Obgyn Blueprints Ch. 1

Front 1

7 signs of pregnancy

Back 1

1) Chadwick's sign
2) Goodell's sign
3) Ladin's sign
4) breast swelling and tenderness
5) development of the linea nigra from umbilicus to pubis
6) telangiectasias
7) palmar erythema

Front 2

4 sxs of pregnancy

Back 2

1) amenorrhea
2) n/v
3) breast pain
4) quickening - fetal movement

Front 3

Chadwick's sign

Back 3

bluish discoloration of vagina and cervix

Front 4

Ladin's sign

Back 4

softening of the uterus after 6 weeks

Front 5

Goodell's sign

Back 5

softening and cyanosis of the cervix at or after 4 wks

Front 6

What are peak levels of b-HCG in a pregnant woman and when does this occur?

Back 6

100

Front 7

b-HCG levels in the 3rd trimester:

Back 7

decrease from peak and level off at 20

Front 8

How do u confirm dx of pregnancy?

Back 8

ultrasound

Front 9

How early and at what bHCG levels may you see the gestational sac on US?

Back 9

at 5 wks or bHCG 1500-2000

Front 10

How early and at what bHCG levels may you see the fetal heart on US?

Back 10

at 6 wks or bHCG 5000-6000

Front 11

Definition: embryo

Back 11

conceptus from fertilization to 8 wks

Front 12

Definition: fetus

Back 12

conceptus from 8wks to birth

Front 13

First trimester

Back 13

0-12 wks

Front 14

Second trimester

Back 14

12-24 to 28 wks

Front 15

Third trimester

Back 15

24 to 28wks - birth

Front 16

Definition: previable

Back 16

infant delivered at <24 wks

Front 17

Definition: preterm

Back 17

infant delivered btw 24-37 wks

Front 18

Definition: term

Back 18

infant delivered btw 37-42 wks

Front 19

Definition: postdate/ postterm

Back 19

infant delivered after 42 wks

Front 20

Definition: gravidity

Back 20

the number of times a woman has been pregnant

Front 21

Definition: parity

Back 21

the number of pregnancies that led to a birth beyond 20 wks GA

Front 22

Definition: gestational age

Back 22

the age of a fetus in wks and days measured from the first day of LMP
= DA + 2 wks

Front 23

Definition: developmental age

Back 23

age of a fetus in wks and days measured from date of fertilization

Front 24

Is gestational age greater or less than developmental age?

Back 24

greater

Front 25

Nagele's rule

Back 25

LMP - 3mos + 7days

Front 26

Exact dating of pregnancy

Back 26

LMP + 280days

Front 27

Definition: estimated date of confinement (EDC)

Back 27

estimated date of delivery (EDD)

Front 28

What is the acceptable discrepancy btw US and LMP dating by trimester?

Back 28

1st: 1wk
2nd
2wks
3rd: 3wks

Front 29

What is the most accurate means of dating in the first half of the first tm?

Back 29

crown rump length

Front 30

How accurate is crown rump length in dating fetus in first tm?

Back 30

within 3-5 days

Front 31

At what time can you start to detect fetal heart sounds by doppler US?

Back 31

10 wks

Front 32

When does quickening begin to occur?

Back 32

16-20 wks

Front 33

Changes during pregnancy: CO

Back 33

increases by 30-50%

Front 34

Changes during pregnancy: BP

Back 34

decrease in systolic (5-10mmHg) and diastolic (10-15mmHg) that nadirs at 24 wks followed by slow return to prepregnancy levels at term

Front 35

Changes during pregnancy: SVR

Back 35

decreases --> fall in arterial BP

Front 36

Changes during pregnancy: tidal volume

Back 36

increases by 30-40%

Front 37

Changes during pregnancy: total lung capacity

Back 37

decreases by 5% (due to elevation of diaphragm)

Front 38

Changes during pregnancy: minute ventilation

Back 38

increase in Vt with constant respiratory rate increases minute ventilation by 30-40%

Front 39

Changes during pregnancy: PaO2

Back 39

increased

Front 40

Changes during pregnancy: PaCO2

Back 40

decreased (from 40mmHg to 30mmHg)

Front 41

Cause of drop in BP during pregnancy:

Back 41

elevated circulating progesterone levels

Front 42

Common pulmonologic sxs during pregnancy:

Back 42

dyspnea (60-70%)

Front 43

What percentage of pregnant women will experience morning sickness?

