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160 Cards in this Set

  • Front
  • Back
describe BP changes during pregnancy
decreases in first trimester, reaches nadir at 24 weeks, and then normalizes by 40 weeks
when can the uterus be palpated above the pubic symphisis?
12 weeks
when does N/V in pregnancy resolve?
by 14-16 weeks when the hCG rise plateaus
hemoglobin less than what is never normal during pregnancy?
11 - most likely iron deficiency
changes in plasma volume and RBC mass
50%, 30%
how many extra calories are needed during pregnancy
how much folate is needed?
1 mg/day
amount of iron supplementation needed in latter half of pregnancy
30-60 mg/day
who gets RhoGAM, and when
Rh - women at 28 wks
triple screen values in trisomy 18
all decreased (estriol, B-HCG, and MSAFP)
triple screen values in trisomy 21
AFP and estriol are decreased and B-HCG is increased
when can amnio be performed?
weeks 15-17
when can chorionic villus sampling be performed?
10-12 weeks
first stage of labor
onset to 10 cm dilation
second stage of labor
complete cervical dilation to delivery of infant
third stage of labor
delivery of infant to delivery of placenta
phases of first stage of labor
latent and active
when is the active phase of stage 1 labor prolonged?
cephalopelvic disproportion
normal response in non stress test
two accelerations of at least 15 bpm above baseline for at least 15 seconds over 20 minute period
aspects of biophysical profile
Test the Baby, MAN
amniotic fluid volume
nonstress test
decelerations that begin and end approx. same time as maternal contraction
cause of early decelerations
cephalic compression
decels that occur at any time during maternal contraction
cause of variable decels
cord compression - change mom's position
decels that begin at peak of contraction and persist until after contraction has finished
late decels
cause of late decels
uteroplacental insufficiency and fetal hypoxemia; possibly due to abruption or hypotension
what is hyperemesis gravidarum?
intractible nausea and vomiting that typically persist beyone 14-16 weeks
in what type of pregnancies is hyperemesis gravidarum more common?
nulliparous and molar
what does hyperglycemia in the first trimester suggest?
preexisting diabetes
when is glucose challenge test typically performed?
24-28 weeks
what is poorly controlled DM associated with?
increased risk of congenital malformations
what types of antihypertensives should not be given in pregnancy?
ACEIs or diuretics
definition of preeclampsia
new-onset HTN and proteinuria occuring at >20 weeks gestation
definition of eclampsia
preeclampsia plus seizures
what is the only cure for pre/eclampsia?
signs of severe preeclampsia?
persistent HA or other cerebral or visual disturbances, persistent epigastric pain, and hyperreactive reflexes
definition of IUGR
fetal weight less than 10th percentile for GAa
discrepancy of >4 cm between fundal height (in cm) and GA (in weeks)
suspect IUGR
definition of oligohydramnios
amniotic fluid index <5 on ultrasound
etiologies of oligohydramnios
fetal urinary tract abnormalities, chronic uteroplacental insufficiency, ROM
definition of mild preeclampsia
BP >140/90 on two occasions >6 hrs apart; proteinuria (>300 mg/24 hrs or 2 + dipsticks)
definition of severe preeclampsia
BP>160/110 on two occasions >6 hrs apart; proteinuria (>5 g/24 hrs or 3-4 + dipsticks) or oliguria
complications of oligohydramnios
clubfoot, facial distortion, pulmonary hypoplasia, fetal hypoxia
definition of polyhydramnios
AFI> 20
etiologies of polyhydramnios
maternal DM, multiple gestation, pulmonary abnormalities, fetal anomalies, twin-twin transfusion
preeclampsia in first trimester is pathognomonic for what?
hydatidiform mole
complete mole
result from sperm fertilization of empty ovum
chromosomal pattern of complete mole
46 XX
incomplete/partial mole
normal ovum fertilized by two sperm
chromosomal pattern of incomplete mole
69 XXY, contain fetal tissue
snowstorm appearance on pelvic ultrasound
complete hydatidiform mole
how do hydatidiform moles typically present?
