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Medicine II > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

When does pregnancy begin?

A

first day of last menstrual cycle

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2
Q

fetal age at first missed menses?

A

3 weeks

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3
Q

gestational age at first missed menses?

A

5 weeks

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4
Q

pregnancy urine test

A

2 weeks after conception

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5
Q

serum pregnancy test

A

9 days after conception

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6
Q

how many weeks is an average pregnancy?

A

40 weeks (38-42 weeks normal)

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7
Q

first trimester

A

until 14 weeks

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8
Q

second trimester

A

until 28 weeks

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9
Q

third trimester

A

until delivery

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10
Q

What does compression of the IVC in supine position cause?

A

supine hypotention

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11
Q

supine

A

lying facing upwards

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12
Q

hypotention

A

abnormally low blood pressure

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13
Q

symptoms of supine hypotension

A
  • feeling faint/dizzy
  • vision “going grey”
  • palor
  • nausea
  • drop in blood pressure from decreased venous return to heart
  • decreased blood flow to uterus
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14
Q

What position helps with supine hypotention

A

left lateral tilt position

-sit patient up, fully recline chair and roll patient to left side

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15
Q

positioning of pregnant patient

A
  • use semi-reclining position as tolerated
  • encourage frequent position changes
  • place small pillow under right side to tilt patient to the left
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16
Q

What is the total weight gain in pregnancy?

A

27.6 lbs

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17
Q

What is the ideal weight gain in in pregancy?

A

25-35 lbs

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18
Q

What are some significant cardiovascular changes with pregnant women?

A

increase in plasma volume and cardiac output (HR + SV)

or decrease in peripheral vascular resistance and BP

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19
Q

what are some respiratory changes in pregnant women?

A

increase in minute ventilation and tidal volume

-in 3rd trimester, supine position can impair respiratory function

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20
Q

in what trimester can supine position impair respiratory function?

A

3rd

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21
Q

Gastrointestinal changes in pregnant women

A
  • gums can become hyperemic
  • decreased motility of GI tract (constipation, reflux, heartburn)
  • relaxed esophageal spincter (GERD and increased risk of aspiration esp in surgery (spinals/epidurals during cesareans help avoid)
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22
Q

hyperemia

A

increase of blood flow to different tissues in the body

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23
Q

gastrointestinal changes

A

nausea/vomiting (hyperemesis Gravidarum)

  • 70% experience in 1st trimester
  • 2% w/ hyperemesis
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24
Q

hyperemesis

A

surface enamel loss through acid-induced erosion

-1 tsp baking soda in 1 cup water- rinse after vomitting

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25
Q

Why should you avoid brushing right after vomiting?

A

can worsen already demineralized teeth

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26
Q

pregnancy periodontal disease

A
  • affects 15% childbearing age
  • up to 40% of pregnant women
  • more common in low income women
  • older age, smoking, diabetes increases risk
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27
Q

pregnancy gingivitis

A
  • common (50-70%)
  • hormones cause increased growth of gum capillaries -hypertrophy of gums
  • inflammation: erythema and edema
  • range from redder looking gums that bleed when brushing teeth to severe swelling and bleeding
  • hormonal changes may cause shift in bacterial flora and increase susceptibility
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28
Q

pregnancy tumor

A
  • pyogenic granuloma (not purulent)

- lobular capillary hemangioma

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29
Q

where can pregnancy tumors be found?

A

hands, arm, face

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30
Q

what percentage of pregnant women have pregnancy tumors

A

10%

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31
Q

What is pregnancy tumors often seen with

A

inflammatory gingivitis or area of local trauma/ irritation

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32
Q

pyogenic granuloma (pregnancy tumor)

A
  • pedunculated outgrowth from interproximal gingiva
  • anterior + maxillary
  • smooth or lobulated red-purple mass
  • early- vascular and bleeds easily
  • later-less vascular, more collagenous and pink
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33
Q

pyogenic granuloma

A

mm to cm

-painless and soft

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34
Q

treatment of pregnancy tumor

A

most resolve after pregnancy, surgical excision if very bothersome?

