Wk 8: Women's health pregnancy (incl. in 11%)

Question 1

1) Placental growth is a cardiovascular change during pregnancy that involves what?
2) What two things does the body increase to compensate for these changes?
3) When does the placenta stop growing?

Answer 1

1) New vessels are added, increased blood flow to placenta
2) HR and cardiac output
3) At ~week 26

Question 2

What does more fluid being present during pregnancy lead to? (2 things)

Answer 2

1) Daytime pedal edema
2) Nocturia/frequent nighttime urination (bc of daytime edema)

Question 3

Why does nocturia/frequent nighttime urination occur in pregnancy?

Answer 3

Excess blood volume that was in her legs all day finally returns to more central circulation and acts like a fluid bolus

Question 4

1) Define physiologic hypotension
2) IVC compression can happen in pregnancy; what are the symptoms and what process in the body causes each?
3) How can IVC compression be relieved?

Answer 4

1) Normal dip in the BP during pregnancy
2) Less venous return > cardiac output is decreased > blood pressure falls > dizziness, presyncope > syncope
3) If she’s on her back or right side, move to left lateral decubitus

Question 5

1) What urinary change is common in pregnancy besides nocturia?
2) What are pregnant people at higher risk of?

Answer 5

1) Mild glucosuria
2) UTI

Question 6

Why are pregnant ppl at a higher risk of UTI?

Answer 6

Dilation of urinary tract (secondary to increased blood volume) = greater risk of ascending infection

Question 7

1) Define gestational diabetes
2) What factors put people at risk for this?

Answer 7

1) Elevated blood glucose that starts after 20 weeks gestation
2) Obesity, being Hispanic or Southeast Asian

Question 8

How is gestational diabetes diagnosed?

Answer 8

All women are screened weeks 24-28 with oral glucose tolerance test (OGTT)

Question 9

List 3 potential GI pregnancy side effects

Answer 9

1) Constipation
2) GERD
3) Gallbladder disease

Question 10

What 2 things should you counsel a pregnant pt with constipation on?

Answer 10

1) Dietary fiber
2) Stool softener vs. motility agent

Question 11

1) What causes GERD in pregnant people?
2) How is it treated? (2 things)

Answer 11

1) LES relaxation plus compression of stomach by gravid uterus = reflux
2) -Lifestyle changes: Avoid caffeine, spicy food, nicotine, mint, large meals, fatty meals
-TUMS (calcium carbonate) acceptable in pregnancy

Question 12

What can accompany gallbladder disease in pregnancy?

Answer 12

1) Formation of new stones
2) Worsening of stones
3) Cholecystitis

Question 13

What causes breast enlargement in pregnancy?
What are the 3 steps?

Answer 13

-Mammary glands
1) Proliferate in 1st trimester
2) Glands differentiate in 2nd trimester
3) Glands produce milk in 3rd trimester

Question 14

When is 1st trimester?
2nd?
3rd?

Answer 14

1st trimester: conception to 12 weeks
2nd trimester: 13-27 weeks
3rd trimester: 28-40 weeks

Question 15

What are 5 potential skin changes that can occur w pregnancy? Describe each

Answer 15

1) Hyperpigmentation: “mask of pregnancy” also called “melasma”
-Etiology unknown
2) Linea nigra: Darkening of skin over linea alba
3) Palmar erythema
4) Spider angiomata: telangiectasia

Question 16

1) What should be the causes of weight gain in pregnancy?
2) How much weight gain is normal in each pt of pregnancy?

Answer 16

1) Amniotic fluid, placenta, fetus, maternal adipose stores
2)
1 lb/month first trimester
1lb/week thereafter

Question 17

1) How does being underweight affect pregnancy weight gain recommendations?
2) What abt being overweight?

Answer 17

1) Gain more; build up adipose stores
2) Gain less: adipose stores are adequate, and weight gain should be due to fluid, placenta, fetus

Question 18

Give 4 examples of fetal surveillance

Answer 18

1) Fundal height measurement
2) Kick counts
3) Fetal heart rate auscultation (doppler/stethoscope)
4) Electronic Fetal Monitoring

Question 19

Give 2 examples of Electronic Fetal Monitoring

Answer 19

1) Non-Stress Test
2) Oxytocin Challenge Test (Contraction Stress Test)

Question 20

1) What assesses (grossly) the growth of the fetus?
2) What is this measurement equal to?

Answer 20

1) Fundal height measurement
2) Fundal height (in cm) ≈ gestation age (in weeks) between 16-36 weeks gestation

Question 21

A larger than expected fundal height measurement is concerning for what 4 things?

Answer 21

1) Molar pregnancy
2) Large for gestational age baby/Gestational diabetes
3) Polyhydramnios
4) Multiples

Question 22

A smaller than expected fundal height measurement is concerning for what 3 things?

Answer 22

1) Small for gestational age baby or IUGR
2) Fetal Death
3) Oligohydramnios

Question 23

Define molar pregnancy

Answer 23

Tumor growth as a result of a nonviable fetus

Question 24

When it comes to assessment of fetal well-being via kick counts what is normal?

