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51 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Corpus Luteum is responsible for
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Secreting Estrogen and progesterone to maintain early pregnancy until the placenta can takes over. Its functional up until about end of 1st trimester.
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HCG is produced by ___ and can be detected ____.
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The trophoblasts and can be detected by 8 to 10 days after conception, a day after implantation occurs.
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positive PPD in pregnancy
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Woman needs a chest xray after the 1st trimester. Use and abdominal shield to protect the fetus from radiation.
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Treatment for positve PPD in pregnancy
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Treatment is determined by the results of the chest xray and timing of seroconversion if known.
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If xray is negative for active TB but pregnant woman is determined to be a recent converter, i.e. positive by exposure to active disease or HIV+, Treatment should be given due to active disease risk is high.
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CDC guidelines for HIV screening in pregnancy
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Not required, but CDC recommends universal screening for pregnant women done as routine early prenatal testing with option to opt out of testing, or decline testing.
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Repeat testing recommended in 3rd trimester for woman with elevated risks factors.
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Chloasma appears as_____,
Prognosis is _______ |
"The pregnancy mask"
seen as irregular brownish discoloration of the forehead, cheeks, and nose. |
The discoloration will usually fade and disappear after pregnancy is over.
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Chloasma etiology
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As a result of melanocyte stimulated effects of estrogen and progesterone.
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HPL
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Stimulates growth of breast AND has lactogenic properties AND have Metabolic effects.
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?
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Causes vasodilation and drop in blood pressure seen in the 2nd trimester.
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Relaxin
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Causes a relaxation of the joints - results in "waddle gait"
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?
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Promotes development of oxytocin receptors in the cervix
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Hemodynamic changes in pregnancy
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Increased Cardiac Output,
Increased Heart Rate Increased Blood Volume WBC increase in 2nd/3rd trimester. Red blood cell mass increase (hemodilution ccours due to increased blood volume - leading to decrease in Hgb and Hct) |
Decrease in Systolic and Diastolic BP in the 2nd trimester with return to prepregnant levels in the 3rd trimester.
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TSH in pregnancy
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TSH remains normal in pregnancy.
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TBG in pregnancy
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There is an estrogen induced increase in TBG. The increase in TBG results in an increase in total T4 and T3 levels. T4 and T3 concentrations do not change in pregnancy.
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CDC Treatment of Condyloma Acuminata
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Use Trichloroacetic acid (TCA) or Cryotherapy in pregnancy as genital warts in pregnancy often proliferate and become friable in pregnancy.
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CDC Contraindicated Treatment of Condyloma Acuminata in pregnancy.
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CDC states Podophyllin, Podofilox and Imiquid should not be used in pregnancy.
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Podofilox
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The preferred treatment in non pregnant patients. Can be self applied.
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Risk factors of IUGR
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Hypertension, Poor maternal nutrition, smoking, diabetes, substance abuse, multiple gestation, placental abnormalities (Pevia, abruption), short interval between pregnancy.
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How does Methotrexate work in treatment of Ectopic Pregnancy?
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Methotrexate is a folic acid antagonist which interferes with DNA and cell multiplication.
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Preconception counseling for IDDM woman
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Counseling should include a glycosylated hemoglobin (Hgb A1C) which provides an accurate long term index of the client's average blood glucose over the previous 8 to 12 weeks. This is helpful for the woman to obtain strict control of her glucose levels prior to pregnancy.
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Insulin needs in pregnancy
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The need for insulin usually decreases int he 1st trimester and then begins to rise int he 2nd trimester.
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Fetal macrosomia
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results when there are high levels of maternal glucose. Strict glucose control during pregnancy may reduce this.
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Antiphospholipid Syndrome (APS) Diagnosis is made when at least one of the clinical and one of the laboratory criteria are met.
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Clinical - Vascular Thrombosis (one or more confirmed episode) and pregnancy morbidity (one or more uneplained deaths of normal fetus after the 10th week gestation.; or one or more premature births before 34 weeks due to preeclampsia or severe placental insufficiency or 3 or more consecutive SAB prior to 10 weeks,
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Laboratory criteria is presence of Anticardiolipin antibody of IgG and or IgM on at least 2 or more times at least 6 weeks apart and presence of lupus anticoagulant on 2 or more occasions at least 6 weeks apart.
