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61 Cards in this Set
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>24 AFI
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Polyhdramnios
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<5 AFI
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Oligohydramnios
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Fetal conditions a/w Oligohydramnios
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Fetal Erythroblastosis
Chromosomal abnormalities congenital anomalies growth restriction demise postterm pregnancy ruptured membranes |
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Placental conditions a/w Oligohydramnios
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Abruption
Twin Twin Transfusion |
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Maternal conditions a/w Oligohydramnios
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Uteroplacental Insufficiency
Hypertension Preeclampsia Diabetes |
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What is involved in the first trimester screening?
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PAPA
Beta HCG Nuchal translucency |
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Drugs conditions a/w Oligohydramnios
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Prostaglandin synthase inhibitors
ACE inhibitors Idiopathic |
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Oligohydramnios Prognosis
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Early Onset - Poor outcome
Pulmonary hyperplasia increases Late onset (more C/S for fetal distress |
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Polyhydramnios a/w
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Diabetes, GI tract anomalies, Neural Tube Defects, Rh Isoimmunization, and multiple getstations.
Complications are PTL, Abruption, prolapsed cord with ROM, and PPH because of Uterine Overdistention. |
1% incidence of all pregnancies.
2/3 - idiopathic - 1/3 a/w: Fetal anomalies, unknown;Maternal Diabetes or Multiple Gestation Etiology: CNS or GI of fetus (ancephaly, esophgeal atresia) S/S: Size >Dates Difficult palpating fetal parts and FHR, Maternal Dyspnea, edema, Heartburn, & Nausea from mechanical pressure of large uterus. |
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Polyhydramnios outcome
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The greater the Poly, the greater the perinatal mortality.
Preterm Labor increases |
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Polyhydramnios Manangement
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AP -Amnio to relieve maternal distress and enable testing of Fetal lung maturity and chromosomes &
Indomethicin. |
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RF for vasa praevia?
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bilobed placenta or succenturiate lobes (vessels run through the membranes joining the separate lobes together)
history of low-lying placenta in 2nd trimester multiple pregnancy IVF |
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Symmetrical Growth Retardation appears
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Mid pregnancy - around 18-20 weeks.
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Symmetrical Growth Retardation caused by
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*CONGENITAL Infections
*CHROMOSOMAL Abnormalities, *MATERNAL Drugs Insults i.e., alcohol, Tobacco, Dilantin, Cocaine Heroin |
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Asymmetrical Growth Retardation appears
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Later in pregnancy
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Asymmetrical Growth Retardation appears
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as "Head Sparing" ~Caused by a reduction in the cell size not the number of cells.
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At what stage are placenta praevia's usually picked up?
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Usually documented on 18-20 week scan
BUT usually move higher as lower uterine segment stretches and thins in remainder of pregnancy 5% are placenta praevia at term Re-scan at 30 weeks to see if still low |
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Describe the anatomical changes that occur during pregnancy
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Bluish discolouration of cervix and vagina (Chadwick's sign) at 6 weeks due to vascular engorgement
Softening and cyanosis of cervix at 4 weeks (Goodell's sign) Softening of the uterus at 6 weeks (Heager's sign) Uterine enlargement Breast swelling and tenderness Linea nigra from umbilicus to pubis Telangectasia Palmar erythema |
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Asymmetrical Growth Retardation caused by
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Abnormalities in UTEROPLACENTAL INSUFFICIENCY due to Maternal, fetal and placental factors
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Asymmetrical Growth Retardation IUGR occurs when there is Uteroplacental Insufficiency in later pregnacy after the growth of the size of the cell (hypertrophy) rather the growth in the number of cells (hyperplasia).
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Symptoms and signs of early pregnancy
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Amenorrhea
Breast swelling and tenderness Hyperemesis gravidum (N/V) Quickening - fetal movement Weight gain in non-obese patients |
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Asymmetrical Growth Retardation Maternal factors
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Hypertension
Anemia Collagen Disease Diabetes (IDDM) |
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How do you manage a woman with placenta praevia?
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+ bleeding --> term or severe bleeding - caesar; pre-term - keep baby in, admit, steroids, don't give tocolytics as contractions are helping to control the bleeding
no bleeding - council about bleeding, when to present Grade 1 (placenta > 2.5 cm from os) - can deliver vaginally All others delivery C/S elective caesar at 37-38 weeks (NB: N 39+) |
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What cardiovascular changes occur in pregnancy
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Increased cardiac output via stroke volume (early) then increased HR (later)
Systemic vascular resistance drops (probably related to progesterone = vasodilation to compensate for increased blood volume) --> decreased BP |
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Asymmetrical Growth Retardation Fetal factors
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Multiple gestation
Anomalies |
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What respiratory changes occur in pregnancy
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Increase in tidal volume despite decrease in lung capacity (due to rising diaphgram) --> drop in respiratory reserve capacity by 20%
Increase in minute ventilation increases O2 and blows off CO2 creating larger gradient between maternal and foetal circulations |
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Asymmetrical Growth Retardation Placental factors
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Previa
Abruption Malformations Infarctions |
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What haematological changes occur in pregnancy
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Increase in RBC (30%), increase in plasma volume (50%) - hemodilution of pregnancy- physiologic anemia,
WBC increases in pregnancy, labor and just after birth, Some thrombocytopenia not below 100 million Hypercoaguable state = increase in fibrinogen, factor VII - X,(protective mechanism from hemorrhage), BUT clotting and bleeding times do not change so increase in VTE may be due to other parts of Virchow's triad - venous stasis and endothelial damage |
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Asymmetrical Growth Retardation Fetal Effects/ Outcome
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Fetus adjusts to conditions by conserving energy and decreasing metabolic requirements
Fetus stops growing Risk of IUFD (Demise) |
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What makes up the biophysical profile?
