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OB/GYN > Pregnancy & prenatal care > Flashcards

Pregnancy & prenatal care Flashcards

1
Q

Beta-hCG levels in each trimester

A

Peak 100,000 at 10 weeks. Decreases during 2nd tri. Levels off at 20-30,000 in 3rd tri.

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2
Q

Gestational sac present when?

A

5 weeks

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3
Q

Morning sickness

A

N&v 12-16 weeks

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4
Q

Fetal heart when? At what bhCG?

A

6 weeks, bHCG of 5-6,000

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5
Q

Embryo

A

Up to 8 weeks

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6
Q

Fetus

A

8 weeks (10 weeks gestational age) or later

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7
Q

GA vs. DA

A 
GA = days from LMP
DA = days from conception. Usually 2 weeks less than GA.
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8
Q

Infant

A

Delivery to 1 year

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9
Q

Trimesters

A 
1st = up to 12 -14weeksGA 
2nd= from 12-14 weeks to 24-28 weeks
3rd = from 24-28 weeks to delivery
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10
Q

Term vs. preterm vs. post term

A

Term = 37-42
Preterm = 24-37
Post term = after 42

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11
Q

Previable

A

Before 24

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12
Q

G4P1123

A

Been pregnant 4 times, 1 term delivery, 1 preterm, 2 abortions, 3 living children (1 of the deliveries m/h/b twins)

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13
Q

Gravidity

A

times been pg

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14
Q

Parity

A

times having delivered beyond 20 weeks GA, or an infant > 500g

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15
Q

S&s of pg’y

A 
Chadwick sign ( blue vag & cervix)
Goodall sign (softening & cyanosis of cervix at or after 4 weeks) 
Ladin sign (softening of uterus after 6weeks)
Breast swelling & tenderness
Linea Nigra dvpt from umbilicus to pubis
Telangiectasias
Palmar erythema
Amenorrhea
N&v
Breast pain
Quickening (fetal mvt)
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16
Q

Nagele rule

A

For calculating EDC (estimated date of confinement) or EDD

LMP - 3 mos + 7 days

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17
Q

EDC (# days from…)

A

280 days after LMP, or 266 days after date of ovulation

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18
Q

U/s s/n differ from LMP by how much

A

1 week during 1st tri, 2 weeks during 2nd tri, 3 weeks during 3rd tri

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19
Q

When can fetal heart tones be heard?

A

10 weeks by Doppler

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20
Q

When does quickening occurr?

A

16-20 weeks

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21
Q

How much does CO INCREASE BY?

A

30-50%, most during 1st tri

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22
Q

BP changes during pg’y

A

SVR drops 2/2 PGs
DBP drops more than SBP
lowest at 24 weeks, then slowly returns to pre-pg’y levels till delivery but s/n exceed them

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23
Q

Plum changes during pg’y

A

VT increases by 30-40% => ERV drops by 20%
TLC decreases by 5% 2/2 diaphragm pushed up
RR is constant but VT increases => increased minute ventilation by 30-40%
PaO2 increases. PaCO2 decreases

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24
Q

GI changes during pg’y

A

N&v 2/2 ES, PG, hCG, or hyopG
Prolonged gastric emptying times, LES relaxes => reflux
Ptyalism (increased saliva)
Prolonged transit times in large bowel => increased water absn, constipation

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25
Q

Renal changes during pg’y

A

Increased rates of pyelo 2/2 increased kidney & ureter size
GFR increases by 50% => BUN & Cr drop
Increase RAAS actvn

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26
Q

Heme changes during pg’y

A

Plasma vol increases by 50%
RBC vol drops by 20%-30%
Hct drops
WBC increases (mean 10.5). Can be really high (>20) during labor
Plts drop but if < 100 or if sudden drop, further investig needed
Elevations in coag factor levels but clotting & bleeding times don’t change

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27
Q

Endo changes during pg’y

A

Increased:
ES (placenta) - low levels correlate with fetal death
hCG (same alpha subunit as TSH, FSH, LH) - placenta produces it to maintain progesterone prodn by CL
hPL (placenta) - maternal lipolysis, IN blocker, diabetogenic effect
Elevated T3/T4
Prl increases during pg’y, drop after delivery, increase w/suckling

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28
Q

How do hCG levels change?

A

Double q48h early on. Peak at 10-12 weeks. Decline to steady state by 15 weeks.

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29
Q

Effects of progesterone

A

SMC relaxation

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30
Q

Nutritional requirements

A

Increased by 300 kcal/day during pg’y, 500 kcal/day during breast feeding

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31
Q

Wt gain during pg’y

A

20-30 lbs. obese women s/gain 15-20. Thin women 25-35.

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32
Q

Recommended Ca++ intake

A

1.5 g/d

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33
Q

Folate needs

A

Increase from 0.4 to 0.8 mg/d

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34
Q

When will a urine pg’y test be positive?

