Cne Etp Ob Quiz 3

Front 1

What is the ectoderm & what does it give rise to?

Back 1

upper layer of the embryonic disk

gives rise to:
- CNS
- glands
- epidermis
- skin
- nails
- hair
- lens of eye
- tooth enamel
- floor of amniotic cavity

Front 2

What is the mesoderm & what does it give rise to?

Back 2

middle layer of embryonic disk

gives rise to:
- muscles
- CV system
- dermis
- connective tissue
-spleen
- urogenital system

Front 3

What is the endoderm & what does it give rise to?

Back 3

lower layer of embryonic disk

gives rise to:
- epithelial lining of respiratory tract
- GI tract
- oropharynx
- liver
- pancreas
- urethra
- vagina
- bladder

Front 4

preembryonic phase

Back 4

conception - 14 days

Front 5

embryonic phase

Back 5

3 weeks - 8 weeks

Front 6

fetal phase

Back 6

9 weeks - birth

Front 7

what does CRL stand for

Back 7

crown rump length:
- measuring from head to butt
- gets bigger as fetus develops

Front 8

function of hCG

Back 8

- preserves function of corpus luteum
- ensures continued supply of estrogen & progesterone is present in order to maintain pregnancy

Front 9

function of HPL

Back 9

- stimulates maternal metabolism
- increases maternal resistance to insulin (allows higher BG level)
- facilitates glucose transport across the placental membrane
- stimulates breast development to prepare for lactation

Front 10

function of progesterone during pregnancy

Back 10

- stimulates maternal metabolism
- stimulates development of breast alveoli

Front 11

function of estrogen during pregnancy

Back 11

- stimulates uterine growth
- stimulates uteroplacental blood flow
- causes proliferation of glandular breast tissue

Front 12

which 2 pregnancy hormones have very similar functions

Back 12

HPL & progesterone

Front 13

chorion vs amnion

Back 13

chorion = outer membrane
amnion = inner membrane

Front 14

how much does the basal metabolic rate increase during pregnancy?

Back 14

15 - 20%

Front 15

how much does blood volume increase during pregnancy?

Back 15

50%

Front 16

normal increase in HR during pregnancy

Back 16

10 bpm

Front 17

normal CO increase during pregnancy?

Back 17

30 - 50%

Front 18

normal change in BP during pregnancy?

Back 18

lowers by 10 - 15 mmHg (ONLY during 2nd trimester)

Front 19

increase in GFR during pregnancy?

Back 19

50% (same as increase in blood volume)

Front 20

increase in kcal needed

Back 20

increase of 300 kcal/day

Front 21

increase in protein needed

Back 21

need to be up to 60 g/day

Front 22

increase in iron

Back 22

need to be up to 30 mg/day

Front 23

increase in calcium

Back 23

need to be up to 1200 mg/day

Front 24

recommended weight gain for women w/ low BMI

Back 24

25 - 40 lbs

Front 25

recommended weight gain for women w/ normal BMI

Back 25

25 - 35 lbs

Front 26

recommended weight gain for women w/ high BMI

Back 26

15 - 20 lbs

Front 27

recommended weight gain for women w/ BMI above 29 (obese)

Back 27

15 lbs

Front 28

pattern of weight gain during pregnancy

Back 28

1st trimester --> 3-4 lb increase

by 20 weeks --> should be around 10 lbs weight gain

2nd & 3rd trimester --> 1 lb increase/week

Front 29

how is PIH diagnosed

Back 29

beyond 20 weeks, 2 measurements at least 6 hours apart:

> 140/90 (don't need both values to be above)
OR
an increase in the baseline by:
>30 mmHg systolic
>15 mmHg diastolic

Front 30

how is pre-eclampsia diagnosed

Back 30

PIH w/ proteinuria after 20 weeks

also edema that's not just dependent (so especially in the hands & face)

Front 31

sxs of pre-eclampsia

Back 31

- headaches
- visual changes
- epigastric pain
- elevated BP
- sudden excessive weight gain (4.4 lb/week)
- hand & face edema
- proteinuria

Front 32

mild vs severe pre-eclampsia

Back 32

MILD:
- BP 140/90
- 2+ to 3+ proteinuria
- moderate puffiness
- DTRs WNL

SEVERE:
- BP 160/110
- 3+ to 4+ proteinuria*
- generalized edema & noticeable puffiness (anasarca)
- hyperreflexive (3+ to 4+ DTRs)
- symptomatic
- oliguria

Front 33

drug given to prevent seizures (and its antidote) & in which cases of pre-eclampsia would it be given?

