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82 Cards in this Set
- Front
- Back
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How to get the estimated due date (EDD) using Naegle's rule?
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1) add 7 days to last menstrual period (LMP)
2) substract 3 months |
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How long is the avarge pregnancy duration?
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280 days +- 17 days
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How to acurately assess the gestational age?
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- establish an EDD on first visit
- confirn EDD: first trimester sonogram most accurate |
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How often do you schedule prenatal visit before 28wk gestation? 28-36 wk? and after that?
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- before 28 wks: every 4 wks
- 28-36 wks: every 2 wks - after 36 wks: every week |
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What types of physical exam should you perform on each prenatal visit?
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- weight
- BP - edema - urine dip - fundal height - detal heart tones - fetal position |
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Which chromosome is Rh D on?
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chromosome 1
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List some causes of Rh isoimmunization.
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- Rh+ fetus and Rh- mother
- fetomaternal hemorrhage - maternal capacity to produce anti-D |
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What drug do you give to Rh- mother who is carrying a Rh+ baby?
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Rhogam
- give at 28 wk if no IDC - at delivery - for antepartum transplacental hemorrhage (TPH) - give within 72 hrs of fetal-maternal hemorrhage |
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When are you able to detect fetal heart tones by doppler?
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12 wks
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When should you do a triple screen?
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15wks
- AFP - hCG - unconjugated estriol - detect trisomy 18, 21, etc |
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When are you able to detect fetal heart tones by fetoscope?
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20 wks
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What type of prenatal screening test should you do at 28 wk gestation?
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- CBC
- RPR for syphilis - IDC for dilated cardiomyopathy - BCM - Rhogam |
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What type of prenatal testing should you do at 36 wk gestation?
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- cultures
- hemoglobin |
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What supplement does a pregnant women need to take during pregnancy?
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- iron
- folate to prevent NTD: 0.4mg 3 month prior to conception - B12 for strict vegetarians |
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What nutritions allowances double during pregnancy?
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- iron
- folate - vitamin D |
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Which dietary supplement prevent NTD in a newborn and when should a women start taking it?
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folate
- start taking 0.4 mg 3 month prior to conception - neural tube closes at 28 days |
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What is the usual weight gain during pregnancy for normal weight?
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25-35lb
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What is the usual weight gain during pregnancy for underweight person?
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40 lb
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What is the usual weight gain during pregnancy for overweight person?
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15-25lb
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What immunizations should a pregnant women take? to avoid?
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to take:
- influenza - bacterial, toxids, tetnus - recombinant to avoid: live attenuated vaccines - rubella - varicella - mumps |
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What defines labor?
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- progressive cervical dilation and regular uterine contraction
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Is this person in labor?
- cervical dilation without uterine contraction |
no
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Is this person in labor?
- uterine contractions without cervical dilation |
no
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What are the three phases of labor?
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1. onset of full dilation (latent phase, active phase)
2. full dilation to delivery 3. delivery of infant until delivery of placenta |
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What is considered prolonged latent phase of 1st stage of labor?
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> 20 hrs for nulliparous
> 14 hrs for parous |
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What is considered primary dysfunctional labor?
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<1.5 cm/hr nulliparous
< 1.2 cm/hr parous |
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What is considered secondary arrest in labor?
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cessation for 2 hrs
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When does uterus involute after birth?
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by 6 wks
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When does a non-lactating woman start to ovulate again after delivery?
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as early as 27 days
mean is 10 wks |
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When does a lactating woman start to ovulate again after delivery?
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6 month
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What are some postpartum cardiovascular changes?
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- diminished plasma volume
- transient tachycardia and rise in BP |
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When does mature milk form postpartumly?
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1-2 wks after delivery
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How often does maternal blues occur?
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70%
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What does women have?
these occur in the 1st wk postpartumly - transient state of tearfullness, anxiety, irritation, restlessness |
maternal blue
- resolve by day 10. |
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How often does postpartum depression occur?
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8-15%
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What is the rate of recurrance of postpartum depression for someone who has had one?
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50-100%
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What should you do if someone is in postpartum psychosis?
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hospitalize
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What is the most common cause of neonatal morbidity and mortality?
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preterm birth
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What is considered preterm?
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birth prior to 37 gestation
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What tests can you perform to determine if the membrane has ruptured?
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- nitrazine paper to test pH: positive if it's alkaline
- Fern: microscopic crystallization |
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Name some medication that can stop premature labor.