A

At time of missed menses

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35
Q

Need to take ________ to meet nutrient reqts.

A

Prenatal vitamins

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36
Q

First prenatal visit is sched’d when?

A

6-10 wks

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37
Q

Hx to take at initial visit

A 
LMP
Sx's of pg'y
Prior pg'ies (date, outcome)
Abortions
Ectopic pg'ies 
Term deliveries
Preterm
Mode of delivery
Length of time in labor & second stage
Birth weight
Complications
Complete medicl, surgical, fam hx
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38
Q

Physical Exam at initial visit

A

Complete
Pap unless one has been done in past 6 mos
G & C cx
Bimanual exam to dtm uterus size

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39
Q

1st tri labs

A 
Hct
Blood type & screen
RPR
Rubella Ig 
HBsAg
G&C cx
PPD
UA & cx
VZV if no hx of exposure
HIV offered
Urine pg'y test if pt unsure if pg
b-hCG if bleeding or cramping
Toxo titers
Nuchal translucency testing for aneuploidy
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40
Q

Additional testing in AfAms

A

Sickle cell/Hgb electrophoresis

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41
Q

Additional testing in women age 35 or older at time of EDC

A

Prenatal genetics referral

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42
Q

Prior gestational DM, FHx of DM, Hispanic, NAm, SE Asian

A

Early G loading test

43
Q

Additional testing in pt w/pre gestational DM, unsure dates, recurrent miscarriages

A

Dating sonogram.

44
Q

Additional testing in HTN, renal dis, pre gestational DM, prior preeclampsia, renal tx, SLE

A

24-hr urine collection for proteinuria & cr clearance

45
Q

Additional testing in pre gestational DM, prior cardiac dis, HTN

A

ECG

46
Q

Additional testing in Pre gestational DM

A 
HbA1c
Ophtho exam
Dating sonogram
24-hr urine for prot & cr CL
ECG
47
Q

Additional testing in graves dis

A

TSI

48
Q

Additional testing in all thyroid dis

A

TSH

maybe T4

49
Q

Additional testing in SLE

A

Anti-rho

Anti-La

50
Q

Labs in 2nd tri

A

MSAFP/triple screen
U/s
Amniocentesis in AMA pts

51
Q

Labs in 3rd tri

A 
Hct
RPR
GLT
repeat G&C
Cxr if PPD + 
GBS cx
52
Q

What is taken at each prenatal visit

A

BP
Wt
Urine dipstick for prot, G, leukocyte esterase
Meast of uterus
Doppler for fetal heart tones
Ask about vag bleeding, discharge, leaking fluid, uti sxs

53
Q

If uterine fundal height is what then an u/s is ordered to eval

A

Progressively decreasing

3 cm diff from GA In Weeks

54
Q

What is asked about after 20 weeks in addition to usual?

A

Quickening

Ctrns

55
Q

Braxton-hicks vs. PTL

A 
b-h = irregular, occur thru third tri
Ptl = regular ctrns more than 5-6 per hr
56
Q

What is MSAFP & when ordered

A

Maternal serum alpha fetoprotein
Increased levels = increased risk of neural tube defects
Decreased levels = risk of anuepldy
Ordered 15-18 weeks

57
Q

What is triple screen

A

MSAFP + b-hCG + estriol

58
Q

Quad screen

A

Triple screen + inhibin a

59
Q

When is screening u/s offered?

A

18-20 weeks

60
Q

When are childbirth classes offered & why

A

After 12 weeks b/c risk of SAB drops after 12 weeks

61
Q

What if b-h become regular

A

Examine cervix to eval for ptl

62
Q

How often are visits during 3rd tri

A

Q2-3 weeks from 28-36 weeks

Weekly after 36 weeks

63
Q

Who & when to give RhoGam

A

Rh negative moms, at 28 weeks

64
Q

When to do Leopold maneuvers

A

32-34 weeks to dtm fetal presentation

65
Q

Cervix examined at every visit when?

A

After 37 weeks

66
Q

Who gets iron supplements & when

A

Hct < 32-33%

Also give stool softener

67
Q

What is GLT

A

50-g oral G given. Check serum G 1 hr later. If > 139, do GTT.

68
Q

What is GTT

A

Fasting serum G, then give 100g oral G.

Measure serum G at 1, 2, 3 hrs.

69
Q

GDM dx:

A 
2 or more:
Fasting G > 95
1-hr G > 180
2-hr G > 155
3-hr G > 140
70
Q

what to do if GBS cx is + in third tri?

