Pregnancy And Prenatal Care

Front 1

Chadwick's sign

Back 1

Blue discoloration of vagina and cervix (indicates pregnancy)

Front 2

Goodell sign

Back 2

softening and cyanosis of the cervix at or after 4 weeks

Front 3

Ladin sign

Back 3

Softening of the uterus after 6 weeks

Front 4

2 ways to confirma viable pregnancy

Back 4

ultrasound - gestational sacs (5 weeks) or B-hCG (1500-2000) or fetal heart

Front 5

Time period of
a. embryo
b. fetus
c. infant

Back 5

a. 8 weeks
b. 8weeks - birth
c. delivery - 1 yo

Front 6

time period for an infant delivered
a. previable
b. preterm
c. term
d. postterm

Back 6

a. before 24wks
b. 24-37
c. 37-42
d. after 42 wks

Front 7

GA?
DA?
Difference?

Back 7

Gestational age = time since LMP

Developmental age = time since fertilization

DA is 2 weeks less than GA

Front 8

How do you calculate estimated date of confinement/delivery using the nagele rule

Back 8

(LMP - 3 months) + 7 days

Front 9

By how much does ultrasound differ from LMP in dating EDC
a. first trimester
b. second
c. third

Back 9

a. 1 week
b. 2 weeks
c. 3 weeks

Front 10

2 effects of pregnancy on the CV system

Back 10

1. CO increases 30-50% (max btwn 20-24wks)

2. systemic vascular resistance falls (sysolic by 5-10; diastolic 10-15; returns to normal from 24wks to term)

Front 11

How does pregnancy affect tidal volume?

how does this affect
a. ERV
b. minute ventilation
c. PaO2
d. PaCO2

Back 11

Tidal volume increases 30-40%

a. 20% decrease
b. increase 30-40%
c. inccreases
d. decreases (30mmHg by 20wks, 40mmHg prepregnancy)

Front 12

What is the probably etiology of increased tidal volume in pregnancy

Back 12

progesterone --> increase in respiratory system responsiveness to CO2 or primary stimulant

Front 13

What causes nausea/vomiting in pregnancy (3 factors)

when should it resolve by

Back 13

estrogen, progesterone, hCG

14-16 weeks

Front 14

how does pregnancy affect the stomach

Back 14

prolongs emptying, relaxes sphincter tone --> reflux, ptyalism (spitting)

Front 15

how does pregnancy affect the large bowel

Back 15

decreased motility --. water reabsorption increases --> constipation

Front 16

how does pregnancy affect
a. GFR
b. BUN/Cr
c. RAAS

Back 16

a. GFR increases by 50%
b. BUN and Cr decrease by 25%
c. increased RAAS --> increased aldo --> increased Na reabsorption

Front 17

How does pregnancy affect
a. plasma volume
b. Hct
c. WBC count
d. platelets

Back 17

a. increase by 50%
b. decrease (b/c RBC volume only increases 20-30%)
c. increases to 6-16 million/mL
d. slight decrease (not normal to drop below 100)

Front 18

How do levels of hCG grow in pregnancy

Back 18

double ever 48 hrs in early pregnancy; peak at 10-12 weeks

Front 19

what is the role of hPL in pregnancy

Back 19

produced in placenta --> ensures nutrient supply to the fetus
-lipolysis --> increase in FFA
-insulin antagonist --> increases levels of insulin and protein synthesis

Front 20

Nutrition during breastfeeding

a. how much increase in calorie intake in pregnancy
b. how much increase in breast feeding

Back 20

a. 300kcal/day
b. 500kcal/day

Front 21

pregnancy
a. Protein requirement
b. Ca intake
c. folate

Back 21

a. 60 --> 75g/day
b. 1/5g/day
c. 0.4-0.8 mg/day

Front 22

When do you screen for maternal serum alpha fetoprotein and why

Back 22

2nd trimester (15-18 weeks), -increase is correlated with an increased risk of NT defects
-decrease is correlated with aneupoloidies like Downs

Front 23

Time line - when do these occur?
a. fetal heart sounds
b. quickening
c. resolution of N/V

Back 23

a. 2nd trimester
b. 16-20wks
c. second trimester

Front 24

Prenatal visits - how often in 3rd trimester

Back 24

every 2-3 weeks (28-36 wks), every week (after 36 wks)

Front 25

When do Rh negative patients recieve RhoGam

Back 25

28 weeks

Front 26

When are leopold maneuvers performed and why

Back 26

32-34 weeks, determine fetal presentation

Front 27

Patients with a Hct < 32-33% in third trimester are given what

Back 27

iron supplementation + stool softeners

Front 28

What is a glucose load test?

Back 28

test for gestational diabetes
-give 50g oral glucose load, check serum glucose 1hr later --> if 140, do GTT

Front 29

glucose tolerance test?

Back 29

GTT - fasting serum glucose measure, then give 100g bolus, measure 1,2,3hr

gestational diabetes if 2 or more elevated
-fasting 95
-1hr 180
-2hr 155
-3hr 140

Front 30

constipation in pregnancy
a. cause
b. Rx

Back 30

a. progesterone --> increases transit time in large bowel, increases water reabsorption

b. PO fluids, stool softeners, bulking agents, laxatives (but not in 3rd trimester)

Front 31

what are braxton hicks contractions

difference from preterm labor

Back 31

irregular contractions several times per day - several times per hour, possibly caused by dehydration

preterm labor - regular contractions very 10 minutes, cervical change

Front 32

hemerrhoids in pregnancy

a. what causes them
b. treat

Back 32

a. congestion of the pelvic vessels + increased abdominal pressure with bowel movements

b. fluids, fiber, stool softeners

Front 33

Rx for edema in pregnancy

Back 33

elevate lower extremities, tell patient to sleep on sides

Front 34

Rx for GERD in pregnancy

Back 34

antacids, eat smaller meals, avoid lying down after eating, H2 blockers or PPIs

Front 35

How to treat round ligament pain in pregnancy

Back 35

warm compress, acetaminophen

Front 36

What is a nonstress test and when is it done

Back 36

test of fetal heart rate done in third trimester

Abnormal if there are 2 accelerations of the fetal HR in 20 minutes thqat are at least 15 beats above normal for at least 15 seconds

Front 37

what is an oxytocin challenge test

Back 37

get at least three contractions in 10 minutes, analyze fetal heart rate (same criteria as NST)

-late decelerations with at least half ofthe contractions --> positive test, worrisome