Cs3 Pregnancy Complications

Front 1

What are the "pregnancy hormones"?

Back 1

Human chorionic gonadotropin (hCG)
Human placental lactogen (hPL)
Estrogen
Progesterone

Front 2

hCG is secreted by the _ during what time frame?

It stimulates the release of _

Back 2

fertilized ovum, 1st trimester

estrogen and progesterone from the corpus luteum

Front 3

When measuring hCG what subunit are we measuring, and why?

Back 3

Beta subunit

bc alpha is structurally similar to LH.

Front 4

Home urine pregnancy tests will register positive at _ days post conception, correlating to Beta hCG level of _

Back 4

8

25

Front 5

Beta hCG in early pregnancy increases _ every day.

A chemical diagnosis of a miscarriage would be when _

What happens to the hCG level in an ectopic pregnancy?

Back 5

2x every day (doubles every day)

when hCG levels drop when comparing hCG levels two days apart

hCG plateaus in an ectopic pregnancy, increases at a slower rate than normal

Front 6

Human Placental Lactogen is secreted by _.

What is the role of this hormone in pregnancy?

the max level is reached at _

Back 6

syncytiotrophoblasts of the developing placenta

It decreases maternal metabolism of glucose, and supports maternal metabolic needs (anti insulin) - thus why it plays a role in gestational diabetes

38 weeks

Front 7

What hormone exerts an effect on gestational diabetes?

Back 7

Human Placental lactogen (hPL)

Front 8

Estrogen is secreted by _

Back 8

the ovaries initially and then the placenta later on in the 1st trimester

Front 9

_ Stimulates uterine growth, increases perfusion to uterus, relax pelvic ligaments (in preparation for birth), support breast development.*

Back 9

Estrogens

- secreted by ovaries and placenta

Front 10

_: Plays primary role in supporting and maintaining implantation of the developing embryo in early pregnancy.

Back 10

Progesterone

Front 11

Progesterone plays a primary role in _

Back 11

Plays primary role in supporting and maintaining implantation of the developing embryo in early pregnancy.

Front 12

_ is a potent mediator of smooth muscle relaxation, resulting in slowing of GI motility, esophageal reflux, etc

What would you recommend for a patient who complains of these symptoms?

Back 12

Progesterone
(Constipation may also be attributable to Iron, and prenatal vitamins are loaded with iron)

Eat more fiber

(progesterone is also used to treat preterm labor)

Front 13

_ contributes to sodium and water retention, leading to edema in the feet and legs

Back 13

Estrogens

Front 14

_ is anti prostaglandin, which decreases uterine tone. Therefore administration of this hormone is used to treat preterm labor

Back 14

Progesterone

Front 15

You can measure _ levels on day 19 to prove that a patient has ovulated

Back 15

progesterone

blood serum levels are helpful in assessment of pregnancy viability

Front 16

Average weight gain of a pregnant patient is _ lbs from pre-preg. weight
_ in first 20 weeks
_ after 20 weeks

Back 16

25-40

10-13 lbs

1 lb./week

Front 17

What are two reasons that the GI system slows down during pregnancy?

Back 17

Progesterone causes Smooth muscle relaxation

Decrease in Motilin, which normally stimulates GI smooth muscle

Front 18

Folic acid is supplemented to a pregnant woman for what reason?

Back 18

to prevent neural tube defects

Front 19

What is the most common complaint a pregnant women presents with, (regarding the GI tract)?

What would you recommend to your patient with this complaint?

Back 19

GERD - this is due to relaxation of the gastroesophageal sphincter, of which is mediated by progesterone


PPIs, Tums, antacids, eat smaller meals 5x a day as opposed to 3 big meals

Front 20

A low fibrinogen level in the third trimester is associated with _ and _

Back 20

preeclampsia and disseminated intravascular coagulation.

Front 21

Formation of gall stones is (more/least) likely to occur in a pregnant woman. Why?

Back 21

More (2x more)

i don't know...

Front 22

What vitamin supplementation helps in the case of hyperemesis gravidarum?

Back 22

Vitamin B6

Front 23

Acute pancreatitis in a pregnant female is usually _ mediated.

Back 23

progesterone

It is not an infection, but actually biliary stasis and sludging

Front 24

16 week pregnant patient presents with Blotches of pale brown skin appear on forehead, cheeks, and nose. What is this called?

Back 24

Chloasma

Front 25

What does PUPPS stand for in reference to a pregnant patient?

Back 25

Pruritic Urticaric Pregnancy Papules

These are d/t histamine release and results in an intense, itchy, expanding rash.

It may be associated with liver disease or be benign

Front 26

26 week Pregnant patient presents with radiating upper abdominal pain, nausea, and vomiting. Your attending informs you that this appears to be acute pancreatitis and asks you to run labs. What lab values to you expect to see?

How are you going to treat this patient?

Back 26

Elevated amylase and lipase

IV hydration and supportive care

Front 27

How do the heart sounds change in a pregnant patient?

