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95 Cards in this Set
- Front
- Back
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What vaccine do you need to check at the first pregnancy visit
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rubella titer
varicella titer hepatitis b series |
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what are the DM management needed for preconception, what medications for CAD must be discontinued
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HgA1C must be below 7%, contraindicated >10%
stop ACE, ARB, Statin, BB, Diuretics insulin is first choice then metformin |
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what if someone becomes pregnant on oral anticoagulation therapy
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switch from coumadin to heparin, it does not cross the placenta
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why is smoking cessation important in pregnancy
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cause LBW, preterm labor
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Why should obesity be controlled in pregnancy
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increase HTN, DM, pelvic fat can make delivery unsafe and large babies
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how much caffeine can a pregnant women have per day
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200mg
12 oz coffee 4-12 oz tea 5 - 12oz soda |
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what are the 3 lays of primary germ cells in cellular differentiation
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ectoderm - outerlayer
mesoderm endoderm |
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what weeks are the embryonic development
what is so important in this stage |
weeks 3-8
where most issues with development occur - tetrogens |
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what are the two layers of the placenta called
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chorion
amnion |
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what is the purpose of the amniotic fluid
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protect fetus, control temperature, medium for movement
replaced every 2 hours |
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how much amniotic fluid is at
12 weeks 20 weeks 38 weeks 43 weeks |
50ml
400ml 1000ml <500ml - why increased risk for meconium aspiration when late |
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what is cotyledons in the placenta
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segment that gives the nutrition, gas exchange, immune function, and hormone production - hog, hpl, estrogen and progesterone
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what is the umbilical cord comprised of
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2 - arteries brings back un02
1 - vein - give o2 whartons jelly around it approx 22inches |
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if the umbilical cord has a variant - 2 veins and 1 artery what do you do
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work up for congenital defect
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when is all fetal development, external and internal structures developed
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embryonic stage weeks 3-8
develop head to toe |
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what is pre-embryotic stages
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first 14 days
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what is developed in embryonic stage
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digits
cartilage bone deposits begin muscle development basic fetal circa digestive tract 22 days - after fertilization - heart beat most serious stage |
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when is the most rapid growth
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from 8 weeks until birth
organs mature |
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how much does the fetus gain after 26 weeks
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8 ounces/week
why start to check fundal height |
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when does functional defects and minor morphological defects
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fetal stage >8 weeks
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at how many weeks does the brain mature, alveoli appear and eyes complete
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24 weeks
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what should you start at 24 weeks
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DHA
protien because of rapid brain growth |
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when do eyes open and brain begins to regulate some body functions, eyes open
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28 weeks
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how much does a fetus weigh at 28 weeks
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1000 grams
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when does the fetus weigh 2000 grams and reflexes are present
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32 weeks
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when are most systems complete in a fetus
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36 weeks
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how is the fetal circulation
starts through one vein |
enters right atrium thru foramen oval and small amount in pulmonary system
rest thru ductus arterioles into aorta then to brain and rest of body * not much blood going to lungs |
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when does PDA/ FO close
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once placenta removed from circulation - closes, because of of SVR is increased and causes it to close
FO - usually within 15 hours, born with murmur PDA - structurally close within weeks, usually by discharge |
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what are the most common congenital heart defects
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VSD - 35%
ASD - 9% PDA - 8% PS - 8% AS Coaction of the aorta - 6% TOF - 5% Transposition - 4% |
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what is quickening
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first fetal movement 16 - 22 weeks, younger if have other children
20 weeks average |
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when is the fetal heart beat heard on the daptone
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10 weeks
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how much should the mother gain during pregnancy and how much should account for the fetus
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16.4lb mother
10.11lb fetus total - 27.9 lbs |
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what is
gravida primigravida multigravida para primipara multipara grandmulipara nullipara |
any pregnancy
women's first pregnancy >1 pregnancy births after 20 weeks - whether alive or not 1st birth after 20 weeks >2 or more births after 20weeks >5 births No prenancy |
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What is GTPAL
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Pregnancies
term >38 weeks Preterm <38 weeks Abortions Living child |
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This is the 4th pregnancy, she had one abortion at 12 weeks, she had triplets born at 32 weeks, and she gave birth to a stillborn at 39 weeks
