Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/116

Click to flip

116 Cards in this Set

  • Front
  • Back
Trimesters
12 and 28
Timeline fetal development
1wk
implantation (trophoblasts b-hCG)
3wk
maternal fetal circulation
12wks
distinguish sex
17wks
fetal movements
24wks
surfactant production (earliest chance for survival)
38wks
full term
Daily Caloric Intake during pregnancy
~2500 kCal
Calcium
1200mg/day
Folate
1mg/day 4wks before attempted pregnancy
Iron
30mg/day
Protien
60g/day
Weight Gain
BMI <19 28-40lbs, 19-26 BMI 25-35lbs, >26 BMI 15-25 (normal should be 25 unless underweight (less) or over weight (more)
Gain throughout pregnancy
1st TM ~2lbs, 1lbs/week in 2nd and 3rd
Physiology
Caridovascular
CO increases 40%, increased SV 10-30%, HR 12-18 BPM. Decrease in systolic/diastolic BP
Respiratory
Decrease in RV, FRC, ERV. Increased TV 40% and minute ventilation
Renal
GFR increases 40%
Endocrine
hPL-glucose intolerance, Increased Triglicerides, Cortisol
Hematological
RBC production, hematocrit decrease, hypercoaguable
Screeing Initially
EVERYTHING, CBC, Rh, Pap, Gono/Chlam, Urinanalysis, RPR, Rubella titers, PPD, Hep B, HIV, (Cystic Fibrosis in selected population)
16-18wks
Quadruple screen
18-20
US Dating, Abnormalities
24-28
1hr glucose challenge for DM
23-36
GBStrep screening and N. gono/Chlam selected population
Transvaginal US vs Transabdominal
b-hCG of 1500mIU/mL vs 6500mIU/mL
Chorionic Villi Sampling
9-12wks early detection
Quadrple screen
16-18wks a-feto, estradiol, hCG, Inhibin A
21 trisomy
Increased a-feto, estradiol. Decreased hCG, Inhibin
18 trisomy
all low, except Inhibin A
NT
a-feto high
Percutaneous Umbilical Cord Sample
10-22wks, late detection of genetic disroders or Rh sensativity
Amniocentesis
>16wks indicated after an abnormal quadruple screen, >35yo, risk of Rh sensativity
Gestational DM Screening
1hr 50g glucose tolerance test, >140 do 3hr 100g glucose tolerance test, fasting >105, 1hr-190, 2hr-165, 3hr-145.
Gestational DM
after 1st TM most frequent in 3rd, Screen at 24-28wks, abn glucose tolerance or a fasting glucose >105. Tx Diet/Exercise, Glyburide, Insulin. F/u fetal development stress test US
Pregestational DM
follow hemoglobin A1c, control glucose. 3rd trimester echocardiogram and US to follow fetal abnormalities
Preeclampsia
HTN, Proteinuria, Edema after 20wks gestation. BP >140/90 or 30mmhg rise in systolic or 15 in diastolic. Proteinuria 2+ or >4g/24 hrs. Tx definitive is delivery. severe or far from delivery: MgSO4 siezure prophylaxis, Hydralizine or Labetalol for HTN. (know history of epililepsy, not cured with delivery)
HELP
Hemolysis, Elevated Liver, Low Platelets. Form of preeclampsia with poor fetal prognosis.
Eclampsia
SIEZURES, tx MgSO4 or Diazapam for siezures, continue for 24hrs after delivery. 25% of siezures within 24hrs postpartum.
Maternal Asthma
Mild-Inhaled B-agonist, Mod Cromolyn or inhaled steriod, Severe oral corticosteriods.
Epilepsy
Phenobarbital, drug of choice in early pregnancy, low teratagenicity. Diazapam to break active siezures.
Maternal Nause Vomiting
usually in 1st TM. If severe, hyperemesis gravidum. Tx antacids, H2 antagonist or PPI.
Maternal DVT
US/Doppler studies. Tx IV heparin to treat active DVT PTT 2xNL. Low molecular wt heparin if significant time of delivery, switch to unfractionated 2wks till delivery. STOP all anticoagulants during labor and 6hrs to delivery. Anticoagulants continued postpartum (warfarin, caution when breast feeding)
Drug Use
Cocaine
Maternal arrythmias, Fetal IUGR, premature, stroke
Ethanol
Fetal alcohol withdrawl symptoms (MR, IUGR, sensory and motor neuropathy, facial abnormalities (filthrum)).
Hallucinogens
Developmental Delays
Marijuana
Prematurity
Opioids
Maternal infections (needles). Fetal narcotic withdrawl, prematurity, IUGR,
Stimulants
Maternal malnutrition, arrhythmias. Fetal IUGR
Tobacco
Abrupto placenta, Placenta Previa. Spontaneous abortion, prematurity, IUGR, respiratory neonatal infections.
Medications Teratogenic
ACE-I
Renal
Aminoglycosides
CN 8, skeletal abnormalities
Carbamazepine
Facial Abn, IUGR, MR, Cario, NTD
Chemo
Fetal demise
Diazepam
Cleft Palate
DES
Clear cells cancer of vagina
Fluoroquilolones
cartilage
Heparin
prematurity, fetal demise. safer than warfarin
Iodide
Goiter, hypothyroid, MR
OCP's
fetal demise, abnormal genitalia
