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Endrocrine & Reproduction II Exam #1 > The Normal Pregnancy > Flashcards

The Normal Pregnancy Flashcards

1
Q

What are 2 things to be done for prenatal care to decrease birth defects?

A

Starting folic acid at least 1 mo. prior to conception (reduces risk of spina bifida and anencephaly)

Adequate glucose control in patients with DM

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2
Q

How much folic acid should be given to women in their first pregnancy vs. subsequent preganncies?

A

No history: 0.4 mg

History: 4.0 mg

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3
Q

Gravity and Parity (4)

A

Gravity: number of times a woman has been pregnant

Parity: number of pregnancies that led to a birth at or beyond 20 wks or >500 g.
-includes full-term, pre-term, abortions, living

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4
Q

Normal findings associated with pregnancy include… (6)

A

Systolic murmurs (splitting and S3)

Palmer erythema

Spider angiomas

Linea nigra

Striae gravidarum

Chadwick’s sign (bluish hue of vagina on pelvic exam)

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5
Q

Labs/vaccines done at 1st visit (9)

A

CBC

Type and screen (Rh)

Rubella vaccine if not immune

Syphilis

Hep B sAg

HIV

Cervical cytology and Gonorrhea and Chlamydia

DM screening

Urine culture

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6
Q

What are 2 lab abnormalities in pregnancy?

A

Increased fibrinogen and clotting factors

Decreased Hct and Hb due to diluted volume

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7
Q

Most important thing to establish on first visit is…

A

Approximate due date

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8
Q

When can hCG be detected on pregnancy test?

What levels suggest it is negative vs. positive?

What is the level at menses?

A

6-8 days post ovulation

Negative: <5 IU/L
Positive: >25 IU/L

Approx 100 IU/L at menses

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9
Q

How frequently does hCG double in the first 30 days of pregnancy?

A

hCG doubles every 2ish days in the first 30 days

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10
Q

When is gestational sac seen?

A

When hCG is 1500-2000 IU/L

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11
Q

How can gestational age and due date be estimated? (3)

A

LMP - Naegel’s rule: minus 3 mo. and 7 days = due date (does not work if pt’s cycles are irregular or cannot remember, etc.)

PE - size of uterus

US

  • crown rump length (CRL) between 6-11 wks can determine due date within 7 days
  • 12-20 wks measuring femur length, biparietal diameter and abdominal circumference can determine due date within 10 days
  • 3rd trimester can be off by +/- 3 wks
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12
Q

Women >35 y/o are at an increased risk…

A

Autosomal trisomies (13, 18, or 21) or sex chromosome abnormalities

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13
Q

Which recessive disease should be genetically screened for in all pregnant women?

A

CF, because up to 15% of carriers are undetected

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14
Q

Which 2 sex-linked disorders should be genetically screened for?

A

*Fragile X syndrome: most common form of inherited mental retardation

Duchenne muscular dystrophy

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15
Q

What is the most common inherited multifactorial disorder?

A

Neural tube defects (1/1000 live births)

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16
Q

What are 4 parts of the first trimester screening (up to 14 weeks)?

A

Maternal age

Fetal nuchal translucency (NT) thickness (echo free area at the back of the fetal neck from 10-14 wks)

Maternal serum b-hCG

Pregnancy associated plasma protein-A (PAPP-A)*

17
Q

Which 2 screens are done in the second trimester (weeks 14-28)? What do they test for?

A

Triple screen: b-hCG, maternal serum alpha fetoprotein (AFP) biochemical markers. Done between 16-20 wks. 70% detection rate of trisomy 21.

Quadruple screen: b-hCG, estriol, AFP and inhibin A. 80% detection rate of trisomy 21.

18
Q

What is the better way to do prenatal testing in high risk patients?

A

Cell-free fetal DNA testing

19
Q

When is cell-free fetal DNA testing done?

Where does the DNA come from?

What should it NOT be used for?

A

9-10 weeks (can be done in first or second trimester)

Apoptosis of trophoblastic cells that have entered maternal circulation

NTD - evaluate maternal-AFP instead

20
Q

Which patients should Cell-free fetal DNA testing be done? (5)

A

High maternal age

H/O pregnancy with a trisomy

FH of chromosomal abnormalities

US findings suggestive of aneuploidy

Positive serum screening in first trimester or triple/quad screening (second trimester)

*due to high cost

21
Q

If a cell-free fetal DNA test is positive, what is the next step?

