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CSI > pregnancy > Flashcards

pregnancy Flashcards

1
Q

preggo dx

A

Fetal heart tones by ultrasound: 5-6 weeks
Fetal heart tones by Doppler: 10-12 weeks
Fundus above pubic symphasis: 12-15 weeks
Fundus at umbilicus: 20 weeks

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2
Q

Pregnancy: dating

A

Last menstrual period
Naegele’s rule: LMP + 7 days – 3 months
Eg LMP 1/11 + 7 days = 1/18 – 3 months = 10/18
Pregnancy wheel

PLUS ultrasound
First trimester: 1 week variation (most accurate)
Second trimester: 2 week variation
Third trimester: 3 week variation

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3
Q

HCG

A

Identical alpha subunit as: LH, FSH, TSH

Maintains corpus luteum  progesterone: 8-10 wks

  • Elevated: multiples, hydatidiform moles, choriocarcinoma, Down syndrome
  • Decreased: abnormal pregnancy, Edward syndrome, Patau syndrome
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4
Q

HCG secreted by ??

A

Secreted by syncytiotrophoblasts in the placenta
Double every 29-53 hours

Blood: within 1 week
Urine: within 2 weeks

Peak at 8-10 weeks
Around 60,000-90,000

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5
Q

slide 9

A

gestational landmarks

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6
Q

trimester definitions

A

First trimester: 0-12 weeks
Second trimester: 12-28 weeks
Third trimester: 28-42 weeks

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7
Q

term definitions

A 
Full term: 37 weeks
Late preterm: 34 – 36 6/7 wks
Early term: 37 – 38 6/7 wks
Full term: 39 – 40 6/7 wks
Late term: 41 – 41 6/7 wks
Post term: ≥ 42 wks

Fetal “viability”: 24 weeks (can be resuscitated)

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8
Q

Initial laboratory tests:

A 
Blood type
Rhesus type
Antibody screen
Hemoglobin/Hematocrit
Sickle cell screening?
Rubella immunity
Varicella immunity
Urinalysis and urine culture
STIs
Gonorrhea/Chlamydia
Syphilis (RPR)
Hepatitis B (HBsAg)
HIV
Cervical cytology
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9
Q

optional lab tests

A 
Fetal aneuploidy screening
Invasive: CVS or amniocentesis
Noninvasive:
-“First trimester screening” (nuchal translucency (12wks, PAPP-A, HCG) ~90% sn
-Quad screen (2nd trim.: maternal a-FP, UC estradiol, HCG, ??) 60-70% sn.
-Cell free fetal DNA
Screening for CF, SMA
Fragile X

Tay-Sachs, Canavan dz, familial dysautonomia for Ashkenazi Jewish population

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10
Q

Ovulation–> Fertilization

A

Occurs in ampulla of fallopian tube

Occurs within 1 day of ovulation

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11
Q

Fertilization–>Implantation

A

Occurs in the wall of the uterus

Occurs within 6 days of ovulation

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12
Q

s/s preggo dx

labs??

imaging??

A 
Amenorrhea
Nausea/vomiting
Breast tenderness
Urinary frequency/urgency
Fatigue
Vaginal cyanosis
Enlarged/globular uterus
Softened cervix

labs: HCG
imaging: U/S

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13
Q

prenatal visits

A

Q4 weeks – until 28 weeks
Q2 weeks – until 36 weeks
Q1 week – until delivery

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14
Q

every prenatal visit

A 
Weight
BP
Fundal height
FHTs
Urine protein
Urine glucose
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15
Q

6-12 weeks ??

12 weeks ??

16-20 weeks??

20 weeks ??

A

Confirm dates
CVS

First trimester screening

AFP or Quad screen
Amniocentesis

Fetal anatomy ultrasound
Cervical length

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16
Q

24-28 Weeks

28 weeks?

35-36 wks?

41 wks?

