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Review > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Abruptio placentae presentation

A
  • sudden onset vaginal bleeding
  • contracted uterus
  • painful
  • 20% without bleeding (trapped between placenta and uterine wall)
  • severe cases lead to hemorrhage and loss of life.
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2
Q

High risk for abruptio placentae

A
  • HTN
  • preeclampsia
  • cocaine use
  • history of abruptio placentae
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3
Q

Placenta previa complaints

A
  • new onset painless vaginal bleeding

- worsened by intercourse

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4
Q

Placenta previa presentation

A
  • uterus soft and nontender

- if cervix not dilated –> strict bed rest

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5
Q

What is administered if there is cramping with placenta previa

A

IV mag

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6
Q

Placenta previa and vaginal insertion

A

anything in vagina is absolute contraindication

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7
Q

Preeclampsia presentation

A
  • sudden onset of severe recurrent headaches
  • visual abnormalities
  • pitting edema (face, eyes, fingers)
  • sudden rapid weight gain
  • new onset RUQ pain
  • BP >140/90
  • urine protein >+1
  • decrease in urine output (oliguric)
  • N/V –> encephalopathy
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8
Q

Earliest time period that preeclampsia/eclampsia can occur

A

20 weeks

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9
Q

Cure for preeclampsia/eclampsia

A

delivery of baby

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10
Q

HELLP stands for

A

Hemolysis, Elevated Liver Enzymes, Low Platelets

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11
Q

What is HELLP

A

serious but rare complication of preecmplsia/eclampsia

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12
Q

HELLP presentation

A
  • s/sx if preeclampsia with RUQ pain
  • labs: elevated LFTs, elevated bilirubin, elevated LDH
  • low platelets and Hgb/Hct
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13
Q

Which lab value is expected to increase in pregnancy

A
  • alk phos
  • WBCs
  • ESR
  • Total T3
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14
Q

Why is alk phos elevated in pregnancy

A
  • due to growth of fetal bones

- higher in multiple gestation pregnancies

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15
Q

Why are WBC’s elevated in pregnancy

A
  • leukocytosis with neutrophilia normal if without s/sx of infection
  • high throughout pregnancy
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16
Q

When is ESR elevated in pregnancy

A

-elevated by 3rd trimester

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17
Q

Why is total T3 elevated in pregnancy

A
  • increased levels of thyroid binding globulin

- TSH, free T3, free T4 should remain unchanged

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18
Q

Which lab value is expected to decrease in pregnancy

A

-Hgb and Hct

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19
Q

Why is Hgb and Hct low in pregnancy

A
  • hemodilution

- to rule out IDA, check MCV

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20
Q

Where is serum AFP produced

A
  • liver of fetus and mother

- majority of maternal AFP comes from fetus

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21
Q

What does low AFP indicate

A
  • possible DS

- order triple screen or quad screen

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22
Q

What is the triple screen

A
  • AFP
  • hCG
  • estriol
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23
Q

What is the quad screen

A
  • AFP
  • hCG
  • estriol
  • inhibin-A
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24
Q

What does high AFP indicate

A
  • rule out neural tube defects or multiple gestation
  • most common reason is pregnancy dating error
  • Order triple/quad screen and US to r/o NTD
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25
Q

Prevention of NTD

A
  • folic acid 400 mg per day

- take prenatals when planning on getting pregnant

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26
Q

Gold standard for testing genetic disorders

A

fetal chromosomes/DNA

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27
Q

Which genetic disorder is most common among Jewish descent

A
  • Tay-Sachs disease

- no cure

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28
Q

Which genetic disorder is most common among whites

A

cystic fibrosis

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29
Q

Which genetic disorder is most common among AA

A

sickle cell anemia

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30
Q

When can CVS be done

A

10-12 weeks

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31
Q

When can amniocentesis be done

A

15-18 weeks

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32
Q

When is “doubling time” of hCG not used

A

after 12 weeks

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33
Q

Normal hCG levels

A

-hCG doubles every 48 hours during first 12 weeks

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34
Q

Ectopic pregnancy and hCG

A
  • hCG lower than normal

- increases slowly and does not double as expected

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35
Q

Inevitable abortion and hCG

A
  • hCG decreases rapidly, no doubling

- cervix dilates

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36
Q

When is GBS tested

A
  • 35-37 weeks

- swab vaginal introitus and rectum for C&S

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37
Q

What to do if GBS is positive

A
  • intrapartum abx prophylaxis of PCN G 5 million units IV

- followed by 2.5-3 million units IV every 4 hours until delivery

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38
Q

Which STD’s to test for

A
  • HBsAg
  • HIV
  • gonorrhea
  • chlamydia
  • syphilis
  • HSV 1 and 2
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39
Q

