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Womans Health EOR > prenatal care/normal pregnancy > Flashcards

prenatal care/normal pregnancy Flashcards

1
Q

At what intervals do they perform a APGAR score?

A

at 1 and 5 minutes

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2
Q

What are the criteria in the APGAR score?

A
  1. Activity= 2 if moving
  2. Pulse = 2 if greater 100
  3. Grimace = 2 if pulls away/ sneeze
  4. Appearance = 2 if pink
  5. Respiration = 2 if crying
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3
Q

A score of _____ is good and a score of _______ requires resuscitation

A
  1. 6

2. 4

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4
Q

Macrosomia is what and associated with greater risk of what?

A

this is when the birth weight is greater than 90th percentile for gestational age/>4500g)

It is associated with shoulder dystocia

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5
Q

What does fetal attitude relate to to like what does it describe?

A

it is the relationship of fetal parts to one another

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6
Q

which is normal fully flexed or not flexed?

A

fully flexed

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7
Q

The relationship of fetal cephalocaudal axis (spinal column) to maternal cephalocaudal axis is called what?

A

The fetal lie

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8
Q

Out of longitudinal lie vs transverse lie vs oblique lie which are ideal and which aren’t

A

Longitudinal lie the others are non-ideal

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9
Q

What fetal presentation do you want for when giving birth?

A

Cephalic

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10
Q

What are the different types of breech presentations?

A
  1. Frank breech
  2. Complete breech
  3. Incomplete breech
  4. Shoulder breech
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11
Q

Describe the different kinds of breech?

A
  1. Frank- Hips flexed, knees extended, bottom presents
  2. Complete- hips and knee flexed, bottom presents
  3. Incomplete- one/both hips not completely flexed, feet present
  4. Shoulder- Transverse lie, shoulders present first
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12
Q

Does the prevalence of a breech increase or decrease with increasing gestational age?

A

decreases

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13
Q

How do you Dx breech presentation?

A

physical examination, with ultrasound confirmation, if the diagnosis is uncertain

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14
Q

How to tx a breech presentation?

A

External cephalic version

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15
Q

a 24-year-old G2P1 comes for her 13-week office visit she has a fundal height and an alpha-fetoprotein which are greater than expected for her due date. What is going on with this young gal?

A

Multiple gestations

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16
Q

How common is it to have twins?

A

in the US it is 1 out of every 80 births

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17
Q

What are the terms used to describe multiple births or the genetic relationships of their offspring.

A

Monozygotic (Identical) – multiple (typically two) fetuses produced by the splitting of a single zygote

Dizygotic (Fraternal) – multiple (typically two) fetuses produced by two zygotes

Polyzygotic – multiple fetuses produced by two or more zygotes

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18
Q

What are some clues that will make you think someone is having multiple children at one time?

A
  1. fundal height is usually greater than dates
  2. Extra fetal Heart tones
  3. Elevated maternal alpha-fetoprotein
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19
Q

Should prenatal visits happen more or less often with multiple gestations?

A

more often

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20
Q

what is the most common complication of multiple gestations?

A

spontaneous abortion and preterm birth

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21
Q

what are some other complications that occur at greter frequency with multiple gestations than regular ones?

A

preeclampsia and anemia

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22
Q

What are the three stages of labor?

A
  1. Uterine contractions
  2. Cervical changes
  3. Delivery of baby, placenta
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23
Q

Signs of false labor?

A

aka Braxton-Hicks contractions

irregular, intermittent contractions, no cervical changes, pain in abdomen, walking may decrease pain

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24
Q

Describe true labor?

A

Regular, increase in frequency, duration, intensity.

Produce cervical changes

Pain begins in lower back and radiates to abdomen and not relieved by walking

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25
Q

First stage of labor is last until the cervix is dilated to what size?

A

Till it is dilated to 10cm aka fully dilated

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26
Q

The first stage of labor is broken down into 3 more stages what are they?

A
  1. Early/latent
  2. Active
  3. Transition
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27
Q

Describe the early/latent phase of the first stage of labor?

