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Pregnancy Flashcards

1
Q

Ovulation –> fertilization occurs in the

A

ampulla of the fallopian tube

-occurs within 1 day of ovulation

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2
Q

Fertilization –> implantation occurs in the

A

wall of the uterus

-occurs within 6 days of ovulation

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3
Q

HCG is secreted by

A

syncytiotrophoblasts in the placenta

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4
Q

HCG doubles every

A

29-53 hours (doubles every 48 hours)

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5
Q

When can HCG be detected in your blood and urine?

A

blood- w/in 1 week
urine- w/in 2 weeks

-HCG peaks at 8-10 weeks (around 60-90,000)

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6
Q

HCG maintains

A

the corpus luteum (for about 8-10 weeks), until it starts secreting progesterone

-Interacts with the LHCG receptor of the ovary and promotes the maintenance of the corpus luteum during the beginning of pregnancy. This allows the corpus luteum to secrete the hormone progesterone during the first trimester. Progesterone enriches the uterus with a thick lining of blood vessels and capillaries so that it can sustain the growing fetus.

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7
Q

When is HCG elevated?

A
  • multiples
  • hydatidiform moles
  • choriocarcinoma
  • Down syndrome
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8
Q

When is HCG low?

A
  • abnormal pregnancy
  • Edward syndrome
  • Patau syndrome
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9
Q

Pregnancy diagnosis s/s

A
  • amenorrhea
  • N/V
  • breast tenderness
  • urinary frequency/urgency
  • fatigue
  • vaginal cyanosis
  • enlarged/globular uterus
  • softened cervix
  • HCG
  • ultrasound positive
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10
Q

Can hear fetal heart tones via ultrasound by

A

5-6 weeks

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11
Q

Can hear fetal heart tones by doppler by

A

10-12 weeks

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12
Q

Fundus is above pubic symphysis by

A

12-15 weeks

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13
Q

Fundus is at umbilicus by

A

20 weeks

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14
Q

Naegele’s Rule

A

-How to calculate estimated delivery date based on LMP

LMP + 7 days - 3 months= due date

ex: LMP was 1/11
add 7 days…1/18, now subtract 3 months= 10/18 is due date

-most clinics use pregnancy wheel

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15
Q

Naegele’s Rule can only be used for

A

28 day cycles

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16
Q

Pregnancy lasts

A

40 weeks (280 days)

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17
Q

Ultrasound, during 1st trimester there will be _______ of variation when predicting due date

A

1 week (most accurate bc fetus is small and entire uterus will fit into ultrasound)

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18
Q

Ultrasound, during 2nd trimester there will be _______ of variation when predicting due date

A

2 weeks

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19
Q

Ultrasound, during 3rd trimester there will be _______ of variation when predicting due date

