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OB/Peds > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Presumptive signs of pregnancy

A

Changes felt by the woman (breast, no period, N/V, urinary freq, fatigue, “flutters”)

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2
Q

Probable signs of pregnancy

A

Changes observed by an examiner (goodell sign, chadwick sign, hear sign, positive test, braxton hicks contractions)

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3
Q

Goodell sign

A

Softening of the cervix

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4
Q

Chadwick sign

A

Bluish discoloration of the cervix

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5
Q

Hegar Sign

A

Softening of the uterine isthmus

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6
Q

Braxton Hicks contractions

A

Myomas and other tumors

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7
Q

Positive signs of pregnancy

A

Changes attributed only to the fetus (visualization of fetus, fetal heart tones on doppler, fetal movements palpated or visible)

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8
Q

Where is the fundus at 22-24 weeks gestation?

A

At the level of the umbilicus

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9
Q

Where is the fundus at term?

A

At the level of the xiphoid process

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10
Q

What is used as an estimate for the duration of pregnancy?

A

Fundus Height

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11
Q

Cervial changes during pregnancy

A

Multipara (oval), nullipara (rounded), increased vascularity, goodell sign

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12
Q

Vaginal changes during pregnancy

A

Mucosa thickens and connective tissue loosens in prep for delivery, chadwick sign, mucous plug (operculum) barrier against bacteria, secretions are more acidic

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13
Q

Breast changes during pregnancy

A

Enlargement, sensitivity, tingling, heaviness in response to increased estrogen and progesterone, nipples and areolae become more pigmented, sebaceous glands might be visible (montgomery tubercles), blood vessels are more visible, stretch marks may appear, colostrum

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14
Q

Striae gravidarum

A

Stretch marks

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15
Q

Cardiovascular changes during pregnancy

A

Blood volume increases by 40-50%, cardiac output increases, slight cardiac enlargement as a result of increased blood volume and output, increase in fibrinogen and factors VII VIII IX and X

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16
Q

Pulse increase during preg

A

Between 14-20 weeks and persists to term

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17
Q

BP decrease/increase during preg

A

Decreases during 1st trimester, continues to drop until 24-30 weeks, gradually increases and returns to prepreg levels by term

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18
Q

Respiratory changes during preg

A

Ligaments of the rib cage relax as a result of estrogen, diaphragm is displaced, chest breathing replaces abdominal breathing, decreased tolerance for apnea and hypovent, upper respiratory tract becomes more vascular as a result of elevated levels of estrogen (sinus stuffiness and nosebleeds)

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19
Q

Renal changes during preg

A

Larger volume of urine is held and urine flow is slow due to ureteral obstruction, increased risk of UTI bc pressure by gravid uterus on ureters and increased blood flow to kidneys

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20
Q

Pressure on bladder during preg

A

Pressure during 1st, symptoms decrease during 2nd, presenting part descends in 3rd and symptoms increase

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21
Q

Integumentary changes during preg

A

Hyperpigmentation (nipples, areolae, axillae, vulva), stretch marks and linea nigra, palmar erythema, mild itching, angiomas (vascular spiders) of neck, thorax, face, arms, facial melasma (chloasma or mask of preg) blotchy, brownish, hyperpig of skin over cheeks, nose, and forehead

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22
Q

Musculoskeletal changes during preg

A

Increasing weight of the fetus causes the mother’s posture to change, center of gravity shifts forward, extra strain on muscles, ligaments and joints in the lower back

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23
Q

GI changes during preg

A

N/V proportional to hCG levels and decreases in the second and third trimesters, delayed gastric emptying bc decreased peristalsis, hemorrhoids bc constipation and pressure on vessels, emptying time of gallbladder decreases may lead to stones, cardiac sphincter relaxes so HB, anesthesia should always assume a full stomach

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24
Q

Normal weight women before pregnancy will gain how much?

A

25-35 pounds

25
Q

Underweight before preg

A

get to normal weight then 28-40 pounds

26
Q

Overweight before preg

A

15-25 pounds

27
Q

Prenatal visits

A

Every 4 weeks up to 28 weeks, every 2 weeks from 29-36 weeks, every week from 37 weeks to birth

28
Q

Goals of antepartum testing

A

Identify fetuses at risk for injury caused by acute or chronic interruption of oxygenation, identify oxygenated fetuses so unnecessary interventions can be avoided

29
Q

Monitoring begins when?

