Pregnancy Flashcards
1
Q
1st trimester
A
1-13 weeks
2
Q
2nd trimester
A
14-27 weeks
3
Q
3rd trimester
A
28 weeks-birth
4
Q
when to initiate folic acid supplementation … and how much
A
4 weeks before conception
400 mcg po qday
5
Q
preterm
A
born between 20-37 weeks gestation
6
Q
term infant
A
born between 37 and 41 weeks gestation
7
Q
post-term infant
A
born after 42 weeks gestation
8
Q
low birth-weight infant
A
live birth infant = 2500g
9
Q
fetal growth restriction
A
at or below 10th percentile at any gestational age
10
Q
neonatal period
A
birth through the 28th day of life
11
Q
perinatal period
A
28 weeks gestation to first 7 days of life
12
Q
how long should mom + dad wait to conceive after being exposed to zika
A
mom - 8 weeks to attempt pregnancy
dad - 6 weeks
13
Q
when is nausea common in pregnancy
A
begins as early at 2 weeks gestation –> up until the 13-16th week
14
Q
when does colostrum secretion begin
A
as early as 16 weeks gestation
15
Q
hyperemesis gravidarum
A
extreme N/V –> dehydration, weight loss, ketonuria –> may require hospitalization, IVF, antiemetics, TPN
16
Q
fetal movement in primiparous women can be felt when
A
weeks 18-20
17
Q
fetal movement in multiparous women can be felt when
A
14 weeks gestation
18
Q
why is basal body temp elevated during pregnancy
A
progesterone
19
Q
how much is basal body temp elevated during pregnancy
A
0.5*
20
Q
chloasma/melasma what and when
A
skin darkening of forehead, bridge of nose, cheek bones
usually occurs after 16 weeks
21
Q
why linea nigra
A
melanocyte-stimulating hormone increases = darkening of the nipples and lower midline
22
Q
why striae
A
due to collagen separation
23
Q
why spider telangiectasia
A
elevated plasma estrogen
24
Q
pruritic urticarial papules and plaques (PUPPS) what and tx
A
2nd/3rd trimester
tx: topical cortisone
25
chadwick's sign
blueish tinge to the vagina/cervix
26
hegar's sign what and when
softening/widening of the cervix
| 6-8 weeks gestation
27
when can you start to appreciate abdominal enlargement
| when can the fetus be palpated
18 weeks
| fetus palpated at 22 weeks
28
when do Braxton hick's contractions begin
28 weeks gestation and increase in regularity
29
how early is B-hcg detected
8-11 days after fertilization (right before menstruation)
30
when do B-hcg levels peak
~10 weeks gestation
31
fetal heart tones can be detected with *doppler ultrasound* when
after 10 weeks gestation
32
fetal heart tones can be detected by fetoscope when
after 18-20 weeks gestation
33
normal fetal HR
110-160
34
Naegele's rule to determine estimated date of delivery
(date of LNMP - 3 months) + 7
or 280 days from LNMP
typically just use online calculator
35
how to dx early pregnancy loss
US
| bhcg if US equivocal
36
how to dx late pregnancy loss
typically identified by mother via lack of fetal movement
| if fetal heart tones absent --> confirm with US
37
increase in plasma volume during pregnancy
50%
| causes a drop in hematocrit
38
cardiac output and stroke volume increases
CO increases 40%
| SV increases 25-30%
39
blood pressure changes during pregnancy
declines - lowest BP at 24-28 weeks (end of 2nd tri)
| back to normal by 36 weeks
40
PVR during pregnancy
decreases most during 1st trimester = varicosity development
41
heart murmurs in pregnancy
systolic ejection murmurs
S3 heart sounds common
wide splitting of S1 and splitting of S2 in 3rd trimester
42
changes to pulmonary system during pregnancy (diaphragm, tidal volume, minute ventilation)
diaphragm elevation
increased tidal volume
increased resting minute ventilation and respiratory drive
43
renal system changes during pregnancy
length of kidneys increase, dilation of renal calyces, pelvices, ureters
increase in renal plasma flow, increase in GFR, decrease in Cr, mild proteinuria
bladder displaced
*dysuria/hematuria is always abnormal - treat it!*
44
Ptyalism
excessive salivation
| "water thrush"
45
when is reflux the most common
1st > 2nd > 3rd
46
when are hemorrhoids the most common
3rd trimester
47
white blood cell count changes in pregnancy
leukocyte count increases (5,000-12,000)
48
clotting factors that increase in pregnancy
fibrinogen and factor VIII
| causes an increased risk of VTE and hemorrhage
49
what type of analgesic is safe to use in pregnancy
APAP! (do not use ibuprofen)
50
uncomplicated pregnancy schedule
initial - 6-10 weeks gestation
Q4 weeks - 0-32 weeks gestation
Q2 weeks - 32-36 weeks gestation
Qweek - after 36 weeks
51
primigravida
first time pregnant
52
nulligravida
never been pregnant, not pregnant now
53
multigravida
2 or more pregnancies
54
nullipara
no pregnancy beyond 20 weeks
55
primipara
first delivery, first pregnancy > 20 weeks
56
multipara
delivered 2 or more pregnancies
57
when should you do a pelvic exam on a pregnant woman
first visit then after 36 weeks
| unless she had a pelvic in the last year, the first one is not necessary
58
CBC during a pregnancy
anemia, leukocytosis, slight thrombocytopenia
59
if Rh(D) is negative and antibody screen is negative at initial visit...what should you do
recheck antibody screen at 28 weeks and again at time of delivery
60
treatment of Rh(-) mothers
RhoGam to prevent her from forming antibodies against Rh + blood
61
additional blood tests besides HCG, CBC, RH, blood group
```
varicella, rubella (if immunity is unknown)
VDRL/RPR for syphilis
HBsAg
HIV test
NAAT for chlamydia
glucose challenge test - with hx of gestational DM
selective - TSH?
