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Clinical review > Prenatal > Flashcards

Prenatal Flashcards

1
Q

Follicular phase

A

Starts on the first day of the period

Ends when luteinizing hormone LH peaks and ovulation occurs

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2
Q

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

A

FSH and LH

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3
Q

Function of FSH on egg during follicular phase

A

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

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4
Q

Function of LH on the egg during follicular phase

A

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

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5
Q

What is the basic function of the proliferation phase

A

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

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6
Q

Luteal surge

A

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.

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7
Q

Luteal phase

A

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

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8
Q

What does the corpus luteum produce

A

More progesterone and some estrogene

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9
Q

Function of progesterone in the luteal phase

A

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

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10
Q

What occurs to the corpus luteum if pregnancy occurs?

A

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

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11
Q

What structures in the body produce estrogene

A 
Ovary: theca and granulosa cells together
Breasts
Adrenal gland
Placenta
Fat cells
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12
Q

Other estrogen impacts on the body

A

Reduces LDL and increases HDL

Slows down the osteoclasts and maintain bone density

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13
Q

Main hormones produced during pregnancy

A

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

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14
Q

Pregnancy CV changes

A

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

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15
Q

Puerperium

A

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

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16
Q

Chorionic villi

A

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

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17
Q

Where does embryonic blood mix with maternal blood?

A

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

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18
Q

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

A

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

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19
Q

Order of blood flow for maternal blood and for fetal blood

A

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

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20
Q

Name interpret the different diagnostic tests used to confirm a pregnancy

A

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

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21
Q

Describe G’s and P’s and GTPAL

A

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

22
Q

How to calculate gestational age and estimated date of confinement?

A

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

23
Q

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?

A

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

4 mg if previous NTD

24
Q

How often for prenatal care visits?

A

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

25
Q

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

A 
Maternal weight
uterine fundal height
maternal BP
UA by dipstick
FHT's
compare all findings with previous visits
26
Q

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

A

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

27
Q

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

A 
obstetric hx
medical hx
surgical hx
family hx
social hx
28
Q

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

A 
BP
bony pelvis configuration
uterus: to confirm gestation age
cervix: length
adnexa: bimanual
check for edema
29
Q

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

A 
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
30
Q

What lab test for 3rd trimester?

A

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

31
Q

What are the components of the quad screen?

A

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

32
Q

What does the quad screen check for? When is it done?

If positive what next?

A

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.

33
Q

When and why is amniocentesis done?

A

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

34
Q

When and why chorionic villus sampling (CVS)

A

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

35
Q

When and why percutaneous umbilical blood sampling (PUBS)?

A

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

36
Q

Timing of RhoGAM administration

A

Mothers who are Rh- carrying Rh+ babies

Need at 28 weeks and within 72 hours of delivery

37
Q

Components of biophysical profile

A
  • Fetal breathing movements
  • Fetal movements
  • Fetal tone (extension return to flexion or open close of hand)
  • amniotic fluid volume
  • Normal stress test (cardiac function)
38
Q

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

A

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

39
Q

Threatened abortion

A
  • 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
40
Q

Incomplete abortion

A
  • 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
41
Q

Inevitable abortion

A
  • 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
42
Q

Missed abortion

A

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

43
Q

Complete abortion

A

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

44
Q

Septic abortion

A

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

45
Q

Recurrent abortion

A

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

46
Q

Ectopic pregnancy

A

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

47
Q

Premature rupture of membranes

A

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

48
Q

Gestational hypertension

A

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

49
Q

Pre-eclampsia

A

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

50
Q

Eclampsia

A

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

51
Q

HELLP syndrome

A

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

52
Q

Umbilical cord prolapse

A

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Clinical review (18 decks)

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