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139 Cards in this Set

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  • Back
When does beta-HCG peak and at what level?
by 10 weeks gestation, peaks at 100,000mIU/mL
fertilization until 8 weeks (10 weeks GA)
8 weeks until birth
delivery before 24 weeks
delivery between 24 and 37 weeks
delivery beyond 42 weeks
# of times a woman has been pregnant
# of pregnancies that have led to a birth at or beyond 20 weeks GA or weighing >500g
# of Term, Preterm, Abortuses and Living Children
Chadwick's sign
bluish color of vagina and cervix
Goodell sign
softening and cyanosis of the cervix at or after 4 weeks
Ladin sign
softening of the uterus after 6 weeks
Gestational age (GA)
age in weeks and days since LMP
Developmental age (DA)
(conceptional age) is number of weeks and days since fertilization
Nagle rule
to calculate the estimated date of delivery:
LMP - 3 months + 7 days
Cardiac output
increases by 30-50% during pregnancy (most during 1st trimester)
Systemic vascular resistance
decreases during pregnancy--causes fall in BP, probably due to increased progesterone causing smooth muscle relaxation
Tidal Volume
increases by 30-40% despite the TLC decreasing by 5% b/c of diaphragm rising
increases by up to 50% causing a BUN and Cr levels to decrease by about 25%
Plasma volume
increases by up to 50% but the plasma only increases by 20-30% so hematocrit decreases
Hormones with the same alpha-subunit
alpha-HCG, LH, FSH and TSH
Human placental lactogen (hPL or hCS)
made by placenta, important for fetal nutrition, causes lipolysis and increase in free fatty acids
Normal weight gain
20-30 lbs
Protein requirement during pregnancy
increases to 70-75g/day (from 60g/day)
Calcium intake during pregnancy
Folate requirement during pregnancy
increases to 0.8mg/day (from 0.4mg/day)
Maternal Serum Alpha Fetoprotein screening (MSAFP)
usually between 15-18 weeks.
Elevated MSFAP
increased risk of neural tube defects
Decreased MSFAP
seen in some aneuploidies (including Down syndrome)
Biophysical profile (BPP) components
amniotic fluid volume, fetal tone, fetal activity, fetal breathing movements, and nonstress test (NST) of the fetal heart rate
Fetal lung maturity measurement
Usually use the lecithin to sphingomyelin (L/S) ratio. It should increase
Lab tests for an ectopic pregnancy
Beta-HCG should double approximately every 48 hours
Medical management of uncomplicated ectopic pregnancies
Methotrexate--in reliable patients due to necessary follow up
Incidence of ectopic pregnancies
Spontaneous Abortion (SAB)
before 20 weeks gestation
fetus lost before 20 weeks, less than 500g, or less than 25cm
Complete Abortion
complete expulsion of all the POC before 20 weeks gestation
Incomplete Abortion
partial expulsion of some but not all POC before 20 weeks' gestation
Inevitable Abortion
no expulsion of products, but bleeding and dilation of cervix such that a viable pregnancy is unlikely
Threatened Abortion
any intrauterine bleeding before 20 weeks, without dilation of the cervix or expulsion of any POC
Missed Abortion
death of the embryo of fetus before 20 weeks with complete retention of POC; these often proceed to complete abortions in 1-3 weeks but are sometimes retained for much longer
Treatment of incomplete, first trimester abortion
expectant management, D&C, or prostaglandins (misoprostol)to induce contractions and cervical dilation
Incompetent cervix
Painless dilation and effacement of cervix, often in 2nd trimester--causes ~15% of 2nd trimester losses. Can lead to infection, PTL or PPROM
suture placed vaginally around the cervix to close it--one possible treatment for an incompetent cervix
Recurrent pregnancy loss
3 or more consecutive SABs
Sickle cell disease
AR, single point mutation in gene for beta chain in hemoglobin
Tay-Sachs disease
AR, deficiency of hexosamindase A (hex A)--buildup up Gm2 gangliosides in lysosomes, esp. in brain
Sx seen several months after birth when beta would normally replace gamma chains
Hb Bart (4 alleles)
HbH (3 alleles)
Alpha thal trait (2 alleles)
(1 allele)-mild microcytic anemia
Triple Screen
MSAFP, estriol, beta-hCG
Quad Screen
MSAFP, estriol, beta-hCG PLUS inhibin A
1st semester Down Syndrome screen
Ultrasound for nuchal translucency (NT)and serum for free beta-hCG and pregnancy associated plasma protein A (PAPP-A) give an 80% sensitivity together
Trimsomy 18
Edward syndrome: die by 2 years old--can often be detected by US or triple screen. Clenched fists, overlapping digits, rocker bottom feet.
