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76 Cards in this Set

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Goals of preconception counseling include:
- optimize maternal health prior to pregnancy
- minimize adverse health effects for mother and fetus
- Assess genetic disorders
- update immunizations
- control or stabilize chronic diseases
What is Naegele's rule?
Estimate the EDD (Estimated date of Delivery) by adding 7 days to first day of LMP, subtract 3 months, and add 1 year.
Risk factors for genetic disorders include:
- advanced maternal age (>35)
- advanced paternal age (>50)
- Prior preg with trisomy
- Hx of early preg loss
- ethnicity
Down Syndrome is a trisomy of chromosome ____
21
Trisomy 18 is known as ___ syndrome and has what survival rate?
- Edward's syndrome
- 5-10% survival at 1 year
Patau syndrome is a trisomy of chromosome ___ and has what survival rate?
- Trisomy 13
- 20% (80% die 1st year)
What is Hegar sign?
Palpable softening of the uteus at the isthmus.
___ is softening of the cervix/ isthmus and is an early diagnostic sign of pregnancy.
Hegar's sign
What is Chadwick's sign?
- Increased vascularity throughout the pelvic region causes the vagina to take on a bluish color in early pregnancy
During the first PN visit, a pt should be assessed for what risks?
- ectopic pregnancy
- inc. blood pressure
- dehydration
- leukorrhea vs STI
- bleeding,
- leaking amniotic fluid
An abdominal ultrasound can detect gestational sac and fetal cardiac activity at what gestational age.
5-6 weeks
WHat labs should you order on the initial PN visit?
- cbc, syphilis, HIV, glucose, antibody screen, rubella, varicella, Rh &ABO
What are leopold maneuvers? What age do they become useful?
- 4 maneuvers to identify fetal presentation after 28 weeks gestational age
Describe expected fundal height at the following intervals:
- 16 wks
- 20 wks
- 36 wks
: 16 = 1/2 way between pubis and umbilicus
20 = umbilicus
36= xyphoid
Define the following abbreviations:
- LGA
- SGA
- IUGR
- NTD
- LGA = large for gestational age
- SGA = small for gestational age
- IUGR = intrauterine growth restriction
- NTD = neural tube defect
Fetal heart tones may be heard as early as ____
10-12 weeks EGA
If a RH - mother has a RH+ baby, ___ must be given at __ weeks and within ____ hours of delivery to prevent future problems.
1. Rhogam
2. 28 weeks
3. within 72h of delivery
Which hormone is responsible for maintaining the corpus luteum, and also is used to detect pregnancy?
Serum hCG
What effects does progesterone have during pregnancy?
- embryo implantation
- endometrial support
- mammary glands
- increased gastric reflex
What is the function of the hormone relaxin during pregnancy?
- relaxes pubic symphysis and joints
Describe the changes of the thyroid gland during pregnancy.
- stays normal in size
- effects of estrogen result in fluctuations of free T3 and T4
- is reciprocal with B-hCG in first trimester
Describe the effects of estrogen on the pituitary gland during pregnancy.
- result in enlargement and stimulation of lactotrophs
- increased melanocyte stimulation (hyperpigmentatio - melasma)
- increase prolactin and ACTH levels
Describe the effects of estrogen on the adrenal and hepatic systems during pregnancy.
- induces hepatic synthesis of cortisol bindding globulin (increases serum cortisol)
- increased aldosterone synthesis
- decreased DHEA
How are gasses exchanged across the placenta?
simple diffusion
Glucose metabolism in the placenta occurs with ____ whereas amino acids require ____
1. glucose = facilitated diffusion
2. active transport = amino acids
Which immunoglobulin can pass across the maternal placenta? What is the significance of this?
IgG
- allows for passive immunity from mother to child
What are striae gravidarum? What are risk factors? What can minimize? what can diminsh them after the fact?
- stretch marks
- risks: genetic and ethnic disposition
- minimize/prevent: circulation/massage, topical creams
- remove/diminish: topical creams, retinoids, dermabrasion, laser
What ethnicities are at greatest risk for stretch marks?
Caucasian
The most rapid change in the maternal breast occurs when?
1st 8 weeks
What changes occur around the nipple during pregnancy?
- enlargement
- ductal growth
- increased blood flow
- production of colostrum in last trimester
What GI changes should be expected during pregnancy?
- inc. appetite
- blunted sense of taste
- food/odor aversions
- food cravings (PICA? )
- Constipation
- Hemorrhoids
Why are hemorrhoids more likely during pregnancy?
- increased portal venous pressure due to fetus in abdominal cavity
CV changes in pregnancy include:
- heart shifts up and left, apex shifts laterally
- Increased CO (inc HR, SV, and blood volume with decreased peripheral resistance)
The uterus consumes what percent of CO by the end of pregnancy?
Increases from 2% to 20%
Uterine blood flow increases by ____ compared to non-pregnant levels.
20-40 times
What physiologic changes occur in the lungs as a result of pregnancy?
- 20% inc oxygen consumption
- Increased insp capacity
- decreased lung capacity d/t elevated diaphragm
- Progesterone during pregnancy affects the lungs what way?
- increases maternal sensitivity to CO2,
- results in increased ventilation and relative respiratory alkalosis
- kidneys increase excretion of bicarb to compensate.
