Test 1 - Antepartum Flashcards
What is a Basal Body Temperature?
One way of estimating the day of ovulation
What are you looking for when taking a Basal Body Temperature?
- Ovulation causes a sustained increase of at least 0.2 degreesC
- Temp DROPS just before ovulation
- Temp RISES slightly 0.2 degrees C ( just after ovulation ) and stays higher for 3 full days (ovulation has occurred). The fertile period has likely passed
Avoid sex until ___ days after the temperature rise to ________ pregnancy
5, prevent
When should a pt take her basal body temp?
AM before getting out of bed or eating / drinking / smoking
What route(s) can you use when taking basal body temp?
Oral
Vaginal
Rectal
** Make sure to use same route each time
Calories should be increased by ___ kcal / daily during pregnancy above normal caloric intake
300
How many pounds should an underweight pt gain during pregnancy? Healthy Weight? Overweight? Obese?
Underweight —> 28-40lbs
Healthy weight —> 25-35lbs
Overweight —> 15-25lbs
Obese —> 11-20
Dizygotic twins originate from __ fertilized egg and __ ________ sperm
2, 2 separate
Dizygotic twins share the same DNA (True or False?)
FALSE
Dizygotic twins aka __________ ______ have _______ placentas and ________ amniotic sacs
fraternal twins
separate
separate
*** Dichorionic and Diamniotic
Monozygotic twins originate from __ fertilized egg and __ sperm
1
1
Monozygotic twins aka _________ _____ have __ ____ DNA
identical twins
the same
Monozygotic twins may have separate placentas, amniotic sacs, or shared (True or False)
TRUE
What is amniotic fluid and what does it do?
Amniotic fluid is clear (slightly yellow) fluid without odor. The amniotic fluid maintains STABLE temperature, cushions the fetus from injury, and helps with LUNG development
What is the function of the placenta?
*The placenta supplies FOOD and OXYGEN to the fetus via the umbilical cord and helps fetus get rid of wastes
*Passive transfer of antibodies (immune protection) to the fetus from mother
*It is fully formed by the 10TH week of pregnancy
*Barrier to some (not all) harmful substances especially viruses and drugs
*Produces hormones of pregnancy including HCG (human chorionic gonadotropin), estrogen/progesterone
What is the umbilical cord and what does it do?
*The umbilical cord is a rope-like structure that connects the fetus to the mother’s placenta in which nutrients are received and wastes are removed
*The umbilical cord prevents the mixing of mother-fetal blood (separate circulation)
** ARTERY carries deoxygenated blood and waste products AWAY from fetus
** VEIN carries oxygenated blood and nutrients TO the fetus
A pt presents to an appointment and the provider notes a bluish coloration of the cervix. What sign is this?
Chadwick’s Sign
What does Hegar’s Sign show?
Softening of the isthmus of the uterus, the area between the cervix and the body of the uterus, occurring between 6-8 weeks of pregnancy
What does the Goodell’s Sign show?
Softening of the cervix
What is Ballottement?
The passive fetal movement elicited by pushing up against the cervix with 2 fingers. This pushes the fetal body up and, as it falls back, the examiner feels a rebound
A pt that is 24 weeks comes into her appt with a dark line of skin down the middle of her abdomen, what is this dark line called?
Linea Nigra
What is a blastocyst?
Inner solid mass of cells within the morula
What are gametes?
Female or male germ cell; contains a haploid number of chromosomes
What does morula mean?
Development stage of the fertilized ovum in which there is a solid mass of cells
What is a zygote?
Fertilized Egg
Seafood is _______ for fetal ______ and development
crucial
growth
The Omega-3 fatty acids in many fish, including docosahexaenoic acid (DHA), also can promote your baby’s _____ development
brain
How many ounces of fish is recommended per week?
8-12 ounces
Why should a pregnant woman avoid mercury?
This can damage the baby’s lungs/ kidneys/ nervous system
What fish should you AVOID when pregnant?