Trisomy 13
Patau syndrome: 85% die by 1 year. Similar signs as Trisomy 18. Can use US to screen but not triple screen.
Turner Syndrome
Klinefelter syndrome
16 cells, by day 4
Inner cells--embryo
Outer cells--trophoblast
Implants in endometrium by end of day 7
Trophoblast differentiation
By start of week 2
give rise to placenta
Inner cell mass differentiation
by start of week 2
divides into bilaminar germ disc (epiblast and hypoblast)
during 3rd week
formation of a primative streak on epiblast--invagination of epilbast cells into 3 germ layers
Endoderm layer
GI and respiratory systems
Mesoderm layer
CV, musculoskeletal, and GU systems
Ectoderm layer
nervous, skin, and many sensory organs (hair, eyes, nose, ears)
Neural Tube Defects
develop d/t defective closure by week 4
Spina Bifida
can be seen with US, elvated MSAFP
Eisenmenger physiology
VSD causing RV hypertrophy, pulmonary HTN, eventual right-to-left shunt
Tetrology of Fallot
Overriding aorta
Pulmonary Stenosis or atresia
RV Hypertrophy
Potter Syndrome
Bilateral renal agenesis causing anhydramnios, pulmonary hypoplasia and fetal contractures
Nuchal Translucency (NT)
screen for aneuploidy (Down in particular)--measures the posterior fetal neck in profile (~70% sensitive)
Triple screen sensitivity alone
3 ways to obtain fetal cells
2-chorionic villous sampling
3-fetal blood sampling
after 15 weeks, can get fetal karyotype--place needle transabdominally thru the uterus into the amniotic sac to withdraw fluid (c sloughed fetal cells)
Fluorescent in-situ hybridization (FISH)
can ID aneuploidy from amniocentesis in 24-48 hours (normal culture takes 5-7 days)
Risk of amniocentesis
1 in 200
Chorionic Villous Sampling (CVS)
fetal karyotype sooner than amniocentesis--at 9-12 weeks. Place catheter in intrauterine cavity and aspirate chorionic villi from placenta
CVS risk
higher than 1 in 200
Fetal Blood Sampling (via PUBS)
needle placed transabdominally into uterus and phlebotomizing the umbilical cord
Fetal Lie
whether the infant is longitudinal or horizontal
Fetal Presentation
either breech or vertex (cephalic)
Premature rupture of membranes--at least one hour before onset of labor (occurs in 10%)
Preterm, premature rupture of membranes--before 37 weeks
Components of Bishop score
3-fetal station
4-cervical position
5-consistency of the cervix
relation of the fetal head to the ischial spines
0--presenting part is level wtih ischial spines--goes + from there
Cervical consistency
firm, soft or in between
contractions that cause cervical change in either effacement or dilation
Normal fetal heart rate
110-160 bpm
Early decelerations
begin and end at approximately the same time as contractions--d/t increased vagal tone secondary to head compression
Variable decelerations
occur at any time and can drop more precipitously than early or late decels. D/t umbilical cord compression
Late decelerations
begin at peak of contraction and slowly return to baseline after contraction is over. D/t uteroplacental insufficiency--worrisome--may become brdaycardia as labor progresses
External Electronic Monitor
External tocometer--belt that goes around fundus--measures during contractions as belly gets firmer
Fetal Scalp Electrode (FSE)
more sensitive. C/I include hx of HIV or maternal hepatitis or fetal thrombocytopenia
Intrauterine Pressure Catheter (IUPC)
used if timing a/o strength of contractions is crucial. Catheter is threaded past presenting part into uterine cavity
Cardinal movements of labor
4-Internal rotation
6-External Rotation (restituion/resolution)
fetal presenting part enters pelvis
head descends into pelvis
allows smallest diameter to present to the pelvis
Internal Rotation
from an occiput transverse (OT) position so that the sagittal suture is parallet to the AP diameter of the pelvis, often to the OA position
as vertex passes beneath and beyond the pubic symphysis
External Rotation
once head is delivered, so that shoulders can be delivered
First Stage of Labor
Onset until full dilation and effacement of cervix
Second Stage of Labor
From full dilation and effacement until delivery of infant
Third Stage of Labor
After delivery of infant until delivery of placenta
Average time for 1st stage of labor
10-12 hours for nulliparous
6-8 hours for multiparous
2 phases of 1st stage of labor
Latent: onset until 3-4cm dilation with slow cervical change.
