Pregnancy phases

Question 1

contraindications to exercising during pregnancy

Answer 1

• amniotic fluid leak
• cervical incompetence
• multiple gestation
• placenta abruption or previa
• premature labor
• preeclampsia/ gHTN
• severe heart or lung disease

Question 2

unsafe exercise in pregnancy

Answer 2

• contact sports
• high fall risk activities –> skiing, gymnastics, horseback riding
• hot yoga

Question 3

category I fetal heart rate

Answer 3

baseline 110-160

moderate variability (6-25)

no late or variable decels

+/- early decelerations and accelerations

Question 4

category III fetal heart rate

Answer 4

absent variability + recurrent late decels

absent variability + recurrent variable decels

absent variability + bradycardia

sinusoidal pattern

causes
-fetal anemia

Question 5

management of category III fetal heart rate

Answer 5

increased risk for fetal hypoxia

intrauterine resuscitative interventions

• oxygen administration
• IVF
• discontinuing utertonics
• may require C section

Question 6

glucose phys during pregnancy

Answer 6

pancreatic beta cell hyperplasia

increased insulin secretion

increased insulin resistance

caused by human placental lactogen

Question 7

Renal changes in preganancy

Answer 7

• Increased GFR
• decreased BUN
• decreased Cr
• increased urinary frequency
• mild hyponatremia

caused by

• increased CO due to progesterone
• increased ADH release

Question 8

heme changes in pregnancy

Answer 8

-dilutional anemia due to increased plasma volume and RBCs

• prothrombotic state
• decreased protein S activity
• increased fibrinogen and coagulation factors

Question 9

CV changes in preganancy

Answer 9

• increased CO and HR
• increased blood volume
• decreased SVR

Question 10

pulmonary changes in pregnancy

Answer 10

• chronic resp alkalosis
• metabolic compensation (increased O2, decreased CO2)
• progesterone stimulates central resp centers
• increases tidal volume and minute ventilation

Question 11

initial prenatal visit

Answer 11

• Rh(D) type and antibody screen
• hg/hct, MCV
• HIV, VDRL/RPR, HBsAg
• rubella and varicella immunity
• pap test
• chlamydia PCR
• urine culture
• urine protein
• inactivated flu vaccine

Question 12

24-28 weeks prenantal visit

Answer 12

• hg/hct
• antibody screen if Rh(D) negative
• 50 g 1 hour GCT

Question 13

35-37 prenatal visit

Answer 13

GBS culture

Question 14

Active phase protraction

Answer 14

• cervical dilation less than 1 cm in 1hr in active phase
• commonly caused by cephalopelvic disproportion (head too large for pelvis)

Risk

• late term pregnancy
• fetal anamoly
• malposition
• maternal obesity
• excessive weight gain
• nulliparity
• AMA
• inadequate contractions

Question 15

High maternal AFP

Answer 15

open neural tube defects

abdominal wall defects

multiple gestation

Question 16

low maternal AFP

Answer 16

aneupoloidies

Question 17

First trimester thyroid changes

Answer 17

• increased total T4 and mild increased free t4
• beta hcg stimulates thyroid hormone production in first trimester
• estrogen stimulates TBG; thyroid increased hormone production to maintain steady free T4 levels

TSH decreases
-increased beta hcg and thyroid hormone suppresses TSH secretion

Question 18

hCG

Answer 18

• secreted by syncytiotrophoblasts
• preserves corpus luteum early during pregnancy
• maintains progesterone secretion until placenta is able to produce it on its own

-secretion begins about eight days after fertilization

• double every 48 hours until they peak at six to eight weeks gestation
• composed of alpha and beta subunits
• alpha is common to hCG, TSH, LH, and FSH

Question 19

prolactin and amenorrhea

Answer 19

• prolactin inhibits GnRH
• low FSH, LH and estrogen
• low estrogen inhibits ovulation
• can have menopause like vasomotor symptoms and vulvovaginal atrophy
• patients may have dyspareunia due to epithelial thinning and vaginal dryness

treat
-nonhormonal lubricants and moisturizers