Which titers to test for

A
  • rubella

- varicella

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40
Q

Category A drugs

A
  • prenatal vitamins
  • Insulin
  • Thyroid hormone
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41
Q

Category B drugs

A
  • antacids
  • colace (stool softener, laxatives should not be used)
  • analgesics (acetaminophen preferred)
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42
Q

Category B antibiotics

A
  • PCN
  • cephalosporins
  • Macrolides
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43
Q

Safest antidepressant to use with pregnant women

A

-Sertraline (Zoloft)

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44
Q

Antihypertensives for pregnant women

A
  • Methyldopa
  • CCB (Procardia)
  • Labetalol (Normodyne)
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45
Q

Which antibiotics are safe for pregnant women

A
  • Amoxicillin,
  • other PCN
  • cephalopsorins
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46
Q

NSAID’s and pregnancy

A
  • avoid in third trimester; blocks prostaglandins
  • either B or C depending on type of NSAID and which trimester
  • Can cause premature labor
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47
Q

Category D drugs

A
  • ACEI, ARB
  • FQs
  • Tetracyclines
  • NSAIDs
  • Sulfa drugs
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48
Q

Why are ACEI/ARBs contraindicated in pregnancy

A
  • fetal renal abnormalities
  • renal failure
  • hypotension
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49
Q

Why are FQs C/I

A
  • fetal cartilage development

- C/I pregnant, lactating, or <18 years old

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50
Q

Why are tetracyclines C/I

A

-stains growing tooth enamel

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51
Q

Why are sulfa drugs C/I

A
  • risk of hyperbilirubinemia

- displaces bilirubin from albumin

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52
Q

Which vaccines are C/I in pregnancy

A
  • MMR
  • oral polio
  • Varicella
  • FluMist
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53
Q

What to do if patient received live vaccine and wants to become pregnant

A

-advise not to get pregnant in next 4 weeks with MMR or 3 months with varicella and shingles

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54
Q

Is chronic hyperglycemia considered a teratogen

A

Yes

-increases risks of NTD and craniofacial defects

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55
Q

What foods to avoid during pregnancy

A
  • soft cheeses (blue cheese, brie)
  • uncooked meats
  • raw milk
  • raw shellfish or oysters
  • cold cuts, uncooked hot dogs
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56
Q

Are hot tubs okay to use during pregnancy

A

No

-avoid hot tubs, saunas, or excessive heat

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57
Q

Is coffee okay during pregnancy

A
  • 8 oz/day is okay

- do not consume too much – premature labor

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58
Q

Normal weight gain for normal weight patients

A

-total of 25-35 lbs

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59
Q

Weight gain for underweight patients

A

-total 28-40 lbs

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60
Q

Weight gain for obese patients

A

-11-20 lbs

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61
Q

Expected weight loss after delivery

A

-15-20 lbs in first few weeks

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62
Q

Palpation of fetus by HCP

A

positive sign of pregnancy

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63
Q

US and visualization of fetus

A

positive sign of pregnancy

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64
Q

Fetal heart tones auscultated

A

positive sign of pregnancy

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65
Q

What method is used to detect FHT in 10-12 weeks

A

Doppler

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66
Q

What method is used to detect FHT in 20 weeks

A

fetoscope/stethoscope

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67
Q

Goodell’s sign

A

Probable sign

  • cervical softening
  • 4 weeks
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68
Q

Chadwick’s sign

A
  • probably sign
  • blue coloration of cervix and vagina
  • 6-8 weeks
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69
Q