first-trimester uterine bleeding, hyperemesis gravidarum, preeclampsia/eclasmpsia, uterine size greater than dates, hyperthyroidism
serum level that is markedly increased in hydatidiform mole
B-hCG (>100,000)
after patient has molar pregnancy, what should be done?
follow B-hCG closely and prevent pregnancy for one year
most common causes of third trimester (>20 wks) bleeding?
placental abruption and placenta previa
premature separation of normally implanted placenta
placental abruption
abnormal placental implantation
placenta previa
total placenta previa
placenta covers cervical os
marginal placenta previa
placenta extends to margin of os
low-lying placenta previa
placenta in close proximity to os
risk factors for placental abruption
HTN, abd/pelvic trauma, tobacco/cocaine use, previous abruption, rapid decompression fo overdistended uterus
risk factors for placenta previa
prior C-sections, grand multiparous, advanced maternal age, multiple gestation, prior placenta previa
painful dark vaginal bleeding that does not spontaneously stop
placental abruption
painless bright red bleeding that often stops in 1-2 hours with or without uterine contractions
placenta previa
diagnosis of placental abruption
primarily clinical
diagnosis of placenta previa
transabdominal/transvaginal US
placenta accreta
placental adherence to myometrium
do not perform digital vaginal exams on women with PROM at what dates
less than 34 weeks
diagnosis of ROM
pooling, + nitrazine paper test, + fern test
definition of preterm labor
regular uterine contractions + concurrent cervical change at <37 weeks gestation
definition of postpartum hemorrhage
loss of >500 ml blood for vaginal delivery or >1000 ml for C/S
most common cause of postpartum hemorrhage
uterine atony
most common presenting symptom of sheehan's
failure to lactate
when is a contractino stress test considered positive?
if late decels are seen with contractions
what defects can chorionic villus sampling not detect?
neural tube defects
rhinitis, saber shins, hutchinson's teeth, interstitial keratitis, and skin lesions
congenital syphilis
cardiovascular defects, deafness, cataracts, microphthalmia
congenital rubella
deafness, cerebral calcifications, microphthalmia
congenital CMV
treatment for chlamydial infection during pregnancy
erythromycin or azithromycin
are preeclampsia and eclampsia risk factors for developing HTN in future?
define true labor
contractions occur every 3 minutes, are fairly regular, and are associated with cervical changes
complications associated with oxytocin use
uterine hyperstimulation, uterine rupture, fetal heart decels, water intoxication/hyponatremia (adh effect)
uterine bleeding without cervical dilatin and no expulsion of tissue
threatened abortion
uterine bleeding with cervical dilation and crampy abdominal pain and no tissue expulsion
inevitable abortion
at what rate does hCG increase in first trimester
roughly doubles every 2 days
when can ultrasound detect an intrauterine gestational sac?
roughly 5 weeks after LMP
fetal scalp pH less than what is indicatin for immediate C-section?
order of fetal positions during normal labor and delivery
descent, flexion, internal rotation, extension, external rotation, expulsion
what type of maternal antibody can cross the placenta?
when should RhoGAM be administered?
at 28 wks and within 72 hours of delivery if mom is Rh - and dad is Rh+
when does ABO incompatibility occur?
when mom is O and baby is A, B, or AB
what if Rh antibodies are present?
you can't give RhoGAM, it is too late
what is PROM?
rupture of amniotic sac before onset of labor
what is PPROM?
premature rupture of membranes before 36-37 weeks
acid base status in pregnancy
hyperventilation - respiratory alkalosis
what does negative fetal fibronectin suggest?
delivery is unlikely within next 2 weeks
what do you do in the case of IUFD?
search for cause
how is IUFD defined?
in utero death >20 wks
treatment for complex endometrial hyperplasia without atypia in premenopausal woman?
cyclic progestins
nuchal fold thickness in down syndrome
characteristics of fetal alcohol syndrome
midfacial hypoplasia, flattened philtrum, microphthalmia, short palpebral fissure, thin vermillion body of upper lip
most common cause of death in eclampsia
hemorrhagic stroke
treatment for uncontrolled vaginal bleeding
IV estrogen
what happens to BUN, Cr, and Hct in pregnancy?
they all decrease
rx for HTN in pregnancy
methyldopa, hydralazine, labetalol
best measurement to predict fetal weight by US in IUGR
abdominal circumference
what causes thyrotoxicosis in infant of mom with grave's?
thyroid stimulating immunoglobulins cross placenta
what type of Ig are antibodies to ABO antigens?