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Amniotic fluid volume -looking for >2cm in largest pocket of AFV. maker of chronic hypoxia all others are acute hypoxia - reassuring, Otherwise if <2cm non-reassuring = oligo.
Breathing - reassuring = at least 1 episode of breathing lasting at least 30 seconds Limb movement - 3 discrete movements Fetal tone - at least one episode of limb extension followed by flexion NST- Reactive =reassuring reassuring = 2 points each Non-reassuring = 0 points |
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Asymmetrical Growth Retardation Midwifery MGMT
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Counsel to Decrease smoking
Nutrition evaluation Maternal positions to facilitate uteroplacental blood flow emotional support |
Serial ultrasounds for growth,
NST AFI, BPP weekly/biweekly TORCH Titer Amniocentesis - Chromosome evaluation of parents If Lungs are Mature - Delivery! |
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Interpret the biophysical profile
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0-4 - BAD - perinatal mortality 200:1000 - deliver fetus if benefits of devliery > risks
6: perinatal mortality 31:1000 - repeat in 24 hours 8: repeat as clinically indicated |
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L/S Ratio
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2:1 or greater ration indicates lung maturity (except in diabetes)
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Lecithin is elevated after 35 weeks
Sphingomyelin remains faitly constant |
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Induction prior to 39 weeks
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Requires evaluation of fetal lung maturity.
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Phosphatidylglycerol (PG)
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If present in combo with a favorable LS ratio = confirms lung maturity
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If PG present ever with LS <2 the risk of RDS is minimal
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Substance Abuse
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NICOTINE (29%) 64 Million are current smokers
Illegal Drugs (6%) 14 Million Alochol 11 million |
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Smoking a/w
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Maternal:
Preeclampsia, abruption, previa, SAB, Ectopic, PROM |
Fetal:
IUGR, Preterm birth, SGA |
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Corticosteroids
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Benefits at 24-34 weeks, unclear after 34 weeks. Treatment most effective a minimum of 24 hours after injection up to a maximum of 7 days only.
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Tocolytic Drugs
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Maternal side effects i.e. pulmonary edema (is the most serious side effect), tachycardia, hypotension (cardiac insufficiency), hyperglycemia, hypokalemia, jitteriness, and death.
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i.e. DO NOT Give Ritodrine, Terbutaline to GDM or IDDM!
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Risk Factors for Psychological Well Being
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Limited Support Network
High level of stress Psyche/Mental Health Issues Problem Pregnancies |
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Gravida
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# times you’ve been pregnant
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Para
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# of pregnancies to viability 500g or 20 weeks.
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Nulligravida
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Woman who’s never been pregnant
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Nullip (never) Gravida (pregnant)
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Primagravida
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Woman who’s pregnant for the first time
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Multigravida
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Woman who’s been pregnant 3 or more times
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Nullipara
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Woman who’s pregnant for the first time or who’s not carried baby to 20 weeks or 500 g
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Woman who had 3 SAB and is now pregnant again for the 4th time.
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Primipara
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Women who’s had 1 pregnancy to birth a fetus at viable age.
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Primip (1st)
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Multipara
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Woman who’s carried >2 pregnancies to viability
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Grand Multipara
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Woman with >7 births
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1st Trimester bleeding prognosis after hearing FHT
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90% of pregnancies with bleeding will continue to term after FHT observed.
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40% of women have some bleeding in 1st trimester
80% f SAB occur in the 1st 12 weeks. |
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Rule of 10
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BhCG = 100 at time of missed menses
BhCG =100,000 at10 weeks BhCG =10,000 at term 24 hours postpartum half life eliminated 90% of ectopics have BhCG <6500 |
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Most frequently identified chromosomal anomaly
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Autosomal Trisomy most frequent followed by Turner’s Syndrome.
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2nd leading cause of maternal death in US
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Ectopic Pregnancy
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Painless dilation, Bloody show, SROM, Vaginal /Pelvic pressure
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Symptoms of Incompetent Cervix
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Incompetent Cervix Treatment
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Cerclage after 12-14 weeks, 80%-90% success rate.
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Risk of infection and or ruptured membranes.
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Placenta migrates upward as gestation increases
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1/3 of women have low lying placenta in 1st trimester.
Only 1% have previa in 3rd trimester. |
Previa responsible for 20% of bleeding in 3rd trimester.
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Risk Factors of Previa
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Smoking
Multiparity Previous C/S /Uterine surgery Materal age >35 (old endometrium covers larger space to get oxygen) |
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Risk Factors of Abruption
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Maternal age>35
Smoking - cocaine Hypertension Poor maternal nutrition ECV Trauma Multiparity Choriamnionitis Sudden decrease in uterine volume/size (i.e.ROM with polyhydramnios between twin delivery uterine anomalies) |
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Malformation
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a fetus or structure is genetically abnormal
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Deformation
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a genetically normal fetus develops in an abnormal uterine environment causing structural changes i.e. Oligo causing limb contractures
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Aneuploidy
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state of abnormal number of chromosomes
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Indications for genetic studies
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general screening
history of birth defects or mental retardation family hx of genetics disorders exposure to teratogens Ingestation of medication in early pregnancy (dilantin) Increased liklihood due to age or ethnic roots |
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