King mackerel
SHARK
Tilefish
MARLIN
Orange roughy
Bigeye tuna
Ahi tuna
What foods can lead to SALMONELLA poisoning and how is this prevented?
Raw egg, cookie dough, homemade ice cream
What foods can lead to LISTERIA poisoning and how is this prevented?
Unpasteurized milk, deli meat , soft cheeses, smoked meat, seafood
Pregnancy women are __x more likely to get listeriosis that other healthy adults
20
What is Nuchal Translucency screening looking for?
Fluid found at the back of the baby’s head and neck — measured by ultrasound
** Increased of ‘thickened’ Nuchal Fold measurement
What could Nuchal Translucency possibly show?
Trisomy 13
*Trisomy 18
* Trisomy 21
When would you perform a Nuchal Translucency Screening?
Ultrasound performed between 11-13 weeks gestation
Alpha-fetoprotein is a protein that is produced by ___ _____
the fetus
What is the QUAD screening?
Blood sample detecting 2 hormones (Human Chorionic Gonadatropin *hCG & Estriol) and 2 proteins (alpha-fetoprotein & Inhibin-A)
QUAD screening assesses for the risk of having…
** Trisomy 21 (downs syndrome)
** Trisomy 18
Neural Tube Defects
QUAD screenings are 80-85% accurate (True or False)
TRUE
What is Chorionic Villus Sampling (CVS)?
Provider obtains a small amount of chorionic villi from the developing placenta. Performed trans abdominal or transvaginal
Who is CVS performed on?
Women who have prior pregnancy history, family genetics, failed screen
CVS is performed between __ and __ weeks
8
12
What is the biggest advantage about CVS?
It is completed SOONER than other diagnostic tests
What are the RISKS of CVS
Preterm labor
Infection
Limb Reduction
Abruption
Fetal loss
What does CVS detect?
** T18
** T21
** Sickle Cell Disease
What is CVS UNABLE to detect ?
**Open neural tube defects (Spinal Bifida)
What is an amniocentesis?
A medical procedure used primarily in the prenatal diagnosis of genetic conditions. It involved removing and testing a small sample of cells from amniotic fluid, the fluid that surrounds the baby in the womb (uterus)
When is an amniocentesis usually performed?
Performed between 15-20 weeks
Purpose for an amniocentesis depend on __________
Trimester
Amniocentesis is performed in 2nd trimester (14-17 weeks) to assess for fetal ….
Anomalies and genetic disorders
An amniocentesis is performed in the 3rd trimester (30+ weeks) is to determine fetal ______ maturity for delivery
Lung
What are the complications of getting an amniocentesis ?
An amniocentesis has the same complications as CVS testing
How do you determine the Expected Date of Delivery (EDD)?
*Count back 3 months from first day of last period
*Add 7 days
* Add 1 Year
During a prenatal visit a pt tells you her last menstrual period was May 21,2019. Based on the Naegle’s Rule, when is the estimated due date of her baby?
February 28, 2020
A pt takes a pregnancy test, and it comes out positive. What hormone is present in order for this to happen?
Human Chorionic Gonadotropin (HCG)
How any veins and arteries are in the umbilical cord? What takes O2 rich blood to the fetus? What removes O2 poor blood from the fetus?
- 2 arteries 1 vein
- The VEIN takes O2 rich blood TO the fetus
- The ARTERY take O2 poor blood away from the fetus
What does GTPAL stand for?
G— Gravida: # of pregnancies (Including current pregnancy) regardless of the outcome
T— Full Term: (38+ weeks)
P— Pre Term: (20-37 weeks)
A— Abortions: terminations and miscarriages (<20wks)
L— Living: living children beyond the neonatal period (first 28 days)
* TWINS COUNT AS ONE PREGNANCY
A woman is currently pregnant at 22 weeks gestation. She previously had 2 miscarriages in the first trimester, now has an 11 yo daughter born at 38 weeks gestation and a 3 yo son born at 28 weeks gestation. What is her GTPAL?