Hegar’s sign

A
  • probable sign
  • softening uterine isthmus
  • 6-8 weeks
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70
Q

Enlarged uterus

A

probably sign

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71
Q

Ballottement

A
  • probable sign

- when fetus is pushed, it can be felt to bounce back by tapping the palpating fingers inside the vagina

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72
Q

Uterine or blood pregnancy tests

A

Probable sign

73
Q

Presumptive signs of pregnancy

A
  • amenorrhea
  • N/V
  • breast changes
  • fatigue
  • urinary frequency
  • slight increase in body temperature
  • quickening: mother feels baby’s movement for the first time (16 weeks)
74
Q

When can quickening begin

A

16 weeks

75
Q

Fundal height at 12 weeks

A

rises above symphysis pubis

76
Q

Fundal height at 16 weeks

A

between symphysis pubis and umbilicus

77
Q

Fundal height at 20 weeks

A

at umbilicus

78
Q

Fundal height between 20-35 weeks

A

-number of weeks +/-2 cm

79
Q

What to do if fundal height not in range

A

order US

80
Q

Heart changes during pregnancy

A
  • shifts anteriorly and toward left
  • rotates toward a transverse position as the uterus enlarges
  • HR increased by 15-20 bpm
  • S3 normal
  • wide S1 split may be heard
  • in 3rd: split S2 may be heard
  • systolic ejection murmur (grade 2-4) over pulmonary and tricuspid is common
  • mammary souffle heard over breasts
  • CO increases by 30-50%
  • SVR reduced
81
Q

Normal heart sounds in pregnancy

A
  • S3
  • Split S1
  • Split S2
  • systolic ejection murmur
  • mammary souffle
82
Q

Preload and afterload

A
  • preload increases

- afterload decreases

83
Q

Blood pressure changes

A
  • decrease and continues to decrease
  • mothers previously HTN may be able to get off meds during pregnancy
  • begins to increase again during 3rd trimester
84
Q

How to avoid orthostatic hypotension

A
  • lay on left lateral position

- pressure on vena cava causes this

85
Q

Coagulation state during pregnancy

A
  • hypercoagulable

- especially after labor

86
Q

Thyroid changes

A

-enlarged

87
Q

GI changes

A
  • decreased peristalsis for progesterone
  • constipation
  • heartburn
88
Q

Skin changes

A
  • linea nigra
  • nipples and areolas darken
  • melasma
  • striae gravidarum
  • telogen effluvium
89
Q

What is telogen effluvium

A

during postpartum period, hair loss may accelerate

-temporary

90
Q

Renal system changes

A
  • kidneys enlarge
  • renal pelvis dilated (physiologic hydronephrosis)
  • GFR higher d/t high CO and renal blood flow
91
Q

ENT changes

A
  • nasal congestion

- epistaxis

92
Q

T/F varicose veins become more severe during pregnancy

A

true

93
Q

Edema and pregnancy

A

-peripheral edema normal

94
Q

Naegele’s rule

A
  • not useful with irregular cycle

- LMP+9 months+7 days

95
Q

Why does cholasma/melasma occur

A

-high estrogen level

96
Q

Gravida

A

number of pregnancies

97
Q

Term

A

number of deliveries after 37 weeks

98
Q

Preterm

A

number of delivers between 20-38 weeks

99
Q

Abortion

A

number of deliveries before 20 weeks

100
Q

Living

A

number of living children

101
Q

Postpartum period

A

right after delivery and up to 6 weeks

102
Q

Sign of atony

A

-soft boggy uterus with heavy vaginal bleeding

103
Q

How long does uterine involution take

A

about 6 weeks

104
Q

Is it normal for postpartum women to have contractiosn

A
  • yes

- especially 2-3 days after delivery

105
Q

Rh-incompabtability disease

A
  • Rh- mom
  • Rh + fetus
  • mom develops antibodies against Rh+ fetus
106
Q

When should RhoGAM be given

A
  • give to ALL Rh- mothers even if they terminate
  • 300 mcg IM at 28 weeks
  • 2nd dose within 72 hours after delivery
107
Q

