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Repro II > Quiz > Flashcards

Quiz Flashcards

1
Q

ACE Inhibitors

A

o MOA: inhibit ACE, increase diuresis
o Clinical use: HF, HTN
o Effects: renal damage, hypocalvaria

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2
Q

Diethylstilbestrol

A

o MOA: inhibits HPG axis > block testicular synthesis of testosterone
o Clinical use: prevent miscarriage
o Effects: vaginal adenosis, clear cell vaginal adenocarcinoma

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3
Q

Isotrentinoin

A

o MOA: inhibits sebaceous gland function and keratinization
o Clinical use: cystic acne
o Effects: extremely high risk of CNS, face, ear, and other malformations

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4
Q

Methimazole

A

o MOA: inhibit TPO reactions, block iodine organification
o Clinical use: hyperthyroidism
o Effects: aplasia cutis, esophageal atresia, choanal atresia, facial abnormalities, mental retardation

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5
Q

Tetracyclines

A

o MOA: inhibit translation by binding 30S ribosomal subunit
o Clinical use: antibiotic
o Effects: discoloration and defects of teeth and altered bone growth

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6
Q

Warfarin

A

o MOA: competitively inhibits vitamin K epoxide reductase complex 1 > deplete functional vitamin K reserves > reduce synthesis of active clotting factors
o Clinical use: blood thinner
o Effects:
First – hypoplastic nasal bridge, chondrodysplasia punctata
Second – CNS malformations
Third – risk of bleeding, D/C 1 month before delivery (really wouldn’t use in pregnancy)

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7
Q

Amount of exercise recommended in the absence of either medical or obstetric complications

A

30 minutes/day

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8
Q

Type of exercise that should be D/C after first trimester… Why?

A

Supine; Uterus puts pressure on IVC

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9
Q

Absolute contraindications to aerobic exercise during pregnancy

A

Heart disease, restrictive lung disease, cervical insufficiency, multiple gestations at risk for premature labor, persistent 2nd or 3rd trimester bleeding, placenta previa (lies low and covers cervix) after 26 weeks premature labor during current pregnancy, ruptured membranes, preeclempsia/gestational HTN, severe anemia

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10
Q

Warning signs to terminate exercise while pregnant

A

Vaginal bleeding, dyspnea prior to exertion, dizziness, headache, chest pain, muscle weakness, calf pain/swelling, regular painful contractions, amniotic fluid leakage

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11
Q

Pica is associated with….

A

Anemia

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12
Q

Elements of nutritional assessment that play and important role in initial antepartum assessment

A

History of dietary habits, special dietary issues/concerns, weight trends

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13
Q

Anorexia and bulemia increase risk of associated problems like…

A

Cardiac arrhythmias, GI pathology, electrolyte disturbances

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14
Q

Recommendations for total weight gain during pregnancy and rate of weight gain per month based on…

A

BMI

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15
Q

Recommended iron supplementation in pregnant women

A

27 mg

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16
Q

Recommended folic acid supplementation in pregnant women @ low risk and @ high risk, respectively

A

0.4 mg; 4 mg

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17
Q

Folic acid supplementation prevents …

A

Neural tube defects

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18
Q

Women that have difficulty accessing food d/t financial and other social problems may rely on these programs

A

WIC, food stamps, Aid for Families with Dependent Children

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19
Q

Benefits of breast feeding

A
  • Nutrition and immune protection for baby
  • Decrease risk of T2DM, HTN, heart disease for baby
  • More rapid uterine involution for mom
  • Bonding
  • Decrease postpartum bleeding for mom
  • Decrease breast and ovarian cancer for mom
  • More rapid weight loss for mom
  • Decrease SIDS risk and prevent health problems in preemies
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20
Q

