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ClinMed3/4 > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

1st trimester

A

1-13 weeks

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2
Q

2nd trimester

A

14-27 weeks

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3
Q

3rd trimester

A

28 weeks-birth

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4
Q

when to initiate folic acid supplementation … and how much

A

4 weeks before conception

400 mcg po qday

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5
Q

preterm

A

born between 20-37 weeks gestation

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6
Q

term infant

A

born between 37 and 41 weeks gestation

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7
Q

post-term infant

A

born after 42 weeks gestation

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8
Q

low birth-weight infant

A

live birth infant = 2500g

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9
Q

fetal growth restriction

A

at or below 10th percentile at any gestational age

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10
Q

neonatal period

A

birth through the 28th day of life

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11
Q

perinatal period

A

28 weeks gestation to first 7 days of life

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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

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13
Q

when is nausea common in pregnancy

A

begins as early at 2 weeks gestation –> up until the 13-16th week

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14
Q

when does colostrum secretion begin

A

as early as 16 weeks gestation

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15
Q

hyperemesis gravidarum

A

extreme N/V –> dehydration, weight loss, ketonuria –> may require hospitalization, IVF, antiemetics, TPN

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16
Q

fetal movement in primiparous women can be felt when

A

weeks 18-20

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17
Q

fetal movement in multiparous women can be felt when

A

14 weeks gestation

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18
Q

why is basal body temp elevated during pregnancy

A

progesterone

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19
Q

how much is basal body temp elevated during pregnancy

A

0.5*

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20
Q

chloasma/melasma what and when

A

skin darkening of forehead, bridge of nose, cheek bones

usually occurs after 16 weeks

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21
Q

why linea nigra

A

melanocyte-stimulating hormone increases = darkening of the nipples and lower midline

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22
Q

why striae

A

due to collagen separation

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23
Q

why spider telangiectasia

A

elevated plasma estrogen

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24
Q

pruritic urticarial papules and plaques (PUPPS) what and tx

A

2nd/3rd trimester

tx: topical cortisone

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25
Q

chadwick’s sign

A

blueish tinge to the vagina/cervix

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26
Q

hegar’s sign what and when

A

softening/widening of the cervix

6-8 weeks gestation

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27
Q

when can you start to appreciate abdominal enlargement

when can the fetus be palpated

A

18 weeks

fetus palpated at 22 weeks

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28
Q

when do Braxton hick’s contractions begin

A

28 weeks gestation and increase in regularity

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29
Q

how early is B-hcg detected

A

8-11 days after fertilization (right before menstruation)

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30
Q

when do B-hcg levels peak

A

~10 weeks gestation

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31
Q

fetal heart tones can be detected with doppler ultrasound when

A

after 10 weeks gestation

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32
Q

fetal heart tones can be detected by fetoscope when

A

after 18-20 weeks gestation

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33
Q

normal fetal HR

A

110-160

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34
Q

Naegele’s rule to determine estimated date of delivery

A

(date of LNMP - 3 months) + 7
or 280 days from LNMP
typically just use online calculator

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35
Q

how to dx early pregnancy loss

A

US

bhcg if US equivocal

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36
Q

how to dx late pregnancy loss

A

typically identified by mother via lack of fetal movement

if fetal heart tones absent –> confirm with US

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37
Q

increase in plasma volume during pregnancy

A

50%

causes a drop in hematocrit

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38
Q

cardiac output and stroke volume increases

A

CO increases 40%

SV increases 25-30%

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39
Q

blood pressure changes during pregnancy

A

declines - lowest BP at 24-28 weeks (end of 2nd tri)

back to normal by 36 weeks

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40
Q

PVR during pregnancy

A

decreases most during 1st trimester = varicosity development

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41
Q

heart murmurs in pregnancy

A

systolic ejection murmurs
S3 heart sounds common
wide splitting of S1 and splitting of S2 in 3rd trimester

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42
Q

changes to pulmonary system during pregnancy (diaphragm, tidal volume, minute ventilation)

A

diaphragm elevation
increased tidal volume
increased resting minute ventilation and respiratory drive

43
Q

renal system changes during pregnancy

A

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
Q

Ptyalism

A

excessive salivation

“water thrush”

45
Q

when is reflux the most common

A

1st > 2nd > 3rd

46
Q

when are hemorrhoids the most common

A

3rd trimester

47
Q

white blood cell count changes in pregnancy

A

leukocyte count increases (5,000-12,000)

48
Q

clotting factors that increase in pregnancy

A

fibrinogen and factor VIII

causes an increased risk of VTE and hemorrhage

49
Q

what type of analgesic is safe to use in pregnancy

A

APAP! (do not use ibuprofen)

50
Q

uncomplicated pregnancy schedule

A

initial - 6-10 weeks gestation
Q4 weeks - 0-32 weeks gestation
Q2 weeks - 32-36 weeks gestation
Qweek - after 36 weeks