What happens if RhoGAM is not given

A

-fetal hemolysis and fetal anemia in future pregnancies

108
Q

Coombs test

A
  • detect Rh antibodies in mother (indirect)
  • detect in infant (direct)
  • conducted in early pregnancy
109
Q

How is RhoGAM effective

A
  • decreases risk of isoimmunization of maternal immune system
  • destroys fetal Rh-positive RBCs that have crossed the placenta
110
Q

Can GDM lead to T2DM

A

-yes

111
Q

Risk for GDM

A
  • history of GDM in previous pregnancies
  • obesity
  • Asian, native American, Pacific Islander, AA, Hispanic
  • macrosomic infants (>9 lbs)
  • > 35
112
Q

When should GDM be evaluated

A
  • screen at first visit if hx of GDM or with risk factors

- if not high risk: screen at 24-28 weeks

113
Q

When is GDM typically diagnosed

A

second to third trimster

114
Q

A women with diabetes in first trimester has what

A

T2DM

115
Q

One-step method for diagnosing GDM

A
  • 75 g oral GTT
  • overnight fast of at least 8 hours, test in AM
  • fasting: >92
  • 1 hour: >180
  • 2 hour: >153
  • if any one value is elevated –> GDM
116
Q

Preprandial target

A

<95

117
Q

1 hour postmeal target

A

<140

118
Q

2 hour postmeal target

A

<120

119
Q

A1C goal

A

6-6.5

120
Q

Preferred medication for GDM

A
  • insulin
  • only if unable to control sugars with diet and exercise
  • need to inject 3-6 times per day
  • ACOG endorses use of glyburide or metformin; FDA does not endorse its use
121
Q

GDM follow-up

A

test for GDM 6-12 weeks postpartum and at least every 3 years after

122
Q

UTI and pregnancy

A

-high risk of preterm birth and LBW

123
Q

Does UTI need to have a confirmatory test after treatment during pregnancy

A

YES

-repeat UA and C&S 1 week after completing abx treatment

124
Q

Macrobid and sulfa drugs should be avoided during which trimester

A

3rd

125
Q

Safe antibiotics to give for UTI in pregnancy

A
  • Augmentin
  • Amoxicillin (high resistance, not first choice)
  • Cephalexin
  • Fosfomycin
126
Q

What classification is given for UTI in pregnancy

A

-Complicated UTI

127
Q

Spontaneous abortion

A

miscarriage

-<20 weeks

128
Q

Threatened abortion

A

vaginal bleeding with closed cervix

-most of these will result in an ongoing pregnancy

129
Q

inevitable abortion

A
  • cervix dilated and unable to stop

- will be aborted

130
Q

Complete abortion

A
  • vaginal bleeding with cramping
  • placenta and fetus completely expelled
  • cervical os will close and bleeding stops
131
Q

Incomplete abortion

A
  • vaginal bleeding with cramping
  • products remain in uterus
  • cervical os dilated
  • treat with D&C and antibiotics
132
Q

Classic triad of preeclampsi

A
  • HTN (>140/90)
  • proteinuria (>+1)
  • edema that occurs after 20 weeks and up to 4 weeks postpartum
133
Q

Colostrum

A

day 1-2
-thick yellow breastmilk
contains maternal antibodies

134
Q

Mature breast milk

A

by 3rd to 4th day

-contains fat, sugar, water, protein, antibodies

135
Q

Which babies need vitamin D supplement

A
  • all breastfed infants need vitamin D within first few days

- formula fed only need iron-fortified formulas which contain vitamin D

136
Q

How often do newborns nurse

A

-8-12 times/24 hours

137
Q

What can be used on the nipple to protect it from skin breakdown

A

-lanolin

138
Q

Maternal benefits of breastfeeding

A
  • stimulates uterine contractions
  • increase bonding (oxytocin)
  • speeds up weight loss
  • lowers risk of breast/ovarian cancer
  • delay ovulation if breastfeeding exclusively
139
Q

fetal health benefits of breastfeeding

A
  • lower rate of infection
  • lower rate of asthma and allergies
  • does not need any extra fluids
  • lower risk of SIDs and obesity
140
Q