A
  1. Last 8-12 hours
  2. Mild contractions 5-30 minutes
  3. Duration of contraction 30 seconds each
  4. Cervical dilation of 0-3cm
  5. Spontaneous ROM
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28
Q

Describe the active phase of first stage of labor?

A
  1. Last 3-5 hours
  2. Contractions every 3-5 minutes
  3. Duration of contractions are >/= to 1 minute
  4. Cervical dilation 3-7cm
  5. Effacement 80%
  6. Progressive fetal descent
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29
Q

Describe the transition Phase of the first stage of labor?

A
  1. Lasts 30minutes to 2 hours
  2. intense contractions every 1.5-2 minutes
  3. contractions last 60-90 seconds
  4. Cervical dilation 7-10cm
  5. Effacement 100%
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30
Q

So at what point does the second stage of labor begin?

A

When the cervix is dilated 10cm

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31
Q

Navigation of the child through the cervical canal is determined by what?

A

The three Ps

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32
Q

What are the three Ps of birth?

A
  1. Power
  2. Passenger
  3. Pelvis/passage
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33
Q

What are the different size/type of pelvises?

A
  1. Gynecoid- rounded pelvic inlet, midpelvis, outlet capacity adequate, this is optimal for vaginal delivery.
  2. Android- heart-shaped pelvic inlet; ↓midpelvis diameters, outlet capacity; associated with labor dystocia
  3. Anthropoid- oval shaped- favorable for vaginal delivery
  4. Platypelloid- oval shaped, decreased midpelvis diameters. Not favorable for vaginal delivery
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34
Q

What is the normal heart rate in a newborn?

A

120-160 beats per minute

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35
Q

Consistent decelerations after a contraction can indicate what?

A

fetal distress

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36
Q

When you perform internal fetal monitoring where is the electrode attached?

A

the infants head

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37
Q

What can variable decelerations be an indication for?

A

Cord compression, they can be considered benign if mild or moderate but if severe its worrisome

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38
Q

What is variable decelerations?

A

Rapid FHR drop with return to baseline

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39
Q

Describe early decelerations?

A

Mirror images of contractions- meaning the fetal head is compressed and is benign

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40
Q

A fetal acceleration is described as what?

A

increase of baseline 15 bpm for 15 seconds, this is a response to feta movement and is reassuring

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41
Q

What kind of fetal heart rate changes is always considered worrisome?

A

Late decelerations

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42
Q

What is a late deceleration?

A

FHR drop at the end of the contraction which implies uteroplacental insufficiency

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43
Q

How much larger does the uterus become in pregnancy?

A

20 times

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44
Q

What is the hegars sign?

A

Softening of uterine isthmus

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45
Q

What volume capacity does the uterus increase to during pregnancy?

A

10ml-5L

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46
Q

The cervix during pregnancy forms what to seal the endocervical canal?

A

Mucus plug

47
Q

What color does the cervix turn?

A

Purplish blue because of increased vascularity

48
Q

What is the Goodells sign?

A

Mild softening due to edema, hyperplasia

49
Q

what hormones does the placenta release?

A

Estrogen, progesterone, relaxin, hcg

50
Q

true or false; the placenta covers 50% of the uterine surface?

A

True

51
Q

What is the function of the placenta ?

A

maternal-fetal organ for metabolic, nutrient exchange

52
Q

What PH does the vagina become during pregnancy?

A

PH of 3.5-6 to protect agains bacterial infections

53
Q

What are some changes that occur with the breasts during pregnancy?

A
  1. ↑ size, weight, nodularity, blood flow, vascular prominence
  2. Areola, nipples are a darker pigmentation due to ↑ melanocyte activity
  3. ↑ activity of Montgomery’s tubercles (sebaceous glands)
  4. Progesterone ↑ alveolar-lobular development; prevents milk production during pregnancy (inhibits prolactin)
  5. Estrogen ↑ growth of lactiferous ducts
  6. Secretion of colostrum begins week 16
54
Q

How is the heart displaced during pregnancy?

A

displaced upward, forward slightly to left

55
Q

Would you expect someone heart to increase or decrease during pregnancy? how much do you expect it to increase or decrease?