51
Q

primigravida

A

first time pregnant

52
Q

nulligravida

A

never been pregnant, not pregnant now

53
Q

multigravida

A

2 or more pregnancies

54
Q

nullipara

A

no pregnancy beyond 20 weeks

55
Q

primipara

A

first delivery, first pregnancy > 20 weeks

56
Q

multipara

A

delivered 2 or more pregnancies

57
Q

when should you do a pelvic exam on a pregnant woman

A

first visit then after 36 weeks

unless she had a pelvic in the last year, the first one is not necessary

58
Q

CBC during a pregnancy

A

anemia, leukocytosis, slight thrombocytopenia

59
Q

if Rh(D) is negative and antibody screen is negative at initial visit…what should you do

A

recheck antibody screen at 28 weeks and again at time of delivery

60
Q

treatment of Rh(-) mothers

A

RhoGam to prevent her from forming antibodies against Rh + blood

61
Q

additional blood tests besides HCG, CBC, RH, blood group

A 
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
Q

when should you consider screening for DM in pregnant women

A

risk factors or hx of gestational DM
fasting >/= 126
HbA1c >/= 6.5%
random plasma glucose >/= 200

63
Q

when should patients be offered genetic screening

A

before 20 weeks gestation

64
Q

what to assess at subsequent pregnancy office visits

A 
maternal weight gain 
blood pressure
uterine fundal height 
fetal heart tones 
edema 
fetal size/position
labs
pelvic exam (at 36 weeks)
65
Q

ACOG recommendation for maternal weight gain

A

25-35 lbs - 2-4 lbs per visit

underweight should gain more, overweight should gain less

66
Q

how often should fundal heights be measured

A

at every visit after 20 weeks

67
Q

fundal height at 8 weeks

A

uterus palpated at pubic symphysis

68
Q

fundal height at 16 weeks

A

uterus at midpoint between pubic symphysis and umbilicus

69
Q

fundal height at 20 weeks

A

uterus is at umbilicus

70
Q

fetal heart tones can be auscultated when with doppler

A

10-12 weeks

71
Q

when should fetal size and position be manually assessed

A

after 26 weeks

72
Q

how to screen for gestational diabetes (and when)

A

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
Q

when to test for GBS

A

35-37 weeks

74
Q

if positive GBS culture … tx?

A

penicillin at time of labor

75
Q

things to assess in cervical exam (after 36 weeks)

A

cervical consistency, effacement, diatation, station

76
Q

1st trimester aneuploidy screening options

A

maternal cell-free fetal DNA test

combined test: US + biochemical markers

77
Q

maternal cell-free fetal DNA test

A

assessment of cell-free DNA in maternal circulation for trisomy 21, 18, 13
done as early as 10 weeks gestation

78
Q

combined genetic testing

A

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
Q

2nd trimester genetic screening options

A

quad screen

80
Q

when can you do quad screen

A

between 15-18 weeks

81
Q

what does quad screen test for

A

neural tube defects and aneuploidy

82
Q

what is included in quad screen

A

serum B-hcg
unconjugated estriol
AFP
inhibin A

83
Q

high levels of AFP concerning for…?

A

neural tube defects

84
Q

low levels of AFP concerning for…?

A

trisomy

85
Q

chorionic villi sampling

A

more invasive than amniocentesis
10-13 weeks gestation
detection for chromosomal abnormalities

86
Q

amniocentesis

A

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
Q

mainstay of imaging in obstetrics

A

ultrasound

typically 2D

88
Q

use of an MRI in pregnancy

A

abnormal neuroanatomy

delivery planning in 3rd tri

89
Q

how to assess amniotic fluid volume

A

US typically in 2nd and 3rd trimesters

90
Q

polyhydramnios (what, risks, when to suspect, most common etiology)

A

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
Q

oligohydramnios (what, etiology, prognosis)

A

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
Q

1st trimester US exam

A

viability US - confirmed with heart beat

93
Q

Anatomy US

A

done after 18 weeks if doing single anatomy screen

if doing two: 1st at 14-16 weeks, 2nd after 20 weeks

94
Q

growth US

A

identify fetal growth abnormalities (fundal height < expected, multiple gestations, complications associated with fetal growth restrictions)

95
Q

evaluation of fetal well-being

A

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
Q

reactive nonstress test

A

> /= accelerations of 15 seconds in a 20 minute period

97
Q

non-reactive nonstress test

A

reactive criteria not met within 30 minutes

98
Q

placental location US

A

during the 2nd trimester anatomy US or 3rd trimester during growth US

99
Q

Greatest effect of a drug on the fetus is during

A

weeks 2-10 after LNMP (organogenesis)

100
Q

when to give live vaccines

A

3 months before pregnancy or post-partum

101
Q

when should pregnant women receive Tdap vaccine

A

27-36 weeks

102
Q

how many calories should they add during pregnancy

A

300kcal/day

103
Q

how many calories should they add during breastfeeding?

A

500kcal/day

ClinMed3/4 (4 decks)

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