A

Invasive diagnostic test to confirm - amniocentesis or CVS (second trimester diagnostic procedures)

22
Q

When can amniocentesis and CVS be done? What are their miscarriage rates?

A

Amniocentesis: 16-20 weeks, 0.3% miscarriage rate

CVS: 11 weeks, 1% miscarriage rate

23
Q

Historical important teratogen:

A

Thalomide, which causes phocomelia

24
Q

FDA classification of drugs in pregnancy (A, B, C, D, X)

A

A - no risk in any trimester

B - studies reveal no risk, however studies might not be adequate

C - animal studies show an adverse effect, but no studies done on pregnant women

D - there is a demonstrated risk to fetus, but the benefits may outweigh the risks on occasion

X - contraindicated - do not use!

Out-dated and not used anymore

25
Q

What is the newer way drugs used in pregnancy are evaluated? What 3 subsections do they evaluate?

A

Pregnancy and lactation labeling rule (PLLR)

Pregnancy
Lactation
F/M reproductive potential

26
Q

What time is the fetus most vulnerable to teratogens? Why?

What happens from the 4th month onward?

A

Day 17-56 post-conception, due to organogesis.

From 4th month to the end is mainly increasing organ size, not development.

27
Q

What are the major teratogens? (9)

A

Alcohol - most common

Smoking

Anti-anxiety meds

Anti-neoplastic (aminopterin and MTX)

Anti-coagulants - do not use Coumadin, must use Heparin instead

Anti-convulsants

Illicit drugs

Infectious agents

Radiation

28
Q

What is thought to be a possible risk of estrogen-progesterone combos in pregnancy?

A

Masculinization of female external genitalia

29
Q

What is the dose dependent aspect of radiation exposure in pregnancy?

When is the critical period for its use?

What is exposure is before 2 weeks?

In most cases, diagnostic levels of radiation…

What is the rule of thumb for determining no risk?

A

Risk increases with dosage

2-6 wks is critical period

Lethal effect or no effect at all < 2 wks

Does not have a teratogenic risk

Rule of thumb: <5 rads of exposure = no risk

30
Q

Frequency of office visits in pregnancy from:

Until 28 wks
28-36 wks
Until delivery

A

Until 28 wks: every 4 wks
28-36 wks: every 2 wks
Until delivery: weekly

31
Q

What is done at routine office visits during pregnancy? (5)

A

BP

Weight

Urine protein

Uterine measurement (20 wks at umbilicus)

Fetal HR (doppler at 12 wks and fetoscope from 18-20 wks)

32
Q

How much weight should be gained for the following BMIs?

<19
19-25
>25

A

<19: 28-40 lbs
19-25: 25-35 lbs
>25: 15-25 lbs

33
Q

How can fetal movement be assessed?

A

Kick counting: 10 movements in 2 hrs

34
Q

When near term, what 2 things should be evaluated?

A

Evaluate fetal lie (longitudinal, oblique, transverse)

Evaluate fetal position (vertex, breech)

35
Q

Screening done at:

20 weeks (1)

28 weeks (4)

35 weeks (1)

A

20 weeks: fetal survey US

28 weeks: gestational DM, and repeat Hb and Hct, Rhogam, Tdap (27-36 wks)

35 weeks: screening for group B strep carrier with vaginal culture

36
Q

What is a reactive non-stress test (NST)?

What does a non-reactive non-stress test require (positive test)?

A

2 accelerations of at least 15 beats above baseline lasting at least 15 sec. during 20 min of monitoring

Further evaluation with a contraction stress test or biophysical profile

37
Q

What is the contraction stress test (CST)?

What is a positive test?

A

Give oxytocin to establish at least 3 contractions in a 10 min period.

If decelerations are noted with the majority of contractions the test is positive and delivery is needed.

38
Q

What 5 biophysical variables are included in determining the biophysical profile?

What do the following scores mean?
8-10
6
<4

A 
Non-stress test
Fetal breathing movements
Fetal movements
Fetal tone
Amniotic fluid volume

8-10: reassuring
6: equivocal, deliver if at term
<4: non-reassuring, consider delivery

Endrocrine & Reproduction II Exam #1 (17 decks)

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