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Women's Health > Pregnancy (Exam #3) > Flashcards

Pregnancy (Exam #3) Flashcards

1
Q

What is opening of the cervical os?

A

Dilation

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2
Q

What is cervical thinning?

A

Effacement

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3
Q

What is the degree of descent of the fetus, and how is this measured?

A

Station

- Head at the level of the ischial spine

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4
Q

What PE exam should be performed to measure membrane status? What three dx tests can also be used, and what does each look for?

A

Speculum Exam

  • Fern Test = fern pattern if rupture
  • Nitrazine test = pH
  • Amniosure = proteins (sensitive but $$$)
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5
Q

What are the four stages of labor?

A
  1. Onset of contractions → full cervical dilation
  2. Delivery of fetus
  3. Delivery of placenta
  4. 2 hours post-delivery of placenta
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6
Q

What are the two phases of Stage 1 of labor?

A
  1. Latent = slow, variable

2. Active = fast, predictable

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7
Q

How long should spontaneous delivery of the placenta take?

A

~30 minutes

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8
Q

Which stage involves delivery of placenta, and what are two possible complications?

A

Stage 3

  • Hemorrhage
  • Placental retention
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9
Q

Which stage of labor involves post-delivery of placenta, and what two populations are most at risk at this time/why?

A

Stage 4

- Major hemodynamic changes = women with CV or pulm. disease more at risk

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10
Q

What is normal “Power” in labor progress?

A

3-5 contractions in 10 minutes averaged over 30 minutes

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11
Q

What is the normal shape of the Anterior Fontanelle? Posterior Fontanelle?

A
  • Anterior = diamond

- Posterior = triangle (upside down)

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12
Q

Which two passageways are most common?

A
  • OP

- LOP

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13
Q

What pelvic shape is best suited for successful vaginal delivery?

A

Gynecoid

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14
Q

What are the two types of decelerations, and what is each due to?

A
  • Early = PHYSIOLOGIC, due to head compression

- Late = due to uteroplacental insufficiency

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15
Q

What is the baseline FHR range? What is the normal variation range?

A

110-160 bpm

- Normal variation = 6-25 bpm

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16
Q

What are the three antepartum tests?

A
  • Fetal kick count
  • Non-Stress Test (NST)
  • BPP
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17
Q

What is a normal fetal kick count?

A

10 kicks in less than 1 hour

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18
Q

What is a normal Non-Stress Test (NST) result?

A

2 accelerations within 30 minutes associated with movement

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19
Q

What four things are measured with a BPP?

A
  • Amniotic Fluid in Deepest Vertical Pocket
  • Fetal movement
  • Fetal tone
  • Fetal breathing
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20
Q

What type of anesthesia is preferred for vaginal delivery? What type for C-section?

A
  • Vaginal = epidural

- C-section = spinal

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21
Q

What is Puerperium?

A

Time from baby/placenta delivery until 6 weeks post-partum

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22
Q

What is the hospitalization stay post-vaginal birth? Post C-Section?

A
  • Vaginal = 1-2 days

- C-section = 2-4 days

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23
Q

Compare Monozygotic twins to Dizygotic twins (3)

A

Mono = identical twins

  • Identical genotype
  • Shared placenta
  • Random occurrence

Di = fraternal twins

  • Separate genotype
  • Separate placentas
  • Genetic predisposition
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24
Q

Are Monozygotic twins or Dizygotic twins more risky? What are three additional risks?

A

Monozygotic

  • Twin-Twin Transfusion
  • Cord entanglements
  • Increased risk of growth restriction and preterm birth
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25
Q

What are the three types of Monozygotic twins? Describe each

A
  • Mono/Mono = one chorion, one amnion
  • Mono/Di = one chorion, two amnions
  • Di/Di = two chorions, two amnions
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26
Q

What is Twin-to-Twin Transfusion? What type of twins is it most common in?

A

Unbalanced transfusion of fluids from one twin to the other

- Mono/Di Monozygotic twins

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27
Q

Where is the most common area for an Ectopic Pregnancy to occur?

A

Fallopian tubes

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28
Q

What two sxs are most commonly seen with an Ectopic Pregnancy?

A
  • Vaginal bleeding (1st trimester)

- Abdominal pain

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29
Q

What are normal Progesterone levels during pregnancy? What level is often seen with an Ectopic Pregnancy?

What other test is positive with an Ectopic Pregnancy?