Back 43

>70%

Front 44

Cause of morning sickness:

Back 44

elevated levels of: 1) estrogen
2) progesterone
3) hCG

Front 45

At what point should n/v resolve during pregnancy?

Back 45

14-16 wks gestation

Front 46

2 causes of esophageal reflux during pregnancy

Back 46

1) prolonged gastric emptying times
2) decreased tone of GES

Front 47

Cause of bloating and constipation during pregnancy:

Back 47

decreased motility of the bowel

Front 48

Changes during pregnancy: GFR

Back 48

increases by 50%

Front 49

What change in the kidneys during pregnancy leads to increased rates of pyelonephritis?

Back 49

kidneys increase in size --> ureters dilate

Front 50

Changes during pregnancy: BUN

Back 50

decrease by 25%

Front 51

Changes during pregnancy: creatinine

Back 51

decrease by 25%

Front 52

Changes during pregnancy: aldosterone

Back 52

increase secondary to activation of RAAS

Front 53

Effect of increased aldosterone levels during pregnancy

Back 53

increased sodium resorbtion

Front 54

Why do plasma sodium levels remain normal throughout pregnancy?

Back 54

because of the simultaneous increase in GFR

Front 55

Changes during pregnancy: plasma volume

Back 55

increases by 50%

Front 56

Changes during pregnancy: rbc volume

Back 56

increases by 20-30%

Front 57

Changes during pregnancy: Hct

Back 57

decreases

Front 58

Changes during pregnancy: WBC

Back 58

increases to mean of 10.5

Front 59

WBC count during labor

Back 59

can increase to >20

Front 60

Changes during pregnancy: platelets

Back 60

slight decrease (100

Front 61

Estrogen production during pregnancy:

Back 61

maternal adrenal glands produce estrogen precursors --> converted by placenta to estrogen

Front 62

What organ produces hCG?

Back 62

placenta

Front 63

Function of hCG

Back 63

maintains progesterone production by the corpus luteum

Front 64

Doubling time of hCG during early pregnancy

Back 64

every 48 hrs

Front 65

What organ produces human placental lactogen( hPL)?

Back 65

placenta

Front 66

General function of hPL

Back 66

ensures constant nutrient supply to the fetus

Front 67

Another name for hPL

Back 67

human chorionic somatomammotropin (hCS)

Front 68

Specific functions of hPL

Back 68

1) lipolysis --> increases circulating FFAs
2) insulin antagonist --> diabetogenic effect (increased insulin levels and protein synthesis)

Front 69

Which organ produces progesterone during pregnancy?

Back 69

early pregnancy: corpus luteum
later pregnancy: placenta

Front 70

General fxn of progesterone:

Back 70

relaxation of smooth muscle

Front 71

Name 2 skin changes that occur during pregnancy secondary to increased estrogen levels:

Back 71

1) spider angiomata
2) palmar erythema

Front 72

Name 5 areas which become hyperpigmented during pregnancy

Back 72

1) nipples
2) umbilicus
3) abdominal midline
4) perineum
5) face

Front 73

What is the cause of skin hyperpigmentation during pregnancy?

Back 73

increased levels of alpha-melanocyte stimulating hormone

Front 74

Healthy weight gain during pregnancy

Back 74

20-30 lbs

Front 75

Name 4 nutrients which are required in larger amounts during pregnancy:

Back 75

1) protein
2) iron
3) calcium
4) folate

Front 76

At what gestational age should the initial visit occur?

Back 76

btw 6 to 10 wks

Front 77

First trimester routine tests:

Back 77

urine pregnancy test (if pt uncertain) + 1) Hct (CBC) 2) blood type and screen
3) rapid plasma regin (RPR)

Front 78

Second trimester routine tests:

Back 78

1) MSAFP/ triple screen
2) ultrasound
3) amniocentesis in AMA pts

Front 79

Third trimester routine tests:

Back 79

1) Hct
2) RPR
3) GLT
4) repeat gonorrhea and chlamydia
5) CXR if PPD+
6) IP GBS Cx