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110 Cards in this Set
- Front
- Back
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stim lactotrophs in ant lobe of pituitary gl
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estradiol
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stores oxytocin and ADH
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pos pituitary gl
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HCG reset recs for thirst and ADH release leading to
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dec Na and sumx polyuria
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size of thyroid in pregnancy
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normal, fluctuations in t3 and t4 and tsh
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contribute to inc insulin res in later pregnancy and a shift from carbohydrate to fat metabolism
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placental hormones
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produce a state of relative hypercortisolism that may be a trigger for labor
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corticotropin releasing hormone and adrenocorticotropic hormone
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effects of progesterone
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tidal vol and minute ventilation inc sumx leading to dyspnea, lower esophageal sphincter tone (GERD), relaxes tone and contraction of ureters (hydronephrosis and inc risk bacteruria)
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cardiovascular changes in pregnancy
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erythrocyte mass and plasma vol inc (physiologic anemia) CO inc, vascular res and BP fall
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musculosketeal changes
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weight gain and relaxin (CL and placenta)
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thick yellowish secretion rich in nutrients from mid-late pregnancy
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colostrum
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inc vascularity, vagina takes on bluish/violet color known as
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Chadwick's sign
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Lactobacillus acidophillus acts on glycogen in vaginal epi to
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dec vaginal pH (more acidic)
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softening at the isthmus, easrly dx pregnancy
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Hegar's sign
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uterus weight and volume with pregnancy
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50-70 g inc to 800-1200, vol 10ml inc to 5L
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pos of uterus after 12 weeks gestation
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straightens and rises out of pelvis, can be felt in abdomen
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uterus rotates to the right
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to accomodate rectosigmoid structures on the left
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cervical canal fill with tenacious mucus plug
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to protect fetus from inf
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normal red velvety mucosa
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cervical erosion/eversion
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small nodule on ovary in early pregnancy
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corpus luteum (ovarian follicle)
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brownish black pigmented line along midline
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linea nigra
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amenorrhea
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every trimester due to high estrogen, progesterone, HCG
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nausea with or without vomiting
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first trimester, 2-5 lb due to slowed peristalsis, changes in taste/smell, weight loss
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breast tenderness, tingling
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1st trimester
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weight loss
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1st tri
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fatigue
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1st/3rd tri, progesterone/ sedative
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amenorrhea
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every trimester due to high estrogen, progesterone, HCG
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nausea with or without vomiting
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first trimester, 2-5 lb due to slowed peristalsis, changes in taste/smell, weight loss
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breast tenderness, tingling
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1st trimester
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weight loss
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1st tri
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fatigue
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1st/3rd tri, progesterone/ sedative
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groin/lower ab pain
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2nd tri (14-20wks) tension/stretching round ligs
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ab striae
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late 2/3rd tri
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contractions
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3rd tri reg, painful then associated with labor otherwise braxton hicks rarely assoc with labor
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loss of mucus plug
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3rd tri, no contractions, bleeding or loss of fluid no cause for concern
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edema
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3rd tri
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heartburn, constipation
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all tri
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backache
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all, relaxation of jnts/ligs
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urinary frequency
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all
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leukorrhea
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all, inc sec vagina and cervix, asx milky white discharge
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best confirmation for pregnancy
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urine testing for beta HCG
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PMH questions for pregnancy
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SLE, STD, deithylstilbesterol, HIV
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most frequently used method of calculation for expected weeks of gestation and EDD
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menstrual age
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Naegele's rule for estimating EDD
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add 7 days to first day of LMP, minus 3 mos, add 1 year
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if pt cant remember LMP or irreg menstrual cycles use
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vaginal US to confirm dating in 1st tri
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inc diet each day by:
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300 kcal, 5-10 g protein, 15 mg iron (27 according to lecture), 250 mg Ca, 400-800 microg folic acid
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amt of folic acid recommended in multivitamin
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400 micrograms
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FDA recommends avoiding fish with high levels of mercury such as
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shark, swordfish, king mackerel, canned albacore tuna
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most weight gain in what tri?