Back 27

S1 becomes louder,
S2 doesn't change

S3 becomes audible in 90% of patinet

The heart is displaced to the left and upward by diaphragmatic elevation

Front 28

Why do pregnant patients have anemia?

Back 28

With erythropoiesis of pregnancy, iron requirements increase. In order to prevent microcytic anemia, pt needs to take supplements

Secondarily, the total plasma volume increases by 50%, the RBC mass increase by only 20-30%. This disproportionate increase results in hemodiluation --> Anemia

Front 29

_ is the most common medical disorder in pregnancy.

What does this result in

Back 29

Hypertension

decreased perfusion to uterus and placenta (uteroplacental insufficiency)

You must be aggressive in treatment to prevent strokes in Mom

Front 30

Pre-eclampsia is a triad of _

Back 30

elevated BP, proteinuria, edema

Front 31

HELLP syndrome stands for _

What condition is this associated with?

Back 31

Hemolysis, elevated liver enzymes, Low Platelets

Pre-Eclampsia

Front 32

Patients with pre-eclampsia should be given _ for seizure prophylaxis

Back 32

Magnesium sulfate

Front 33

Virchow's triad is _,

this is associated with what condition?

Back 33

Venous stasis, hypercoaguability, vascular damage

Deep Venous Thrombosus
(90%) of DVTs occur in the left leg
(pregnancy is a hypercoagulable state)

Front 34

Pregnant women may have bloody noses because of what hormone?

Back 34

estrogen

Estrogen effect on vascularity results in upper airway edema causing nasal and sinus stuffiness

Front 35

Nasal and sinus stuffiness is d/t _ effects

Back 35

estrogen

Front 36

Why should you advise your pregnant patient to sleep on their left side?

Back 36

Dextro-rotation of the uterus impinges on venous

Front 37

T/F Pregnant women can receive the H1N1 injection.

Back 37

True

They should not receive the nasal vaccine because it is a live attenuated virus

Front 38

Dextro-rotation of the uterus has what effect on the kidney?

Back 38

the uterus will imping on the right ureter and cause pyelonephritis

Front 39

The most common source of a UTI in pregnant patients is _

How do you treat it?

Back 39

E coli

Ampicillin, cephalexin, nitrofurantoin

Front 40

(glucose/insulin) can cross the placenta, wherease the other can not.

Back 40

Glucose crosses
Insulin does NOT

insulin levels in the placenta are fetal derived.

Front 41

How do you screen for gestational diabetes? who receives this screening?

Back 41

Everyone gets screens by a 1 hour 50 gm glucola.

If it's higher than 140, then you want to do a 3 hour diagnostic test(higher cutoffs for asians and s.americans)

Front 42

hypo/hyperthyroidism is often diagnosed in a gynecologic setting, Why?

Back 42

Hypothyroidism

because symptoms are weight gain, tired, no menstruation.

Front 43

During pregnancy, TBG causes increased amounts of _ and _ but free fractions of _ and _ remain normal

Back 43

TT3 and TT4 increase

T4 and T3 stay normal

Front 44

HypOthyroidism is (elevated/decreased) TSH

HypERthyroidism is (elevated/decreased) TSH

Back 44

Elevated

Suppressed/decreased

Front 45

What is the DoC of hyperthyroidism in pregnancy?

Back 45

PTU - propylthyrouracil

Front 46

Thyroid storm is most commonly d/t _ THis is a complication of _

Back 46

Graves disease

Hyperthyroid

This is a medical emergency with a 25% mortality!!

Front 47

Gestational trophoblastic disease is a _ pregnancy. It's when _.

What are the symptoms and lab values

Back 47

molar pregnancy
empty sperm fertilizes egg

Bleeding, elevated BPs, hyperemesis

Beta hCG level is 150k-250k, Ultrasound shows a snowstorm pattern

Front 48

8 week pregnant lady presents to your office complaining of bleeding. She has an elevated blood pressure. Palpation for the fundus appears to be 4 cm above the pubic bone and hCG levels are 160k. Dx?

Back 48

gestational trophoblastic disease

irregular bleeding, uterus large for date, increases blood pressure hCG level between 150-250. Also, an US would show a "snowstorm"

Front 49

How long should a patient be on contraception after having gestational trophoblastic disease?

Back 49

1 year

a new pregnancy may activate dormant trophoblastic disease cells

Front 50

T/F an ovarian cyst during pregnancy needs to be surgically removed

Back 50

false.

Most ovarian cysts resolve after delivery

Front 51

Which cancer can metastasize to the developing fetus???

Back 51

Melanoma! *

Front 52

What are two infections that can occur post partum

Back 52

endometritis (treat with triple antibiotics)

Mastitis (appears 7-10 days post delivery). Tell patients to pump and discard milk

Front 53

Mastitis is a post partum infection, usually by _, and it appears when?

Back 53

staph aureus

7-10 days post delivery