A

it should increase by about 15-20 beats/minute

56
Q

Why does blood pressure decrease despite increased CO

A

this is because of progesterone induced vasodilation

57
Q

By what percent do you expect stroke volume to increase to?

A

30%

58
Q

Gravid uterus elevates pressure veins draining legs and pelvic organs. What can you anticipate happening because of this?

A

Varicose veins, hemorrhoids, dependent edema.

59
Q

How much more blood volume do you get when pregnant?

A

1500ml

60
Q

Why does your blood volume go up during pregnancy?

A

Related to sodium, water retention due to changes in osmoregulation, secretion of vasopressin by anterior pituitary, renin-angiotensin-aldosterone system (RAAS)

61
Q

What effect does pregnancy have on blood?

A

increased RBC
Increased WBC
increased Clotting factors (fibrin, fibrinogen)

Plasma becomes greater than RBC volume causing hemodilation decreasing hematocrit (physiological anemia)

62
Q

Pregnancy effect on urine?

A

↑ glomerular filtration rate (GFR)
40–50% by second trimester; ↑ urinary output (25%)
↑ size of kidneys (1–1.5 cm)
Dilation of urinary collecting system →physiologic hydronephrosis
Urinalysis
Glycosuria (due to ↑ glucose load), ↑ protein excretion (due to altered proximal tubule function + ↑ GFR)

63
Q

What PE findings can you see on the skin during pregnancy?

A

Estrogen-induced vascular permeability →spider nevi, angiomas, palmar erythema

64
Q

What does pregnancy do to the pituitary gland?

A

increase size of pituitary gland; mostly due to proliferation of lactotroph cells

65
Q

Would you expect an increase or decrease with the parathyroid gland during pregnancy?

A

an increase to meet the calcium needs of developing fetal skeleton

66
Q

What does pregnancy do to the adrenal gland?

A

physiological hypercortisolism

67
Q

Describe physiological hypercortisolism

A

increase need for estrogen, cortisol which then increase glucocorticoids from adrenal gland, supports fetal somatic, reproductive growth

68
Q

Does the thyroid stimulating hormone increase or decrease during pregnancy?

A

decrease

69
Q

Does thyroid gland increase or decrease and what effect does that have?

A

It increases which causes an increase in total T3 and T4

70
Q

where does progesterone come from during during first and second trimester of pregnancy? How bout during late second and third trimester?

A
  1. Corpus Luteum

2. Placenta

71
Q

what is the recommended calorie increase for a pregnant woman?

A

300kcal/day with a total weight gain of 25-35 pounds

72
Q

What is the breakdown of extra weight during pregnancy?

A 
11 lb. (5 kg): placenta, amniotic fluid, fetus
2 lb. (0.9 kg): uterus
4 lb. (1.8 kg): ↑ blood volume
3 lb. (1.4 kg): breast tissue
5–10 lb. (2.3–4.5 kg): maternal reserves
73
Q

What vitamins should every pregnant person be on?

A

600 mcg folic acid/day → RBC synthesis, placental/fetal growth, ↓ risk of neural tube defects

74
Q

What are the nutritional needs during pregnancy?

A

600 mcg folic acid/day → RBC synthesis, placental/fetal growth, ↓ risk of neural tube defects

1,000–1,300 mg calcium/day supports pregnancy, lactation

60g protein daily supports tissue growth

27 mg iron/day supports ↑ RBCs

75
Q

What is the recommended prenatal care schedule?

A

Monthly visits to a healthcare professional for weeks 4–28 of pregnancy

Visits twice monthly from 28 to 36 weeks

Weekly after week 36 (delivery at week 38–40)

76
Q

Should all pregnant women receive a prenatal vitamin?

A

yes

77
Q

What other supplements must pregnant women take?

A
  1. Folic acid supplementation (0.4–0.8 mg) prior to conception; 4 mg for secondary prevention
  2. Calcium: 1,000–1,300 mg/day; supplement may be beneficial for women with high risk for gestational hypertension
78
Q

What is the recommended dose of iron in pregnant woman?

A

30mg/day if anemic

79
Q

pregnant women in industrialized countries should take what kind of vitamin?

A

vitamin A but less than 5,000 IU/day

80
Q

women with limited exposure to sunlight you should consider giving what?

