Prenatal

Question 1

Follicular phase

Answer 1

Starts on the first day of the period

Ends when luteinizing hormone LH peaks and ovulation occurs

Question 2

What hormones are released by the anterior gland during the follicular phase?

Answer 2

FSH and LH

Question 3

Function of FSH on egg during follicular phase

Answer 3

FSH stimulates growth of the follicule, specifically stimulate growth of granulosa cells which in turn produce estrogene

Question 4

Function of LH on the egg during follicular phase

Answer 4

LH causes thecal cells to produce androstenedione which is converted to estrogen by the granulosa cells

Question 5

What is the basic function of the proliferation phase

Answer 5

Day 7-14, and estrogen levels cause new layer of endometrium.

Question 6

Luteal surge

Answer 6

At about day 14, high levels of estrogen cause spike in LH, but not in FSH because of Inhibin which is released by the granulosa cells. Causes ovulation.

Question 7

Luteal phase

Answer 7

Day 14-28: Creation of corpus luteum from the remainder of the follicle once the egg has been released.

Question 8

What does the corpus luteum produce

Answer 8

More progesterone and some estrogene

Question 9

Function of progesterone in the luteal phase

Answer 9

Progesterone hormone: (gets the uterus ready)
-Increases blood flow to the endometrium by creating spiral arteries
-Increases uterine secretions
-Reduces the contractility of the muscles of the uterine wall to keep the embryo in place.
Also suppress levels of FSH and LH from the pituitary

Question 10

What occurs to the corpus luteum if pregnancy occurs?

Answer 10

Embryo starts to produce Human chorionic gonadotropin hormone (hCG)
Which keeps the corpus luteum functioning

Question 11

What structures in the body produce estrogene

Answer 11

Ovary: theca and granulosa cells together
Breasts
Adrenal gland
Placenta
Fat cells

Question 12

Other estrogen impacts on the body

Answer 12

Reduces LDL and increases HDL

Slows down the osteoclasts and maintain bone density

Question 13

Main hormones produced during pregnancy

Answer 13

Estrogen and progesterone suppress the hypothalamic axis (menstrual cycle)
hCG: (produced by the placenta), maintains progesterone production by the corpus luteum
Prolactin: increases and changes mammary gland
Adrenal hormones: cortisol and aldosterone increase
Parathyroid hormone increases: increase Ca uptake and reabsorption by the kidney
Hyman placental lactogen stimulates lipolysis and fatty acid metabolism

Question 14

Pregnancy CV changes

Answer 14

Blood volume increases up to 50%, mainly through plasma volume by increased aldosterone
This results in increased HR, stroke volume, CO, overall vasodilation

Question 15

Puerperium

Answer 15

Time after the delivery of the baby and placenta until approximately 6 weeks postpartum
Includes: involution: uterus back to pre-prego size; changes in lochia - drainage after birth

Question 16

Chorionic villi

Answer 16

extend from trophoblast/chorion (embryonic) into endometrium (maternal).

Question 17

Where does embryonic blood mix with maternal blood?

Answer 17

Placental sinuses. Epithelial cells in villi separate maternal and fetal blood.

Question 18

How does waste, O2, CO2, glucose, amino acids and hormones transport?

Answer 18

O2, CO2: move by diffusion
Glucose moves by transport proteins
Some Amino acids and hormones are produced by trophoblast layer of placenta and added to maternal and fetal blood

Question 19

Order of blood flow for maternal blood and for fetal blood

Answer 19

Maternal blood: uterine arteries - placental sinuses - uterine vein
Fetal blood: umbilical arteries - chorionic villi - umbilical vein

Question 20

Name interpret the different diagnostic tests used to confirm a pregnancy

Answer 20

hCG: positive @ 4 wks
Serum: positive @ 3 weeks
Rising hCG w/o intrauterine fetal pole suggests ectopic pregnancy

Question 21

Describe G’s and P’s and GTPAL

Answer 21

G: gravidity: number of pregnancies total
T: term: number of infants born 37-40 weeks
P: premature: number of infants born 20-37 weeks
A: abortion: number of pregnancies ending before 20 weeks
L: number of living children

Question 22

How to calculate gestational age and estimated date of confinement?