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2nd
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average weight gain
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28 lbs/ 10 kg
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weight gain for low BMI <19.8
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28-40 lbs
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normal BMI 19.8-26
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25-35 lbs
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high BMI 26-29
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15-25
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obese >29
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15 lbs
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weight gain w twins
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35-45 lbs
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ACOG recs for exercise
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30 mins or more on most days of the week
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prevalence of abuse during pregnancy
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7-20%
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clues to domestic violence
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frequent changes in apts, chronic headache, ab pain, bruises
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approx 20 wks, diminished circulation and may lead to dizziness and fainting esp when lying down
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supine hypotensive syn
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devices for pap smear in pregnant women
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ayre wooden spatula or broom
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gestational HTN
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greater than 140/90 after week 20 and without proteinuria
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chronic HTN
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greater than 140/90 before pregnancy, before week 20 and 12 weeks pospartum
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preeclampsia
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greater than 140/90 after week 20 and with proteinuria
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normal bmi before pregnancy
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19-25
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normal wgt loss for first tri
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no more than 5%
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brownish patches around forehead, cheeks, nose, jaw
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chloasma
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facial edema after 24 weeks suggests
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gestational HTN
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dyspnea with cough, distress
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inf, asthma, pulmonary embolus
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apical impulse
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may be in 4th ICS
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systolic or continuous soufle
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common, inc bld flow in normal BVs
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mammary soufle
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late pregnancy, lactation, 2 or 3rd ICS parasternal areas, sys and diastolic
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fetal movements
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felt by mother 18-20 weeks, by doc after 24 weeks
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regulat uterine contractions before 37 weeks with or without pain or bleeding
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abnormal, preterm labor
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fundal height 4cm greater than expected
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multiple gestation, large fetus, extra amniotic fluid, uterine leiomyoma
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fundal height 4 cm less than expected
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missed abortion, transverse lie, growth retardation, false pregnancy
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weeks FHR can be auscultated
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10 with doptone, 14 w fetoscope
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location of FHR 12-18 wks
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midline of lower ab
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FHR during early and near term pregnancy
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160s, 120-140
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FHR after 32-34 weeks
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inc w fetal movement
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FHR that drops noticeably with fetal movement
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poor placental circulation or dec amniotic fluid volume
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perineal incision to facilitate delivery
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episiotomy
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pink cervix or vagina
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nonpregnant state
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multiparous cervix
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may admit a fingertip thru ext os
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narrow passage btw endocervical canal and uterine cavity
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internal os, closed regardless of parity
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cervix length prior to 34-36 weeks
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1.5-2 cm usual
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shape of uterus until 8 weeks
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inverted pear
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uterus shape 10-12 weeks and size
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globular, 8 cm
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two distinct uterin cavities sep by a septum
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bicornuate uterus
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first leopold maneuver
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upper pole, buttocks- firm and irreg
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second leopold maneuver
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sides of maternal abodomen, hand along back-firm, smoothe, length of hand by 32 weeks; arms/legs irreg bumps
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third maneuver
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lower pole, face womans feet, if hands diverge presenting part is descending into pelvic inlet
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fourth maneuver
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confirmation of presenting part, grasp lower pole with dominant hand and upper with nondominant, head lower pole (smoothe, firm, round)
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duration of pregnancy
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166 days from conception, 180 from LMP, 37 weeks
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post term
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beyond 42 weeks
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para
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number of deliveries after 20 weeks
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preterm labor
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10% in US, before 37 weeks
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screening for neural tube defects
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AFP 15-20 weeks
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drugs contrindicated in pregnancy
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quinolones, tetracycline, aspirin
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interval of prenantal visits
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every 4 weeks until 28 weeks, (28-36) every two weeks, every week after 36 weeks
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size of uterus at 20 weeks
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level of umb
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50 g glucose challenge
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at 28 weeks
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tx for nausea and vom
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frequent meals, B6, antihstamines
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implantation of placenta over cervical os, painless vaginal bleeding, has to be delivered by c section
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placenta previa
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first stage of labor and duration
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onset to complete dilation, 8-15 hrs
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second stage of labor, duration
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complete dilation to delivery of fetus, 1-3 hrs
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third stage of labor
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delivery of fetus to delivery of placenta, 15-30 mins
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active phase of labor
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>4 cm, progressive dilation, cm/hr in nulliparous, -2 cm in multiparous, reg frequent contractions every 2-3 mins
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cardinal movements of labor
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engagement, descent, flexion, int rotations, extension, ext rotation expulsion
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fetal tachycardia
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>160 bpm
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fetal bradycardia, mc cause
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<120 bpm, inc vagal tone
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uterus most easily palpable beyond
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12-14 weeks
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