Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
85 Cards in this Set
- Front
- Back
|
primary functional change in the CV system in pregnancy
|
increase in CO
(30-50%) |
|
|
increase in what parameter is responsible for incr CO...
a. first half of pregnancy b. secnod half of pregnancy |
a. incr SV
b. incr HR |
|
|
what is the effect of progesterone on maternal vasculature?
|
vasodilation
|
|
|
why do some women have dizziness, lightheadedness, and syncope while lying supine?
|
IVC syndrome
ie gravid uterus compresses IVC |
|
|
why are the following normal in a pregnant woman's exam?
-incr S2 split -distended neck veins -low grade SEM |
hyperdynamic state of CV system
|
|
|
progesterone causes increased central chemoreceptor sensitivity to ____
|
CO2
|
|
|
Effect of pregnancy on...
a. FRC b. tidal volume c. RV d. minute ventilation |
a. dec
b. inc c. dec d. inc |
|
|
ABG during pregnancy normally shows a ______
|
compensated resp alkalosis
|
|
|
maternal blood volume increases ____% by term
|
35
|
|
|
maternal iron needs in a woman who's not anemic
|
60 mg Fe/day
|
|
|
risk of thromboembolism increased by ____x during pregnancy and by _____x during puerperium*
*childbirth and immediately after |
2x
5x |
|
|
why do pregnant women get physiologic anemia?
|
incr plasma volume compared to red cell volume
|
|
|
describe the primary changes to the renal system during pregnancy?
|
enlargement and dilation of the kidneys and collecting system
|
|
|
two common urinary sx in pregnant woman
|
-urinary frequency (2/2 bladder compression)
-stress urinary incont |
|
|
why does transit time increase in the gravid woman's GIT?
|
progesterone ->
-lower esoph sphincter tone -decr GI motility -impaired GB contractility |
|
|
morning sickness aka
|
nausea and vomiting of pregnancy
|
|
|
by what point does morning sickness usu disappear?
|
14-16 weeks
|
|
|
severe NVP aka
|
hyperemesis gravidarum
(can't keep anything down) |
|
|
why is total serum alk phos doubled in pregnancy?
|
icreased placental production
|
|
|
why do pregnant women have higher levels of total serum T4/T3 and of total cortisol?
|
estrogen stimulates liver->
-incr Thyroid-binding globulin -incr cortisol binding globulin |
|
|
Due to the effects of __________, maternal response to __________ _________is blunted, producing postprandial hyperglycemia
|
a. human placental lactogen (hPL)
b. glucose load |
|
|
single primary metabolic substrate for placental metabolism is __________
|
glucose
|
|
|
how is maternal met alkalosis helpful to the fetus?
|
aids in transfer of CO2 from fetal to maternal circulation
|
|
|
what is the default fetal external genital organ?
|
female
testes -> testosterone + mullerian inhibitory factor -> inhibited female external genitalia |
|
|
dx:
34yo G3P1 26 weeks with normal exam, "trouble catching her breath" |
physiologic dyspnea of pregnancy
*mech: progesterone-induced hyperventilation |
|
|
why might a woman receiving IVFs and terbutaline have shortness of breath?
|
terbutaline/B-agonists increase susceptibility to pulm edema
|
|
|
maternal CO increases during pregnancy due to increases in ________ and _________
|
HR, SV
|
|
|
why is maternal minute ventilation increased?
|
incr *tidal volume*
no change to RR |
|
|
why do preg women have increased total thyroxine?
|
incr estrogens -> incr TBG -> incr total thyroxine
|
|
|
why is R hydronephrosis more likely in pregnant woman?
|
L ureter is cushioned by sigmoid colon
|
|
|
mgmt:
patient with suspected molar pregnancy via TVUS and BHCG |
CXR to check for metastatic dz
|
|
|
def:
prolonged latent phase a. nullip b. multip |
a. >20h
b. >14h |
|
|
VBAC =
|
vaginal birth after caesarean
*likelihood of a successful VBAC is lower in patients with two previous Cesarean deliveries than in women with one prior Cesarean delivery |
|
|
review risk factors for dystocia
|
fetal macrosomia
maternal obesity diabetes mellitus postterm pregnancy prior delivery complicated by a shoulder dystocia prolonged second stage of labor |
|
|
mgmt:
pt requesting induction whose cervix is unfavorable |
cytotec (misoprostol)
goal is to ripen cervix before starting pitocin |
|
|
mgmt:
arrest of dilation in active phase |
pitocin
goal is to increase frequency and strength of pt's contractions |
|
|
what is the major cause of higher csxn rates in recent years?
|
rate of VBAC has decr in recent years 2/2 studies showing incr risk of complications, especially uterine rupture
|
|
|
multip should have a rate of cervical dilation of at least ____ cm/hour in the active phase
|
1.5 cm/hour
amniotomy if cervix open and arrest of dilation occurs |
|
|
EFM:
variability in FHR baseline is calculated as amplitude of _______ in bpm |
peak-to-trough
|
|
|
EFM:
define an acceleration |
>32 weeks:
incr 15bpm for >15s |
|
|
EFM:
define prolonged accel |
> 2mins
|
|
|
EFM:
if accel lasta >10 mins, it is then called a _________ |
baseline change
|
|
|
EFM:
recurrent vs intermittent decel? |
recurrent: with >50% of contractions in 20 min period
intermittent: with <50% of contractions in 20 min period |
|
|
EFM:
def of prolonged decel |
2 min < decel < 10 min
|
|
|
screening for DM:
50 g OGTT - when should this be done for pts... a. low risk b. avg risk c. high risk |
a. screen not performed
b. 24-28wks c. asap |
|
|
why is radioactive iodine contraindicated in the hyperthyroid mother?
|
concentrates in fetal thyroid (->) congenital hypothyroidism
|
|
|
mgmt:
syphilis in a pregnant pt with a pcn allergy |
desensitization and PCN
|
|
|
why should pregnant patients be treated for BV?
|
BV -> incr risk of preterm delivery
tx with flagyl |
|
|
which medication is contraindicated in pregnancy?