A

3 weeks of variation

may be 3 weeks off when trying to determine due date

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20
Q

During transvaginal ultrasound, gestational sac can be detected at

A

4.5-5 weeks

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21
Q

During transvaginal ultrasound, yolk sac can be seen at

A

5 weeks

yolk sac seen when sac diameter is 8 mm

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22
Q

During transvaginal ultrasound, cardiac activity can be detected at

A

5.5-6 weeks

when gestational sac diameter is 16 mm

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23
Q

During transvaginal ultrasound, measurable crown-rump length can be taken at

A

6 weeks

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24
Q

First trimester

A

0-12 weeks

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25
Second trimester
12-28 weeks
26
Third trimester
28-42 weeks
27
Fetal "viability"
24 weeks (if baby delivers at this gestation, baby can probably be resuscitated and live, will probably have disabilities)
28
Due date is
40 weeks
29
Full term is
37 weeks (delivery without complications to the baby)
30
Late preterm
34-36 weeks
31
Early term
37-38 weeks
32
Late term
41 weeks
33
Post term
42 weeks or more
34
Initial lab test for prenatal assessment
- blood type - rhesus type - ab screening - Hbg/hematocrit (sickle cell screening) - rubella/varicella immunity - urinalysis - STI screen (gonorrhea/chlamydia, syphilis, hep B, HIV) - cervical cytology
35
Optional labs for prenatal assessment
- fetal aneuploidy screening (CVS or amniocentesis) - Non-invasive first trimester screening, quad screen, cell free fetal DNA - screening for CF, SMA - Fragile X - Tay sachs, caravan disease, familial dysautonomia for ashkenazi jews
36
Test that becoming more popular
-Cell free fetal DNA (becoming more popular, 99% sensitivity, can get a few of baby’s cells out with moms placental blood, separate them and can test them)
37
Timeline of prenatal visits
1. every 4 weeks until 28 weeks 2. every 2 weeks until 36 weeks 3. every week until delivery
38
What gets checked at every single prenatal visit?
weight, BP, fundal height, FHTS (fetal heart tones/sounds), urine protein and glucose
39
What gets checked at 6-12 weeks?
confirm delivery date, CVS (chorionic villus sampling)
40
What gets checked at 12 weeks?
First trimester screening (nucal translucency test)
41
What gets checked at 16-20 weeks?
- AFP or Quad screen | - Amniocentesis
42
What gets checked at 20 weeks?
- Fetal anatomy ultrasound (look at entire anatomy- can tell gender) - Cervical length
43
What gets checked at 24-28 weeks?
gestational diabetes screen
44
What gets checked at 28 weeks?
- Rh0 D immune globulin (if Rh-) | - Tdap (all pregnancy people get this, gives baby immunity to pertussis)
45
What gets checked at 35-36 weeks?
GBS screening
46
What gets checked at 41 weeks?
Antepartum fetal testing WIKI: This includes-Biophysical Profile (BPP) is a test that measures the health of the fetus during pregnancy. A BPP test may include a nonstress test with electronic fetal heart monitoring and a fetal ultrasound.
47
Diet for pregnant moms
1. Folic acid: 0.4mg/day (protects against spinal/neuro defects) 2. Caffeine: 200-300mg/day (1 cup)
48
Foods to avoid?
- Raw meat - Raw fish - Unpasteurized cheese - Deli meat - Fish with high mercury level - Thoroughly wash fruits/veggies *These may have Toxoplasmosis, Listeriosis, or Brucellosis
49
WEIGHT GAIN DURING PREGNANCY (test)
BMI 30: 11-20 lbs
50
Alcohol during pregnancy can cause
fetal alcohol syndrome (growth restrictions, facial, skeletal and cardiac abnormalities, CNS problems)
51
Cig smoking during pregnancy can cause
placental abruption, placenta previa, PROM, preterm delivery (PTD), low birth weight
52
Drug use during pregnancy
1. Cocaine: PROM, PTD, IGUR, neurobehavioral deficits, SIDS 2. Amphetamines: same 3. Opioids: IUGR, PTD, fetal death
53
What to avoid during pregnancy
-excessive radiation, excessive heat (hot tubs/saunas), radiation or chemical hazards, cat litter/feces Heat= neural tube defects Cat litter- toxoplasmosis
54
Rhesus alloimmunization
- if Rho (D) negative mom has Rh0 positive fetus - retal RBC enter maternal circulation - Rh0 abs are formed in moms blood (rh- has never seen the rh+ before and will make abs) - these abs can cause hemolytic disease for the NEXT rh+ fetus
55
Rh0 immune globulin is
concentrate of Abs against Rh0 (D) antigen - destroys fetal rh0 + cells that enter mother's circulation - mother does not form antibodies - 300 mg - lasts 12 weeks WIKI: take out any fetal RhD-positive erythrocytes which have entered the maternal blood stream from fetal circulation, before the maternal immune system can react to them, thus preventing maternal sensitization
56
Travel and pregnancy
can travel up to 32 weeks, don't go to endemic areas of yellow fever or malaria
57
Immunizations for pregnancy
NO LIVE VIRUS VACCINES (MMR, yellow fever, small pox, varicella) SHOULD GET: Hep B, Influenza, TDAP
58
physiologic changes in pregnancy
- increase HR, 10-15 beats higher - increased total blood volume and plasma vol - NO increase in RBC, so everyone will have a physiological anemia of pregnancy - hgb around 11 is totally normal, hgb around 10 need to treat) - Increase in coagulation factors and decrease in protein C and resistance to protein S= -Harder to clot - Increased tidal volume and inspiratory capacity, not much change in TOTAL lung capacity
59
Teratogen: ACE inhibitors
renal damage
60
Teratogen: aminoglycoside
CN VIII toxicity
61
Teratogen: DES
vaginal clear cell adenocarcinoma, mullein anomalies
62
Teratogen: Phenytoin
cleft palate, cardiac defects, phalanx/fingernail hypoplasia
63
Teratogen: Warfarin
bone deformities, fetal hemorrhage, ophthalmologic abnormalities
64
Teratogen: Valproate
inhibition of folate absorption, causes NTD
65
Teratogen: vit A
cleft palate, cardiac anomalies
66
What qualifies for labor
contractions AND cervical changes
67
Stage 1: Latent phase
- cervix dilated 0-4 cm -18-24 hrs and 1.2cm/hr for nullpara - 12-16 hours and 1.5 cm/hr for multipara
68
Stage 1: Active phase
-cervix dilated 4-10 cm
69
Stage 2
-complete dilation until delivery of baby (pushing) NULLPARA: 3 hours w/ epidural, 2 hours without MULTIPARA: 2 hours with epidural, 1 hour without
70
Stage 3
-delivery of baby until delivery of placenta NULLPARA AND MULTIPARA BOTH: 30 mins
71
Management for Labor Dystocia (any abnormality with labor)
- Oxytocin augmentation (causes contractions, makes you dilate faster) - Amniotomy (break water) - Fetal rotation - Operative delivery (forceps or vacuum)
72
Effacement of cervix
thinning
73
Dilation of cervix
widening
74
Station of baby
where fetal head is in pelvis (- is high up in pelvis, + is any amount coming out of pelvis)
75
Cardinal movements of baby during birth (8 steps) KNOW!!
1. Head floating, before engagement 2. Engagement; descent, flexion 3. Further descent, internal rotation 4. Complete rotation, beginning extension 5. complete extension 6. Restitution; external rotation 7. Delivery of anterior shoulder 8. Delivery of posterior shoulder
76
OA vs OP position
OA- occiput anterior (baby’s head is down, how baby SHOULD be delivered) OP- occiput posterior
77
Labor monitoring- Tocometer
measures contractions | -intrauterine pressure catheter gives direct measure of contraction force
78
Labor monitoring- Doppler
measures fetal heart tones (FHTS) | -fetal scalp electrode (FSE): attaches to babys scalp for more accurate FHTS
79
Baseline fetal heart tone
110-180
80
Minimal heart tone
81
Moderate heart tone
2-25 bpm
82
Marked heart tone
> 25 bpm
83
Acceleration of fetal heart tone
15 beats above baseline x 15 seconds

CSI- Winter (44 decks)

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