Active: until greater than 9cm of dilation, slope increases.
Factors affecting the Active Phase of the 1st Stage
Powers: strength and size of contractions
Passenger and Pelvis: babe may be too big for pelvis, etc (cephalopelvic disproportion-CPD)
Average time for 2nd stage of labor
nulliparous: within 2 hours or 3 with epidural
multiparous: within 1 hour or 2 with epidural
Uterine hypertonus
a single contraction lasting more than 2 minutes
Uterine tachysystole
>5 contractions in a 10-minute period
Ritgen manuever
moderate upward pressure on fetal chin with posterior hand while suboccipital region is held against pubic symphysis
Time Frame for Placental Seperation
usually within 5-10 minutes of fetal delivery but up to 30 minutes is normal.
3 signs of placental separation
cord lengthening, gush of blood, and uterine fundal rebound
1st degree perineal laceration
involves the mucosa or skin
2nd degree perineal laceration
extend into the perineal body but don't involve the anal sphincter
3rd degree perineal laceration
extend into or completely through the anal sphincter
4th degree perineal laceration
if anal mucosa is entered
Pudendal nerve
just posterior to ischial spine at its juncture with the sacrospinous ligament
Epidural vs. spinal anesthesia
Epidurals: more common during labor
Spinal anesthesia: one time dose, more rapid onset, more common with C-sections
Placenta Previa
abnormal implantation of the placenta over the internal cervical os (complete, partial or marginal)--occurs in 0.5% of all pregnancies and accounts for 20% or all antepartum hemorrhages
Vasa Previa
rare, when a fetal vessel lies over the cervix
Placenta Accreta
abnormal adherence of the placenta to the uterine wall-causes inability of the placenta to seperate from the uterine wall after delivery
Placenta Previa symptoms
sudden and profuse painless vaginal bleeding, usually after 28 weeks gestation
Circumvallate Placenta
occurs when the membranes double back over the edge of the placenta, forming a dense ring around the periphery of the placenta--considered a variant of placental abrubtion
Placenta Increta
abnormal placentation where the placenta invades the myometrium
Placenta Percreta
Abnormal placentation where the placenta invades thru myometrium to the uterine serosa
Velamentous Placenta
When the blood vessels insert b/t the amnion and teh chorion, away from the margin of the placenta. Leaves the vessels unprotected and vulnerable to compression or injury
Succenturiate Placenta
An extra lobe of the placenta that is implanted at some distance away from the rest of the placenta. Fetal vessels may course between the 2 lobes, possibly over the cervix, leaving these blood vessels unprotected and at risk for rupture
Placental Abruption (Abruptio Placentae)
premature separation of the nornally implanted placenta from the uterine wall, causing hemorrhage b/t uterine wall and placenta--occurs in 0.5-1.5% of all pregnancies and is the cause of 30% of 3rd trimester bleeding
Placental Abruption symptoms
3rd trimester vaginal bleeding with severe abdominal pain a/o frequent, strong contractions. 20% have no symptoms d/t concealed hemorrhage.
Apt test
test for vaginal bleeding to see if fetal blood cells (nucleated) are present
Low Birth Weight Infant (LBW)
born weighing less than 2500g
Tocolytic agent
Ritodrine--only FDA approved drug for preventing contractions--can only prolong birth by ~48 hours
a glucocorticoid used to enhance fetal lung maturity when PTL is anticipated
Dehydration and contractions
a dehydrated patient will have more ADH, which is similar in structure to oxytocin and also made in the hypothalamus--so correcting dehydration may reduce contractions
Ritodrine MOA
Beta-mimetic. Increases conversion of ATP-cAMP which decreases the levels of free calcium (via sequestration into sarcoplasmic reticulum ) which decreases uterine contractions
Magnesium sulfate
Decreases uterine tone and contractions by acting as a calcium antagonist and membrane stabalizer
Calcium Channel Blockers
especially nifedipine--decrease influx of calcium into smooth muscle cells--diminish uterine contractions
Prostaglandin Inhibitors
Indomethacin (NSAID)-used as a tocolytic--many potential fetal complications
Rate of Preterm Delivery
occurs in up to 10% of all pregnancies