G— 5
T— 1
P— 1
A— 2
L— 2
A woman is currently pregnant at 16 weeks gestation. She previously has a miscarriage at 8 weeks, now has a 2 yo daughter born at 33 weeks gestation and 3 yo twins born at 39 weeks gestation. What is her GTPAL?
G— 4
T— 1
P— 1
A— 1
L— 3
Why is the fundal height assessment performed?
To measure the size of the uterus to assess fetal growth
How is fundal height measured?
It is measured from the top of the mothers uterus (fundus) to the top of the mother’s pubic symphysis
When does fundal height assessment begin?
Begins 20wks-31st week. Not accurate in the 3rd trimester
What is normal for a fundal height assessment?
Within 2cm of weeks of pregnancy
What would be a normal fundal height for someone who is 31 weeks pregnant?
29cm - 33cm
** add/subtract 2 from the weeks pregnant**
What is a Molar Pregnancy?
It is the result of a genetic error during fertilization that leads to growth of abnormal tissue in the uterus.
Release of HIGH levels of HUMAN CHORIONIC GONADATROPIN HCG
Uterus fills with “grape-like” sacs (cluster) but NO fetus forms. DX by US
If a woman has a molar pregnancy, and they take a pregnancy test, will it be positive or negative?
POSITIVE
** Molar pregnancies release HIGH levels of HCG, which is the hormone that causes pregnancy tests to be positive
What are 2 causes of molar pregnancies?
- Egg with NO genetic material fertilized (not enough genetic material)
- Egg fertilized by 2 sperm (too much genetic material)
How do you treat a molar pregnancy?
D&C to completely remove all molar tissue that can become malignant
** follow up for ONE yr — CRITICAL due to risk of malignancy (cancer)**
The mother is at risk or developing _______________. Def- quick-growing cancer that starts in the placenta
Choriocarcinoma
1 goal of treatment for woman who has been diagnosed with molar pregnancy
PREVENT CANCER
If a woman comes in after having a molar pregnancy removed with increasing HCG levels, _______ and ________________ may be recommended
Chemo
Hysterectomy
A woman who has had a molar pregnancy removed should try to get pregnant again as soon as possible (True or False)
FALSE
** Those who have had a recent molar pregnancy removed should AVOID pregnancy for at least one year
Dry or sticky cervical mucus is a sign that a woman _____ ovulating
is not
Creamy cervical mucous is a sign that ovulation is ___________
coming
wet cervical mucus is a sign that a woman is ______ to ovulation
close
Raw egg white cervical mucus means that ovulation is _________. Usually ___, ______, and ________
approaching
wet
clear
slippery
What is the goal of preventing isoimmunization?
Mother WILL NOT create antibodies against the baby’s Rh-positive blood (prevent isoimmunization)
What is the medical treatment to prevent isoimmunization?
IM injection of Rh Immune Globulin (called Rophylac) — can now give this IV
How does Rophylac work?
It acts like a vaccine that prevents the mother from PRODUCING RH ANTIBODIES
**prevention is key!!!!
Rophylac is administered at __weeks gestation
28
** after delivery only if baby is Rh+
** Any early pregnancy bleeding, TAB, injury, Amniocentesis/CVS test
What happens if the mother is pregnant and we discover she is isomerized? Do we give the Rhophylac or not?
No, mom’s body will have already made antibodies against the baby and Rhophylac will not work at that point
Gestational Diabetes Mellitus (GDM) is when there is a ___________ demand for insulin during pregnancy
Increased
There is a ___% chance f developing DM-2
60
During the first trimester, insulin needs are _________ as fetal needs are minimal
Decreased
During the second trimester, insulin requirements ________
Increase
During the third trimester, insulin requirements may increase x__ - x__
2
4
Insulin needs ________ in pregnancy and ________ after delivery
Increase
decrease
One of the most universal screenings for GDM for pregnant women
The glucose test
Every pregnant woman has to have the glucose test at 24-28 weeks (True or False)
TRUE
1 Hour after drinking the glucose drink, if the woman’s glucose is >____mg/dl, she identifies at risk for GDM and has to take the 3hr test
140
A woman failed the 1hr glucose test, she now has to perform the 3hr test. How many of these tests does this woman have to FAIL for a diagnosis to be considered?
