pregnant

Question 1

what are the immunizations of pregnant people

Answer 1

• Influenza - tetanus - hepatitis - rubella, mumps and measles - varicella

Question 2

Define Naegele’s rule

Answer 2

• method of establishing estimated date of delivery (EDD) - Subtract 3 months from the last menstrual period (LMP) and add 7 days

Question 3

describe the dating of pregnancy

Answer 3

• Physical examnation based on uterine size - ultrasound: often performed at 1st prenatal visit –> accuracy inversely related to length of gestation (least accurate near term)

Question 4

how to determine if pregnancy is viability

Answer 4

• Dates - Doppler for fetal heart tones - beta HCG level - Ultrasound - CRITICAL TO RULE OUT ECTOPIC GESTATION - rule out demise/molar pregnancy

Question 5

describe the 1st physical exam

Answer 5

• General physcial with special focus on a detailed pelvic examination - Height/weight - notation of uterine size/shape - pelvis size/shape - blood pressure baseline

Question 6

Subsequent visits

Answer 6

• Monthly until 26 to 28 weeks - Every 2 weeks until 36 weeks - weekly after 36 weeks

Question 7

describe fundal height

Answer 7

• measured at each prenatal visit after 20 weeks - weeks of gestation = cm from symphysis pubis to top of funds +- 2cm - subjecct to inter-observer and intra-observer error

Question 8

describe the common physical changes of pregnancy

Answer 8

• nausea/vomiting/dehydration (hormonal) - constipation (estrogen and progesterone) - reflux (GERD - estrogen and progesterone) - hemorrhoids (mechanical) - pica - varicose veins (mechanical and hormonal) - urinary frequency (multifactorial) - shortness of breath (mechanical) - breast changes

Question 9

what are the later physical changes of pregnancy

Answer 9

• contractions - edema - excessive weight gain - skin rashes/pigmentation - musculoskeletal changes (progesterone): lordosis, hip and symphyseal changes - carpal tunnel syndrome

Question 10

define spider angiomas

Answer 10

• central feeding vessel, most easily seen in the lesion on the right, leads to other telangiectatic vessels

Question 11

describe the cardiovascular physiology changes in pregnancy

Answer 11

• increased blood volume: plasma volune increases 30%, RBC volume increases 20% - cardiac output increases 30-50% - systemic vascular resistence DECREASES (progesterone)

Question 12

describe the leopold maneuvers

Answer 12

Question 13

describe the positions of the fetal lies

Answer 13

• longitudinal lie
• oblique lie
• transverse lie

Question 14

describe the labor stages

Answer 14

1st stage: onset of labor to complete (10cm) dilation of cervix (8 to 20 hours for first baby)

2nd stage: complete cervical dilation to infant delivery (minutes to 3-4 hours)

3rd stage: delivery of infant to delivery of placenta (up to 30 minutes)

Question 15

describe the length of labor curves by parity

Answer 15

• Parous women have faster labors