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diagonal conjugate
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Only AP diameter that can be measured clinically. Gynecoid >11.5 cm
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extends from middle of sacral promontory to the middle of lower margin of symphysis pubis.
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Obstetric conjugate
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shortest AP diameter of the pelvis. Can't be measured clinically. must used D.C - 1.5 cm = 10
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Bituberous Diameter
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Between ischial tuberosities
about 11 cm |
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Interspinous Diameter (Bispinous)
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The "midplane." Smallest diameter of the pelvis. 10 cm Distance between the ischial spines.
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Ischial spines
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Best if blunt
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Side walls
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Best if straight.
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Sacrum
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best if curved
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Pubic Arch
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Best if at least 90 degree angle.
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Pregnancy Mnemonics
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4- normal vaginal pH
40 weeks - gestation 400 oocytes - from menarche to menopause 400,000 oocytes present at puberty 28 days normal menses cycle 280 GA; from LMP to end gestation |
280-14 = 266 days from conception
280 GA -14 Day of ovulation = 266 days since Conception |
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NDDG 3 hr GTT values:
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105
fasting >105 1hr >190 2hr >165 3hr >145 |
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Amniocentesis
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samples sloughed fetal cells for chromosomal analysis and biochemical markers for open neural tube defects.
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Done 15-19 weeks. Best if done between 14-16 weeks.
Increased pregnancy loss prior to 15 weeks |
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CVC
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done between 10 - 13 weeks. Risk of limb deformaties if done prior to 9 weeks.
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CVS may allow exchange of maternal - fetal blood and therefore may cause a falsely elevated MSAFP
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Multiple Marker screens
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ME low
AB high in Down's syndrome |
MSAFP - low
Estriol - low Inhibin A- high BhCG- high |
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Multiple Marker screens
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Neural tube defects
MSAFP - high |
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First Trimester Screen
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- Ultrasound for nuchal translucency thickenes
- Pregnancy Associated Plasma Protein (PAPP-A) - Free bhCG |
Down's Syndrome - 1st trimester screen:
- Ultrasound for nuchal translucency thickenes 85% detection - Pregnancy Associated Plasma Protein(PAPP-A) HIGH - Free bhCG - HIGH |
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Quad Screen
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MSAFP
Estriol BhCG adds Inhibin A |
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Indications for QUAD screen
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>35 years of age, Hx of birth defects, Diabetes - use of insulin, Use of harmful drugs or toxins in pregnancy, use of radiation or exposure in pregnancy,Viral infection in pregnancy.
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Risks of moderately overweight to obese
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HTN,GDM-insulin,UTI, C/S,
Preeclampsia, Macrosomnia Shoulder Dystocia,Late IUFD, 2 fold increase of NeuralTD |
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Complications a/s weight >300lbs
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Chronic HTN, Diabetes,
Cesarean for CPD, PP infection |
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FHT should be checked at each prenatal visit after 10 weeks.
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May or may not be heard by doppler at 10 weeks. If no FHTs by 13 weeks, confirm, viability and GA with sonogram.
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Fundal height - 1st trimester
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8 wks - size of tennis ball
10 wks - size of orange 12 weeks - size of grapefruit (palpable above symphysis pubis) |
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Uterine Fundus
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12 weeks - symphysis pubis
16 weeks 1/2 way between symphysis pubis &umbilicus 20 weeks 1-2 fingers below umbilicus 24 weeks1-2 fingers above umbilicus |
28-30 weeks 1/3 between
umbilicus & xiphoid process 32 weeks 1/3 between umbilicus & xiphoid process 36-38 weeks 1 finger below xiphoid process 40 weeks 2-3 fingers below xiphoid process if lightening occured. |
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HBsAg
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HBV infection and if present for more than 6 months, chronic status
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HBsAb
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Immunity to HBV
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PPD skin test
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>5
>10 >15 |
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Reading of PPD skin test
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Should be read in 48-72 hours, Can remain positive for up to 1 week. Induration is significant, not the redness.
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So if patient returns in 5 to 7 days and test induration is + , then PPD test is considered +. If induration is -, then test should be repeated and patient to report back in 48-72 hours for reading of skin test.
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Leopold's
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1. Lie /Presentation
2. Position 3. Engagement 4. Attitude |
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Sexual Desires in Pregnancy
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Woman's desires may change in pregnancy.
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