Varney's Ch 19: A&P of Preg.

Question 1

Diagnosis of pregnancy

Answer 1

• presumptive - patient-reported, no period, n/v
• probable - physical changes or labs
• positive - ultrasound or fetal heart tones

Question 2

Methods to confirm pregnancy

Answer 2

•urine hCG - 14 days after fertilization or 4 weeks after menstruation. Cheap and quick.
•blood serum hCG - 8-10 days after fertilization. Can order qualitative (pos/neg) or quantitative. More expensive. Choose for women with complications - bleeding/pain.
• Double every 2-3 days (week 6-8), 3-5 days (weeks 8-10)
• Serum Quant hCG: 1500-2000 =91% gestational sac on U/S
• Serum Quant hCG: 3000 = 99% gestational sac on U/S
•text

Question 3

Establishing pregnancy dating

Answer 3

•LMP - 280 days after first day of LMP OR Nagele’s rule (+) 7 days to first day of LMP and (-) 3 months (Use for 28 day cycle - adjust if not)
•bimanual exam
•transvaginal U/S or transabdominal U/S (when fundus is above pubis)
• U/S - 4.5-5 wks = gest. sac, 5-6 wks = yolk sac, 6-7 wks = embryo w/ cardiac activity

Question 4

Fetal embryology

Question 5

placental physiology

Answer 5

• Simple diffusion is the placental transport mechanism transfers oxygen, carbon dioxide, electrolytes, water, and certain medications

Question 6

hCG

Answer 6

• Human Chorionic Gonadotropin - released from fertilized egg
•can test for up to 9 weeks
• stimulates the production of progesterone from the corpus luteum during pregnancy

Question 7

blastocyst

Answer 7

fertilized egg

Question 8

sperm viability

Answer 8

3 or more days

Question 9

GPTAL

Answer 9

Gravida (pregnancies), Para (preterm+term), Term, Preterm (20-36.6 wks) Abortion (<20wks), Living

Question 10

trophoblast

Answer 10

becomes placenta

Question 11

amniotic fluid

Answer 11

is produced by the amniotic epithelium and fetal functions.

Question 12

late preterm

Answer 12

34.0 - 36.6 weeks

Question 13

early term

Answer 13

37.0 - 38.6 weeks

Question 14

Prenatal visits

Answer 14

• Initial Prenatal - start 6-12 weeks
• Return Prenatal - monthly until 28 weeks, q 2 weeks from 28-32 weeks, weekly 36 weeks til birth
• Postpartum - once at 6 weeks

Question 15

Yolk sac

Answer 15

feeds embryo until placenta takes over from 5 weeks - 10 weeks

Question 16

Human placental lactogen (hPL)

Answer 16

increases insulin resistance and stimulates the production of growth hormones during pregnancy

Question 17

First Trimester

Answer 17

• LMP - 12w6d
• fertilization, implantation, organogenesis
• embryonic period and beginning of fetal period (wk 10)

Question 18

Second Trimester

Answer 18

• 13w0d - 27w6d
• organs mature/functioning
• continuation of fetal period
• fetal movement 18-22 weeks

Question 19

Third trimester

Answer 19

• 28w0d - Birth
•? hypertrophy (growth stage) dominate by 32 weeks