Answer 22

Nagelles rule: (LMP+7) -3 months + 1 year

Question 23

What amount of folic acid is need by a pregnant mother? How much for a women who has had a previous pregnancy affected by a NTD?

Answer 23

400 mcg before conception and through first 3 months of pregnancy.

4 mg if previous NTD

Question 24

How often for prenatal care visits?

Answer 24

q4 weeks for 0-32 weeks
q2 weeks for 32-36
q1 week for 36-

Question 25

What should be done at all prenatal visits after the initial visit

Answer 25

``` Maternal weight uterine fundal height maternal BP UA by dipstick FHT's compare all findings with previous visits ```

Question 26

How much does ACOG recommend for maternal weight gain during a singleton pregnancy

Answer 26

25-35 lbs If underweight: 28-40 lbs If obese: 15-25 lbs

Question 27

What should be covered for history as part of the first prenatal visit

Answer 27

``` obstetric hx medical hx surgical hx family hx social hx ```

Question 28

What should be covered for physical as part of the first prenatal visit

Answer 28

``` BP bony pelvis configuration uterus: to confirm gestation age cervix: length adnexa: bimanual check for edema ```

Question 29

What lab tests should be part of the first prenatal visit?

Answer 29

``` CBC, blood type, VDRL or RPR, hep B surface antigen, serology for HIV and rubella CG/CT (gonorrhea and chlamydia testing) if hx of GDM, do 1 hour GTT UA and culture for UTI If no normal pap in last year do on HSV screening if high risk Genentic screening ```

Question 30

What lab test for 3rd trimester?

Answer 30

GTT (50g glucose) between 24-28 weeks CBC: check for anemia GBS: 35-37 weeks (vaginal and rectal swab)

Question 31

What are the components of the quad screen?

Answer 31

AFP: alpha fetoprotein: protein produced by the fetus (checks for neural tube defects) hCG: hormone made by the placenta estriol: hormone made by placenta and babys liver inhibin-A: hormone made by the placenta

Question 32

What does the quad screen check for? When is it done? | If positive what next?

Answer 32

Down syndrome Trisomy 18 (Edward's syndrome) Spina bifida, anencephaly Done: ideally 15-18 weeks, up to 20 weeks Just a screening test, not diagnostic Next: US, chorionic villi sampling, amniocentesis, etc.

Question 33

When and why is amniocentesis done?

Answer 33

When: between 14-20 weeks Why: after a positive quad screen, if had previous NTD, AMA, history of genetic condition, abnormal US Can rule out some specific genetic conditions but not all

Question 34

When and why chorionic villus sampling (CVS)

Answer 34

When: 10-13 weeks (1st tri) Why: after a positive quad, if had NTD in past, AMA, fam hx, abnormal US

Question 35

When and why percutaneous umbilical blood sampling (PUBS)?

Answer 35

When: preformed after 17 weeks Why: allows for rapid chromosome analysis Risk: higher risk that any other tests, so only in high risk pregancy

Question 36

Timing of RhoGAM administration

Answer 36

Mothers who are Rh- carrying Rh+ babies | Need at 28 weeks and within 72 hours of delivery

Question 37

Components of biophysical profile

Answer 37

- Fetal breathing movements - Fetal movements - Fetal tone (extension return to flexion or open close of hand) - amniotic fluid volume - Normal stress test (cardiac function)

Question 38

When are the 1st, 2nd, and 3rd stages of labour?