CI to breastfeeding

A

Maternal infection

Infant w/ galactosemia

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21
Q

BMI <18 (underweight) expected weight gain during pregnancy

A

28-40 pounds

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22
Q

BMI 18.5-24.9 (NML) expected weight gain during pregnancy

A

25-35 pounds

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23
Q

BMI 25-29.9 (overweight) expected weight gain during pregnancy

A

15-25 pounds

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24
Q

BMI >30 (obese) expected weight gain during pregnancy

A

11-20 pounds

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25
Q

Women who don’t gain sufficient weight during pregnancy @ greatest risk for

A

Small for GA infants

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26
Q

Women who gain excessive weight have increased risk for

A

Macrosomic infant

increased risk of childhood obesity and maternal weight retention

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27
Q

Pregnant women should increase kcals by ________ and ______ in the 2nd and 3rd trimesters, respectively

A

340, 450

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28
Q

Breastfeeding women should eat an additional ______ kcals a day

A

600

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29
Q

Excessive vitamin A can be _________ and cause birth defects

A

Teratogenic

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30
Q

FDA recommends not exceeding ___________ IU of vitamin A in pregnancy

A

10,000

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31
Q

Pregnant women should eat _______ cups/day of fruits

A

2-2.5

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32
Q

Pregnant women should eat _______ cups/day of veggies

A

3-3.5

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33
Q

Pregnant women should eat ________ oz of grains/day

A

6-10

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34
Q

Pregnant women should eat ____ oz of protein/day

A

6-7

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35
Q

Pregnant women should eat ______ cups/day of dairy

A

3

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36
Q

Foods that should be limited or avoided during pregnancy

A

Some fish, increased caffeine, unwashed fruits and veggies, unpasteurized dairy, undercooked meats

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37
Q

Preterm

A

infant delivered before 37 weeks

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38
Q

Early term

A

infant delivered between 37 weeks and 38 6/7 weeks

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39
Q

Full term

A

infant delivered between 39 weeks and 40 6/7 weeks

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40
Q

Late term

A

infant delivered between 41 weeks and 41 6/7 weeks

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41
Q

Post term

A

infant delivered between 42 weeks and beyond

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42
Q

Symptoms of pregnancy

A

Amenorrhea, increased urinary frequency, breast tenderness, nausea, tiredness, fatigue

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43
Q

Presumptive signs of pregnancy

A

Chadwick’s sign - darkening of vaginal walls and vulva (bluish discoloration)
Linea nigra - midline abdomen darkening line
Chloasma - darkening over bridge of nose and under eyes (mask of pregnancy)

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44
Q

Positive sign of pregnancy

A

detection of fetal heart activity

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45
Q

Urine pregnancy test drawbacks

A

hCG shares an alpha-subunit with LH so there needs to be a high concentration of hCG in urine in order to avoid FP tests

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46
Q

When should pregnancy tests be taken?

A

Early morning when hCG levels are highest

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47
Q

Serum pregnancy tests benefits

A

More specific and sensitive than a urine test d/t testing of beta subunit of hCG which is not shared with LH; very early detection

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48
Q

First trimester

A
  • 0-13 6/7 weeks
  • Appointments every 4 weeks
  • Initial appt. = transvaginal US, hx and risk assessment, EDD, physical, labs, screening
  • Screening PAPP-A (decreased is increased risk of Down and Edwards) and B-hCG (increased is increased risk of Down)
  • Nuchal transparency (increased thickness may be sign of chromosomal abnormality)
  • Cell free fetal DNA test (fetal DNA in maternal blood screened for conditions)
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49
Q

Second trimester

A
  • 14-27 6/7 weeks
  • Appt every 4 weeks
  • Quad screen at weeks 15-22 (MSAFP, hCG, unconjugated estriol, dimeric inhibin A) or triple (no inhibin A)
  • Anatomy US 18-22
  • Glucose screening 24-28 (in first if high risk for DM, obesity, previous GDM); if abnormal > glucose tolerance test
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50
Q

GPTPAL

A 
Gravida = pregnancies
Para = births
T = term
P = preterm
A = abortus
L = living kids
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51
Q

What does quad screen have a higher sensitivity for than triple screen?

A

Down

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52
Q

What should be done at every appointment during second trimester?

A
  • Measurement of fundal height (pubic symphysis to top of uterus)
  • Fetal heart tones
  • Urinalysis
  • BP
  • weight
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53
Q

Fundal height @ 8 weeks

A

Uterus still under pubic bone

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54
Q

Fundal height @ 12 weeks

A

Uterus above pubic bone

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55
Q

Fundal height @ 16 weeks

A

Halfway b/w pubic bone and umbilicus

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56
Q

Fundal height @ 20 weeks

A

@ umbilicus

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57
Q

From 16-36 weeks measurements should correlate to….