Answer 24

> 10 movements/2 hrs
2) Fetal movement decreases in response to fetal hypoxemia
If mom perceives decreased fetal movement, further testing should be instituted.

Question 25

1) Auscultation of heart tones can usually be done by fetoscope by the __________th week and with doppler by the _______th week (though typically not done until _____th week) 2) After ____________ fetal heart rate can be assessed with external fetal monitor.

Answer 25

1) 12th; 8th; 10th 2) 16 weeks

Question 26

What are the two questions you should ask abt fetal heart rate during auscultation?

Answer 26

Is the heart rate within normal range? (110-160 bpm) Do you hear/see any abnormalities?

Question 27

1) What is the most common means of assessing the health and viability of the fetus throughout labor? 2) What does it track? What is this a marker of?

Answer 27

1) External Fetal Heart Rate (FHR) Monitor 2) The variability in the fetal heart rate, which, as the fetus matures, is a marker for fetal well-being (moderate variability) 3) Also used to perform Non-Stress and Contraction Stress testing

Question 28

When should a pregnant woman go to the hospital? (4 reasons) *important*

Answer 28

1) Contractions occur approximately every 5 minutes for at least 1 hour 2) A sudden gush of fluid or a constant leakage of vaginal fluid (suggesting rupture of membranes [ROM]) 3) Any significant vaginal bleeding 4) Significant decrease in fetal movement

Question 29

At 20 weeks, fundus should be where?

Answer 29

At the umbilicus (20 cm fundal height) *important*

Question 30

1) What is the most common cause of perinatal morbidity and mortality? 2) What is this defined as?

Answer 30

1) Preterm birth 2) Birth before 37 completed weeks of gestation

Question 31

What are the two types of preterm birth?

Answer 31

Spontaneous vs medically indicated (induced)

Question 32

List the risk factors for preterm labor (PTL)

Answer 32

1) Maternal age <18 years or >40 years 2) PROM or PPROM 3) Low maternal pre-pregnancy weight 4) Smoking 5) Substance abuse 6) Lack of prenatal care 7) Short interpregnancy interval 8) Short cervical length 9) UTI or genital tract infection 10) Multiple gestation 11) Prior preterm birth

Question 33

List 4 maternal complications (medical or obstetric) that may cause PTL

Answer 33

1) Activation of maternal/fetal HPA axis due to stress 2) Inflammation/infection (see next slide) 3) Hemorrhage (e.g., placental abruption) 4) Pathologic uterine distention (polyhydramnios, etc.) -Preterm labor may be secondary to these pathogenic processes

Question 34

List 5 infectious causes of PT

Answer 34

1) Chorioamnionitis 2) Bacterial vaginosis 3) Asymptomatic bacteriuria 4) Acute pyelonephritis (UTI) 5) Cervical/vaginal colonization

Question 35

List 7 fetal causes of PTL

Answer 35

1) Intrauterine fetal death (IUFD) 2) Intrauterine growth retardation (IUGR) 3) Congenital anomalies 4) Abnormal placentation 5) Polyhydramnios 6) Multiple gestation 7) Macrosomia

Question 36

What are 7 S/Sx of preterm labor?

Answer 36

1) Menstrual-like cramps 2) Low, dull backache 3) Abdominal pressure 4) Pelvic pressure 5) Abdominal cramping (with or without diarrhea) 6) Increase or change in vaginal discharge (mucous, watery, light bloody discharge) 7) Uterine contractions, often painless

Question 37

1) Define post-term pregnancy 2) What two groups is it most common in? 3) What is the most common cause of it?

Answer 37

1) Pregnancy that has gone beyond 42 completed weeks 2) Primiparous (first birth/pregnancy), and hx of post-term delivery 3) Incorrect estimation of gestational age

Question 38

1) Who is a post-term pregnancy an increased risk to? What type of assessments must start if post-term? 2) Due to increased morbidity, most practices will not let pregnancy go beyond ___ wks

Answer 38

1) Incr. risk to baby; fetal assessment (kick counts, non-stress tests, ultrasound evaluation of amniotic fluid) 2) 42 wks

Question 39

List 5 conditions assoc. with post-term pregnancy

Answer 39

1) Macrosomia 2) Shoulder dystocia 3) Meconium aspiration syndrome (MAS) 4) Dysmaturity syndrome 5) Oligohydramnios

Question 40

1) Define macrosomia 2) Define shoulder dystocia 3) What can MAS cause?

Answer 40

1) Weigh of >4,500 g (~9.9 lbs) 2) Impaction of the anterior fetal shoulder behind the symphysis pubis during vaginal delivery causing a brachial plexus injury (emergency) 3) Severe respiratory distress/death

Question 41

1) Define dysmaturity syndrome 2) Define oligohydramnios. When is this an indication for delivery?

Answer 41

1) Infants with characteristics resembling chronic growth restriction 2) Decreased amniotic fluid; if >36 weeks