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160 Cards in this Set
- Front
- Back
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describe BP changes during pregnancy
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decreases in first trimester, reaches nadir at 24 weeks, and then normalizes by 40 weeks
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when can the uterus be palpated above the pubic symphisis?
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12 weeks
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when does N/V in pregnancy resolve?
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by 14-16 weeks when the hCG rise plateaus
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hemoglobin less than what is never normal during pregnancy?
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11 - most likely iron deficiency
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changes in plasma volume and RBC mass
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50%, 30%
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how many extra calories are needed during pregnancy
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300/day
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how much folate is needed?
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1 mg/day
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amount of iron supplementation needed in latter half of pregnancy
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30-60 mg/day
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who gets RhoGAM, and when
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Rh - women at 28 wks
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triple screen values in trisomy 18
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all decreased (estriol, B-HCG, and MSAFP)
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triple screen values in trisomy 21
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AFP and estriol are decreased and B-HCG is increased
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when can amnio be performed?
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weeks 15-17
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when can chorionic villus sampling be performed?
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10-12 weeks
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first stage of labor
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onset to 10 cm dilation
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second stage of labor
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complete cervical dilation to delivery of infant
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third stage of labor
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delivery of infant to delivery of placenta
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phases of first stage of labor
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latent and active
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when is the active phase of stage 1 labor prolonged?
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cephalopelvic disproportion
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normal response in non stress test
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two accelerations of at least 15 bpm above baseline for at least 15 seconds over 20 minute period
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aspects of biophysical profile
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Test the Baby, MAN
tone breathing movement amniotic fluid volume nonstress test |
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decelerations that begin and end approx. same time as maternal contraction
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early
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cause of early decelerations
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cephalic compression
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decels that occur at any time during maternal contraction
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variable
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cause of variable decels
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cord compression - change mom's position
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decels that begin at peak of contraction and persist until after contraction has finished
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late decels
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cause of late decels
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uteroplacental insufficiency and fetal hypoxemia; possibly due to abruption or hypotension
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what is hyperemesis gravidarum?
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intractible nausea and vomiting that typically persist beyone 14-16 weeks
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in what type of pregnancies is hyperemesis gravidarum more common?
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nulliparous and molar
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what does hyperglycemia in the first trimester suggest?
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preexisting diabetes
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when is glucose challenge test typically performed?
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24-28 weeks
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what is poorly controlled DM associated with?
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increased risk of congenital malformations
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what types of antihypertensives should not be given in pregnancy?
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ACEIs or diuretics
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definition of preeclampsia
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new-onset HTN and proteinuria occuring at >20 weeks gestation
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definition of eclampsia
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preeclampsia plus seizures
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what is the only cure for pre/eclampsia?
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delivery
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signs of severe preeclampsia?
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persistent HA or other cerebral or visual disturbances, persistent epigastric pain, and hyperreactive reflexes
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definition of IUGR
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fetal weight less than 10th percentile for GAa
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discrepancy of >4 cm between fundal height (in cm) and GA (in weeks)
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suspect IUGR
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definition of oligohydramnios
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amniotic fluid index <5 on ultrasound
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etiologies of oligohydramnios
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fetal urinary tract abnormalities, chronic uteroplacental insufficiency, ROM
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definition of mild preeclampsia
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BP >140/90 on two occasions >6 hrs apart; proteinuria (>300 mg/24 hrs or 2 + dipsticks)
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definition of severe preeclampsia
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BP>160/110 on two occasions >6 hrs apart; proteinuria (>5 g/24 hrs or 3-4 + dipsticks) or oliguria
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complications of oligohydramnios
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clubfoot, facial distortion, pulmonary hypoplasia, fetal hypoxia
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definition of polyhydramnios
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AFI> 20
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etiologies of polyhydramnios
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maternal DM, multiple gestation, pulmonary abnormalities, fetal anomalies, twin-twin transfusion
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preeclampsia in first trimester is pathognomonic for what?
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hydatidiform mole
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complete mole
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result from sperm fertilization of empty ovum
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chromosomal pattern of complete mole
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46 XX
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incomplete/partial mole
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normal ovum fertilized by two sperm
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chromosomal pattern of incomplete mole
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69 XXY, contain fetal tissue
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snowstorm appearance on pelvic ultrasound
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complete hydatidiform mole
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how do hydatidiform moles typically present?
