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Women's health > Week 8 Obstetrics & Prenatal care > Flashcards

Week 8 Obstetrics & Prenatal care Flashcards

1
Q

Which hormone is initially secreted by the blastocyst and later by the placenta?

A

HcG

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2
Q

In pregnancy E3 estriol is the primary estrogen produced by the placenta.
true or false?

A

true

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3
Q

The withdrawal of which of these hormones leads to contractions and onset of labor?

A

progesterone

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4
Q

Which hormone works in combination with relaxin to soften ligaments, widen the pelvis, and facilitate birth?

A

Progesterone

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5
Q

What is a diploid cell containing 46 chromosomes known as?

A

zygote

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6
Q

The cytotrophoblast helps establish nutrient circulation between the embryo and the mother.

true or false

A

false

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7
Q

What is the process through which genetically controlled cell groups become organized and specialized from stem cells into specific cell types?

A

morphogenesis

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8
Q

Presumptive Pregnancy signs

A

Signs: nausea with vomiting, fatigue, amenorrhea, breast tenderness, urinary frequency, cholasma

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9
Q

Probable pregnancy signs

A

Signs: positive Chadwick’s sign, positive pregnancy test, abdominal enlargement

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10
Q

Positive Pregnancy signs

A

Correct
Signs: audible fetal heart tones intrauterine pregnancy on ultrasound

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11
Q

Naegel’s rule is based on which of the following assumptions (select all that apply)?

A

No hormonal contraception is being used, and a typical menstrual period is 28 days long.

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12
Q

A second trimester ultrasound uses a crown-rump length to estimate an EDD within 7 days.

True or false?

A

false

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13
Q

Define multipara

A

Woman has had two or more pregnancies beyond 20 weeks, given birth more than once—counting multiple births as one event

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14
Q

define primapara

A

One pregnancy beyond 20 weeks, has given birth once

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15
Q

define nullipara

A

A woman who has not remained pregnant beyond 20 weeks

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16
Q

define para

A

Number of times a woman has given birth to a fetus of at least 20 gestational weeks, viable or no,t counting multiple birth as one birth event

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17
Q

Define primigravida

A

Woman pregnant for the first time

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18
Q

define nulligravida

A

Never has been pregnant

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19
Q

define gravida

A

Total number of pregnancies regardless of outcome, includes current pregnancy

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20
Q

When is amniotic fluid produced?

A

Last half of pregnancy and in form of lung fluid and urine

Fluid is swallowed and removed by placenta

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21
Q

Polyhydramnios

What

S/S #5

Complications #4

Management

A

What: Excessive fluid around fetus; AFI >24cm

S/S:

  • Uterus larger than expected
  • Dyspnea
  • Vulvar edema
  • GI upset
  • Difficulty auscultating fetal heart tones

Complications

  • Preterm labor
  • Fetal cord prolapse
  • Placental abruption
  • Hemorrhage

Management

  • US to confirm
  • Gestation DM screening
  • Refer
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22
Q

Oligohydramnios

What

S/S

Complications 4

Management

A

What: Between 24-36 weeks expect abnormalities!!!!

AFI <5cm

S/S

  • Fetus easy to palpate
  • Variable Heart decibels during labor d/t cord compression w/ contractions

Complications

  • Fetal demise
  • Pressure deformities
  • Pulmonary hypoplasia
  • IUGR

Management

  • US to confirm
  • R/o SROM (spont rupture of membranes)
  • Refer
  • Hydration
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23
Q

Intrauterine growth restriction

Definition

Associated with #4

Risk factors for IUGR #3

A

Fetal weight <10th percentile

Associated with:

  • stillbirth
  • perinatal mortality
  • Abnormalities
  • Learning disability

Risk Factors

  • HTN
  • Poor weight gain
  • lagging fundal height
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24
Q

When are all major organs developed

How long is the corpus lutetium acting as the placenta?

A

10 weeks

10 weeks

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25
Q

What is human placental lactogen?

