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CSI- Winter > Pregnancy > Flashcards

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
Q

Second trimester

A

12-28 weeks

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26
Q

Third trimester

A

28-42 weeks

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27
Q

Fetal “viability”

A

24 weeks (if baby delivers at this gestation, baby can probably be resuscitated and live, will probably have disabilities)

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28
Q

Due date is

A

40 weeks

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29
Q

Full term is

A

37 weeks (delivery without complications to the baby)

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30
Q

Late preterm

A

34-36 weeks

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31
Q

Early term

A

37-38 weeks

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32
Q

Late term

A

41 weeks

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33
Q

Post term

A

42 weeks or more

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34
Q

Initial lab test for prenatal assessment

A
  • 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
Q

Optional labs for prenatal assessment

A
  • 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
Q

Test that becoming more popular

A

-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
Q

Timeline of prenatal visits

A
  1. every 4 weeks until 28 weeks
  2. every 2 weeks until 36 weeks
  3. every week until delivery
38
Q

What gets checked at every single prenatal visit?

A

weight, BP, fundal height, FHTS (fetal heart tones/sounds), urine protein and glucose

39
Q

What gets checked at 6-12 weeks?

A

confirm delivery date, CVS (chorionic villus sampling)

40
Q

What gets checked at 12 weeks?

A

First trimester screening (nucal translucency test)

41
Q

What gets checked at 16-20 weeks?

A
  • AFP or Quad screen

- Amniocentesis

42
Q

What gets checked at 20 weeks?

A
  • Fetal anatomy ultrasound (look at entire anatomy- can tell gender)
  • Cervical length
43
Q

What gets checked at 24-28 weeks?

A

gestational diabetes screen

44
Q

What gets checked at 28 weeks?

A
  • Rh0 D immune globulin (if Rh-)

- Tdap (all pregnancy people get this, gives baby immunity to pertussis)

45
Q

What gets checked at 35-36 weeks?

A

GBS screening

46
Q

What gets checked at 41 weeks?

A

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
Q

Diet for pregnant moms

A
  1. Folic acid: 0.4mg/day (protects against spinal/neuro defects)
  2. Caffeine: 200-300mg/day (1 cup)
48
Q

Foods to avoid?

A
  • 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
Q

WEIGHT GAIN DURING PREGNANCY (test)

A

BMI 30: 11-20 lbs

50
Q

Alcohol during pregnancy can cause

A

fetal alcohol syndrome (growth restrictions, facial, skeletal and cardiac abnormalities, CNS problems)

51
Q

Cig smoking during pregnancy can cause

A

placental abruption, placenta previa, PROM, preterm delivery (PTD), low birth weight

52
Q

Drug use during pregnancy

A
  1. Cocaine: PROM, PTD, IGUR, neurobehavioral deficits, SIDS
  2. Amphetamines: same
  3. Opioids: IUGR, PTD, fetal death
53
Q

What to avoid during pregnancy

A

-excessive radiation, excessive heat (hot tubs/saunas), radiation or chemical hazards, cat litter/feces

Heat= neural tube defects
Cat litter- toxoplasmosis

54
Q

Rhesus alloimmunization

A
  • 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
Q

Rh0 immune globulin is

A

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
Q

Travel and pregnancy

A

can travel up to 32 weeks, don’t go to endemic areas of yellow fever or malaria

57
Q

Immunizations for pregnancy

A

NO LIVE VIRUS VACCINES (MMR, yellow fever, small pox, varicella)

SHOULD GET: Hep B, Influenza, TDAP

58
Q

physiologic changes in pregnancy

A
  • 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
Q

Teratogen: ACE inhibitors

A

renal damage

60
Q

Teratogen: aminoglycoside

A

CN VIII toxicity

61
Q

Teratogen: DES

A

vaginal clear cell adenocarcinoma, mullein anomalies

62
Q

Teratogen: Phenytoin

A

cleft palate, cardiac defects, phalanx/fingernail hypoplasia

63
Q

Teratogen: Warfarin

A

bone deformities, fetal hemorrhage, ophthalmologic abnormalities

64
Q

Teratogen: Valproate

A

inhibition of folate absorption, causes NTD

65
Q

Teratogen: vit A

A

cleft palate, cardiac anomalies

66
Q

What qualifies for labor

A

contractions AND cervical changes

67
Q

Stage 1: Latent phase

A
  • 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
Q

Stage 1: Active phase

A

-cervix dilated 4-10 cm

69
Q

Stage 2

A

-complete dilation until delivery of baby (pushing)

NULLPARA: 3 hours w/ epidural, 2 hours without

MULTIPARA: 2 hours with epidural, 1 hour without

70
Q

Stage 3

A

-delivery of baby until delivery of placenta

NULLPARA AND MULTIPARA BOTH:
30 mins

71
Q

Management for Labor Dystocia (any abnormality with labor)

A
  • Oxytocin augmentation (causes contractions, makes you dilate faster)
  • Amniotomy (break water)
  • Fetal rotation
  • Operative delivery (forceps or vacuum)
72
Q

Effacement of cervix

A

thinning

73
Q

Dilation of cervix

A

widening

74
Q

Station of baby

A

where fetal head is in pelvis (- is high up in pelvis, + is any amount coming out of pelvis)

75
Q

Cardinal movements of baby during birth (8 steps)

KNOW!!

A
  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
Q

OA vs OP position

A

OA- occiput anterior (baby’s head is down, how baby SHOULD be delivered)
OP- occiput posterior

77
Q

Labor monitoring- Tocometer

A

measures contractions

-intrauterine pressure catheter gives direct measure of contraction force

78
Q

Labor monitoring- Doppler

A

measures fetal heart tones (FHTS)

-fetal scalp electrode (FSE): attaches to babys scalp for more accurate FHTS

79
Q

Baseline fetal heart tone

A

110-180

80
Q

Minimal heart tone

A
81
Q

Moderate heart tone

A

2-25 bpm

82
Q

Marked heart tone

A

> 25 bpm

83
Q

Acceleration of fetal heart tone

A

15 beats above baseline x 15 seconds

CSI- Winter (44 decks)

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