Answer 38

1st: Onset of labor to full cervical dilation 2nd: Full cervical dilation until delivery of baby 3rd: Deliver of the baby until the delivery of the placenta

Question 39

Threatened abortion

Answer 39

* The only one that is associated with possible fetal viability - bloody vaginal discharge, no products of conception (POC) expelled, cervical os is closed.. Dx: US, hCG Tx: supportive care, serial hCG to confirm it's doubling

Question 40

Incomplete abortion

Answer 40

* Pregnancy is not salvageable Some POC expelled some retained, cervix is dilated, heavy bleeding, moderate/severe cramping, boggy uterus Dx: US, hCG Tx: Dillation and evaculation if in 2nd tri, D&C or misoprostol or expectant mgmt if in 1st

Question 41

Inevitable abortion

Answer 41

* Pregnancy not salvageable No POC expelled, progressive cervical dilation, moderate bleeding, moderate/severe cramping Dx: US, hCG Tx: D&E 2nd tri, D&C 1st

Question 42

Missed abortion

Answer 42

Embryo not viable but retained in uterus No POC expelled, os is closed, loss of pregnancy sx Dx: US, hCG Tx: Dillation and evaculation if in 2nd tri, D&C or misoprostol or expectant mgmt if in 1st

Question 43

Complete abortion

Answer 43

Pregnancy is not salvageable All POC expelled, os usually closed, pain ,cramps and bleeding usually subsides Dx: US, hCG Tx: observe further bleeding

Question 44

Septic abortion

Answer 44

Retained POC becomes infected Some POC retained, os closed, cervical motion tenderness, foul brownish discharge, fevers, chills, uterine tenderness, spotting to heavy bleeding Dx: cultures Tx: D&E to remove POC, broad spectrum ABX, if refractory hysterectomy

Question 45

Recurrent abortion

Answer 45

3 or more consecutive pregnancy losses before 20 weeks, each with a fetus weighing less than 500g

Question 46

Ectopic pregnancy

Answer 46

implantation of fertilized ovum outside of the uterine cavity (97% in fallopian tube) Risk: PID, previous ectopic, hx of tubal ligation, endometriosis, IUD use S/sx: TRIAD: unilateral pelvic/abd pain, vaginal bleeding, amenorrhea - ruptured ectopic: severe abdominal pain, dizziness, N/V, syncope, signs of shock (hemorrhage) Dx: serial hCGs, transvag US, - hCG less than 2000 with nonviable uterain pregnancy strongly suggest ectopic Tx: stable: MTX, RhoGAM if needed ruptured laparoscopic salpingostomy

Question 47

Premature rupture of membranes

Answer 47

Eti: spontaneous rupture of chorioamniotic membranes before the onset of labor. Risks: STIs, smoking, prior preterm deliverym multiple gestations, short cervical length, polyhdramnios S/sx: Gush of fluid from vagina Dx: AVOID pelvic exam - nitrazine test: amniotic fluid ph greater than 7.1 - fern test Tx: Deliver the baby

Question 48

Gestational hypertension

Answer 48

ETi: HTN detected for the first time greater than 20 weeks and no proteinuria S/sx: asx Dx: 2 readings greater than 140/90 more than 6 hours apart. - 24 hour urine, LFTs, creatinine, hematocrit, platelets, lactic acid dehydrogenase Tx: mild: monitor fetal size Severe: hydralazine or labetalol

Question 49

Pre-eclampsia

Answer 49

Eti: unknown S/sx: Sxs of HTN (HA, visual sxs), fetal growth restriction, edema (caused by proteinuria = decreased oncotic pressure) Dx: Mild: Elevated BP and proteinuria greater than 300 mg/24hrs or 1+ of dipstick Severe: BP greater 160/110, proteinuria greater than 5g/24hrs, 3+ on dipstick Tx: less than 37 weeks, steroids for lungs, monitor, bed rest. - More than 27 weeks delivery

Question 50

Eclampsia

Answer 50

S/sx: abrupt onset of GTC seizures, HA, visual changes, cardiorespiratory arrest Dx: same as pre-eclampsia Tx: ABCD's, mag sulfate for seizures, delivery if patient stable BP meds: hydralazine

Question 51

HELLP syndrome

Answer 51

Hemolysis, elevated liver enzymes, low platelets Eti: unknown Sxs: RUQ pain, nausea, vomiting, malaise. HTN, proteinuria variable. Halmark: microangiopathic hemolysis leading to elevations in serum lactate dehyrogenase and fragemented RBCs on smear Tx: similar to severe pre-elampsia

Question 52

Umbilical cord prolapse

Answer 52

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