Antenatal Factors

Question 1

Dental concerns in pregnancy

Answer 1

Gingival disease increases, gums bleed easily

Question 2

Gastrointestinal concerns in pregnancy

Answer 2

Appetite increases, reflux occurs, motility and intestinal transit decrease, gallbladder dilates. Constipation and hemorrhoids are common.

Question 3

Respiratory concerns in pregnancy

Answer 3

Oxygen requirement, oxygen pressure tidal volume, inspiratory and and vital capacity, minute volume and PO2 increase. Carbon dioxide pressure, expiratory reserve volume, residual volume, total lung capacity, HCO3, and PcO2 decrease.

Question 4

Cardiovascular concerns in pregnancy

Answer 4

Cardiac output, stroke volume, heart rate, and blood flow to uterus, kidneys, breasts, skin, and brain increase. Systemic vascular resistance and pulmonary vascular resistance decrease.

Question 5

Hematologic concerns in pregnancy

Answer 5

Plasma volume, total erythrocyte volume, mean cell volume, total iron-binding capacity, E-sed rate, and alkaline phosphatase increase. Hemoglobin, hematocrit, serum iron, total protein, albumin, and osmolality decrease.

Question 6

Renal concerns in pregnancy

Answer 6

Kidneys enlarge and bladder tone decreases. Residual volume, renal plasma flow, and GFR increase.

Question 7

Ophthalmic concerns in pregnancy

Answer 7

Blurred vision is common.

Question 8

Integumentary concerns in pregnancy

Answer 8

Vascular spiders, palmar erythema, striae gravidarum, and hyperpigmentation occur. Significant hair loss occurs 2 to 4 months after pregnancy.

Question 9

Why are adolescent mothers younger than 15 at higher risk during pregnancy than adolescent mothers younger than 20?

Answer 9

Because of inadequate prenatal care and not following guidelines and recommendations.

Question 10

What are the increased gestational risks associated with teenage pregnancy?

Answer 10

They are more likely to smoke and gain inadequate weight, increasing the likelihood of premature delivery, low-birth weight infants, iron deficiency anemia, and preeclampsia/eclampsia. There is increased risk of cephalopelvic disproportion because the mother may not be fully mature physically. They also have increased risk of sexually transmitted diseases, drug and alcohol use.

Question 11

What are the gestational risks with mothers over 35?

Answer 11

Risk of death associated with pregnancy increases with age. They are more likely to have preexisting health problems. They are more likely to have a c-section, placenta previa, abruptio placentae, and spontaneous abortion. There also may be increased risk to the fetus (genetic testing).

Question 12

Additional calories in first trimester

Answer 12

None needed.

Question 13

Additional calories in second and third trimesters

Answer 13

300

Question 14

Additional calories in 2nd and 3rd trimesters for twins

Answer 14

600

Question 15

Weight gain chart for pregnancy

Answer 15

Underweight - 28-40lbs
Normal weight - 25-35lbs
Overweight - 15-25lbs
Obese - 15lbs

Question 16

Risks for underweight mothers during pregnancy?

Answer 16

Increased perinatal losses and preterm births, lower Apgar scores, low birth weight.

Question 17

Vitamin and mineral deficiencies during pregnancy

Answer 17

Thiamine - Congestive heart failure, stillbirths
Folic acid - Megaloblastic anemia, neural tube defects
Vitamin D and calcium - Skeletal defects

Question 18

Risks for overweight mothers during pregnancy?

Answer 18

Fetal distress, early neonatal death, meconium aspiration, shoulder dystocia, complications from caesarean birth.

Question 19

Grand multiparity

Answer 19

5 or more deliveries of live or stillborn infants at 20 or more weeks

Question 20

Great grand multiparity

Answer 20

10 or more deliveries of live or stillborn infants at 20 or more weeks

Question 21

Risks associated with multiparity

Answer 21

Increased risk of placenta previa, abruptio placenta, preeclampsia, and hemorrhage. Rates of C-sections are increased significantly.

Question 22

Risks associated with grand multiparity

Answer 22

Often have poor prenatal care, increased rates of disease such as diabetes mellitus and hypertension. Fetal complications include macrosomia, SGA, and malpresentation.

Question 23

Psychosocial issues during pregnancy

Answer 23

Almost all mothers have feelings of ambivalence about the challenges of parenthood. Areas of concern include changing body image and sexuality, labile moods, and personality changes.

Question 24

Causes of female infertility

Answer 24

Non-patent fallopian tubes, ovulation failure, cervical obstruction or uterine abnormality

Question 25

Non-patent fallopian tubes

Answer 25

Fallopian tubes may be scarred by PID, endometriosis, or adhesions. Diagnosed by hysterosalpingography, laparoscopy.

Question 26

Ovulation failure

Answer 26

Hormone levels may be inadequate to promote ovulation. Ovarian cysts may interfere with ovulation. Diagnosed by ultrasound.

Question 27

Cervical obstruction or uterine abnormality

Answer 27

Excess production of mucus or narrowing of the cervical os may prevent sperm from entering the uterus. Thickening, abnormalities, or growths (fibroids, cysts) of the uterus may prevent implantation. Diagnosed by hysteroscopy, endometrial biopsy, postcoital test, ulstrasound.

Question 28

How frequently is the mal responsible for infertility?

Answer 28

30% of the time

Question 29

Male fertility tests

Answer 29

Urogenital history and examination, semen analysis, hormone levels, genetic testing.

Question 30

What are the methods of assisted reproduction?

Answer 30

``` Assisted reproduction therapy with egg and/or sperm donation Gamete intrafallopian transfer Intracytoplasmic sperm injection Intrauterine insemination In vitro fertilization Zygote intrafallopian transfer ```

Question 31

Assisted reproduction therapy (ART) with egg and/or sperm donation

Answer 31

Donor eggs or sperm are combined with the partner's eggs or sperm before intrauterine insemination.

Question 32

Gamete intrafallopian transfer (GIFT)

Answer 32

Sperm and ovum (gametes) are harvested, collected and inserted next to each other in the fallopian tube, where normal fertilization takes place.

Question 33

Intracytoplasmic sperm injection (ISCI)

Answer 33

Individual harvested ovum is injected directly with individual sperm before intrauterine insemination.

Question 34

Intrauterine insemination (IUI)

Answer 34

Sperm are inserted directly into the uterus through a catheter. This procedure may follow hormone treatments to stimulate ovulation.

Question 35

In vitro fertilization (IVF)

Answer 35

Harvested and fertilized ova are inserted into the uterus, often after the woman takes drugs to stimulate ova production. Ova, sperm, or both, may be donated.

Question 36

Zygote intrafallopian transfer (ZIFT)

Answer 36

Sperm and ova are combined, and fertilization occurs outside the body. The zygotes are inserted into the fallopian tube. From there, they travel to the uterus to implant.

Question 37

Gonadotropin treatment for infertility

Answer 37

Requires administration of natural or recombinant hormones: follicle stimulating hormone (FSH) and luteinizing hormone (LH).

Question 38

Bromocriptine and cabergoline

Answer 38

Reduce prolactin levels. Increased prolactin levels can interfere with ovulation in females and decrease testosterone and sperm production in males.

Question 39

Clomiphene

Answer 39

Stimulates hormone production and ovulation in women whose estrogen levels and pituitary function are normal. Often used to stimulate production of multiple ova prior to harvesting.

Question 40

GnRH

Answer 40

Gonadotropin-releasing hormone. Administered before gonadotropin treatment to prevent the pituitary from stimulating production of FSH and LH, so production can be controlled.