A

secreted by placenta by week 2 gestation

Metabolism regulation: breaks fats more efficiently

Insulin resistance: decreases maternal glucose reuptake to free up sugar for the fetus

Prepares mammary gland for lactation

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26
Q

What secretes progesterone? ‘

What is its role in pregnancy?

What about when the fetus is “at term”

A

Secreted by corpus luteum and placenta

Maintains myometrium - relaxes smooth muscles

Mediates immune system fxn

Inhibits production of prostaglandins in the uterus

At term - progesterone withdrawal (sharp drop) leads

to uterine contractions and onset of labor

Progesterone supplementation can be given to moms

who experience bleeding during pregnancy

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27
Q

What is the role of Estrogen during pregnancy? 4

(Estradiol, estrone, estriol) Estriol is primary during pregnancy

A

Prepares breasts for lactation

Promotes uterus growth

Increases uterine blood flow

Involved in onset/timing of labor

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28
Q

What is the role of Relaxin in pregnancy?

What is it secreted by?

A

Secreted by: CL then uterus & placenta

Role:

  • implantation & placental growth
  • Inhibits uterine activity during pregnancy
  • Softens ligaments for SI joint to expand
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29
Q

What is the role of Oxytocin in pregnancy?

A

thins and dilates the cervix

facilitates milk release during BF

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30
Q

What secretes HcG?

When can this be detected in the urine? the blood?

Describe how the levels rise

A

Embryo

  • Urine Detection: 2 weeks
  • Blood Detection: 10 days

Doubles every 48-72 hours in 1st month

Excessive higher with multiple gestation or molar pregnancy

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31
Q

What is the role of HcG in pregnancy?

Describe the different levels of HCG

A

Increases progesterone production

LEVELS:

  • Increase 1st trimester 100,000
  • Peaks at 8 to 12 weeks
  • declines & plateaus at 20,000
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32
Q

What are risk factors for hyperemesis gravidum?

A
  • Thyroid
  • GI
  • Vestibular disorders
  • Obesity
  • Pregnant with multiples
  • Nulliparous
  • Previous history
  • Psych disorders
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33
Q

How do you manage hyperemesis gravidum?

What are approved antiemetics for pregnancy?

A

Supportive care

  • Fluid replacement NO DEXTROSE OR THIAMINE (B1)
  • NPO 24-48 hours
  • Ice chips

Antiemetics

  • Promethazine
  • Prochlorperazine
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34
Q

What is a molar pregnancy?

Risk Factors

A

What: *hydatidiform mole*

  • Growth trophoblastic cells from abn fertilized egg
  • implants INSIDE placenta = proliferation placental tissue
  • Benign, could become malignant

Risk Factors

  • <21 years or >35years
  • history miscarriage
  • hx molar pregnancy
35
Q
A
36
Q

Symptoms Molar Pregnancy 8

A

S/S

  • severe persistent N/V
  • Uterine bleeding
  • Grape like fluid cysts
  • Large for date uterus
  • Enlarged tender ovaries
  • Elevated HcG
  • Preeclampsia prior to 20 weeks gestation
  • No fetal heart tones
37
Q

How to work up molar pregnancy?

How to manage Molar pregnancy?

A

Work up:

  • US “snow storm” pattern
  • Fluid filled vesicles in “grape like” patter
  • Obtain HCG level

Management

  • D&C
  • Hysterectomy
  • F/U
    • monitor gestational trophoblastic neoplasia
    • HCG levels to 0
  • No conception for up to 1 year
38
Q

What is the single most important risk factor for infant morbidity and mortality?

A

Preterm labor that happens before 37 weeks of pregnancy

39
Q

What is the definition of preeclampsia?

A

Systolic BP >140/90 in 2 measurements taken 4 hours apart AND 1…

  • PLT <100,000
  • Elevated LFTs (2x norm)
  • Pulmonary edema
  • H/A, visual disturbance
  • Proteinuria >300 in 24 hours
  • Elevated creat
  • Protein-creat ratio >0.3
40
Q

What is the definition of severe preeclampsia?

A

Severe HTN after 20 weeks gestation

Severe BP >160/110 in single episodes TREAT WITHIN 15 MINS

Any signs of HELLP syndrome

41
Q

What are the signs of HELLP syndrome?