Back 33

magnesium sulfate (antidote: calcium gluconate)

would be given prophylactically in severe cases of pre-eclampsia to prevent seizures

Front 34

define eclampsia

Back 34

pre-eclampsia w/ convulsions

tx: MgSO4 therapy (lessens ctxs & BP)

Front 35

what is the loading dose & the maintenance dose for MgSO4 to treat eclampsia

Back 35

loading dose = 4-6 g over 15-30 min

maintenance dose = 2 g/hr

Front 36

define HELLP syndrome

Back 36

H - hemolysis
E - elevated
L - liver enzymes (AST & ALT)
L - low
P - platelets (below 100,000)

life-threatening variation of pre-eclampsia that happens w/ about 5% of the time

tx: c-section & birth

Front 37

define SAB

Back 37

spontaneous abortion that happens before 20 weeks

early SAB = before 12 weeks
late SAB = 12-20 weeks

Front 38

what are the 6 types of SAB (just list)

Back 38

1. complete
2. incomplete
3. threatened
4. inevitable
5. missed
6. recurrent

Front 39

complete SAB

Back 39

all of the POCs have been passed and expelled through the uterus

cervix is closed

Front 40

incomplete SAB

Back 40

some but not all POCs have been expelled from the uterus

cervix is still opened & could have some POCs in cervix

may have bleeding & uterine cramping

Front 41

threatened SAB

Back 41

w/o cervical change, the woman has some spotting, bleeding, and cramping

POCs are still in uterus

tx: bedrest & no sex for 2 weeks

Front 42

inevitable SAB

Back 42

some but not all POCs have been expelled and cervix is opened

SAB will happen/is inevitable

Front 43

missed SAB

Back 43

POCs are still inside after fetus has died

cervix is closed though

(usually, the uterus has atonied)

Front 44

recurrent SAB

Back 44

3 or more serial pregnancies that end in SAB

Front 45

risks for SAB

Back 45

- endocrine imbalance
- infection
- maternal structural problems
- immunological factors
- systemic disorders
- drug use
- inadequate nutrition

Front 46

define insufficient cervix & tx

Back 46

passive & painless dilation of the cervix within 2nd trimester

tx:
- cerclage in 2nd trimester
- no sex, no standing for long periods of time
- cerclage is often taken out at 37 weeks or during scheduled c-section

Front 47

sxs of ectopic pregnancy

Back 47

- abnormally low or slow-rising hCG levels
- adnexal (outside of uterus) tenderness & fullness on exam
- referred shoulder pain on same side

Front 48

define GTD

Back 48

gestational trophoblastic disease

it's an abnormal growth of trophoblast cells that attach the fertilized ovum to the uterine wall
--> the proliferating trophoblasts fill the uterus w/ vesicles that resemble a cluster of grapes

not a viable pregnancy

Front 49

define molar pregnancy

Back 49

type of GTD in which a slow-growing tumor arises from abnormally growing trophoblast cells

also not a viable pregnancy

2 types: complete & partial

Front 50

complete vs partial molar pregnancy

Back 50

complete = contains no genetic material/fetal tissue
- believed to occur when the ovum is fertilized by sperm & then duplicates its own chromosomes while the chromosomes of the ovum are inactivated

partial = some fetal tissue/membranes & some chromosomal contribution, but the fetus is NOT VIABLE
- cause unknown

Front 51

sxs & tx of molar pregnancy

Back 51

sxs:
- vaginal bleeding
- severe N/V
- uterus is large for gestation dates
- no FHR/tones or activity is detected
- hCG levels are high & rising rapidly
- cramping

tx:
- immediate vacuum evacuation after diagnosis by ultrasound
- identifying tissues to see if there's a malignancy present
- monitor hCG levels weekly (should be down completely by week 3)
- advise woman not to get pregnant for 1 yr & continued monitoring
- grief & bereavement counseling

Front 52

2 causes of late pregnancy bleeding & which of these is painful

Back 52

1. placenta previa
--> merely a POSITION, so it's PAINFUL

2. placental abruption
--> this is a SEPARATION so it's SUPER PAINFUL

Front 53

define placenta previa

Back 53

when the placenta partially or completely covers the internal cervical os

Front 54

3 types of placenta previa & which can be delivered vaginally?

Back 54

generally, placenta previa can't be delivered vaginally

3 types:
1. complete (covers all of internal os)
2. partial (covers part of internal os)
3. marginal (only covers small part of internal os --> SOMETIMES the placenta will switch positions and move up & can be delivered vaginally)

Front 55

management of placenta previa

Back 55

- bed rest
- NPV
- evaluation of fetal well-being
- NEVER DO VAGINAL EXAMS
- c-section

Front 56

sxs of placental abruption

Back 56

- board-like abdomen
- localized uterine tenderness
- vaginal bleeding may be concealed

Front 57

what must you r/o if a woman comes in with placental abruption?

Back 57

domestic violence (a risk factor for placental abruption is physical trauma)

Front 58

how is GDM diagnosed

Back 58

GDM = gestation diabetes, onset is after 24 weeks

screening = GCT (glucose challenge test) --> 24-28 weeks
diagnostic = GTT (glucose tolerance test) --> f/u to elevated GCT

to diagnose GDM:
- GCT value > 200
OR
- 2 abnormal values on GTT (could be fasting, 1 hr, 2 hr, 3 hr)
- fasting = >105

[remember! normal values =
(65-70) - (100-105)]

Front 59

causes of s<d

Back 59

s<d = size is less than dates

causes:
- IUGR
- SGA
- oligohydramnios (low AF)

Front 60

causes of s>d

Back 60

- macrosomia
- LGA
- multifetal pregnancy
- fibroid uterus
- polyhydramnios (too much AF)

Front 61

2 types of IUGR

Back 61

1. symmetrical = long-term insult (baby is small everywhere, including head)

2. asymmetrical = happens late & is head-sparing

Front 62

normal AFI for term baby

Back 62

AFI = amniotic fluid index

normal = 5-20 cm

Front 63

what constitutes oligohydramnios?

