Pregnancy and Prenatal Care Flashcards
Chadwick sign
Bluish discoloration of the vagina and cervix
Goodell sign
Softening and cyanosis of the cervix at or after 4 weeks
Ladin sign
Softening of the uterus after 6 weeks
Cardiovascular changes in pregnancy
- Increased cardiac output (30-50%)
- (+)SV, followed by (+)HR
- (-)SVR due to elevated progesterone
Pulmonary changes in pregnancy
(+)Tidal volume
(-)Expiratory reserve volume
What facilitates oxygenation and ventilation of the fetus?
(-)PaCO2 (arterial), creating CO2 gradient b/w mother and fetus
Hyperemesis gravidarium (define, 2 features)
- Severe morning sickness
- Weight loss (> 5% pre-pregnancy weight)
- Ketosis
GI changes in pregnancy (3)
- Prolonged gastric emptying (reflux)
- Decreased GE sphincter tone (ptyalism)
- Decreased large bowel motility
Renal changes in pregnancy (3)
- Increased GFR (50%)
- Decreased BUN and creatinine (25%)
- Increased RAAS activation, but normal serum Na
Hematologic changes in pregnancy (3)
- Dilutional anemia
- Elevated levels of fibrinogen, factors VII-X
- Normal clotting and bleeding times
What produces increased estrogen in pregnancy, and from what is it derived?
- Produced primarily by the placenta
- Derived from circulating precursors in plasma from maternal adrenal glands
Effects of Human Placental Lactogen (hPL) (2)
- Lipolysis (increased circulating free FAs)
- Insulin antagonist (diabetogenic, +protein synthesis)
Urine tests in pregnancy (3)
- Glucose
- Protein (preeclamsia)
- Leukocyte esterase
Elevated/decreased maternal serum AFP is associated with:
- Elevated: neural tube defects
- Decreased: aneuploidies (Down syndrome)
Components of the quad screen:
- Estriol
- AFP
- Inhibin A or B
- B-hCG
Treatment offered to patients who are Rh negative
Rho-GAM (good for 12 weeks)
Third-trimester labs (3-5):
- Hematocrit (near nadir)
- RPR/VDRL
- Glucose loading test
- High risk: GC/CT
- Group B strep
Components of the biophysical profile (5):
- Amniotic fluid volume
- Fetal tone
- Fetal activity
- Fetal breathing movement
- Nonstress test (NST)
Risk factors for ectopic pregnancy (6):
- Prior ectopic pregnancy (10% for one, 25% for two)
- History of STIs or PID
- Previous surgery (tubal, pelvic, abdominal)
- Assisted reproduction
- IUD
- Smoking
Causes of vaginal bleeding in the first trimester (5):
- Spontaneous abortion (SAB)
- Postcoital bleeding
- Ectopic pregnancy
- Lesions/lacerations
- Extruded molar pregnancy
Diagnosis for rupture of membranes (3)
- Pool: inspection for fluid
- Nitrazine: alkaline on pH paper
- Fern: microscopy
Bishop score
Five elements of cervical examination
- Dilation
- Effacement
- Fetal station
- Cervical position
- Consistency of the cervix
Methods for induction of labor (4):
- Oxytocin
- Prostaglandins
- Manual dilation of the cervix
- Artificial ROM (amniotomy)
Early decelerations indicative:
Compression of the fetal head during contraction, causing increased vagal tone
Variable decelerations are indicative of:
Umbilical cord compression
Late decelerations indicate:
Uteroplacental insufficiency
Three signs of placental separation:
- Cord lengthening
- Gush of blood
- Uterine fundal rebound
All must be noted prior to delivery of the placenta
Major causes of antepartum hemorrhage (3):
- Placenta previa (20%)
- Placenta abruption (30%)
- Uterine/fetal vessel rupture
- Non-OB: cervical pathology, vaginal lacs, etc.
The greatest risk from having placenta previa is:
Placenta accreta
Sinusoidal pattern on FHM suggests:
Fetal anemia
A succenturiate lobe increases the risk for development of :
Vasa previa
Use of betamethasone in labor:
- Used in conjunction with tocolytics (+48 hrs)
- Decreases incidence of RDS and other preterm complications
Mechanism by which B2 mimetics inhibit contractions:
- Stimulate B2 receptors, causing increased ATP production
- ATP is converted to cAMP, which sequesters Ca
Options for tocolysis (4):
- B2 agonists
- Magnesium
- CCBs
- Prostaglandin inhibitors
How do antibiotics affect the latency period in PPROM?
Extend the latency period. Use ampicillin +/- erythromycin.
Pre-uterine causes of fetal bradycardia (6):
- Seizure
- PE
- Amniotic fluid embolus
- MI
- Respiratory failure
- Epidural or spinal placement
Uteroplacental causes of fetal bradycardia (3):
- Placental abruption
- Uterine tetanic contraction
- Uterine rupture
Post-placental causes of fetal bradycardia:
- Cord prolapse
- Cord compression
- Fetal vessel rupture (e.g. vasa previa)
Risk factors for shoulder dystocia (4):
- Prior shoulder dystocia
- Macrosomia
- Diabetes/obesity
- Post-term pregnancy
Maneuvers for shoulder dystocia (5):
- McRoberts maneuver
- Suprapubic pressure
- Rubin maneuver
- Wood’s corkscrew maneuver
- Delivery of posterior arm/shoulder
McRoberts maneuver:
Sharp flexion of maternal hips
Rubin maneuver
Compression of shoulder towards anterior chest
Common causes of decreased growth potential (4):
- Genetic abnormalities
- Chromosomal (trisomy)
- Teratogens, drugs, radiation
- TORCH infections
Common causes of IUGR (2):
- Maternal (HTN, anemia, CKD, DM)
- Placental (previa, abruption)
Methods for estimating neonatal risk of delivery (4):
- NST
- Oxytocin challenge
- BPP
- Umbilical doppler
Screening for fetal anemia if Rh+
MCA Doppler (anemic fetuses have increased cerebrovascular flow)
