208/209/210 - Normal and Abnormal Pregnancy, Anatomy and Pathology of Implantation Flashcards Preview

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Flashcards in 208/209/210 - Normal and Abnormal Pregnancy, Anatomy and Pathology of Implantation Deck (51)
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1

How will the following change during pregnancy?

  • D-Dimer:
  • Alk phos:
  • Albumin:

  • D-Dimer: increase
    • Does not indicate VTE - but pregnancy is a hypercoagulable state, so make sure not to miss?
  • Alk phos: increase
  • Albumin: decrease

 

2

In general, at what gestational age is it better to perform a preterm delivery than to manage expectantly?

(In situations like preeclampsia, PROM, etc)

34 weeks

 

Before 34 weeks, try to manage expectantly - usually delivery will occur within 1 week, but give a chance to administer antenatal steroids, give the baby a few extra days to grow

 

3

What defines fetal growth restriction?

Why is it important to diagnose?

Fetal growth below the 10th percentile

 

  • Counsel pts on prognosis, options
  • Start antenatal surveillance
  • Administer antenatal steroids if preterm birth is looking likely

 

4

What defines preeclampsia?

New onset HTN + proteinuria

Defined as severe if ANY of the following are present, even w/o proteinuria

  • BP > 160/110 on 2 occasions, at least 4 hours apart
  • Maternal symptoms (headache, visual changes, RUQ pain)
  • Hepatic injury
  • Renal dysfunction
  • Pulmonary edema
  • Coagulopathy
  • HELLP syndrome
  • Eclampsia

 

5

How will the following change during pregnancy?

  • GFR: 
  • Serum CR:
  • Ureter position:
  • Kidney size: 

  • GFR: increase
  • Serum CR: decrease
  • Ureter position: displacement, R>L
  • Kidney size: increase slightly

 

6

List 3 important steps in the management of preterm labor

  • Give mom steroids -> accelerates fetal lung development
  • Give mom penicillin: GBS prophylaxis
    • Empirically, even if screening test has not been completed yet
  • Give mom magnesium: fetal neuroprotection
    • Reduces cerebral palsy risk

 

7

Describe the management of preeclampsia 

Definitive treatment is delivery

If not severe and <34 weeks, may attempt expectant management

  • Control BP
  • MgSO4 to prevent seizure
  • Give antenatal steroids

 

8

How is isoimmunization managed?

The pregnancy at risk is the second pregnancy, after Rh(-) mother develops antibodies to Rh during first pregnancy

(If mother was not given Rh immmunoglobulin during first pregnancy)

  • Look at serial antibody titers
  • 1:32 and above (so 1:16 and 1:8), fetus is at risk of anemia
  • Transfer adult RBCs to fetus to prolong gestation

 

9

What is the difference between spontaneous abortion and stillbirth?

Gestational age

  • Sponataneous abortion
    • Pregnancy loss < 20 weeks gestation
       
  • Stillbirth (aka intrauterine fetal demise)
    • Pregnancy loss ≥ 20 weeks gestation
    • Less common than spontanteous abortion

 

 

 

10

List the causes of fetal vascular malperfusion (4)

  • Umbilical cord abnormalities:
    • Twisting
    • Velamentous insertion
    • Mechanical obstruction
  • Thrombus formation

 

 

11

What physiologic difference will be present in the chest x-ray of a pregnant person?

Enlarged cardiac silouette due to elevation of the diaphragm

 

Heart will look too big, but it's fine

12

How do estrogen and prgesterone affect the uterus during pregnancy?

Estrogen -> Uterine hypertrophy

Progesterone -> Relaxation of uterine walls so fetus can grow

13

Which umbilical vessels deliver oxygenated blood to the fetus?

Umbilical vein

 

Umbilical arteries deliver deoxygenated blood from fetus to placenta

14

How will the following change during pregnancy?

  • HR:
  • CO:
  • BV:
  • SV:
  • BP:

  • HR: increase
  • CO: increase
  • BV: increase
  • SV: increase
     
  • SVR: decrease
  • BP:
    • 1st trimester: normal 
    • 2nd trimester: may dip a bit 2/2 decreased SVR
    • 3rd trimester: back to normal

 

15

At what gestational age does the fetus begin to synthesize its own thyroid hormone?

