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15 Cards in this Set

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How do you date pregnancy?
Menstrual age (obstetricians) counts from the first day of the last period (pregnancy lasts about 280 days)
Embryologists date from ovulation (around 266 days)
Trimesters
First: 1-12 6/7 weeks
Second: 13-27 6/7 weeks
Third: 28-40 weeks
Normal Pregnancy-Changes in Breast
Early: tenderness, hypersensitivity
6-8 weeks: less tender, still hypersensitive, enlargement due to hypertrophy of alveoli (estrogen), deep pigmentation of areoli
Normal Pregnancy-Changes in Urinary Tract
Beginning of second trimester: Kidney size increases, ureteral elongation/dilation, GFR increases 30-50% by 14 weeks (estrogen), enhanced reabsorption in tubules because of higher steroid hormone level, net water and salt accumulation, urinary frequency due to increase in urine formation and widening/deepening of bladder trigone (muscle hyperplasia)
Normal Pregnancy-Changes in Metabolism/Endocrine
BMR increases by 20 weeks due to hormones
Weight gain
Increase protein and iron requirements-->serum concentrations are lower than normal
Lower serum glucose than normal
HPL-->lipolysis-->high free fatty acids
Pregnancy us potentially diabetogenic
Normal Pregnancy-Changes in Hematologic/Cardiovascular/Respiratory
Blood volume increases 50%
Hematocrit decreases
WBC normal to slightly elevated
CO, HR increase
TPR decreases (progesterone)
Arterial bp decreases
Increased tidal volume
Decreased FRC, EV, pCO2, paCO2, bicarb
Normal Pregnancy-Changes in Reproductive Anatomy
Stretching and hypertrophy of myometrium (progesterone)
Cervix becomes soft and cyanotic
Glands of cervical mucosa multiply to produce thick mucous plug
No ovulation
Increased vascularity in vagina, vulva
Softening of CT-->increased length of vaginal wall
Acidic discharge (estrogen, increased lactobacillus)
Naegele's Rule
To estimate expected date of confinement, add 7 days to the first date of last menses and subtract three months
Most important task in prenatal care?
Accurate assessment of gestational age
Braxton Hicks contractions
Painless uterine contractions occurring at irregular intervals starting early in pregnancy, become more frequent in last four weeks
Gestational Trophoblastic Disease
Maternal tumor arising from fetal tissue
Abnormal proliferation of trophoblastic tissue
Types of Gestational Trophoblastic Disease
Hydatidiform Mole
Persistent/Invasive GTD
Choriocarcinoma
Placental Site Trophoblastic Tumors
Clinical Characteristics of Molar Pregnancy
Irregular bleeding
Uterine size > dates
No fetal heart
Abnormally high hCG titers
Development of pregnancy complications
Exaggerated Pregnancy symptoms
Snowstorm ultrasound
Possible malignant transformation
Complete Mole
Hydropic Placental villi only
Paternal origin
46 XX
Fertilization of empty egg with sperm that duplicates
No vessels, fetus, amnion
20% risk of trophoblastic neoplasia
Incomplete Mole
Fetal tissue present
69 XXY
One haploid maternal set, two haploid paternal sets
Dispermic fertilization
5% risk of trophoblastic neoplasia