Two tests must be failed
What is the implantation of the fertilized ovum OUTSIDE of the uterus known as? Where is the most common location for this to happen?
Ectopic Pregnancy
Fallopian tubes
What are the symptoms of having an Ectopic Pregnancy?
Unilateral lower quadrant pain
Vaginal Bleeding
An ectopic pregnancy is diagnosed by __________ (screen) and _____________ (diagnostic)
Ultrasound
**Laparoscopy
If the tube ruptures, what will the pt experience?
Syncope
Right Shoulder pain
Tender Abdomen (bleeding in the abdominal cavity)
If a patient is STABLE, and the embryo is ____cm in size or less, what would be the treatment of choice?
3.5
Methotrexate (folic acid antagonist)
If a patient is UNSTABLE and the embryo is > _____cm in size, what would be the treatment of choice?
3.5
Laparoscopy with salpingostomy (open tube and remove products of conception)
** if tube ruptured,laparoscopy with salpingectomy (removal of the tube) is necessary
A family where children live in a household with both biological parents and no other relatives or persons is known as :
A nuclear family
A family where the couple shares household and child rearing responsibilities with parents, siblings, or other relatives. Families may reside together to share housing expenses and child care. This family is known as:
Extended Family
A specific form of an extended family in which two nuclear families or primary or unmarried kin live in proximity to each other. The family shares a social support network, chores, goods, and services. This family is known as :
extended kin network family
The head of the household is widowed, divorced, abandoned, or separated. This is known as a:
single-parent family
This family incudes 2 parents with biological children from previous marriage or relationship who marry or cohabitate. This family is known as a:
Blended or reconstituted nuclear family
- Initiation of puberty
- Responsible for maturity of each egg
- Signals the endometrial lining to thicken
* What hormone does this describe?*
Estrogen
What hormone surges to stimulate the growth of a mature egg?
Follicle Stimulating Hormone (FSH)
Induces ovulation by stimulating release of estrogen and progesterone
** What hormone ones this describe?**
Luteinizing Hormone
Women may experience the following during ovulation :
- _____ cervical mucus — thin, slippery, and egg white
- ______ basal body temperature
- ___________ sense of smell
More
Raised
Heightened
Hormone that thickens endometrium (preparing for implantation)
Progesterone
This hormone increased progesterone secretion during the first trimester to maintain pregnancy . This is what is detected during positive pregnancy tests
Human Chorionic Gonadotropin (HCG)
What is the goal of the menstrual cycle?
To release the mature ovum (egg) approximately once a month
What is the average length of the menstrual cycle?
28 days
During the menstrual phase (days __-__) no implantation during the last fertile window, the thickened uterine lining is ________ (referred to menses)
1-5
expelled
During the proliferation phase (days __-__) ___________ of the endometrial lining
6-14
thickening
They secretory phase (Days __-__) ____________ rises to make the endometrium more receptive to implantation
15-28
Progesterone
The Menstrual, Proliferative, and Secretory days are all part of the __________ cycle
Uterine
A couple of wine coolers and some red wine here and there are safe during pregnancy and with breastfeeding. (True or False)
FALSE … you better have said false 😐🤨
When are times that magnesium sulfate are used?
When severe pre-eclampsia is present
Anticonvulsants — to prevent seizures
What are some adverse effects of magnesium sulfate?
Flushing
Sweating
Foggy thoughts
What are the toxicity symptoms of magnesium sulfate?
Sudden drop in BP, decreased deep tendon reflexes
What is the antidote for magnesium sulfate
Calcium / gluconate / chloride
Recurrent pregnancy loss is also known as:
Habitual Aborter
A woman is considered a habitual aborter when she has __+ consecutive spontaneous pregnancy losses
3
Why do recurrent pregnancy losses happen?