A

Weeks gestation (i.e. 16 cm @ 16 weeks)

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58
Q

If fundal height is greater than expected…

A

Incorrect assessment of gestational age, multiple pregnancies, macrosomia, hydatidiform mole, polyhydramnios

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59
Q

If fundal height is less than expected…

A

Incorrect assessment of gestational age, hydatidiform mole, fetal growth restriction, oligohydramnios, intrauterine fetal demise

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60
Q

Third trimester

A
  • 28-40+ weeks
  • Appt every 2 weeks from 32-36 weeks then every week
  • GBS screening between 35-38
  • Repeat Hb and hematocrit
  • Tdap b/w 27-36 weeks
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61
Q

Why do we screen for GBS?

A

NML vaginal flora in some women > can cause health complications in newborn so treated with Abx @ time of delivery

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62
Q

FHR

A

NML baseline FHR should be 110-160 bpm

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63
Q

Variability

A

Amplitude from peak to trough (fluctuations in HR)

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64
Q

Accelerations

A

visually apparent increases (onset to peak in < 30 sec) in FHR from baseline

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65
Q

Decelereations

A

visually apparent decreases in FHR from baseline; gradual (>30 sec) or abrupt

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66
Q

If there is good variability in the strip, bradycardia can be tolerated b/w ___________ bpm for long periods of time

A

100-110

67
Q

What isn’t a reassuring bpm?

A

80-100

68
Q

< __ bpm may predict soon onset of fetal demise

A

80

69
Q

Causes of bradycardia

A
  • Mother taking beta blockers?
  • Hypothermia, hypoglycemia, hypothyroidism
  • Fetal heart block
  • Issues with fetal oxygenation
70
Q

Causes of tachycardia

A
  • Chorioamnionitis
  • Maternal fever
  • Thyrotoxicosis
  • Medications
  • Fetal cardiac arrhythmias
71
Q

Tachy b/w _________ bpm can be well tolerated if NML variability

A

160-200

72
Q

What is considered “good” variability

A

Moderate - good sign that oxygenation is happening and NML brain function is present

73
Q

Decreased variability can be d/t

A
  • Fetal hypoxia
  • Acidemia
  • Prolonged contractions
  • Prematurity
  • Fetal sleep
74
Q

Accelerations are an increase in FHR of at least __ bpm for at least __ seconds

A

15x15

75
Q

Early decelerations

A
  • Associated with uterine contractions (gradual deceleration >30 sec during contractions)
  • Pressure on head > vagus n.
  • NML physiologic response (but absence doesn’t mean anything is wrong)
76
Q

Variable decelerations

A
  • ABRUPT, apparent decreases, variable association with contractions
  • Usually associated with umbilical cord compression (wrapping of cord, fetal anomalies, knots, oligohydramnios)
77
Q

Late decelerations

A
  • gradual decreases associated with contractions
  • Associated with uteroplacental insufficiency (leads to hypoxia, why it’s late)
  • NOT REASSURING
78
Q

First stage of labor

A
  • Effacement and dilation, fetal descent and station
  • Membranes may or may not rupture
  • Primipara 6-18 hours
  • Multipara 2-10 hours
79
Q

Station 0

A

@ ischial spines

80
Q

Latent stage

A

Cervical effacement and early dilation (1-5 cm)

81
Q

Active stage

A

Rapid cervical dilation (usually starts around 6 cm)

82
Q

Second stage of labor

A
  • Complete cervical dilation to delivery
  • Cardinal movements of infant
  • Primapara 30 min - 3 hours
  • Multipara 5-30 minutes
83
Q

Cardinal movements of delivery

A
  • Engagement (station 0 - means baby has navigated narrowest part of canal)
  • Flexion (creates smaller diameter)
  • Descent (necessary for successful completion of passage)
  • Internal rotation (presentation of optimal diameters)
  • Extension (as it reaches introitus to accommodate upward curve of birth canal)
  • External rotation/restitution (head rotates to face forward and in line w/ shoulders)
  • Expulsion
84
Q