other infections
genetic screening
UA/culture
```
62
when should you consider screening for DM in pregnant women
risk factors or hx of gestational DM
fasting >/= 126
HbA1c >/= 6.5%
random plasma glucose >/= 200
63
when should patients be offered genetic screening
before 20 weeks gestation
64
what to assess at subsequent pregnancy office visits
```
maternal weight gain
blood pressure
uterine fundal height
fetal heart tones
edema
fetal size/position
labs
pelvic exam (at 36 weeks)
```
65
ACOG recommendation for maternal weight gain
25-35 lbs - 2-4 lbs per visit
| underweight should gain more, overweight should gain less
66
how often should fundal heights be measured
at every visit after 20 weeks
67
fundal height at 8 weeks
uterus palpated at pubic symphysis
68
fundal height at 16 weeks
uterus at midpoint between pubic symphysis and umbilicus
69
fundal height at 20 weeks
uterus is at umbilicus
70
fetal heart tones can be auscultated when with doppler
10-12 weeks
71
when should fetal size and position be manually assessed
after 26 weeks
72
how to screen for gestational diabetes (and when)
at 24-28 weeks - 1 hr glucose test after 50g glucose load
abnormal >130
if abnormal --> 3-hr glucose test (100g glucose after fasting glucose is checked, then checked at 1, 2, 3 hours)
73
when to test for GBS
35-37 weeks
74
if positive GBS culture … tx?
penicillin at time of labor
75
things to assess in cervical exam (after 36 weeks)
cervical consistency, effacement, diatation, station
76
1st trimester aneuploidy screening options
maternal cell-free fetal DNA test
| combined test: US + biochemical markers
77
maternal cell-free fetal DNA test
assessment of cell-free DNA in maternal circulation for trisomy 21, 18, 13
done as early as 10 weeks gestation
78
combined genetic testing
US - increased fluid indicative of possible abnormality
biochemical markers - pregnancy-associated plasma protein A (PAPP-A) and B-hcg
performed at 11-14 weeks
79
2nd trimester genetic screening options
quad screen
80
when can you do quad screen
between 15-18 weeks
81
what does quad screen test for
neural tube defects and aneuploidy
82
what is included in quad screen
serum B-hcg
unconjugated estriol
AFP
inhibin A
83
high levels of AFP concerning for...?
neural tube defects
84
low levels of AFP concerning for...?
trisomy
85
chorionic villi sampling
more invasive than amniocentesis
10-13 weeks gestation
detection for chromosomal abnormalities
86
amniocentesis
usually used for confirmation of a positive screen in 1st/2nd trimesters
performed at 15-20 weeks
US-guided needle aspiration of amniotic fluid for direct assessment of AFP
87
mainstay of imaging in obstetrics
ultrasound
| typically 2D
88
use of an MRI in pregnancy
abnormal neuroanatomy
| delivery planning in 3rd tri
89
how to assess amniotic fluid volume
US typically in 2nd and 3rd trimesters
90
polyhydramnios (what, risks, when to suspect, most common etiology)
excessive volume of amniotic fluid
risks: preterm birth, placental abruption, fetal anomalies
suspected when fundal height is out of proportion
most common cause: fetal structural anomaly/anomalies
91
oligohydramnios (what, etiology, prognosis)
less than expected amniotic fluid
caused by a decrease in fetal urine production or increase in swallowing
many causes
poor prognosis if in 1st trimester
92
1st trimester US exam
viability US - confirmed with heart beat
93
Anatomy US
done after 18 weeks if doing single anatomy screen
| if doing two: 1st at 14-16 weeks, 2nd after 20 weeks
94
growth US
identify fetal growth abnormalities (fundal height < expected, multiple gestations, complications associated with fetal growth restrictions)
95
evaluation of fetal well-being
during 3rd trimester when pregnancy at-risk or evidence of fetal distress
4 US parameters + nonstress test = points to assess risk of fetal hypoxia or intrauterine death
96
reactive nonstress test
>/= accelerations of 15 seconds in a 20 minute period
97
non-reactive nonstress test
reactive criteria not met within 30 minutes
98
placental location US
during the 2nd trimester anatomy US or 3rd trimester during growth US
99
Greatest effect of a drug on the fetus is during
weeks 2-10 after LNMP (organogenesis)
100
when to give live vaccines
3 months before pregnancy or post-partum
101
when should pregnant women receive Tdap vaccine
27-36 weeks
102
how many calories should they add during pregnancy
300kcal/day
103
how many calories should they add during breastfeeding?
500kcal/day