A

By 32-34 weeks of gestation

30
Q

Ultrasounds

A

High freq sound waves, waves deflect off tissue in abdomen, noninvasive, painless, no known harmful effects to mother or baby

31
Q

Indications for ultrasounds in 1st trimester

A

Confirm preg, determine gestational age, rule out ectopic preg, cause of bleeding, maternal abnormalities, visualization for chorionic villus sampling

32
Q

Indications for ultrasounds in 2nd trimester

A

Establish or confirm dates and viability, detect polyhydramnios, oligohydramnios, congenital anomalies, intrauterine growth restriction, assess placental location, visualization during amniocentesis

33
Q

Indications for ultrasounds in 3rd trimester

A

Detect macrosomia, placenta previa or abruption, placental maturity, fetal position, doppler blood flow, biophysical profile, visualization during amniocentesis and external version

34
Q

Too much fluid

A

Polyhydramnios

35
Q

Not enough fluid

A

Oligohydramnios

36
Q

Oligohydramnios would have what kind of

A

Variable bc cord compressions

37
Q

Biophysical Profile

A

Reliable predictor of fetal well-being, used in late 2nd and 3rd, considered as a physical exam of the fetus, including determination of vitals

38
Q

BPP includes what?

A

Fetal breathing movements, fetal movements, fetal tone, fetal HR pattern by means of a nonstress test, amniotic fluid index

39
Q

BPP scoring

A

2 points for normal findings, 0 for abnormal.
8-10: normal, low risk for chronic asphyxia
4-6: suspect chronic asphyxia
0-2: strongly suspect fetal asphyxia

40
Q

Macrosomia

A

Big babies

41
Q

When do you admin RhoGAM?

A

28 weeks gestation, again within 72 hours of birth

42
Q

Amniocentesis

A

Obtains amniotic fluid which contains fetal cells, possible after 14 weeks

43
Q

Amniocentesis indications

A

Diagnosis of genetic disorders or congenital anomalies (neural tube defects), assessment of pulmonary maturity, diagnosis of fetal hemolytic dz

44
Q

Chorionic Villus Sampling

A

Removes small tissue specimen from the fetal portion of the placenta, tissues reflect the genetic makeup of the fetus, performed between 10 and 13 weeks, transcervically or transabdominally

45
Q

Percutaneous Umbilical Blood Sampling

A

Direct access to the fetal circulation during the 2nd and 3rd, used for fetal blood sampling and transfusion

46
Q

PUBS indications

A

Diagnosis of inherited blood disorders, karyotyping of malformed fetus, fetal infection, assessment and tx of isoimmunization and thrombocytopenia in the fetus

47
Q

Post-PUBS

A

Continuous fetal heart rate monitoring for 1-2 hours, kick counts at home

48
Q

Maternal Serum Alpha-fetoprotein

A

Screening tool for NTD’s in preg, 15-20 weeks but 16-18 weeks is ideal

49
Q

What is AFP produced by?

A

Fetal liver and increasing levels are detectable in the serum of preg women from 14-30 weeks

50
Q

Abnormal MSAFP values mean what?

A

Follow up genetic testing and counseling

51
Q

Nonstress test

A

Most widely applied technique for antepartum evaluation of the fetus, noninvasive, relatively inexpensive with zero complications

52
Q

What happens if underlying uteroplacental insufficiency exists?

A

Contractions produce late decelerations

53
Q

Vibroacoustic stimulation

A

Performed in conjunction with NST, combination of sound and vibration to stimulate the fetus, monitored for 5 minutes before stimulation to obtain a baseline FHR, stimulation for 3 seconds, should see acceleration in 3 minutes and if not, test may be repeated 3 times. If still no response, further testing is recommended

54
Q

Contraction Stress Test

A

Provides a warning of fetal compromise, nipple-stimulated contraction test, oxytocin-stimulated contraction test

55
Q

Negative CST

A

At lease 3 uterine contractions in a 10 minute period with no late or significant variable decels

56
Q

Positive CST

A

Late deceleration occur with 50% or more of contractions even if there are fewer than 3 contractions in 10

57
Q

Suspicious or equivocal CST

A

Prolonged variable or late decelerations occurring with less than 50% of the contractions

58
Q

Equivocal-Hyperstimulatory CST

A

Decelerations that occur in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds

59
Q

Unsatisfactory CST

A

Failure to produce 3 contractions within a 10 minute window or inability to trace the FHR

OB/Peds (11 decks)

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