A

Normal = 20+

- Ectopic = <5; also +hCG

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30
Q

What is the discriminatory zone, and what condition is it associated with?

A

Ectopic Pregnancy

- If hCG is 3500+, normal IUP landmarks are evident on US

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31
Q

What are normal IUP landmarks, and what is it called if you cannot localize the pregnancy?

A
  • Double ring sign at 5 weeks
  • Fetal pole/heart at 5.5-6 weeks

Cannot localize = “pregnancy of unknown location”

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32
Q

When would expectant tx be considered for an Ectopic Pregnancy (2)?

A
  • NO sxs

- Reliable for F/U

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33
Q

What medication can be used to treat an Ectopic Pregnancy, and what tissue is it acting on?

What is the major AE of this medication?

A

MTX acts on actively replicating tissue

- AE = abdominal pain

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34
Q

What are the three tx options for an Ectopic Pregnancy?

A
  • Expectant (serial beta-hCG)
  • MTX
  • Surgery
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35
Q

What two surgeries can be considered for an Ectopic Pregnancy?

A
  • Salpingostomy = fallopian tubes remain in place

- Salpingectomy = fallopian tubes removed (partial or complete)

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36
Q

For what two Ectopic Pregnancy tx does serial hCG levels need to be taken, and to what level?

A

Until non-pregnant level reached (takes 2-4 weeks)

  • MTX
  • Salpingostomy
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37
Q

What condition involves an abnormal proliferation of placental tissue?

A

Gestational Trophoblastic Disease

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38
Q

What are the three types of Gestational Trophoblastic Disease, and which is most common?

A
  • Benign/Non-neoplastic
  • Hydatidiform Moles = most common
  • Gestational Trophoblastic Neoplasia
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39
Q

Which type of Hydatidiform Mole involves paternally derived?

A

Complete Hydatidiform Mole

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40
Q

Which type of Hydatidiform Mole involves paternally AND maternally derived?

A

Partial Hydatidiform Mole

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41
Q

Which type of Hydatidiform Mole involves absence of fetus?

A

Complete Hydatidiform Mole

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42
Q

Which type of Hydatidiform Mole involves presence of fetus?

A

Partial Hydatidiform Mole

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43
Q

Which type of Hydatidiform Mole involves “snow storm” on US? What are hCG levels?

A

Complete Hydatidiform Mole

- Elevated hCG

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44
Q

Which type of Hydatidiform Mole involves “swiss cheese” on US? What are hCG levels?

A

Partial Hydatidiform Mole

- Normal hCG

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45
Q

What is seen on US with an Invasive Mole?

A

Intrauterine mass with increased vascularity

46
Q

What are the two types of Gestational Trophoblastic Neoplasia, and what is the tx for each?

A
  • Choriocarcinoma = MTX

- Placental Site Trophoblastic Tumor = hysterectomy

47
Q

What is the tx for Partial AND Complete Hydatidiform Moles? What should be monitored for future pregnancies (2)?

A

Removal of uterine products

- In future, monitor hCG levels and EARLY US

48
Q

What is the tx for Invasive Moles?

A

MTX

49
Q

What three anti-HTN meds can be used to tx Pre-Eclampsia or Eclampsia?

A
  • IV Labetolol
  • IV Nifedipine
  • IV Hydralazine
50
Q

What three meds/groups of meds should be administered in the tx of Pre-Eclampsia or Eclampsia?

WHY???

A
  • Anti-HTN (Labetolol, Nifedipine, Hydralazine)
  • Magnesium Sulfate for seizure prophylaxis
  • Glucocorticoids for fetal lung maturation
51
Q

What are the two tx for Hyperemesis Gravidarum?

A
  • IVF

- Anti-emetics (Vitamin B6, Doxylamine)

52
Q

What must be given PRIOR to IVF in tx of Hyperemesis Gravidarum, and why?

A

Banana bag prior to prevent Wernicke’s Encephalopathy

53
Q

What is Rh D Alloimmunization, and what two conditions can this lead to in the fetus?

A

Mother is Rh- and Fetus is Rh+

- Can lead to fetal hemolytic anemia or fetal hydrops

54
Q

What does UNSENSITIZED Rh- mean? What is the recommended tx in this case (2)?

A

Ab screen is NEGATIVE for Rh antigen

  • Type/screen at 1st visit AND at 28 weeks
  • Administer RhoGAM to mother at 28 weeks
55
Q

What does SENSITIZED Rh- mean? What is the recommended tx in this case (2)?