A

Vitamin D

81
Q

What should be done at first prenatal visit?

A

a full physical exam

82
Q

After first prenatal exam what should be recorded at the following visits?

A

Weight: Total weight gain range (lb) should be 25–35 lb, except in obese women, for whom weight gain should be <15 lb.

BP

UA

Fundal height

83
Q

What does the ACOG define hypertension in a pregnant woman?

A

BP >140 mm Hg systolic or >90 mm Hg diastolic

84
Q

When should you expect to hear a fetal heart rate

A

at 12 weeks

85
Q

When do you want to check for fetal position?

A

at 36 weeks

86
Q

A woman thats pregnant and 35 or older should be offered what kind of test?

A

genetic testing for abnormalities

87
Q

What is Naegeles rule and what is it used for?

A

its used to calculate due date and its 1’st day of last menstrual period + 7 days – 3 months + 1 year

88
Q

When should your first visit be when pregnant?

A

6 weeks after LMP

89
Q

At each pregnancy visit they will assess what?

A

Fetal heart tones, blood pressure, fundal height, fetal movement and urinalysis

Ultrasound should be able to detect fetal heart activity 1-2 weeks after 1st missed cycle (around 5-6 weeks)

90
Q

What does a triple screen consist of?

A

AFP, HCG, Estriol

91
Q

What does a quad scree consist of?

A

AFP, HCG, Estriol Inhibin A

92
Q

When can you do Chronic villus sampling?

A

between 10-12 weeks

93
Q

When can you perform an amniocentesis?

A

15-18 weeks (beginning of the second trimester) – especially for women over age 35 in the high-risk group

94
Q

When do you want to do a 65 g 2-hour oral glucose test?

A

between weeks 26-28

95
Q

When do you test for Group B strep?

A

between weeks 35-37

96
Q

The first trimester from weeks 11-14 you can due what tests?

A

Ultrasound for nuchal translucency
PAPP-A and hCG
Increase levels are seen in chromosomal abnormalities
Low levels of PAPP-A can be associated with Down’s Syndrome

97
Q

Cell free fetal DNA can be done around what week and what trisomies does it test for?

A
  1. 10 weeks

2. 13, 18, and 21

98
Q

If you have positive tests from the Cell free DNA test what should you follow it up with?

A

CVS or amniocentesis

99
Q

What does CVS test for?

A

Collect placental tissue to test for chromosomal and genetic abnormalities

100
Q

increase in AFP with a quad screen means what?

A

neural tube or abdominal wall defects

101
Q

if you have an increase in hCG and inhibin but decrease in AFP and estriol with a quad screen you should think what?

A

down syndrome

102
Q

a decrease in AFP, hCG and estriol should make you think what?

A

Edwards syndrome

103
Q

Visits during the first trimester weeks 1-12 should happen how often?

A

every 4 weeks

104
Q

At every visit during the first trimester you should evaluate what?

A 
weight gain / loss
BP
pedal edema
fundal height
urine dip for glycosuria and proteinuria
trace glucose is normal due to ↑ GFR
trace protein is not normal and should be evaluated
105
Q

How often should visits be during the second trimester (weeks 13-26)?

A

still once a month

106
Q

At 15-18 weeks what test should you offer?

A

offer triple marker screen (hCG, estriol, AFP)

used to detect neural tube defects or trisomies

107
Q

At 16-20 weeks what test should you offer if person is older than 35 and history indicates it?

A

amniocentesis

108
Q

at 17 weeks what should you document?

A

movement

109
Q

at 24 weeks what test should you do?

A

glucose test

110
Q

What are some routine 3rd trimester tests?

A
  1. UA

2. Blood glucose

111
Q

At visits between the weeks 27-end you should ask about what?

A

vaginal bleeding
contractions
rupture of membranes

112
Q

When if indicated should you give RhoGAM?

A

between weeks 28-30

113
Q

Between the weeks 28-32 mothers with pre-gestational diabetes should undergo what?

A

twice weekly non-stress testing until deliery

114
Q

between the weeks 36-40 what STIs should you check for?

A

chlamydia and gonorrhea

Womans Health EOR (10 decks)

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