- ___________ cervix
- Chromosome _____________
- Structural ______
Incompetent
Abnormalities
Defect
More than ___% of all classes will remain unexplained
33
Group B Strep is found in the ______ or __________ in 30% of pregnant women. Both men and women carry it
vagina
perineum
How is Group B Streptococcus transmitted?
Through the vaginal tract during delivery
All patients are screened for Group B strep at __-__ weeks gestation
35-37
How is Group B strep managed ?
Penicillin during labor
What are fetal-neonatal risks when it comes to group B strep?
Apnea/Pneumonia
Shock
Meningitis
Neurological Complications
What is vena cava syndrome?
When the fetal weight compresses the major blood vessels (esp. the inferior vena cava) of the mother resulting in insufficient blood to the heart,kidneys, and fetus
What are symptoms of vena cava syndrome?
- ** Acute pain
- ** Dizziness
- Shortness of breath
- Pelvic Cramping
The lay down rule is called the left __________ position
Lateral
Why is the left lateral position so important?
Maximum blood flow to the fetus, maternal uterus, and maternal kidneys
What are the presumptive signs of pregnancy?
- Absent menstrual periods (amenorrhea)
- Nausea and/or vomiting
- Unexplained fatigue
- Breast tenderness
- A sensation (perception of movement in the abdomen between 16-20 weeks (“quickening”) felt by the pt
What are probable signs of pregnancy?
- Positive pregnancy test
- Goodell’s sign : Softening of the cervix
- Chadwick’s sign : Bluish coloration of the cervix
- Uterine enlargement
What are the positive signs “ Definite signs” of pregnancy ?
- Fetal heart beat hear by doppler
- Fetus visible on ultrasound
- Fetal movements palpated by healthcare clinician
What are some diseases that are under the Class 1-2 Heart disease?
ASD
VSD
PDA
Corrected Coarctation, Tetralogy of Fallot
Most women who have class 1-2 heart disease will have NO _____________ in pregnancy
Complications
Asymptomatic (Class __ Heart Disease)
Symptomatic with exertion ( Class __ Heart Disease)
1
2
Women with class 1-2 heart disease can plan to have a ________ delivery plan with spontaneous onset
normal ( Vaginal birth unless other risks)
What are diseases that fall under Class 3-4 Heart disease
Eisenmenger Syndrome
Pulmonary HTN
Uncorrected Coarctation
Women with class 3-4 heart disease are ____________ at rest
symptomatic
Women with class 3-4 heart disease are recommended to _______ pregnancy. There are risk for severe ____________in pregnancy
avoid
complications
The mortality rate for pregnant women with class 3-4 heart disease is ___%-___%
30-60
Women with class 3-4 heart disease can plan to have a ____________ delivery
C-section ( Avoid stress of labor on the woman’s heart
Peripartum Cardiomyopathy is known as:
dilated cardiomyopathy of UNKNOWN origin
Peripartum is characterized by :
- _______ _______ in the last month of pregnancy — 5 months after pregnancy
- No other cause of cardiac failure or _______ disease during pregnancy. We don’t know why this happens !!
Cardiac Failure
Heart
Peripartum cardiomyopathy can happen in women _______ pre-existing heart disease (Unknown cause)
without
Cardio myopathy can occur during the _____ month of pregnancy or __ months postpartum
last
5
Are women who had peripartum cardiomyopathy recommended to have another pregnancy? Why?
NO — it will happen again and the mortality increases
Gestational Hypertension is where the blood pressure is ____/__ or systolic pressure elevated__ or diastolic pressure elevated — above pregnancy level. Is there proteinuria or edema?
140/90
30
15
NO proteinuria or edema
Gestational HTN resolves within ___ weeks of delivery
12
Is GHTN is not resolved, it will lead to : *3
GHTN preeclampsia without severe features , preeclampsia with severe features, eclampsia, and HELLP syndrome
Chronic Hypertension is when the BP of ___/__ of higher before pregnancy or before the 20th week of pregnancy
140/90
If you have chronic hypertension, you are considered a ____ risk pregnancy requiring strict medical and OB management
HIGH
What does HELLP stand for?