A. Levothyroxine B. Labetalol C. Acyclovir D. Lisinopril E. Amitriptyline |
D - lisinopril
assoc w/ oligohydramnios, fetal growth retardation and neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death |
|
|
classic morphology for iron-def anemia
|
erythrocyte hypochromia and microcytosis
|
|
|
mgmt:
symptomatic pregnant lady with MVP (anxiety, palpitations, atypical chest pain, and syncope) |
B-blocker
|
|
|
review mechanisms of increased materno-fetal mortality if mom is obese
|
-chronic HTN
-GDM -preX -macrosomia -higher rate of csxn and postpartum complications |
|
|
dx/mgmt:
pregnant lady with intense itching for 2 weeks and mild yellowing of skin |
dx: pruritis gravidarum
(less severe form of intrahepatic cholestasis of pregnancy) mgmt: ursodeoxycholic acid |
|
|
which is contraindicated in pregnancy?
A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Fluoxetine (Prozac) D. Nortriptyline (Norpress) E. Bupropion (Wellbutrin) |
a. paroxetine
causes incr risk of fetal cardiac defects and pulm HTN |
|
|
why is radiotherapy contraindicated in pregnant woman with BrCa?
|
scatter to abdomen/pelvis -> excessive radiation of fetus
|
|
|
what is the "non-stress test"?
|
assessment of fetal well-being that measures the fetal heart rate response to fetal movement
|
|
|
Prolonged periods of fetal tachycardia are frequently found with ___________ or ___________
|
maternal fever or chorioamnionitis
|
|
|
variable decelerations are thought to result from _______
|
cord compression
(esp in setting of low amniotic fluid volume) |
|
|
late decels are thought to result from _______
|
uteroplacental insufficiency
|
|
|
most likely structural abnormality in fetus of diabetic mother who has poor control?
|
cardiac anomaly
|
|
|
valproate is assoc with incr risk of this anatomical problem in fetus?
|
neural tube defect
|
|
|
why is inhibin A included to create the "quad screen"?
ie what is better about the quad versus the triple scrn? |
greater sensitivity in testing for Down syndrome
|
|
|
four components of quad screen
|
AFP
BHCG unconj estriol inhibin A |
|
|
estimate fetal loss (%) with CVS
|
1%
|
|
|
most common form of inherited mental retardation
|
Fragile X
|
|
|
2x components of first trimester genetic screen
|
nuchal translucency screen
maternal serum PAPP-A |
|
|
most effective screening test for Down's in 2T?
|
quad screen
|
|
|
which form of diabetes places moms at risk of IUGR?
|
PREgestational diabetes
with gdm -> macrosomia |
|
|
dose of folic acid for women with previous NTD?
|
4mg/day
|
|
|
mgmt:
25yo G2P1 @ 38wks has IUPC placed with 300cc of frank blood amd amniotic fluid flowing out of vagina at placement |
remove IUPC - concern for uterine rupture
monitor fetus replace IUPC if FHT reassuring |
|
|
why is there no role for routine episiotomy in modern obstetrics?
|
greatly increases 3rd and 4th degree laceration rate
|
|
|
def:
ctx that are short in duration, less intense than true labor, and with discomfort felt in the lower abdomen and groin areas |
Braxton hicks contractions
|
|
|
what is the 511 rule?
|
when pt begins having ctx q5 mins, lasting 1 minute each, for 1 hour -> go to L+D for suspected labor
also come if -fetal mvmt less than 10 episodes/2h -VB -LOF |
|
|
fourth stage of labor?
|
the first 2h after delivery of placenta
|
|
|
typical appearance of an infant in a mom with chorioamnionitis ?
|
pale, lethargic, high temp
(septic) |
|
|
review APGAR scores
|
Appearance: blue | acrocyanosis | pink
Pulse: absent | <100 | >100 Grimace: none | grimace/feeble cry | cry/pull w stim Activity: none | some flxn | flxn w/ resistance+active Respiration: absent | weak/irreg | strong lusty cry |
|
|
why should naloxone not be used in an infant with poor respiratory effort and maternal hx of drug use?
|
can ppt life-threatening withdrawal
|
|
|
safest method to suppress lactation in a mom that's not breast feeding?
|
breast binding, ice packs, analgesics
avoid breast stimulation |
|
|
most common cause of postpartum fever
|
endometritis
|
|
|
infant suckling stimulates this hormoen
|
oxytocin
-> milk ejection |
|
|
signs that a baby is getting enough milk:
a. ____ to _____ stools in 24h b. ____ wet diapers in 24h c. __________ |
a. 3 to 4 stools
b. 6 wet diapers c. appropriate weight gain |
|
|
which hormone prevents formation of milk until parturition?
|
progesterone
|
|
|
mgmt:
postpartum mastitis |
antibiotics
|
|
|
mgmt:
postpartum mastitis with a fluctuant area |
abcess has developed -> I+D
|
|
|
dx:
22yo G2P1 breastfeeding 3 mo old daughter p/w sensitive nipples, burning pain in breasts; exam with pink/shiny nipples and peripheral peeling |
candidiasis
check baby's mouth |