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first-trimester uterine bleeding, hyperemesis gravidarum, preeclampsia/eclasmpsia, uterine size greater than dates, hyperthyroidism
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serum level that is markedly increased in hydatidiform mole
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B-hCG (>100,000)
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after patient has molar pregnancy, what should be done?
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follow B-hCG closely and prevent pregnancy for one year
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most common causes of third trimester (>20 wks) bleeding?
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placental abruption and placenta previa
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premature separation of normally implanted placenta
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placental abruption
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abnormal placental implantation
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placenta previa
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total placenta previa
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placenta covers cervical os
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marginal placenta previa
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placenta extends to margin of os
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low-lying placenta previa
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placenta in close proximity to os
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risk factors for placental abruption
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HTN, abd/pelvic trauma, tobacco/cocaine use, previous abruption, rapid decompression fo overdistended uterus
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risk factors for placenta previa
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prior C-sections, grand multiparous, advanced maternal age, multiple gestation, prior placenta previa
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painful dark vaginal bleeding that does not spontaneously stop
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placental abruption
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painless bright red bleeding that often stops in 1-2 hours with or without uterine contractions
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placenta previa
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diagnosis of placental abruption
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primarily clinical
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diagnosis of placenta previa
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transabdominal/transvaginal US
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placenta accreta
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placental adherence to myometrium
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do not perform digital vaginal exams on women with PROM at what dates
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less than 34 weeks
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diagnosis of ROM
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pooling, + nitrazine paper test, + fern test
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definition of preterm labor
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regular uterine contractions + concurrent cervical change at <37 weeks gestation
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definition of postpartum hemorrhage
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loss of >500 ml blood for vaginal delivery or >1000 ml for C/S
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most common cause of postpartum hemorrhage
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uterine atony
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most common presenting symptom of sheehan's
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failure to lactate
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when is a contractino stress test considered positive?
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if late decels are seen with contractions
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what defects can chorionic villus sampling not detect?
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neural tube defects
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rhinitis, saber shins, hutchinson's teeth, interstitial keratitis, and skin lesions
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congenital syphilis
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cardiovascular defects, deafness, cataracts, microphthalmia
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congenital rubella
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deafness, cerebral calcifications, microphthalmia
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congenital CMV
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treatment for chlamydial infection during pregnancy
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erythromycin or azithromycin
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are preeclampsia and eclampsia risk factors for developing HTN in future?
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no
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define true labor
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contractions occur every 3 minutes, are fairly regular, and are associated with cervical changes
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complications associated with oxytocin use
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uterine hyperstimulation, uterine rupture, fetal heart decels, water intoxication/hyponatremia (adh effect)
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uterine bleeding without cervical dilatin and no expulsion of tissue
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threatened abortion
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uterine bleeding with cervical dilation and crampy abdominal pain and no tissue expulsion
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inevitable abortion
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at what rate does hCG increase in first trimester
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roughly doubles every 2 days
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when can ultrasound detect an intrauterine gestational sac?
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roughly 5 weeks after LMP
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fetal scalp pH less than what is indicatin for immediate C-section?
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<<7.2
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order of fetal positions during normal labor and delivery
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descent, flexion, internal rotation, extension, external rotation, expulsion
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what type of maternal antibody can cross the placenta?
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IgG
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when should RhoGAM be administered?
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at 28 wks and within 72 hours of delivery if mom is Rh - and dad is Rh+
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when does ABO incompatibility occur?
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when mom is O and baby is A, B, or AB
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what if Rh antibodies are present?
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you can't give RhoGAM, it is too late
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what is PROM?
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rupture of amniotic sac before onset of labor
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what is PPROM?
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premature rupture of membranes before 36-37 weeks
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acid base status in pregnancy
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hyperventilation - respiratory alkalosis
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what does negative fetal fibronectin suggest?
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delivery is unlikely within next 2 weeks
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what do you do in the case of IUFD?
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search for cause
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how is IUFD defined?
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in utero death >20 wks
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treatment for complex endometrial hyperplasia without atypia in premenopausal woman?
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cyclic progestins
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nuchal fold thickness in down syndrome
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increased
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characteristics of fetal alcohol syndrome
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midfacial hypoplasia, flattened philtrum, microphthalmia, short palpebral fissure, thin vermillion body of upper lip
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most common cause of death in eclampsia
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hemorrhagic stroke
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treatment for uncontrolled vaginal bleeding
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IV estrogen
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what happens to BUN, Cr, and Hct in pregnancy?