H= Hemolysis
EL= Elevated liver enzymes
LP= Low platelets
What is the typical presentation of HELLP syndrome? - Generalized ________
- Epigastric ____ Pain
- N/V
- Headache
- Malaise
- RUQ
Regardless of gestational age, all women with true HELLP syndrome should ________ ASAP
Deliver
HELLP usually shows up between ___ and ____ weeks
27-37
The first symptoms of HELLP syndrome is vague. Mom may think she has the flu (True or False)
TRUE
You may NOT SEE ____________ or _____________ with HELLP syndrome
- Hypertension
- Proteinuria
What does TORCH stand for?
T= toxoplasmosis
O= other infections
R= rubella
C= Cytomegalovirus
H= Herpes Simplex
What is toxoplasmosis and how is it spread?
-Parasite, usually acquires through eating raw/undercooked meat. Transmitted to fetus through placenta
- Spread through under cooked meat and cate feces (eating infected rodent)
Highest risk of fetal disease from toxoplasmosis is during the ___ trimester
1st
What is rubella and how is it spread?
- A viral illness that results in a rash or skin eruption
- Spread from one person to another through direct contact with discharge from the nose and mouth ** Baby at most risk during 1st trimester.
what is the treatment for rubella ?
Prevention through vaccination
Is the rubella vaccine given to mother in pregnancy?
NO — this is a live vaccine
What family for the Cytomegalovirus (CMV) belong to?
Herpes
CMV is spread by ________ _______
Bodily fluids
Where is CMV harbored in a pregnant patient?
In the placenta or cervical canal
CMV s/s of neonate?
Hearing loss
MR
epilepsy
*** Major concern if a mother becomes first infected while pregnant
How is Herpes simplex virus transmitted?
Sexually
Kissing
How is HSV transmitted to the fetus?
ascending infection within 4-6 hours after rupture of membranes or direct contact of active lesions during delivery
What is the maternal management of HSV?
Oral antiviral therapies
Prophylactic treatment from 32 weeks until delivery
If a pt has lesions present at time of onset labor, how does she have to deliver?
C-section
How much amniotic fluid is there in the amniotic sac?
700-1000mL
When is the placenta fully developed?
The 10th week
The perfusion of the placenta is influenced by :
Maternal _______ ________ (high or low)
Conditions of the maternal _______ _______
Uterine ____________
Maternal position
Blood pressure
Blood vessels
Contractions
First Trimester is week _ to week __
1-12
Second trimester week __ to week __
13-27
Third trimester is week __- week __
28-40
About _ -_% of pregnancies will be lost in the second trimester
2-3%
When is the fetus at the highest risk for gross anomalies?
First trimester (organ development )
What medications are examples of teratogens in pregnancy?
Accutane
Seizure Meds
Illicit Drugs
Effect of tobacco on pregnancy?
Increased risk of miscarriage
Fetal growth restriction
Placenta abruption
Preterm labor
Mono/Di twins share __ placenta but _________ amniotic sacs
1
separate
Mono/ Di twins are always ___________. There are at risk for _______ to ______ transfusion syndrome
identical
Twin to twin
Mono Mono twins are always _________. They have ___ placenta and ___ amniotic sac
Identical
1
1
Mono mono twins are at high risk for ________________
Twin to twin transfusion
What is twin to twin transfusion
Blood flows unequally between twins that share a placenta
cardiac output increases __-__%
30-50
stroke volume increases __- __%
30-50
Heart rate increases __-__bpm
10-20
systemic peripheral resistance decreases ___%
30
Systolic and Diastolic BP _________( unless underlying dz. or development of preeclampsia
decreases
what medication is given to treat severe pre eclampsia
Hydralazine
Labetalol
What medication is given to pts with severe pre eclampsia to prevent seizures
Magnesium sulfate
What medication is given for fetal lung maturity?
Betamethasone
What is the only cure for severe preeclampsia?
DELIVERY
