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Ob/Gyn > Pregnancy and Prenatal Care > Flashcards

Pregnancy and Prenatal Care Flashcards

1
Q

Chadwick sign

A

Bluish discoloration of the vagina and cervix

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2
Q

Goodell sign

A

Softening and cyanosis of the cervix at or after 4 weeks

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3
Q

Ladin sign

A

Softening of the uterus after 6 weeks

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4
Q

Cardiovascular changes in pregnancy

A
  • Increased cardiac output (30-50%)
  • (+)SV, followed by (+)HR
  • (-)SVR due to elevated progesterone
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5
Q

Pulmonary changes in pregnancy

A

(+)Tidal volume

(-)Expiratory reserve volume

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6
Q

What facilitates oxygenation and ventilation of the fetus?

A

(-)PaCO2 (arterial), creating CO2 gradient b/w mother and fetus

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7
Q

Hyperemesis gravidarium (define, 2 features)

A
  • Severe morning sickness
  • Weight loss (> 5% pre-pregnancy weight)
  • Ketosis
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8
Q

GI changes in pregnancy (3)

A
  • Prolonged gastric emptying (reflux)
  • Decreased GE sphincter tone (ptyalism)
  • Decreased large bowel motility
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9
Q

Renal changes in pregnancy (3)

A
  • Increased GFR (50%)
  • Decreased BUN and creatinine (25%)
  • Increased RAAS activation, but normal serum Na
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10
Q

Hematologic changes in pregnancy (3)

A
  • Dilutional anemia
  • Elevated levels of fibrinogen, factors VII-X
  • Normal clotting and bleeding times
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11
Q

What produces increased estrogen in pregnancy, and from what is it derived?

A
  • Produced primarily by the placenta

- Derived from circulating precursors in plasma from maternal adrenal glands

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12
Q

Effects of Human Placental Lactogen (hPL) (2)

A
  • Lipolysis (increased circulating free FAs)

- Insulin antagonist (diabetogenic, +protein synthesis)

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13
Q

Urine tests in pregnancy (3)

A
  • Glucose
  • Protein (preeclamsia)
  • Leukocyte esterase
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14
Q

Elevated/decreased maternal serum AFP is associated with:

A
  • Elevated: neural tube defects

- Decreased: aneuploidies (Down syndrome)

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15
Q

Components of the quad screen:

A
  • Estriol
  • AFP
  • Inhibin A or B
  • B-hCG
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16
Q

Treatment offered to patients who are Rh negative

A

Rho-GAM (good for 12 weeks)

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17
Q

Third-trimester labs (3-5):

A
  • Hematocrit (near nadir)
  • RPR/VDRL
  • Glucose loading test
  • High risk: GC/CT
  • Group B strep
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18
Q

Components of the biophysical profile (5):

A
  • Amniotic fluid volume
  • Fetal tone
  • Fetal activity
  • Fetal breathing movement
  • Nonstress test (NST)
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19
Q

Risk factors for ectopic pregnancy (6):

A
  • Prior ectopic pregnancy (10% for one, 25% for two)
  • History of STIs or PID
  • Previous surgery (tubal, pelvic, abdominal)
  • Assisted reproduction
  • IUD
  • Smoking
20
Q

Causes of vaginal bleeding in the first trimester (5):

A
  • Spontaneous abortion (SAB)
  • Postcoital bleeding
  • Ectopic pregnancy
  • Lesions/lacerations
  • Extruded molar pregnancy
21
Q

Diagnosis for rupture of membranes (3)

A
  • Pool: inspection for fluid
  • Nitrazine: alkaline on pH paper
  • Fern: microscopy
22
Q

Bishop score

A

Five elements of cervical examination

  • Dilation
  • Effacement
  • Fetal station
  • Cervical position
  • Consistency of the cervix
23
Q

Methods for induction of labor (4):

A
  • Oxytocin
  • Prostaglandins
  • Manual dilation of the cervix
  • Artificial ROM (amniotomy)
24
Q

Early decelerations indicative:

A

Compression of the fetal head during contraction, causing increased vagal tone

25
Q

Variable decelerations are indicative of:

A

Umbilical cord compression

26
Q

Late decelerations indicate:

A

Uteroplacental insufficiency

27
Q

Three signs of placental separation:

A
  1. Cord lengthening
  2. Gush of blood
  3. Uterine fundal rebound
    All must be noted prior to delivery of the placenta
28
Q

Major causes of antepartum hemorrhage (3):

A
  • Placenta previa (20%)
  • Placenta abruption (30%)
  • Uterine/fetal vessel rupture
  • Non-OB: cervical pathology, vaginal lacs, etc.
29
Q

The greatest risk from having placenta previa is:

A

Placenta accreta

30
Q

Sinusoidal pattern on FHM suggests:

A

Fetal anemia

31
Q

A succenturiate lobe increases the risk for development of :

A

Vasa previa

32
Q

Use of betamethasone in labor:

A
  • Used in conjunction with tocolytics (+48 hrs)

- Decreases incidence of RDS and other preterm complications

33
Q

Mechanism by which B2 mimetics inhibit contractions:

A
  • Stimulate B2 receptors, causing increased ATP production

- ATP is converted to cAMP, which sequesters Ca

34
Q

Options for tocolysis (4):

A
  • B2 agonists
  • Magnesium
  • CCBs
  • Prostaglandin inhibitors
35
Q

How do antibiotics affect the latency period in PPROM?

A

Extend the latency period. Use ampicillin +/- erythromycin.

36
Q

Pre-uterine causes of fetal bradycardia (6):

A
  • Seizure
  • PE
  • Amniotic fluid embolus
  • MI
  • Respiratory failure
  • Epidural or spinal placement
37
Q

Uteroplacental causes of fetal bradycardia (3):

A
  • Placental abruption
  • Uterine tetanic contraction
  • Uterine rupture
38
Q

Post-placental causes of fetal bradycardia:

A
  • Cord prolapse
  • Cord compression
  • Fetal vessel rupture (e.g. vasa previa)
39
Q

Risk factors for shoulder dystocia (4):

A
  • Prior shoulder dystocia
  • Macrosomia
  • Diabetes/obesity
  • Post-term pregnancy
40
Q

Maneuvers for shoulder dystocia (5):

A
  • McRoberts maneuver
  • Suprapubic pressure
  • Rubin maneuver
  • Wood’s corkscrew maneuver
  • Delivery of posterior arm/shoulder
41
Q

McRoberts maneuver:

A

Sharp flexion of maternal hips

42
Q

Rubin maneuver

A

Compression of shoulder towards anterior chest

43
Q

Common causes of decreased growth potential (4):

A
  • Genetic abnormalities
  • Chromosomal (trisomy)
  • Teratogens, drugs, radiation
  • TORCH infections
44
Q

Common causes of IUGR (2):

A
  • Maternal (HTN, anemia, CKD, DM)

- Placental (previa, abruption)

45
Q

Methods for estimating neonatal risk of delivery (4):

A
  • NST
  • Oxytocin challenge
  • BPP
  • Umbilical doppler
46
Q

Screening for fetal anemia if Rh+

A

MCA Doppler (anemic fetuses have increased cerebrovascular flow)

Ob/Gyn (13 decks)

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