A

Ab screen is POSITIVE for Rh antigen

  • Collect titers at 1st visit
  • Collect titers every 4 weeks
56
Q

With SENSITIZED Rh-, what titer value is considered increased risk for fetal hydrops? If this reduces, what is the tx? If it continues, what is the tx?

A

1: 16+ = risk for fetal hydrops
- If <1:16 = expectant tx
- If 1:16+ continues = perform amniocentesis

57
Q

When would an amniocentesis be performed with SENSITIZED Rh-, and what is it checking for?

A

If titer continues to be 1:16+

- Checking fetal blood type

58
Q

If an amniocentesis is performed with SENSITIZED Rh-, what is the recommended tx if fetal blood type is -? What is fetal blood type is +?

A
  • NEG = expectant tx

- POS = screen for fetal anemia using MCA Doppler

59
Q

What is the leading cause of maternal morbidity and mortality in the U.S.?

A

HTN in pregnancy

60
Q

What is chronic HTN in pregnancy?

A

Diagnosis PRIOR to 20 weeks gestation

61
Q

What is Gestational HTN?

A

Diagnosis AFTER 20 weeks gestation with previously normal BP

62
Q

What is Pre-Eclampsia (__ AND __OR__)?

A

Diagnosis AFTER 20 weeks gestation AND…
- Proteinuria
OR
- Thrombocytopenia or renal insufficiency or impaired LFTs or pulmonary edema, or new HA (refractory to tx)

63
Q

What is Eclampsia (__ + __)?

A

Diagnosis of Pre-Eclampsia + seizures (tonic-clonic)

64
Q

What is the recommended tx for Eclampsia?

A

Immediate C-section

65
Q

What is HELLP, and what is the recommended tx?

A

Hemolysis + Elevated LFTs + Low Platelets

- Tx = immediate C-section

66
Q

What condition involves failure to establish utero-placental blood flow?

A

Pre-Eclampsia

67
Q

What is the dx criteria (BP values) for Pre-Eclampsia (__ OR (severe))?

A
  • TWO readings of 140+/90+
    OR
  • Severe = persistent 160+/110+ needing IV anti-HTN meds
68
Q

What are the two tx options for Pre-Eclampsia?

A

NOT severe = OP, monitor weekly
- Deliver at 37 weeks

Severe = IP, IV anti-HTN meds
- Deliver at 34 weeks

69
Q

What is Intrauterine Growth Restriction (IUGR)?

A

EFW <10th percentile

70
Q

What condition involves EFW <10th percentile?

A

Intrauterine Growth Restriction (IUGR)

71
Q

What is the etiology of Intrauterine Growth Restriction (IUGR)?

A

TORCH

  • Toxoplasmosis
  • Other (Syphilis, Varicella)
  • Rubella
  • CMV
  • HSV
72
Q

What is the dx criteria for abnormal Intrauterine Growth Restriction (IUGR)? What should be ordered next?

A

3+ cm off on fundal height measurements

- US/Doppler next

73
Q

What is the recommended delivery time for IUGR with NO complications? For IUGR with other condition? For IUGR with abnormal uterine dopplers?

A
  • IUGR with NO complications = 38-40 weeks
  • IUGR with other condition = 34-38 weeks
  • IUGR with abnormal uterine dopplers = 32-37 weeks
74
Q

What is Gestational DM (GDM)?

A

Insulin resistance due to placental secretion of diabetogenic hormones

75
Q

What are the two recommended screening times for GDM?

A
  • 1st visit

- 24-28 weeks

76
Q

What screening test is used for GDM, and what is a a positive test (2)?

A

1-hour/3-hour glucose tolerance test
- ONE of 200+
OR
- 1-hour = 135+ and 3-hour = 200+

77
Q

What is the 1st line tx for GDM, and why?

A

INSULIN
- Doesn’t cross placenta

Metformin if too expensive or non-compliant

78
Q

What is Pre-Term Labor (PTL)?

A

Contractions after 20 weeks and before 37 weeks

79
Q

What four medications can be used to tx Pre-Term Labor (PTL)?

A
  • Betamethasone
  • Tocolytic drugs
  • Abx
  • Magnesium sulfate
80
Q

What are three examples of Tocolytic drugs used to tx Pre-Term Labor (PTL)?