Signs placenta has detached

A
  • Umbilical cord lengthening
  • Uterus rising in abdomen
  • Gush of blood from vagina
85
Q

Third stage of labor

A

Delivery of infant to delivery of placenta

86
Q

1st degree perineal laceration

A

Involves vaginal epithelium or perineal skin

87
Q

2nd degree perineal laceration

A

Extends into sub-epithelial tissues but does NOT involve muscles

88
Q

3rd degree perineal laceration

A

Anal sphincter involvement

89
Q

4th degree perineal laceration

A

rectal mucosa involvement

90
Q

APGAR scores 0

A

No HR, no RR, limp (no muscle tone), no reflex irritability, blue/pale in color

91
Q

APGAR scores 1

A

<100bpm, resp irregular, slow, gasping, some flexion, grimace on reflex, pink trunk with pale/blue extremities

92
Q

APGAR scores 2

A

> 100 bpm, vigorous, crying respirations, active motion, cough, sneeze, or pull away on reflex, completely pink

93
Q

a change in DNA sequence, or anomalies resulting from a change in sequence

A

Mutation

94
Q

non-mutagenic development of a birth defect, produced by exposure to a factor that interferes with a developmental process without changing DNA sequence

A

Teratogenesis

95
Q

present @ birth

A

congenital

96
Q

disorder present at birth, produced by teratogenesis or mutation. These can be morphological, behavioral and metabolic.

A

birth defect/congenital anomaly

97
Q

morphologic defect of an organ or body region

A

malformation

98
Q

malformation due to mechanical force, e.g. limb amputation due to amniotic band constriction

A

Deformation

99
Q

malformation produced after initial formation of a normal structure, e.g. teratogenesis

A

Disruption

100
Q

tissue abnormality

A

dysplasia

101
Q

multiple anomalies occurring together due a common etiology

A

syndrome

102
Q

different anomalies, with no obviously related etiology, occurring together more frequently than predicted by random chance

A

associations

103
Q

misplaced implantation

A

ectopic pregnancy

104
Q

little or no fetal tissue

A

hydatidiform mole

105
Q

empty trophoblast, embryo death, multiple factors can cause this

A

blighted ovum

106
Q

tumors with multiple cell types

A

teratoma

107
Q

anal teratoma due to incomplete primitive streak regression

A

sacrococcygeal teratoma

108
Q

placenta overbridging internal os

A

placenta previa

109
Q

premature separation of placenta from uterine wall

A

placenta abruptio

110
Q

low amniotic fluid volume

A

oligohydramnios

111
Q

anemia due to isoimmunization

A

erythroblastosis fetalis

112
Q

fluid filled lymphatic lesion, usually posterior triangle neck (Turner)

A

cystic hygroma

113
Q

ventricles distended with cerebral fluid

A

hydrocephaly

114
Q

opening of the spinal canal or cranium

A

neural tube defects

115
Q

underdevelopment of caudal structures

A

caudal dysgenesis

116
Q

brittle bones d/t collagen mutations

A

osteogenesis imperfecta

117
Q

separate gestational sacs

A

dichorionic twins

118
Q

shared placenta and chorion, dizygotic, or monozygotic

A

monochorionic twins

119
Q

shared amniotic cavity, monozygotic

A

monoamniotic twins

120
Q

fused bodies

A

conjoined twins

121
Q

one twin resorbed

A

vanishing twin

122
Q

one twin receives more blood from a monochorionic placenta

A

twin transfusion syndrome

123
Q

Symptoms of ectopic pregnancy

A

Severe hemorrhaging and abdominal pain

124
Q

Preferred method for terminating ectopic pregnancy

A

IM MTX

125
Q

what condition can result from an ectopic pregnancy @ internal os?