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- calcium channel blocker
- magnesium: ca channel antagonist - terbutaline: beta2 agonist - indomethacin: antacid, PG inhibitor, help fibroids - ethanol |
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Name some medication that can delay premature labor.
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antenatal steroids
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What is the risk of using Mg to stop preterm labor?
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- decreased deep tendon reflex
- respiratory depression - cardio toxicity - comma - death |
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What is the risk of using terbutaline to stop preterm labor?
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- premature closure of ductus arteriosus
- decreased amnionic fluid - do not give beyond 32 wks |
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What are some general consideration in managing preterm labor?
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- consider stopping
- administer antenatal steroids: RDS, IVH. use if 24-34 wk. do not use if >32 wks - prophylaxis for group B strep - maternal support |
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What are some risk factors for preterm labor?
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- 2nd trimester bleeding
- GU infection - black race - low pre-pregnancy weight - age <18 yrs - smoking - prior preterm birth |
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Is bleeding in first trimester common?
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30%
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What percentage women have spontaneous abortion after first trimester bleeding?
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50%
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What are pregnant women with first trimester bleeding at risk for?
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- spontaneous abortion
- Rh-D isoimmunization |
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What type of spontaneous abortion is this?
- bleeding with closed cervix |
threatened
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What type of spontaneous abortion is this?
- passed some tissue, some left in the uterus - cervix open |
incomplete
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What type of spontaneous abortion is this?
- no bleeding - embryo has died |
missed
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What type of spontaneous abortion is this?
- no tissue - cervix open |
inevitable
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What type of spontaneous abortion is this?
- passed all tissue - cervix closed |
complete
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What type of spontaneous abortion is this?
- empty sac in uterus |
blighted ovum
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What is the most common cause of spontaneous bleeding?
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aneuploid
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What is the most common karyotype that causes spontaneous abortion?
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45 XO
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What is the most common category in aneuploidy that causes spontaneous abortions?
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trisomy 16
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What is the leading cause of maternal death during 1st trimester?
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ectopic pregnancy
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What is the most common site of ectopic pregnancy?
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ampulla of fallopian tube
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What are some risk factors for ectopic pregnancy?
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- prior ectopic pregnancy
- tubal surgery - PID - assisted reproductive technology |
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What is the diagnosis of this pregnant women?
- severe abdominal pain - hypotension - syncope - hCG > 2000 |
ectopic pregnancy (emergency)
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What are some surgical treatments for ectopic pregnancy?
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- laparotomy
- laparoscopy - salpingectomy: removal of fallopian tube - salpingostomy |
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What are some medical treatment for ectopic pregnancy?
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methotrexate: folate antagonist
- need to assess liver status - follow patients - make sure patient is stable |
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Which has a higher risk for neoplasm, complete or incomplete mole?
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complete
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What is this disease?
- persistent molar tissue - may progress to choriocarcinoma |
gestational trophoblastic disease
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What is this disease?
- no fetus - 46 xx or 46 xy paternal |
complete mole
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What is this disease?
- fetal tissue present - 69 xxx, 69xxy |
partial mole
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How to treat a hydatidiform mole?
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- evacuation of uterus
- follow resolution of beta hCG |
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How to treat gestational trophoblastic disease?
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chemotherapy: low risk or multi agent
surgical resection |
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What is this disease?
- hypertenion in 2nd half of pregnancy - proteinuria |
pre-eclampsia
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What to manage eclampsia (convulsions)?
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magnesium sulfate
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Mild or severe pre-eclampsia? management?
- BP: 140/90 - proteinuriaL > 30mg |
mild
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Mild or severe pre-eclampsia? management?
- BP: 160/110 - proteinuriaL > 5 gm |
severe
- deliver if > 34 wk |
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What result from 1 hour glucola test indicate DM in pregnancy?
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blood glucose > 135
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What result from 3 hour OGTT indicate DM in pregnancy?
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fasting > 95
1 hour > 180 2 hour > 155 3 hour > 140 |
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How does DM in pregnancy affect the fetus?
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birth defects
- CNS - Cardiac (VSD) chronic hypoxia |
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What are some risks of gestational diabetes to fetus?
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- stillbirth
- congenital malformations - growth disturbance (truncal obesity) |
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What are some risks of gestational diabetes to neonates?
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- birth injury
- hypoglycemia - dismaturity |
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What are some risks of gestational diabetes to the mother?
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- progression of disease
- DKA |
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How to manage gestational DM?
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- serial glucose monitoring
- insulin or sulfonyurea |
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How to manage pre-existing DM?
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- Hg A1c
- serial glucose monitoring - serial fetal and maternal assessment |