what is the GTPAL |
Gravida 4
Term - 1 Para - 1 (triplets are counted as one) Abortions - 1 Living - 3 |
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how do you calculate due date with Naegeles Rule
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start with first day of LMP
subtract 3 months add 7 days |
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Use Naegeles Rule
LMP 1/7/2011 LMP 11/3/2011 |
10/14/2012
8/10/2012 |
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What are the duration of the trimesters
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1 - weeks 1-14
2 - 15-28 week 3 week 29 - 42 |
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what are braxton hicks
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contractions begin at 8 weeks
normal unless regular increase with increased pregnancies because they know what it feels like increase with dehydration, full bladder |
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how do the ovaries work with physiological changes in pregnancy
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cease ovum production
secrete hcg to maintain corpus luteum corpus luteum produces hormones until 9-10 weeks then placenta takes over |
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what is the size of the uterus at:
8 weeks 12 weeks 16 weeks 20 weeks >20 weeks |
tennis ball
small grapefruit - between symphisis pubis and umbilicus at umbilicus measure from symphsis pubis to top of fundus |
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what are the physiological changes of the cervix in pregnancy
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hypertrophy and hyperplasia of the cervical glands - mucus plug forms soon after conception, increase secretions
Goodell's sign - soften and increased vascularity Chadwicks sign - blue/purple color from increased vascularity |
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what are the changes in thyroid
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10% enlargement - by increased estrogen, increase vascularity
TOTAL free T3 and T4 decrease TBG T4 and T3 increase by 50% Lower TSH Free T4 increase in 1st trimester then back to normal TSH - transient drop by HCG then increase after 1st trimester BMR increase 25% Fetal thyroid develops at 10-12 weeks TSH only hormone to cross placenta |
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What are skin changes in pregnancy
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color deepens - areola, nipple, vulva
linea nigra - by increased estrogen and progesterone - increase melanocytes choasma - dark pigment on cheek bones in dark haired women decreased hair growth Striae - increased adrenal steroid, rupture of collagen cutaneous vascular changes - palmar erythema and vascular spiders - by increased BMR |
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what are the TSH levels you want in each trimester
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1st - 0.1 to 2.5
2nd - 0.2-3 3d - 0.3 - 3 |
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what are the breast changes in pregnancy
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early - tender and tingling
after 8 weeks - enlarge with hypertrophy of mammary alveoli veins more visible nipples - larger colostrum develops within a few months |
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what are the changes in the respiratory system in pregnancy
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capillary engorgement occurs causing nasopharynx, trachea, bronchi, and vocal cords to become swollen and red
cause mouth breathing diaphram raises 4 cm - increased SOB Rib cage flares - 70 to 105 degrees - relaxation of ligaments increase TV 30-40% increase 02 delivered airway resistance decrease bc of progesterone - increase volume TLC decrease - increase diaphragm breathing becomes thoracic pulmonary function NOT impaired increase risk of pneumonia and uri |
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what are the changes in the heart with pregnancy
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heart rotates to the left 4th ICS
increase size decrease pulm PVR, lowest during 2nd trimester Vena Cava Syndrome - compress on VC - drop BP, faint if lay on back - after 28 weeks drop in BP |
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what heart sounds change in pregnancy
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increase loudness
exaggerated S1 systolic murmur in 3d trimester increase HR by 15-20 BPM Venous pressure increase in lower extremities caused by venous obstruction - decreased PVR - increased edema, low bp, fainting transient diastolic murmur no change in ECG |
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what hematologic changes occur in pregnancy
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blood increase 30-50%
RBC increase 20-30% plasma increase 50% physiological anemia - RBC increase later and less than plasma (concentrated) WBC - 14-16,000 Fibrin increase 40%/Fibrinogen 50% increase decrease albumin platlets decrease |
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why do you need to drink a lot of water in pregnancy
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to help increase blood volume, help prevent pre-eclampsia
especially with increased babies (twins) |
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what changes occur in the GI system in pregnancy
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displacement of stomach, intestines
decreased smooth muscle tone - increased gastric emptying, constipation - reflux by decreased tone gums soften and bleed hemorrhoids with constipation GB distended - decreased emptying of bile - risk for stones |
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what changes in the urinary tract occur in pregnancy
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increase GFR by 50%
increase renal tubular reabsorption dilation of kidney and ureter R>L renal plasma flow 75% - effected by posture Creatnine increase, decrease serum BUN, creatnine, and uric acid increased Renin, angio I and II |
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what changes in MS during pregnancy
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relaxation of pelvic joints and increased motility
progressive lordosis d/t anterior position of uterus - shifts center of gravity increased back back pain diastasis recti relaxation of round ligaments (uterus to labia) - get sharp pain in vagina, increased pain with standing, sudden - have flex hip and goes away upper extremity numbness bc of poor posture |
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what are the metabolic changes in pregnancy
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lower FBS increases insulin
insulin doesn't cross the placenta increase lipid and triglycerides iron requirement increases - concentration decreases, TIBC increases increase sed rate |
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what is the blood PH changes in pregnancy
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decrease PCO2, respiratory alkalosis
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how is CHO metabolism altered in pregnancy
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potentially diabetogenic
increase resistance of tissue and liver affect to insulin Human Placental LActinogen - oppose action of insulin prog and estrogen cause insulin resistance hypertrophy of beta cells increase insulin requirement - decrease response to it |
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Presumptive signs occur when?