A

Placenta previa

126
Q

Symptoms of placenta previa from ectopic pregnancy @ internal os

A

non-painful, bright red, vaginal bleeding, postpartum hemorrhage

127
Q

MC location of ectopic pregnancy

A

Tubal - specifically @ ampulla

128
Q

Results of rupture of tube

A

intra-abdominal bleeding, hemorrhagic shock, maternal death

129
Q

Options for termination of tubal pregnancy

A

MTX, salpingectomy, wedge resection

130
Q

Interstitial/cornual pregnancy

A

implantation @ interstitial part where the tube meets the uterine cavity and penetrates the muscular layer of the uterus

131
Q

Why is the risk so much higher with interstitial pregnancy than tubal?

A

Interstitial part widens so fetus can grow much larger before tube will rupture

132
Q

Termination of interstitial pregnancy

A

MTX, cornuostomy, salpingectomy, or hysterectomy

133
Q

why do ovarian pregnancies have maternal risk?

A

Intra-abdominal bleeding

134
Q

Termination of ovarian pregnancies

A

MTX or oophorectomy

135
Q

Why can the embryo escape into the abdominal cavity?

A

Infundibulum isn’t connected to the ovary

136
Q

MC site for abdominal implantation

A

Peritoneal lining of rectouterine cavity (Douglas’ pouch)

137
Q

Termination of abdominal pregnancies

A

MTX or laproscopic removal of fetus

138
Q

Metastatic malignancy that can develop from hydatidiform moles

A

Choriocarcinoma

139
Q

why do sacrococcygeal teratomas form?

A

Primitive streak fails to regress completely

140
Q

MC newborn tumors

A

sacrococcygeal teratomas

141
Q

why does caudal dysgenesis occur?

A

Primitive streak regresses prematurely and there’s insufficient caudal mesoderm

142
Q

sirenomelia

A

fusion of lower limbs and organs produces mermaid-like fetus

143
Q

Symptoms of caudal dysgenesis

A

vertebral abnormalities, renal agenesis, imperforate anus, anomalies of UG organs

144
Q

teratogenic factor for caudal dysgenesis

A

maternal diabetes

145
Q

symptoms of FAS

A

intellectual disability, orbital hypotelorism, cleft lip/palate, holoprosencephaly

146
Q

Dysraphism

A

vertebral arches fail to close

147
Q

Spina bifida occulta

A

Underlying meninges and spinal cord develop normally and don’t protrude through the opening; simply dysraphism

148
Q

Spina bifida cystica

A

Herniation

149
Q

Meningocele

A

Only meninges with no neural tissue herniate through opening

150
Q

Myelomeningocele

A

Meninges and neural tissue herniate

151
Q

Dysraphism most common at…

A

L5 or S1 > the further from there the more severe

152
Q

_________ and __________ are more common with anterior defects in neural tube

A

Hydrocephaly; neurologic deficit

153
Q

________ ________ is more common with posterior defects in neural tube

A

Urinary incontinence

154
Q

Symptoms of myelomeningocele

A

B&B incontinence, CSF leakage, flaccid paralysis, hydrocephaly

155
Q

neural tube fails to close @ level of brain vesicles, or when neuropore fails to close (more frequent)

A

Anencephaly

156
Q

What fetal proteins are excreted into the amniotic cavity with OPEN defects?

A

Alpha-fetoprotein and AChase

157
Q

Down levels

A

Lower alpha-fetoprotein and unconjugated estriol; higher hCG and dimeric inhibin A

158
Q

Dizygotic twins

A

Fraternal produced from 2 eggs, simultaneously ovulated and fertilized by separate sperm

159
Q

Monozygotic twins

A

Identical produced from one egg that splits during embryogenesis (single zygote)

160
Q

Symptoms of erythroblastosis fetalis

A

Traces of bilirubin in amniotic fluid, abundance of erythroblasts, enlarged liver, spleen, or heart, fluid buildup in abdomen, lungs, or scalp; neonates will be jaundiced

161
Q

Extreme erythroblastosis fetalis characterized by edema

A

Hydrops fetalis

162
Q

Symptoms of hydrops fetalis

A

Severe swelling, polyhydramnios, enlarged placenta, fetal demise; neonates will have severe jaundice, bruising, and breathing difficulty

163
Q

When is RhoGam administered?

A

28 weeks and after delivery in Rh- mothers to reduce sensitization; when there is suspicion of placental bleeding

Repro II (4 decks)

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