globulin due to rising levels of estrogen and cross-stimulation of thyroid-stimulating hormone (TSH) receptors by beta-hCG.
-This results in a slight increase, usually in the normal range, in serum concentrations of free T3 and T4, while serum TSH concentrations appropriately decrease. This transient apparent “hyperthyroidism” should be considered physiologic.
-Normal pregnancy is considered a euthyroid state throughout all trimesters.

Answer 5

Thyroid function

Question 6

…is secreted by the corpus luteum and placenta and is involved in the remodeling of reproductive tract connective tissue to facilitate delivery, increased renal hemodynamics, and increased serum osmolality.
-Despite its name, it does not affect peripheral joint laxity during pregnancy.

Answer 6

Relaxin

Question 7

increases during pregnancy, which raises erythrocyte mass. Plasma volume increases to a greater extent, causing relative hemodilution and physiologic anemia, which can protect against blood loss during birth.

Answer 7

Erythropoietin

Question 8

purplish striae gravidarum or “

Answer 8

stretch marks”

Question 9

a brownish black pigmented vertical stripe along the midline skin, may appear

Answer 9

linea nigra,

Question 10

As tension on the abdominal wall increases with advancing pregnancy, the rectus abdominis muscles may separate at the midline, called

Answer 10

diastasis recti.

Question 11

Increased vascularity throughout the pelvis gives the vagina and cervix a bluish color, known as

Answer 11

the Chadwick sign.

Question 12

Normal vaginal secretions may become thick, white, and more profuse, known as

Answer 12

leukorrhea of pregnancy

Question 13

refers to the number of times that a woman has been pregnant, a

Answer 13

Gravidity

Question 14

is the number of times that she has given birth to a fetus to a viable age (≥24 gestational weeks), regardless of whether the child was born alive or was stillborn

Answer 14

parity

Question 15

Parity is further broken down into term deliveries, preterm deliveries, abortions (spontaneous abortions and terminated pregnancies), and living children, which yields the mnemonic “

Answer 15

TPAL

Question 16

obstetric visits traditionally follow a set schedule:

Answer 16

monthly until 28 gestational weeks, then biweekly until 36 weeks, then weekly until delivery.

Question 17

are used to determine the fetal position in the maternal abdomen beginning in the second trimester; accuracy is greatest after 36 weeks’ gestation

Answer 17

Leopold maneuvers

Question 18

Compression interferes with venous return from the lower extremities and pelvic vessels, causing the patient to feel dizzy and faint, also known as

Answer 18

supine hypotension.

Question 19

Weight loss due to nausea and vomiting that exceeds 5% of prepregnancy weight is considered excessive, representing …what?, and can lead to adverse pregnancy outcomes.

Answer 19

hyperemesis gravidarum

Question 20

is systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg first documented after 20 weeks, without proteinuria or other evidence of preeclampsia, that resolves by 12 weeks postpartum.

Answer 20

Gestational hypertension

Question 21

rregular brownish patches around the forehead, cheeks, nose, and jaw are known as ….what? the “mask of pregnancy,” a normal skin finding during pregnancy.

Answer 21

chloasma or melasma,

Question 22

Thyroid issues that are abnormal and require investigation during pregnancy

Answer 22

Thyroid enlargement, goiters, and nodules

Question 23

often found during pregnancy due to increased blood flow through the breast vasculature.

Answer 23

venous hum or a continuous mammary souffle (“a puff of air,” pronounced soo-fuhl)

Question 24

Definition of Preeclampsia

Answer 24

SBP ≥140 or DBP ≥90 after 20 weeks on two occasions at least 4 hours apart in a woman with previously normal BP or BP ≥160/110 confirmed within minutes and proteinuria ≥300 mg/24 hours, protein to creatinine ratio ≥0.3, or dipstick 1+;
Or

New-onset hypertension without proteinuria and any of the following: thrombocytopenia (platelets <100,000/μL), impaired liver function (liver transaminase levels more than twice normal), new renal insufficiency (creatinine >1.1 mg/dL or doubles in the absence of renal disease), pulmonary edema, or new-onset cerebral or visual symptoms.20

Question 25

There may be increased splitting of S1 due to increased circulating blood volume and 90% of patients will have an audible

Answer 25

systolic murmur.

Question 26

what king of murmur is not normal in pregnancy and should be investigated further

Answer 26

A diastolic murmur

Question 27

a spontaneous mild leakage often accompanied by a cramping sensation in the breast during a hot shower or orgasm in the third trimester.

Answer 27

let down

Question 28

The maternal sensation of fetal movement is traditionally known as

Answer 28

“quickening.”

Question 29

when does the examiner can feel movement externally?
-When does mother feel movement?

Answer 29

The examiner can usually feel movements externally after 24 gestational weeks;
-the mother can usually feel these by 18 to 24 weeks.

Question 30

when is regular uterine contraction are abnormal?

Answer 30

Before 37 weeks, regular uterine contractions with or without pain and bleeding are abnormal, suggesting preterm labor.

Question 31

when should the fundal height be measured?

Answer 31

Measure the fundal height if gestational age is >20 weeks, when the fundus should reach the umbilicus.
-Though subject to error between 16 and 36 weeks, measurement of the fundal height in centimeters should roughly equal the number of weeks of gestation.

Question 32

abnormal fetal height measurement

Answer 32

-If fundal height is 4 cm larger than expected, consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma.
- If fundal height is 4 cm smaller than expected, consider low-level amniotic fluid, missed abortion, intrauterine growth retardation, or fetal anomaly.
-These conditions should be investigated by ultrasound.

Question 33

when can fetal heart tone be detected?

Answer 33

fetal heart tones, which is normally audible as early as 10 to 12 weeks’ gestation.
-Detection of fetal heart tones may be slightly delayed in patients who are obese.

Question 34

Inaudible fetal heart tones may indicate

Answer 34

fewer weeks of gestation than expected, fetal demise, false pregnancy, or observer error; inability to locate the FHR should always be investigated with formal ultrasound

Question 35

the inner portion of the cervix everts slightly during pregnancy, and appears as a glandular friable darker pink or red area inside the os.

Answer 35

called ectropion

Question 36

A pink cervix suggests a nonpregnant state.
Cervical erosion, erythema, discharge, or irritation suggests what?

Answer 36

cervicitis, and warrants investigation for STIs.

Question 37

Investigate abnormal vaginal discharges for?.

Answer 37

for possible candida or bacterial vaginosis, which can affect pregnancy outcom

Question 38

cervix softening during pregnancy is called

Answer 38

Hegar sign

Question 39

Cervical opening or shortening (cervical effacement) prior to 37 weeks may indicate

Answer 39

preterm labor.

Question 40

Cervical opening or shortening

Answer 40

(cervical effacement)

Question 41

An irregularly shaped uterus suggests

Answer 41

uterine leiomyomata, or fibroids, or a bicornuate uterus, one with two distinct cavities separated by a septum.

Question 42

are used to determine the fetal position in the maternal abdomen beginning in the second trimester; accuracy is greatest after 36 weeks’ gestation

Answer 42

Leopold maneuvers

Question 43

zygote

Answer 43

week 1

Question 44

blastocysts

Answer 44

week 2

Question 45

embryo

Answer 45

week3-week 8

Question 46

fetus

Answer 46

week 9-week 38