Back 63

AFI< 5 cm

generally means baby isn't urinating --> could be a/w congenital anomalies, IUGR, PROM, post-maturity, or fetal distress during labor

associated w/ increased perinatal mortality rate

Front 64

normal AFV for a term baby

Back 64

AFV = amniotic fluid volume

normal = 800-1200 ccs

Front 65

what constitutes polyhydramnios?

Back 65

AFI > 20 cm

also a/w:
- difficulty auscultating fetal heart tones & palpating fetus
- unstable fetal lie (increased risk for cord prolapse)
- need to r/o GDM & ABO/RH disease

Front 66

complications of polyhydramnios

Back 66

- fetal malpresentation (baby is moving around excessively)
- placental abruption (uterus is heavy b/c of so much fluid)
- uterine dysfunction during labor
- PPH
- cord prolapse
- preterm labor

Front 67

requirements for use of forceps or vacuum

Back 67

- ROM
- cervix fully dilated
- absence of CPD (must r/o)
- empty bladder

Front 68

most common type of forceps classification

Back 68

low forceps (baby is at 2+ station)

Front 69

advantages of vacuum-assisted birth over forceps delivery

Back 69

- less maternal discomfort
- less risk of lacerations/perineal & cervical trauma

disadvantages:
- could have major caput or cephalohematoma

Front 70

indications for a c/s (c-section)

Back 70

- maternal or fetal distress
- CPD
- malpresentation (breech or transverse)
- placental previa or abruption
- cord prolapse
- failed induction
- multi-fetal pregnancies
- pre-eclampsia/eclampsia
- active herpes infection

Front 71

classical c/s

Back 71

- rare today
- vertical incision into upper body of uterus where fundus is (creates major scar tissue)

*VBAC is contraindicated

Front 72

lower uterine segment c/s

Back 72

2 types:
1. low transverse
*VBAC is possible!!

2. low vertical incision
*VBAC is contraindicated

Front 73

contraindications for c/s

Back 73

- if platelets are <90 [normal is (150-165) - (400-450)] or other coagulation defects
- fetal death (FD)
- fetus is not expected to survive

Front 74

complications of a VBAC

Back 74

- uterine rupture
- retained placenta
- cord prolapse
- shoulder dystocia
- PPH
- PP infection

Front 75

2 types of uterine rupture

Back 75

1. incomplete rupture
- pain may not be present
- non-reassuring signs (decreased FHR, no accels)
- woman may experience N/V, faintness, abdominal tenderness, hypotonic uterine ctxs
- lack of progress

2. complete rupture
- woman may complain of sudden, sharp, shooting abdominal pain
- may state that "something gave way"

Front 76

3 types of adherent placenta

Back 76

1. acreta
- slight penetration of myometrium

2. increta
- "in deep"
- deep penetration of myometrium

3. percreta
- "per"/perforation
- complete perforation of uterus

Front 77

management of cord prolapse

Back 77

- put woman in reverse trendelenberg or knees to chest
- w/ gloves on, put hand inside vagina & push up on baby's head
- give O2 & IV fluids
- monitor FHR
- keep cord wet/perfused w/ gauze if possible
- birth by c/s

Front 78

define shoulder dystocia and why would it happen?

Back 78

shoulder dystocia = anterior shoulder can't pass under the pubic arch of maternal pelvis (gets stuck)

r/t macrosomia (large baby) and pelvic anomalies

turtle sign = think shoulder dystocia!!!

Front 79

management of shoulder dystocia

Back 79

- mcrobert's maneuver (pull knees to chest to simulate squatting --> opens pelvic outlet)
- suprapubic pressure to collapse shoulder angle

Front 80

risk factors for PPH

Back 80

- most common is uterine atony
- retained placenta fragments
- placenta acreta
- uterine rupture or inversion from pulling on cord
- cervical or vaginal lacerations
- hematomas (collections of blood)
- infection (endometritis)
- coagulopathies

Front 81

management of PPH

Back 81

- bimanual compression (massaging on top & from within)
- pharmacological interventions (pitocin)
- uterine exploration (via surgery)
- surgical interventions (hysterectomy)

Front 82

1st and 2nd line drug therapy for management of PPH

Back 82

1st line:
pitocin (10-40 units)

2nd line:
methergine (vasoconstrictor) (0.2 mg IM)
**containdicated in HTN/PIH --> could cause stroke

Front 83

primary sxs of uterine inversion

Back 83

- hemorrhage
- pain
- shock (r/t pain OR hemorrhage)

Front 84

define post-partum infection

Back 84

any infection that occurs within 28 days after miscarriage, ETOP, and childbirth

fever >100.4 on 2 successive days of the first 10 PP days