A

Hemolysis

Elevated LFT

Low PLT

42
Q

Who is at risk for developing preeclampsia?

A
  • Nulliparous
  • >35 yrs
  • Obestity
  • FMH
  • HTN
  • CKD
  • Pre-gestation DM
  • AAmer
  • Multiple gestations
  • Molar pregnancy
  • Vascular/connective tissue disease
43
Q

preeclampsia

S/S

Management

A

s/s

  • Nonspecific
  • proteinuria
  • HELLP
  • HA/ vision disturbances
  • GI
  • Decreased UO
  • SOB

Management

  • Refer to OB
  • Delivery of baby
44
Q

What is Cell free DNA (“non invasive prenatal testing” NIPT)

A

1st trimester screening 9-10 weeks

Blood sample

Detects trisomies, sex chromosome abnormalities

45
Q

What is the Quad screen

What does it look at?

A

Done at 15 to 18 weeks, up to 22 weeks

  • HCG
  • AFP
  • estriol
  • Inhibin A
  • Neural tube defects
  • Trisomy 18 & 21
46
Q

What prenatal labs are you taking at the first prenatal visit?

A
  • Blod type, RH, antibody screen
  • CBC
  • Hep B surface antigen
  • HIV /STI screening
  • Rubella & Varicella titers
47
Q

What is the timing for subsequent prenatal visits?

A
  • Every 4 weeks until 28 weeks
  • Every 2 weeks until 36 weeks
  • Every week until delivery
48
Q

When do you do the glucose tolerance test?

A

24 to 38 weeks

49
Q

Preterm labor diagnostic criteria

S/S

A

diagnostic

  • Labor between 20 to 37 weeks
  • Uterine contractions
  • Effacement of 80%
  • Cervical dilation over 1cm

Symptoms

  • Frequent contractions
  • Low dull backache
  • abdominal cramping
  • Pelvic pressure
  • Increased vaginal discharge/bleeding
  • Rupture membranes
50
Q

Preterm labor risk factores

A
  • Uterine overdistension
  • Infection
  • Cervical disease/LEEP
  • Stress
  • Decline in progesterone
  • Low socioeconomic status
51
Q

Hedgar’s sign

A

Softening of lower uterine segment

52
Q

Goodell’s sign

A

softening of cervix 6 weeks

53
Q

What are the definitive positive signs of pregnancy?

A

US

Audible fetal heart tones

Fetal movement felt by provider

54
Q

What are the risk factors for diabetes that would make you obtain an A1C and fasting glucose at the initial visit?

A
  • Hx gestational diabetes or glucose intolerance
  • BMI >25
  • Hx macrosomia or still birth
  • 1st degree relative w/diabetes
  • Non white race
55
Q

When do you do the 1 hour glucose tolerance test for gestational diabetes?

A

24-28 weeks

56
Q

When do you do Group B strep screening?

A

36 to 38 weeks

57
Q

When do you do US for dating and anatomical survey?

A

18 to 20 weeks

58
Q

When do you start folic acid supplementation?

How much?

How much if history of infant with NTD?

A

3 months prior

400mcg

4mg/day if prior

59
Q

What medications can you take for nausea

A

Vitamin B6 and Doxylamine (unisom)

Diclegis (+urine screen)

60
Q

Explain GTPAL

A

Gravida: # pregnancys regardless outcome includes current pregnancy

Term: # pregnancies delivered at or after 37 weeks

Preterm: # pregnancies delivered from 20 to 36 weeks

Abortion: # pregnancies ending before 20 weeks

Living: # living children

61
Q

What is lochia? how long does it last?

A

shedding of uterine lining after delivery: blood mucous and uterine tissue

Lasts for 4 to 6 weeks after childbirth

62
Q

What is/length of time

Lochia rubria

Lochia Serosa

Alba

A

Rubra: 3-4 days after birth, blood clots

Serosa: Days 4 to 10; Mucus/Pinkish/Brown; less volume, few clots

Alba: days 10 to 28; whitish, no odor, no real flow

63
Q

What is uterine involution?