The renal physiologic changes during pregnancy include:
- kidneys enlarge
- inc. residula volume and decreased bladder tone
- increased renal plasma flow by 75%
- this increases GFR by 50% and promotes Na loss
- Decreases BUN, Cr, Uric Acid
- Increases CrCl
- Inc urinary glucose secretion
- no change in protein loss
The recomended total weight gain for a single pregnancy is between ___ lbs dependign on BPI.
- between 15-40lbs
- LOW BMI should gain MORE
By what amounts should a pregnant women increase her diet each day?
- 300 extra calories
- 5-10g protein
- 15mg iron
- 250mg Ca
- 400-800 folic acid
Prenatal multivitamins should contain at least ___ g of folic acid
400 mcg
Guidelines regarding exercise in pregnancy suggest:
- Women exercising regularly before pregnancy can continue mild to moderate exercise three days a week
- Those who didnt' should engage in moderate exercise for 30+ mins most days of te week
Why does supine hypotensive syndrome occur?
- because the baby is compressing the vena cava and preventing blood from reaching the heart
What classifies gestational hypetension?
- SBP >140, DBP >90, occring first after week 20 without proteinuria
What is the difference between gestational hypertension and preeclampsia?
- the presence of proteinuria
What is hyperemesis?
Excessive vomiting during pregnancy.
What is the difference between conception age and menstrual age?
Conception age is weeks since day of conception. SInce the exact day of conception is usually unknown, weeks since the first day of the last period is used - this is menstrual age
During which trimester should you gain the most weight? The least?
Most = second
Least = first
A woman with a low BMI (<19.8) should gain about how many lbs in pregnancy?
28-40
A woman with a Normal BMI (19.8 - 26) should gain about how many lbs in pregnancy?
25-35lbs
A woman with a high BMI (26-29) should gain about how many lbs in pregnancy
15-25
A woman with an obese BMI (>29) should gain about how much wieght in pregnancy?
~15lbs
What is the average range of weight gain for women carrying twins?
35-45lbs
Young adolescent females (<2 years from menarche) should try to gain weight on what end of the spectrum? What other group has as special exceptioN
- Young should gain on high end of range for BMI
- short women should gain on low end of range for BMI
Which vaccines are recommended and safe during pregnancy?
- tetanus, influenza, pneumococcal, meninococcal, hep B
First-trimester weight loss is due to ___ and should not exceed ___
- nausea and vomiting
- not to exceed 5% prepartum weight
The word used to describe darkened pigmentatons round the forehead and cheeks, across the nose, or jaw
- melasma or chloasma
A pt is >24 wks pregnant with facial edema, you suspect __
gestational hypertension
Venous hum and systolic or continuous mammary souffle are (common/ uncommon) in pregnancy
Common
Where is mammary souffle heard?
- late in pregnancy, 2nd or 3rd intercostal in parasternal areas (systolic or systolic and diastolic)
What occurs with the PMI in pregnancy?
- moves slightly higher around the 4th intercostal space
The mother will typically feel fetal movements around ___ weeks, and an examiner around ___ weeks.
- mother: 18-20
- examiner: 24
What should you consider if you cannot feel fetal movements at 24 weeks.
- error in calculating gestation
- fetal death or morbidity
- false pregnancy
Irregular uterine contractions may occur after ___ weeks and are (normal/abnormal). Regular contractions before ____weeks suggest ___
1. 12 weeks
2. normal
3. 37 weeks
4. preterm labor
For weeks 20-32 , where should fundal height be?
- measurement in cm should roughly equal weeks of gestaton
Multiple gestation should be suspected if fundal height is _____
more than 4cm higher than expected.
If fundal heighs is 4cm+ higher than expected, you should suspect what?
- multiple gestation
- large fetus
- extra amniotic fluid
- uterine leiomyoma
If fundal height is lower than expected, consider __
- missed abortion
- transverse lie
- growth retardation
- false pregnancy
Lack of audible fetal heart by doppler after ____ weeks suggestas what?
1. 10 weeks
2. fetal demise or false pregnancy
FHR is usually ___ in early pregnancy, ___ by term, and should ___ with fetal movement in late pregnancy.
1. 160s
2. 120-140
3 increase
FHR that drops noticeably near term with fetal movement could indicate ___-
poor placental circulation or decreased amniotic fluid
In the third trimester, you should expect what with fetal heart rhytm?
- variance of 10-15 beats per minute over 1-2 mins.
Absence of beat-to-beat variability in the third trimester needs _
investigation with FHR monitor
The pregnant cervix should look how?
- bluish or violet in color
- deep rugae
- increased milky-white discharge
Describe each of Leopold's maneuvers.
1. upper pole - palpate upper abdomen to determine what body part is upper (usually buttocks)
2. sides - place one hand on each side of abdomen to capture fetus between... ID which side is fetal back.
3. lower pole - use palmar surfaces palpate area just above symphysis. feel for head (smooth, firm, rounded surface) or buttock
4. confirmation of presenting part- one had on lower pole, one on upper - compare to confirm which is head or buttcok
If when doing the 3rd leopold maneuver the hands touch, it means ____, if they don't it means ___
touch = not descended yet
don't touch = fetus descended into pelvis