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35
Q

periodontal disease

A

15% childbearing age women and 40% pregnant women

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36
Q

periodontal disease and preterm birth

A
  • pathogen and proinflammatory cytokines spread via hematogenous transport
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37
Q

periodontal disease and preterm birth is associated with

A

CV disease, DM, respiratory function

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38
Q

2.8 fold increase risk of preterm birth with

A

maternal periodontal infection, intervention may not help

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39
Q

periodontal care in pregnancy

A
  • VERY IMPORTANT
  • GENERAL MATERNAL HEALTH MAINTENANCE
  • STUDIES SHOW IT IS SAFE
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40
Q

no adverse serious medical events of adverse pregnancy outcomes for

A
  • routine, essential dental care,
  • nonsurgical periodontal care
  • use of topical/ local anesthesia
41
Q

is dental caries increased by pregnancy?

A

NO, pre-existing dental disease may become exacerbated due to pregnancy influences

42
Q

teratogen

A

any agent or factor to which fetal exposure produces a permanent alteration in form or function of offspring

43
Q

pre-implantation period

A

2 weeks from fertilization to implantation

-“all or none” period - death vs. injury w/ complete compensation

44
Q

emybryonic period

A
  • 2nd through 8th week following conception

- organogenesis- structural malformations

45
Q

fetal period

A
  • 9 weeks and beyond

- some organs still vulnerable (e.g. brain, heart)

46
Q

determining teratogenicity

A
  • timing of exposure
  • duration of exposure
  • route of administration
  • concurrent exposure to other agents
  • individual maternal + fetal metabolism
  • placental transport
47
Q

FDA category A

A

well controlled human studies show no fetal risk

48
Q

FDA category B

A

animal studies show no risk but no human studies OR animal studies show risk but human studies show NO risk

49
Q

FDA category C

A

animal studies show averse effects but no studies in women - benefits may warrant use

50
Q

FDA category D

A

positive evidence of human risks but benefits may outweigh the risks

51
Q

FDA category X

A

risks demonstrated and outweigh benefits

52
Q

drugs contraindicated in pregnancy

A 
alcohol
anticonvulsants
warfarin
ACE inhibitors
retinoids
androgens + DES
antineoplastic agents
antimicrobials
53
Q

antimicrobials contraindicated in preganncy

A

tetracycline + sulfonamides

54
Q

anticonvulsants contraindicated in pregnancy

A 
phenytoin
carbamezepine
valproate
trimethadione
phenobarbitol
55
Q

tetracyclines (doxy + monocycline)

A

yellow-brown discoloration of deciduous teeth

56
Q

antibiotics with potential toxicity

A

sulfonamides (Bactrim)
nitrofurantoin (Macrodantin, macrobid)
tetracyclines

57
Q

sulfonamides (bactrim)

A
  • mixed data about teratogenicity
  • displace bilirubin from protein binding sites
  • theoretical concern hyperbilirubinemia near delivery
58
Q

nitrofurantoin (macrodantin, macrobid)

A

mixed data about teratogenicity

59
Q

ACOG says sulfonamides and nitrofurantoins safe in

A

2nd/3rd trimester but avoid in 1st unless it’s the only option

60
Q

antibiotics that are safe to use

A

penicillin
cephalosporins
erythromycin
clindamycin

61
Q

analgesics in pregnancy

A

salicylates (aspirin)

indomethacin

62
Q

salicylates (aspirin)

A
  • potent PG inhibitor
  • theoretical concern premature closure of ductus arteriosus
  • no cases found when studied for preeclampsia prevention
63
Q

indomethacin

A
  • constriction of ductus arteriosus & pulmonary HTN

- decreased fetal urine output

64
Q

analgesics in pregnancy

A
  • acetaminophen safe to use
  • narcotics safe to use (oxycodone, codeine)
  • avoid aspirin use
  • ibuprofen and naproxen (fair evidence of safety, avoid 1st and 3rd trimesters
65
Q

when should you avoid ibuprofen and naproxen?

A

1st + 3rd trimesters

66
Q

are local anesthetics safe to use in pregnancy?

A

yes!

67
Q

general anesthesia

A
  • non are teratogens
  • if crosses CNS of mother, it will cross the placenta + depress CNS of fetus
  • GI transit time is prolonged so risk of aspiration increased
68
Q

nitrous oxide

A
  • safe for pregnant women but
  • chronic exposure (occupational) w/out proper scavenging of exhaleed gases assos with: reduced fertility + increased in miscarriages
69
Q

X-rays in pregnancy

A

no single diagnostic X-ray procedure results in radiation exposure to a degree that would threaten the well-being of the developing pre-embryo, embryo or fetus

70
Q

which radiologic tests are very safe in pregnancy?