10 weeks

Relies on maternal TH until then

16

How will the following change during pregnancy?

  • Clotting factors:
  • tPA:
  • Protein S:
  • Activated protein C: 

  • Clotting factors: increase
  • tPA: increase
  • Protein S: decrease
  • Activated protein C: decrease 

 

Also, RBCs and plasma volume both increase, but plasma volume increases more -> physiologic anemia

17

Onset of labor before what gestational age counts as preterm?

<37 weeks

37 weeks + 0 days = term

18

Does the umbillicl cord contain maternal blood or fetal blood?

List the vessels in the cord

Fetal blood only

  • 1 umbilical vein carries oxygenated blood from placenta to fetus
  • 2 umbillical arteries carry deoxygenated blood from fetus to placenta

 

19

What is the most common cause of spontaneous abortion?

Chromosomal abnormalities

20

Describe the management of placenta previa

  • Pelvic rest
  • Manage expectantly if <37 weeks
  • Planned C-section at 37 seeks
    • Labor is a risk factor for maternal hemorrhage

 

21

What is happening during stage 1 of labor?

Onset of labor -> full cervical dilation

  • Latent phase happens slowly
  • Active phase = acceleration
    • Usually at 4-6 cm
    • Usually happens more quickly in people who have delivered a baby before

 

22

List the stages of labor and what is happening at each stage

  • Stage 1
    • Onset of labor -> full cervical dilation
  • Stage 2
    • Full cervical dilation -> delivery of fetus
  • Stage 3
    • Delivery of neonate -> delivery of placenta

 

23

Describe the pathophsyiology of isoimmunization

Rh (-) mother is exposed to Rh (+) fetal blood

  • -> Maternal production of antibodies
  • -> Next pregnancy = antibodies attack fetal RBCs 

 

Prevent by administering Rh immune globulin to all pregnant women who are Rh (-) at 28 weeks, after delivery, and any time there is concern for breakage of the feto-maternal barrier

Manage by transfering adult RBCs to fetus to prolong gestation if fetal anemia is developing

24

Which two classes of drugs can be given to stop labor?

  • Beta-2 agonists (terbutaline)
    • Maintain relaxation of the myometrium
  • Calcium channel blockers (nifedipine)
    • Prevent depolarization of myometrial cells

 

25

The corpus luteum supports pregnancy until __ weeks gestation

The corpus luteum supports pregnancy until  7  weeks gestation

26

How will the following change during pregnancy?

  • Minute ventilation:
  • Residual volume:
  • Tidal volume:
  • Functional residual capacity:
  • Acid/base balance: 

  • Minute ventilation: Increase
  • Tidal volume: Increase
  • Residual volume: Decrease
  • Functional residual capacity: Decrease
  • Acid/base balance: Respiratory alkylosis
    • Due to decrease in maternal pCO2, compensated by excretion of bicarbonate

 

Most changes are compensatory 2/2 elevated diaphragm

27

What is an "abnormally adherent placenta"?

What are the 3 different types?

The placenta implants into a layer of the uterus that is deeper than the decidua 

  • Accreta = implantation on the myometrium
  • Increta = invasion into the myometrium
  • Percreta = invation through uterine serosa into adjacent structures

 

 

 

28

What protective structure is lost if a fetus has velamentous umbilical vessels?

Wharton's jelly

  • Supposed to surround the umbilical vessels
  • If cords insert directly into the membrane (instead of the disk), they are at risk for rupture

 

 

29

Which situation is more urgent:

  1. Bleeding from placenta previa
  2. Bleeding from vasa previa

How do you tell them apart on presentation?

b. Bleeding from vasa previa

More dangerous because fetal blood - fetus can bleed out very quickly - do an emergency c-section!! (within seconds-minutes)

 

Vasa previa will have worrisome fetal monitoring; placenta previa will have reassuring fetal monitoring

Also, Apt test: fetal hemoglobin is resistant to lysis by alkaline solutions (but realistically, you don't have time to do this test)

 

 

30

How is cervical insufficiency managed?

Cerclage

  • If CI is happening => emergent cerclage
    • Contraindications: contractions (implies labor), fetal demise, infection
  • If risk factors but has not happened yet => prophylactic cerclage

 

Cerclage = suture that gives structural integrity/closure of cervix