IgM (don't cross placenta)
recommendations for exercise in pregnancy
keep it the same as prior
most common cause for increased AFP
wrong dates
rx for bacterial vaginosis in pregnancy
clindamycin cream or metronidazole cream
what happens to HR, CO, and stroke volume in pregnancy?
all increase
what happens to SVR in pregnancy?
decreases; progesterone causes smooth muscle relaxation
are systolic murmur and s3 normal in pregnancy?
is a new diastolic murmur normal in pregnancy?
how does increased estrogen affect thyroid-binding globulin?
increases it
what happens to total and bound T3/T4 in pregnancy?
what acts as an insulin antagonist in pregnancy to maintain fetal glucose levels?
human placental lactogen
what happens to tidal volume in pregnancy?
increases by 40%
what happens to TLC, RV, and ERV in pregnancy
diagnosis of gestational DM
fasting glucose > 126 or 3 hour OGTT showing fasting >95, one hour >180, 2 hours >155, 3 hrs >140
effect of cocaine
bowel atresia, IUGR, microcephaly
effect of streptomycin
CN VIII damage/ ototoxicity
effect of tetracycline
tooth discoloration, inhibition of bone growth, small limbs, syndactyly
effect of sulfonamides
effect of quinolones
cartilage damage
effect of isotretinoin
heart and great vessels, craniofacial dysmorphism, deafness
effect of iodide
congenital goiter, hypothyroidism, MR
effect of MTX
CNS malformations, craniofacial dysmorphism, IUGR
effect of DES
clear cell adenocarcinoma of vagina/cervis, genital tract anomalies (cervical hood, T-shaped uterus, hypoplastic uterus), cervical incompetence
effect of thalidomide
limb reduction (phocomelia), ear and nasal anomalies, cardiac and lung defecs, pyloric/duodenal stenosis, GI atresia
effect of coumadin
stippling of bone epiphyses, IUGR, nasal hypoplasia, MR
effect of ACEIs
oligohydramnios, fetal renal damage
effect of lithium
ebstein's anomaly, other cardiac diseases
effect of carbamazepine
fingernail hypoplasia, IUGR, microcephaly, neural tube defects
effect of phenytoin
nail hypoplasia, IUGR, MR, craniofacial dysmorphism, microcephaly
effect of valproic acid
neural tube defects, craniofacial and skeletal defects
when is the fetus most suceptible to teratogens?
weeks 3-8 (organogenesis)
type of IUGR in which only abdominal circumference is decreased
how does RhoGAM work?
destroys Rh+ cells in maternal circulatin and prevents Rh sensitization
which type of mole can contain fetal parts?
definition of failure to progress in primip/multip woman
failure to have progressive cervical change >20/>14 hours
what are tocolytics
beta agonists - ritodrine, terbutaline
up to 75% of breech babies change to vertex by when?
week 38
pathogen in mastitis
s. aureus
treatment of mastitis
abx if severe & continue breast feeding
durg of choice for HTN in pregnancy
side effect of ritodrine
ovarian solid tumors in pregnant AA
pregnancy luteoma
signs/sx of pregnancy with normal endometrial stripe on US
treatment for mild preeclampsia
decrease salt intake; steroids if pregnancy is remote from term
what is the role of hCG in pregnancy?
to maintain corpus luteum, which secretes progesterone
treatment for toxoplasmosis in pregnancy
1st trimester- spiramycin, 2/3rd- pyrimethamine/sulfadiazine
treatment for lactation suppresson
tight bra/ice packs
how does pregnancy affect graves and migraine?
improves both
what is active phase arrest?
failure to progress in active phase over 2 hours
rx for pregnant patient with syphilis who is pen allergic
penicillin sensitization
screening test for gestational diabetes
1 hour OGTT
treatment for IUGR and oligohydramnios
score less than what on BPP indicates need for delivery