A

-those that don’t involve ionizing radiation like ultrasound and MRI

71
Q

what radiation exposure is safe?

A
72
Q

fetal exposures of CXR (2 views)

A

.02-.07

73
Q

fetal exposures of skull film

A

.004

74
Q

fetal exposures of CT scan head or chest

A
75
Q

fetal exposures of CT abdomen

A

1-2

76
Q

fetal exposures of daily background

A

.036

77
Q

radiologic tests that are NOT SAFE in pregnancy

A 
radioactive iodine for therapeutic purposes: 1 crosses placenta
2 affects fetal thyroid
3 especially if used after 10-12 wks
4 contraindicated in pregnancy
5 treat patients AFTER delivery
78
Q

nuclear medicine tests to use cautiously

A

1 radiopaque contrast agents for CT/X-rays
-no problems in nursing babies
2 paramagnetic contrast agents for MRI
3 radionucleotide testing for V/Q, thyroid, bone and renal scans

79
Q

fetal risks of high dose radiation exposure

A
  • embryonic death
  • teratogenic effects
  • carcinogenesis
  • genetic effect or germ cell mutations
  • ?? adverse genetic effects on future generations
  • intrauterine growth restriction
80
Q

embryonic death

A
  • high-dose radiation before implantation
  • most likely lethal to embryo
  • animal studies
  • “all or none” phenomenon in early embryonic development
81
Q

teratogenic effects

A
  • data from atomic bomb survivors
  • growth restriction
  • microcephaly
  • mental retardation
  • CNS effects greatest if exposed 8-15 wks
  • threshold may be 20-40 rad
82
Q

fetal risks of high dose radiation exposure- carcinogenesis

A

-unclear risk but probably small
-estimated 1-2 rad fetal exposure may increase incidence leukemia by 1.5-2
-estimated 1 in 1000 cases per rad
-background risk is 1 in 3000
nonirridiated sibs also have higher incidence

83
Q

principles for radiographic testing in pregnancy

A
  • no radiologic test performed unless medically necessary
  • if testing indicated, shield the fetus and limit exposure
  • do not put patient at risk by avoiding indicated test
  • highest risk for fetus during organogenesis (3-10 weeks)
84
Q

dental care in 1st trimester

A

evaluate dentition, perform established dentistry regimen

85
Q

dental care in 2nd trimester

A

any routine or major necessary procedures

86
Q

dental care in 3rd trimester

A

continue established maintenance programs; perform major procedures as required

87
Q

all essential dental treatments can be maintained

A

routine extractions, periodontal treatment, restorations, continuation of orthodontic treatment, placement of movable and fixed prosthesis, placement of crowns

88
Q

what is best left till postpartum period

A

elective surgery

89
Q

how long should infants be breasted?

A

6 mos

90
Q

how long should breasfeeding continue

A

until 1 yrs of age with supplementation of solid foods after 6 mos.

91
Q

benefits of breastfeeding

A
  • colostrum helps digestive system
  • antibodies help immune system
  • lower risk of asthma, obesity, allergies
  • protein/fat better used than those in formula
  • less gas, feeding problems, constipation
  • less SIDS- sudden infant death
92
Q

breastfeeding contraindicated

A

taking antineoplastic, thyrotoxic and immunosuppressive agents

  • receiving radioactive isotopes
  • undergoing chemotherapy or radiation therapy
93
Q

safe meds for breastfeeding

A

antibiotics, antihistamines, nasal decongestants , analgesics, IV contrast agents

94
Q

which antibiotics are safe for breastfeeders

A

penicillins, cephalosporins, macrolides, aminoglycosides

95
Q

nasal decongestants

A

may reduce milk supply

96
Q

analgesics safe for breastfeeders

A

tylenol, NSAIDS (no ASA), opiates (may cause sedation)

97
Q

primary contraceptive methods

A

female sterilization, male sterilization, oral contraception, injectables/implant/patch, condom, others

98
Q

hormonal contraceptives

A

supresses midcycle surge of LH from pituitary so ovulation does not occur
-supresses FSH secretion during folicular phase

Medicine II (8 decks)

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