How long does this take?

A

Uterus transforms to nonpregnant state

Takes 5 to 6 weeks

Fundal height decreases 1cm/day

No longer palpable by day 10

64
Q

When do you provide Rhogam to a RH negative mom that had an abortion?

A

within 72 hours

65
Q

What symptoms should the patient report when having an abortion?

A

Saturating more than 1 pad/hour

Temp >100.4/chills

Passing clots larger than golf ball/50cent piece

66
Q

What is the Nuchal Translucency US and blood draw for free beta HCG and PAPP-a do?

When is it done?

A

10 - 14 weeks

Looks for Down’s syndrome

High false positives

67
Q

What is the nasal bone calcification evaluation and when is it done?

A

first-trimester screening

Increases chances of detecting trisomy 21

68
Q

What are the life threatening conditions you need to r/o with bleeding during pregnancy?

A
  • Ectopic pregnancy
  • maternal hemorrhage

NEXT

  • determine fetal viability
  • origin of bleeding
69
Q

What are some differentials for bleeding during pregnancy?

A
  • ectopic
  • cervicitis
  • cervical polyps
  • implantation
  • subchorionic hemorrhage
  • vulvar varicosities
  • hemorrhoids
  • cystitis
  • molar pregnancy
70
Q

How to work up bleeding during pregnancy

A
  • HCG levels
    • Q1.5 days until week 5
    • Q 2days until week 6
    • Q 2-2.5 days until week 7
    • HCG should plateau and fall weeks 8 to 10
  • CBC
  • Progesterone level
  • STI testing
  • Transvaginal US
71
Q

What are the signs of ectopic pregnancy?

Risk factors

A

Symptoms

  • Spotting/bleeding
  • lower sharp abdominal pain
  • Tender adnexal mass

Risk Factors

  • Previous history
  • Hx PID or surgery
  • <25 or >35
  • 3.5x more common in June and Dec
72
Q

How do you manage Ectopic Pregnancy?

A

Diagnose early to preserve fertility

Hospitalization

73
Q

What is Vasa Previa?

A

Fetal blood vessels cross cervical opening that can result in hemorrhage

Can palpate pulsating cord

74
Q

What is placenta previa?

What if it does not improve by 28 weeks?

A

Malposition of the lower uterine segment and extends across the cervical os

Hallmark sign: Sudden onset painless vaginal bleeding

*no improvement within 28 weeks = c section

75
Q

Abruptio Placentae

What

Cause

Signs

A

What: Placenta separates prior to birth

Associated with:

  • Uterine scar from c/s
  • smoking
  • Advanced maternal age
  • multiple gestations/parity
  • hypertension

Signs

  • mimic labor
  • Blood discharge
  • firm tender abdomen
76
Q

Management of low lying placenta and partial previa

A

f/u at 24 to 28 weeks gestation

77
Q

Management of complete previa

A

serial US and pelvic rest

78
Q

Management of vasa previa

A

antenatal corticosteroids 28 to 32 weeks

hospitalization at 30 to 34 weeks

C section at 35 to 37 weeks

79
Q

Naegele’s rule

A

EDD +/- 5 days

Count back 3 months and add 7 days

80
Q

How long until an ultrasound can measure EDD?

A

13 weeks

81
Q

What are complications for mother that gestational diabetes can cause? 6

A
  • pregnancy loss
  • HTN/preeclampsia
  • increased chance of c/s d/t macrosomia
  • prolonged labor
  • risk of DM 2 within 10 years
  • pyelonephritis
82
Q

What are complications for the baby if the mother has gestational diabetes?

A
  • fetal anomalies
  • IUGR
  • premature birth
  • hypoglycemia
  • hyperbilirubinemia
  • obesity & type 2 diabetes in adulthood
83
Q

What is the screening process for gestation diabetes?

A

Screened at 24 to 28 weeks gestation

50g oral glucose

1hr test >130 —- needs 3 hour test

if 1 hr test >180 —— Dx GESTATIONAL DIABETES

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