cessation of menses change in breast chadwicks sign nausea change in urination fatigue sensation of movement skin pigmentation |
10days to 8 weeks
first 2 months 6-8 weeks 6-8 weeks 6-8 weeks first 13 weeks 16-20 weeks 20-24 weeks |
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what physiological changes can occur and be detected on exam during pregnancy
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uterus size ; cervix 6-8 weeks
pregnancy 7-10 days enlarged abdomen 12 weeks braxton hicks after 13 weeks ballotment 20 weeks outline of uterus 20-24 weeks |
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what positive signs are directly attributable to the fetus during pregnancy
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ID fetal heart sounds
10-12 weeks dap tone 18-20 weeks fetoscope - look like stethoscope US can ID fetus 5-6 weeks |
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what are the initial labs you obtain in pregnancy
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CBC, blood type and RH
antibody screen urine protien and culture rubella titer HBsAg TSH HIV Syphilis Varicella GC Chlamydia Pap |
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what is ptyalism
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pica
haitains - spit in cup eat cornstarch eat ice cubes |
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if a pregnant women is incontinent and you want to make sure its not amniotic fluid what do you order
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see ferrning under the microscope
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when is the quad screen ordered
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15-20 weeks
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when is the 1 hour glucose test ordered
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24-28 weeks
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when is the antibody screen and rhogam ordered
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at 28 weeks if RH negative
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when is the beta strep ordered
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35-37 weeks
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when is the first US
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18-20 weeks
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when is an amnio
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16 weeks
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when is the contraction stress test ordered
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>36 weeks
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what does increased AFP indicate
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neural tube defect
abdominal wall defect multiple gestation fetal death |
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what does a decreased AFP mean
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downs syndrome or trisomy
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when is the triple screen offered and for who
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in women over 35 years
in 3d trimester - nonstress test, AF volume, respiratory motions, fetal movement and placental grading (8-10 normal) check estriol - decrease is in downs or trisomy or turners check hcg - increased in downs and turner decreased hcg - fetal demise and trisomy 18 |
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what does the quad screen consist of
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AFP
HCG U estrodial Inhibin A 81% detect downs 5% false positive only if need further testing |
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when would you order an US - need a reason because insurance only pays for 18-20 weeks
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confirmation of pregnancy
assess age check malformation fetal presentation amniotic fluid confirm life if bleeding in early pregnancy |
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what does amnio detect
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chromosomal testing
biochemical determinants |
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when are the prenatal visits and what is done during the visit
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every 4 weeks until 28 weeks
every 2 weeks until 36 weeks then weekly measure fundus leopold maneuver - check position at 28 weeks BP measure dipstick protien and glucose weight check edema check for s/sx of preterm labor |
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how much weight should you gain if normal weight and then overweight
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25-35 pounds
11-20 pounds if above 30 |
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what is the complications of varicella pneumonia
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encephalitis, penumonia, must have immediate antiviral therapy
if exposure - check Igg serology - if positive then fine if negative - give immunogoblin and give antivirals and hospitalize Get CXR |
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what are the complications of varicella in the first 20 weeks of pregnancy
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2% of congenital varicella syndrome - limb hypoplasia, scars, cataracts, atrophy, microcephaly,
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what is neonatal varicella
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occurs when mom contracts varicella 5 days before or 2 days after delivery, 30% mortality - severe
if contract varicella 5-21 days before delivery - mild symptoms check with US to see fetal injury |
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what occurs with Parvovirus B19 in pregnancy
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no serious compilation, no mental retardation, or congenital issue
get rash, joint pain, swelling if first half of pregnancy - fetal anemia, and can have miscarriage <5% |
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which drug category
controlled studies show no risk |
category A
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what drug category
no evidence of risk in humans - no animal or human study has shown fetal risk |
category B
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what drug category
risk cannot be ruled out - animal studies have revealed adverse effects |
category C
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which drug category
positive evidence of risk - shown risk in humans but if benefits outweigh the risk then acceptable |
category D
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what drug category
contraindicated in pregnancy - shown fetal abnormalities |
category X
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which medication is category A
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synthroid
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can a pregnant women have NSAIDS
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no especially 3d trimester
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why is topamax a category D
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cause cleft lip or palate
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what can you give for yeast infections
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7 day therapy preparations
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what should you do if a women is pregnant and taking antidepressant
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See if you can stop it while pregnant -
Link between SSRIs and persistent pulmonary hypertension Must weigh benefits and risks: Low birth wt, PTD, l lower Apgar scores, poor prenatal care, failure to recognize and report signs of labor, and an increased risk for fetal abuse, neonaticide or maternal suicide. |
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why is paxil a category D
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cardiac defect
should not abruptly stop, wean off |
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can a pregnant women have an xray
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yes, but avoid until after 20 weeks
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why would you check a quantitative HCG
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to see the rise, can check once and then in 48 hours to see how fast its rising
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