A

IV penicillin when in labor

71
Q

routine problems of pg’y:

A 
back pain
constipation
contractions
dehydration
edema
GERD
hemorrhoids
PICA
round lig pain
urinary freq
varicose veins
72
Q

recommedations for back pain of pg’y

A 
mild exercise/stretching
Tylenol
massage
heat
m. relaxants or narcotics if severe
73
Q

why does constipation occur during pg’y

A

PG’s cause decreased bowel motility (SMC relaxation) => prolonged transit time in sm bowel => more water abs’n

74
Q

recommendations for constipation in pg’y

A

increased PO fluids

stool softeners/bulking agents (docusate, miralax)

75
Q

are laxatives used during pg’y

A

can be, but usually avoided during 3rd tri b/c of theoretical risk of PTL

76
Q

how much water should a pg pt drink?

A

10-14 glasses per day to prevent dehy, which can => ctr’ns

77
Q

when are ctr’ns considered a sign of PTL? What to do?

A

when they’re regular, as often as q10min. Need to do cervical exam. If there is no cervical change, then labor is not imminent.

78
Q

why does dehydration occur?

A

expanded intravascular space, increased 3rd-spacing

79
Q

why does dehydration promote ctr’ns

A

ADH is rel’d, which cross-reacts w/oxytocin R’s

80
Q

why does edema occur

A

IVC & pelvic v.’s compressed by uterus => increased hydrostatic P in lower limbs

81
Q

how to treat edema

A

elevate lower limbs, sleep on side

82
Q

severe edema of face & hands may indicate…

A

preeclampsia

83
Q

mgt of GERD:

A

first try antacids, eating multiple small meals, don’t lay down w/in 1 hr of eating.
then try H2 blockers or PPIs

84
Q

why do hemorrhoids occur

A

increased venous stasis & IVC compression + increased ab’l P w/BM’s 2/2 constip => hemorrhoids.

85
Q

tx of hemorrhoids

A

topical anesthetics & steroids. Increase fluids, fiber. Stool softeners.

86
Q

tx of round lig pain:

A

usually self-limited. Try tylenol or heat.

87
Q

when does round lig pain occur

A

late 2nd or early 3rd tri, 2/2 rapid expansion of uterus & stretch of ligs

88
Q

what 3 factors contrib to urinary freq:

A

1) increased intravasc vol
2) increased GFR
3) compression of bladder

89
Q

why do varicose veins of lower limbs or vulva develop?

A

increased venous hydrostatic P, relaxation of venous SMC

90
Q

tx of varicose veins:

A

elevate legs, compression stockings.

Should resolve by 6 mos post-partum. If not, refer for surgery.

91
Q

how to obtain fetal karyotype & genetic screen:

A

amniocentesis or CVS

92
Q

what is looked for on routine screening u/s (18-20 weeks)

A

placental location
amniotic fluid volume
gestational age
fetal malformations

93
Q

biophysical profile (BPP)

A

obtained in 3rd tri in high-risk pg’ies. Looks at 5 categories:

1) amniotic fluid volume
2) fetal tone
3) fetal activity
4) fetal breathing mvts
5) nonstress test

94
Q

what is a nonstress test

A

test of fetal HR. Is + if there are 2 accelerations of fetal HR in 20 ins that are at least 15 bpm above baseline for at least 15 sec.

95
Q

how is a BPP scored

A

each of 5 categories is given a score of 0 or 2. A score of 8 or more is reassuring.

96
Q

How is umbilical a. bf assessed & what does it indicate?

A

eval’d on u/s. If bf is decreased, reversed, or absent, it suggests placental insufficiency

97
Q

Antenatal tests of fetal well-being

A

NST (nonstress test)
OCT (oxytocin challenge test)
BPP

98
Q

what is OCT?

A

induce at least 3 ctr’ns in 10 mins, monitor fetal HR. Is considered + if at least 2 accelerations of fetal HR in 20 mins that are at least 15 bpm above baseline for at least 15 sec. Also + if there are late decelerations in fetal HR with at least 1/2 of ctr’ns.

99
Q

when is a NST ordered?

A

in high-risk pg’ies at 32-34 weeks, or at 40-41 weeks in undelivered pts

100
Q

what if NST ordered but is negative?

A

eval fetus w/u/s

101
Q

when is an OCT ordered?

A

if there are any worrisome decelerations in fetal HR, or if BPP is not reassuring

102
Q

how is fetal blood sampling obtained?

A

phlebotomize the umbilical cord, through uterus.

103
Q

why would you need to do fetal blood sampling?

A 
Rh isoimmunization
eval of fetal anemia
hydrops fetalis
fetal transfusion
karyotype analysis
eval of fetal plts in alloimmune thrombocytopenia
104
Q

how to eval fetal lung maturity?

A

lecithin to sphingomyelin ratio. L/S should increase as pg’y progresses.
if L/S ratio < 1.5, increased risk of resp’y distress syndrome.

OB/GYN (29 decks)

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