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they all decrease
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rx for HTN in pregnancy
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methyldopa, hydralazine, labetalol
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best measurement to predict fetal weight by US in IUGR
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abdominal circumference
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what causes thyrotoxicosis in infant of mom with grave's?
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thyroid stimulating immunoglobulins cross placenta
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what type of Ig are antibodies to ABO antigens?
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IgM (don't cross placenta)
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recommendations for exercise in pregnancy
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keep it the same as prior
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most common cause for increased AFP
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wrong dates
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rx for bacterial vaginosis in pregnancy
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clindamycin cream or metronidazole cream
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what happens to HR, CO, and stroke volume in pregnancy?
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all increase
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what happens to SVR in pregnancy?
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decreases; progesterone causes smooth muscle relaxation
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are systolic murmur and s3 normal in pregnancy?
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yes
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is a new diastolic murmur normal in pregnancy?
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no
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how does increased estrogen affect thyroid-binding globulin?
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increases it
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what happens to total and bound T3/T4 in pregnancy?
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increase
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what acts as an insulin antagonist in pregnancy to maintain fetal glucose levels?
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human placental lactogen
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what happens to tidal volume in pregnancy?
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increases by 40%
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what happens to TLC, RV, and ERV in pregnancy
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decreased
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diagnosis of gestational DM
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fasting glucose > 126 or 3 hour OGTT showing fasting >95, one hour >180, 2 hours >155, 3 hrs >140
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effect of cocaine
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bowel atresia, IUGR, microcephaly
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effect of streptomycin
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CN VIII damage/ ototoxicity
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effect of tetracycline
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tooth discoloration, inhibition of bone growth, small limbs, syndactyly
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effect of sulfonamides
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kernicterus
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effect of quinolones
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cartilage damage
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effect of isotretinoin
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heart and great vessels, craniofacial dysmorphism, deafness
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effect of iodide
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congenital goiter, hypothyroidism, MR
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effect of MTX
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CNS malformations, craniofacial dysmorphism, IUGR
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effect of DES
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clear cell adenocarcinoma of vagina/cervis, genital tract anomalies (cervical hood, T-shaped uterus, hypoplastic uterus), cervical incompetence
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effect of thalidomide
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limb reduction (phocomelia), ear and nasal anomalies, cardiac and lung defecs, pyloric/duodenal stenosis, GI atresia
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effect of coumadin
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stippling of bone epiphyses, IUGR, nasal hypoplasia, MR
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effect of ACEIs
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oligohydramnios, fetal renal damage
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effect of lithium
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ebstein's anomaly, other cardiac diseases
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effect of carbamazepine
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fingernail hypoplasia, IUGR, microcephaly, neural tube defects
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effect of phenytoin
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nail hypoplasia, IUGR, MR, craniofacial dysmorphism, microcephaly
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effect of valproic acid
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neural tube defects, craniofacial and skeletal defects
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when is the fetus most suceptible to teratogens?
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weeks 3-8 (organogenesis)
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type of IUGR in which only abdominal circumference is decreased
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asymmetric
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how does RhoGAM work?
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destroys Rh+ cells in maternal circulatin and prevents Rh sensitization
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which type of mole can contain fetal parts?
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partial
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definition of failure to progress in primip/multip woman
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failure to have progressive cervical change >20/>14 hours
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what are tocolytics
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beta agonists - ritodrine, terbutaline
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up to 75% of breech babies change to vertex by when?
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week 38
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pathogen in mastitis
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s. aureus
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treatment of mastitis
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abx if severe & continue breast feeding
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durg of choice for HTN in pregnancy
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labetalol
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side effect of ritodrine
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edema
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ovarian solid tumors in pregnant AA
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pregnancy luteoma
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signs/sx of pregnancy with normal endometrial stripe on US
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pseudocyesis
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treatment for mild preeclampsia
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decrease salt intake; steroids if pregnancy is remote from term
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what is the role of hCG in pregnancy?
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to maintain corpus luteum, which secretes progesterone
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treatment for toxoplasmosis in pregnancy
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1st trimester- spiramycin, 2/3rd- pyrimethamine/sulfadiazine
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treatment for lactation suppresson
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tight bra/ice packs
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how does pregnancy affect graves and migraine?
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improves both
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what is active phase arrest?
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failure to progress in active phase over 2 hours
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rx for pregnant patient with syphilis who is pen allergic
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penicillin sensitization
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screening test for gestational diabetes
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1 hour OGTT
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treatment for IUGR and oligohydramnios
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delivery
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score less than what on BPP indicates need for delivery
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4
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