Week 4 - First Trimester

Question 1

which dermatological change reverses after delivery?

Answer 1

cholasma

Question 2

cholasma

Answer 2

melanocytes stimulated by estrogen & progesterone
usually found on face and other sun exposed areas
reverses after delivery

Question 3

linea nigra

Answer 3

increased melanocyte production
on Conception Vessel (TCM)
DOES NOT REVERSE AFTER DELIVERY

Question 4

normal CV changes in 1st trimester that mimic heart disease?

Answer 4

• dyspnea (@ rest & before 20 wks gestation)
• altered heart sounds
• peripheral edema
• mild tachycardia
• JVD

Question 5

physiology behind constipation?

Answer 5

changes in SI motility
changes in mechanical forces lead to increased intragastric pressure and a changed angle of the gastroesophageal junction

Question 6

what is Naegel’s Rule?

Answer 6

estimated date of delivery
40 weeks from LMP (most popular)
LMP + 1 year + 7 days - 3 months
standard deviation of 13 days

Question 7

which preconception supplement has potential to be teratogenic?

Answer 7

vitamin E - avoid high doses (heart problems in fetus)

vitamin A - toxicity in first 6 wks of fetal development (>10,000 IU/d)

Question 8

what is the dose & efficacy of vitamin B6 for hyperemesis?

Answer 8

pyridoxine

25mg q 8h effective for NVP BUT NO EFFECT ON HYPEREMESIS

Question 9

dose of ginger for n/v

Answer 9

350mg gel capsule as effective as 25mg B6

250mg 4x/d

Question 10

safety of conventional tx of candida during pregnancy?

monistat, canesten

Answer 10

antifungals that are local and not absorbed into bloodstream are considered safe in pregnancy

Question 11

what lab evaluation(s) would you do for first trimester bleeding?

Answer 11

bHCG

• ectopic pregnancies do not show typical doubling seen in intrauterine pregnancies
• nonviable pregnancies will show lower levels than expected for dates
• follow levels serially every 48hrs

Question 12

normal pregnancy levels of bHCG

Answer 12

hCG doubles approximately every 48 hrs

Question 13

hCG levels in spontaneous abortion?

Answer 13

hCG will fall

Question 14

hCG levels in ectopic pregnancy?

Answer 14

hCG will rise inappropriately (i.e. not usual doubling)

Question 15

hCG levels in molar pregnancy?

Answer 15

hCG level extremely high

Question 16

what are symptoms of a threatened miscarriage?

Answer 16

scant amount of bleeding
mild amount of uterine cramping
internal os of cervix closed
no passage of tissue and no presence of tissue in the vagina
fetal heart rate is present
variable clinical course

Question 17

what are symptoms of incomplete miscarriage?

Answer 17

heavy bleeding
severe uterine cramping
passage of tissue
open cervix with tissue in cervix

Question 18

symptoms of complete miscarriage?

Answer 18

slight bleeding or no bleeding
mild cramping
passage of tissue
possible to have tissue left in vagina
cervical os is closed
uterus is smaller than expected for dates of pregnancy

Question 19

symptoms of inevitable miscarriage

Answer 19

moderate amount of bleeding
moderate cramping
cervical os is open
no passage of tissue or tissue in the vagina

Question 20

when is trimester 2?

Answer 20

weeks 13-28

Question 21

what does fetal development look like at week 16?

Answer 21

skin begins to form and is translucent
meconium forms - first BM
sucking motion begins
4-5 inches long & weighs 3 oz

Question 22

what does fetal development look like at week 20?

Answer 22

lanugo, hair, nails form
babe can hear & swallow
6” long, weighs 9 oz

Question 23

what does fetal development look like at week 24?

Answer 23

lungs formed
taste buds developed on tongue
girl: all eggs for lifetime now formed
boy: testicles descent into scrotum
12" long & weighs 1.5 lbs

Question 24

normal RR for a pregnant woman

Answer 24

~20 breaths per minute