Sore nipples are common and will typically resolve by when

A

common in 1st week, less pain after 2nd week

141
Q

Common cause of mastitis

A

Staph aureus

142
Q

Prevention of mastitis

A
  • frequent and complete emptying of breast and proper breastfeeding technique
  • breast engorgement and poor technique increases risk
143
Q

Mastitis with low risk of MRSA treatment

A
  • Dicloxacillin 500 mg or cephalexin

- do not use sulfas during newborn period

144
Q

Mastitis with high risk of MRSA

A
  • Bactrim or clindamycin
  • continue to breastfeed on affected side
  • if abscess, order US, I&D may be needed
  • cold compress, Tylenol
145
Q

Newborn complications of chlamydia positive mother

A
  • trachoma (conjunctivitis of newborn)

- PNA

146
Q

When is test-of-cure needed for chlamydia positive mothers

A

after 3 weeks of completed treatment

147
Q

In women who do not breastfeed, when will they typically start to ovulate

A

-39 days postpartum

148
Q

oral contraception for postpartum women

A

-progestin-only pill Micronor

149
Q

other contraceptive options postpartum

A

-IUDs, Nexplanon, Depo-Provera, barrier methods

150
Q

Which hormone is contraindicated postpartum and with breastfeeding

A

-estrogen

151
Q

Folic acid dose to take before pregnancy

A

-0.4 mg daily

152
Q

Folic acid dose to take during pregnancy

A

1 mg daily

153
Q

Nausea in pregnancy treat with

A
  • Diclegis

- Doxyalmine (antihistamine) and Pyridoxine (B6)

154
Q

T/F, urine and blood tests are about equally accurate

A

true

155
Q

Risk factors for ectopic pregnancy

A
  • Previous ectopic pregnancy
  • tubal pathology
  • current IUD use
  • previous cervicitis
  • PID
  • etc.
156
Q

When should pregnant women not go on a plane

A

after 36 weeks

earlier if history of preterm labor

157
Q

Cramping during pregnancy without bleeding

A
  • due to hormonal changes and growing uterus
  • usually normal
  • encourage rest and fluids
158
Q

F/u until 28 weeks

A

every 4 weeks

159
Q

F/u until 29-36 weeks

A

every 2 weeks

160
Q

F/u after 36 weeks

A

every week

161
Q

First trimester

A

0-14 weeks

162
Q

Second trimester

A

14-28 weeks

163
Q

Third trimester

A

after 28 weeks

164
Q

two-step GDM screening

A
  • screening: 50 g nonfasting, check in 1 hour
  • if 140 or more, rule out GDM
  • order 100 g OGTT
  • any 2 indicates GDM
  • fasting: >95
  • 1 hour: >180
  • 2 hour: >155
  • 3 hour: >140
165
Q

Low back ache early in pregnancy may indicate what

A

preterm labor/abortion

166
Q

How often should a healthy fetus move

A

3-5 times per hour

167
Q

Kick counts

A
  • start at 28 weeks
  • lie on left side for 30 minutes after eating
  • record when she feels a kick and at what time
168
Q

PPROM nitrazine testing

A
  • 7-7.7

- vaginal pH more acidic

169
Q

Fern test

A

-fluid swabbed and dried, amniotic fluid appears like a fern

170
Q

Postpartum blues typically resolve by

A

2 weeks

171
Q

Why are COC’s not used during postpartum

A

-milk flow could be compromised by COC

172
Q

When can COC be used after childbirth without other risk factors and is not breastfeeding

A

3 weeks

173
Q

Inhibin A is elevated with

A

DS

174
Q

AFP is low with

A

DS

175
Q

Patient with previous history of births with NTD should take how much folic acid?

A

4 mg at least 1 month before conception and 3 months during gestation

176
Q

Medication used to prevent preeclampsia

A

-low dose ASA

177
Q

High risk for preeclampsia

A
  • history of preeclampsia
  • multifetal gestation
  • renal disease
  • autoimmune disease
  • type 1 or 2 DM
  • chronic HTN
178
Q

Moderate risk for preeclampsia

A
  • nulliparity
  • obesity
  • family history of preeclampsia
  • > 35
  • personal risk factors

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