A

Gestational Diabetes screening

Rh0 (D) Immune Globulin
Tdap

GBS screening

Antepartum fetal testing

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17
Q

patient education: diet

A

Folic acid: 0.4mg/day
Weight gain:
BMI 30: 11-20 lbs

18
Q

patient education: caffeine and foods to avoid

A

Caffeine: 200-300mg/day
Avoid: Raw meat, Raw fish, Unpasteurized cheese, Deli meat, Fish with high mercury level
Thoroughly wash fruits/veggies
-to avoid Toxoplasmosis, Listeriosis, Brucellosis

19
Q

pt education: etOH and smoking

A 
Alcohol: Fetal alcohol syndrome: growth restrictions; facial, skeletal and cardiac abnormalities; CNS dysfunction
Cigarette smoking:
Placental abruption
Placenta previa
PROM, PTD
Low birth weight
20
Q

drug use

A

Cocaine: PROM (prem. rupture of membranes), PTD, abruption, IGUR, neurobehavioral deficits, SIDS
Amphetamines: PROM, PTD, abruption, IGUR, neurobehavioral deficits, SIDS
Opioids: IUGR, PTD, fetal death

21
Q

radiation

A

Excessive radiation
-less than 0.05 Gy (5 rads): no problem, carcinogenesis? (unclear)
-0.05 – 0.50 Gy (5-50 rads): unknown
-First 14 days: “all or nothing”: 1 Gy kills 50% of embryos
-14 days – 20 weeks
Possible malformations, mental retardation or growth restriction more than 0.1-0.2 Gy
-Ultrasound/MRI: no problem

22
Q

other things to avoid

A

Excessive heat (hot tubs/saunas)
Radiation or chemical hazards
Cat litter/feces

23
Q

Rhesus alloimmunization: IF Rh0 (D) negative mother has Rh0 (D) positive fetus

A

Fetal red cells enter the circulation
Rh0 (D) antibodies are formed
These antibodies can cause hemolytic disease for subsequent Rh0 (D) positive fetuses

24
Q

Rh0 (D) immune globulin = concentrate of antibodies against Rh0 (D) antigen

A

Destroy fetal Rh0 (D) positive cells
Mother does not form antibodies
300 mg
Lasts 12 weeks

25
Q

travel

A

Okay to travel up to 32 weeks

Do not travel to endemic areas of yellow fever or malaria

26
Q

teratogen chart

A

25

27
Q

NO live virus vaccines:

A

MMR
Yellow fever
Small pox
Varicella

28
Q

Should vaccinate:

A

Hep B
Influenza
Tdap

29
Q

OMM

A

-Increasing lumbar lordosis
-Anterior pelvic tilt due to center of gravity shifting anteriorly
-Strained lower back muscles can lead to Unlevel sacral base, Unequal length of the LE
-Interstitial edema increases Carpal tunnel syndrome, Myofascial dysfunction
more slide 27

30
Q

physiologic changes in pregnancy

A

listen

31
Q

labor

A

painful contractions and cervical change

32
Q

stage 1 labor

A

begining to contract: gets to 10 cm

18-24 hours

33
Q

stage 2 labor

A

complete dilation to baby out

3 hours w. epidural, 2 hrs w.out

34
Q

stage 3 labor

A

baby out to placenta out

less than 30 min, if more get it out

35
Q

labor dystocia

A 
Protracted labor (taking too long)
Arrest of dilation
Protracted second stage (taking too long while pushing)
Arrest of descent
Retained placenta
Management:
Oxytocin augmentation
Amniotomy
Fetal rotation
Operative delivery (pull the baby out)
36
Q

cervical change

A

Dilation (cm), effacement (%), station (cm) (where head of baby is)
(eg 5/90/-1)

37
Q

cardinal movements

A 
Engagement/Flexion
Internal rotation
Extension
External rotation (restitution
slide 32
38
Q

OA vs “sunny-side up”

A

want to be OA, face down

39
Q

Tocometer: measures ??

A

contractions

  • Intrauterine pressure catheter (IUPC): direct measurement of contraction force
  • Montevideo units (MVU): area under the curve x10 minutes
40
Q

Doppler: measures ??

A

fetal heart tones (FHTs)

-Fetal scalp electrode (FSE): attaches to baby’s scalp for more accurate FHTs

41
Q

FHTs

A

-Baseline: 110-180
-Variability:
Absent
Minimal: less than 5bpm
Moderate: 5-25bpm
Marked: more than 25bpm
-Accelerations: 15 beats above baseline x15 seconds
-Decelerations
Early
Late
Variable
Prolonged

CSI (75 decks)

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