A
  • Terbutaline
  • Nifedipine
  • Indomethacin
81
Q

What dx test can be used for Pre-Term Labor (PTL)?

A

Fetal Fibronectin (fFN)

82
Q

When can a Fetal Fibronectin (fFN) be used, and what does a positive finding indicate?

A 
AT TERM (35+ weeks)
- If + = at risk for Pre-Term Labor (PTL)
83
Q

What is the leading cause of 3rd trimester bleeding?

A

Placenta Previa

84
Q

What two dx tests can be used for Placenta Previa? What should be avoided?

A

Transabdominal US then Transvaginal US

- NO bimanual/cervical exam

85
Q

When would a C-section be scheduled for Placenta Previa if NO bleeding?

When would an immediate C-section be indicated (2)?

A

NO bleeding = 37-38 weeks

- Immediate C-section if spontaneous labor or hemorrhage

86
Q

What condition involves painless bleeding in the 3rd trimester?

A

Placenta Previa

87
Q

What is a major RF associated with Abruptio Placentae?

A

Abdominal trauma

88
Q

What are the two most common sxs seen with Abruptio Placentae?

A
  • Hemorrhage

- Abdominal pain

89
Q

What sxs is seen with Vasa Previa?

A

Changes in FHR

90
Q

What is the dx used for Vasa Previa?

A

US with color doppler

91
Q

When are steroids given for Vasa Previa? When should C-section be scheduled for?

A
  • Steroids at 28-32 weeks

- C-section at 35 weeks

92
Q

What is a major RF associated with Premature Rupture of Membranes (PROM)?

A

Smoking

93
Q

What is the primary complication associated with Premature Rupture of Membranes (PROM), and when does it become more likely?

A

Chorioamnionitis

- Increased risk if 24+ hours since PROM

94
Q

What is the recommended tx of PROM without Chorioamnionitis? What is the tx of PROM WITH Chorioamnionitis?

A
  • Without = admit for labor induction

- With = PROMPT delivery

95
Q

When does PPROM occur?

A

PROM before 37 weeks gestation

96
Q

When can tx of labor induction occur with PPROM?

A

If 34+ weeks

97
Q

What is Postterm/Prolonged Pregnancy?

A

42+ weeks

98
Q

What are two major complications of Postterm/Prolonged Pregnancy?

A
  • Stillbirth

- Fetal dysmaturity

99
Q

What is the most common cause of Postterm/Prolonged Pregnancy?

A

Inaccurate estimation of gestational age

100
Q

What five tests can be checked to ensure accurate estimation of gestational age (to avoid Postterm/Prolonged Pregnancy)?

A
  • Obtain correct LMP
  • Uterus size
  • Quickening (18-20 weeks if primiparas, 16-18 weeks if multiparas)
  • 20 weeks = fundus is 20 cm above symphysis
  • 1st trimester US
101
Q

What is the recommended tx for Postterm/Prolonged Pregnancy?

A

Induce labor at 41 weeks

102
Q

What is the major MATERNAL risk of VBAC? FETAL risk of VBAC?

A
  • Maternal = uterine rupture

- Fetal = perinatal morbidity/mortality

103
Q

What are the two major malpresentations, and what is the tx for both (2)?

A
  • Breech
  • Transverse Lie

Tx = ECV or C-section (vaginal with Breech too)

104
Q

What can cause Cephalopevlic Disproportion (3)?

A
  • Decreased pelvic size
  • Larger fetus
  • Combination of both
105
Q

What two intrapartum complications are EMERGENT?

A
  • Cord prolapse

- Shoulder dystocia

106
Q

What is the most common cause of Cephalopelvic Disproportion?

A

Mid-pelvis contraction during 2nd stage of labor

107
Q

What is the major finding seen with Fetal Intolerance to Labor?

A

Changes in FHR

108
Q

What two conditions are characterized by changes in FHR?

A
  • Vasa Previa

- Fetal Intolerance to Labor

109
Q

What is the most common cause of Postpartum Hemorrhage (PPH)?

A

Uterine atony

110
Q

What is the dx of Postpartum Hemorrhage (PPH)?

A

Blood loss of 1000+ mL

111
Q

What is PRIMARY Postpartum Hemorrhage (PPH)? What is SECONDARY Postpartum Hemorrhage (PPH)?

A
  • Primary = within first 24 hours post-delivery

- Secondary = 24 hours to 12 weeks post-delivery

Women's Health (2 decks)

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