Phenobarbital
neonatal withdrawl
Phenytoin
facial abnormalities, IUGR, MR, Cardio
Retinoids
CNS abnormalities, Cardiovascular abnormalites, facial and spontaneious abortion
Sulfonamides
Kernicterus
Tetracycline
skeletal, limb and teeth discoloration
Thalidomide
limb abnormalities
Valproic Acid
NTD, facial, cariovasacular, skeletal
Warfarin
Spontanoues abortion, IUGR, CNS, facial and MR
Ectopic Pregnancy
outside of uterus at ampula of fallopian tube, abdominal pain. b-hCG low for gestational age. Tx <6wks methotrexate, anything else IV hidration surgical excision.
Spontaneous Abortion
<20wks gestation, 25% all pregnancies. B-hCG assess fetal age, US to asses fetal viability.
Threatend SA
cervical os closed, no expelled uterine contents, US detects viable fetus Tx: bed rest, limited activity
Inevitable SA
cervical os opened, no expelled uterine contents, US may detect fetusTx: D&C
Incomplete SA
cervical os opened, some expelled uterine contents, Tx: D&C
Complete SA
cervical os closed, All expelled uterine contents, Tx: None
Missed SA
cervical os closed, no expelled uterine contents, US detects unviable fetus Tx: None
Intrauterine Fetal Demise
>20 weeks of gestation. Tx Dilation and Evacution if <24wks, induced labor if >28wks
IUGR
initial finding abd circumfrence <10th percentile
Symmetric
(baby issues or drugs) congenital infection, chromosomal abnormalities or maternal drug use Length:abdominal ratio normal
Asymmetric
(maternal or multiple) multiple gestations, poor maternal health, placental insufficiency. Length:abdominal ratio increased
Fetal Lung Maturity
L:S >2 or phosphatidylglycerol in amniotic fluid.
Tocolytic Therapy
MgSO4, terbutaline, ritodrine, indomethacin, nifedipine
Premature Rupture of Membranes
manual exam not performed due to increased infection risk, ferning, nitrazine paper blue. US confirm oligohydramnios and asses residual volume. Tx >34wks delivery. Chorioamnionitis delay deliver until anbiotics started.
Preterm Labor
before 38 wks, labor (>8uterine contractions/hr, cervical dilation and effacement).
Placenta Previa
Implantation near cervical OS, painless vaginal bleeding in 3rd trimester. US to determine location. Tx Tocolysis and Cesarean.
Abruptio Placenta
premature separation, painful vaginal bleeding, US inconsistently shows separation. Tx mild-bedrest, delivery or cesarean for hymodynamically unstable.
Multiple Gestations
Tx starting at 20wks weekly follow-up, 36wks activity restriction and frequetn nonstress tests. Vertex-vertex vaginal delivery, all other require caesarean.
Non Stress Test
Effects of fetal movement on heart rate. Normal reactive if 2 or more 15bpm accelerations fo fetal heart rate lasting 15 seconds each within 20 min
Biophysical profile
Nonstress test, Bishop Score: amiotic fluid index, fetal breathing rate, fetal movement, fetal tone 8-10 is good, anything else fetal distress
amniotic fluid index
5-23 cm
fetal breathing
>1 episode or rhythmic breathin lasting 20 sec in 30 min period
fetal movements
>2 episodes discrete fetal movement withing 30 min period
fetal tone
1> spine and limb extension with return to flexion
Contraction Stress test
beat to beat variability ~5 bpm, long-term heart rate variability, heart rate accelerations (2 accelerations of 15 bpm lasting at least 15 seconds within 20 minute period)
Early
head compression
Late
uteroplacental insufficiency, fetal hypoxia, prompt delivery
Variable
umbilical cord compression, change mother position
Stages of Labor
1- Latent
start of uterine contractions till 4cm dilated. Time for 1' stage Nullparous 6-18 hrs Multiparious <10hrs
Active
4cm -10 cm
2-Full
10cm-Delivery, Null <3hrs Multi<30min
3-Placenta
<30min
4-1st hr postpartum
hemodynamic stabilization of mother for 1hr
Fetal presentation
fetal head down, chin tucked, occiput directed towards birth canal.
Colostrum
protiens, fat, minerals, IgA
Breast Milk
protiens, fat, water, lactose
APGAR
heart rate
0-none 1-<100 2->100bpm
respirations
0-none 1-poor weak cry 2- good strong cry
muscle tone
0-poor 1-some movement 2- active movement
stimulation
0-none 1- grimace 2-strong cry
color
0-blue pale 1- pink torso 3-pink
Hydatiform mole
complete xx-father, incomplete fetal parts xxy, grape like vesicles US snowstorm appearance,
Choriocarcinoma
malignant trophoblastic neoplasm, CT metastasis