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Antepartum > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Risk Factors for post term pregnancy

A

Nulliparity, history of post term pregnancy, maternal obesity, carrying a male fetus, having a family history of post-term pregnnacy

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2
Q

Maternal risk for post term pregnancy

A

dysfunctional labor, operative birth, operative vaginal birth, perineal trauma, postpartum hemorrhage (associated with risk of macrosomia)

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3
Q

fetal risk in post term pregnancy

A

mec stainted fluid
areas of infarction and calcium on placenta
amniotic fluid normally begins to decrease at 38 weeks.. oligo incidence higher in post term pregnancy= cord compression and fetal distress during labor
risk of still birth after 42 weeks is twice as high
risk of death during first year of life is higher

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4
Q

labor stimulating activities

A

stripping of membranes
60mg castor oil PO (diarrhea and cramping)
unprotected intercourse

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5
Q

Induction for post dates/bishops scoring

A 
42+ for sure a candidate
>6 is a good bishops score 
0= closed, 0-30, -3. firm, posterior 
1= 1-3 cm, 40-50, -2, medium, midline 
...
3 = >5 cm ect..
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6
Q

Post dates fetal surveillance

A 
fetal movement count (daily) 
NST (twice weekly)
BPP (twice weekly) 
modified Bpp (twice weekly) 
AFI (twice weekly) 
CST? weekly
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7
Q

Placenta Previa risk factors

A 
AMA >35
multiparity
prior c section 
infertility treatments
smoking
unexplained AFP 
multiple gestation 
short inter pregnancy interval 
prior uterine cutterage
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8
Q

Placenta previa Presentation

A

painless vaginal bleeding in late second or early third trimester

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9
Q

Placenta previa management

A

no digital exam!

asymptomatic previa- delivery 36-37 weeks, complicated deliver immediately

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10
Q

Risks for Placental Abruption

A 
HTN!!
short interpregnancy interval 
C sections 
PPROM 
smoking
cocaine
black or caucasian
polyhydramnios
multiple gestation 
uterine decompression 
thrombophelias 
uterine leiomyoma 
maternal trauma 
unexplained elevated AFP
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11
Q

Maternal Issues Placental Abruption

A

risk for shock, coagulopathy, renal failure, death
high recurrence rate
couvelaire uterus- blood seeping into uterine musculature

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12
Q

Placental Abruption Presentation

A

could be no s/s, especially with a concealed abruption
visible bleeding in a marginal placental separation
** hallmarks are visible bleeding and abdominal pain (uterine hypertonicity and tenderness)

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13
Q

Management- bleeding in second half of pregnancy

A

blood type, rh risk factors: Rhogam within first 48-72 hours (before 12 weeks dose if 50, after dose is 300) of bleeding onset
CBC, coags
ultrasound to see location of placenta (no digital exam!)
hospitalization for bleeding with previa
serial growth US for women with history of abruption

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14
Q

Complete pregnancy loss

A

history of heavy bleeding, cramping, passage of clots/tissue, followed by an abrupt decrease in pain and bleeding
complete passage of products of conception
cervix closed
uterus small
may see blood in vaginal vault

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15
Q

Incomplete pregnancy loss `

A

cramping intense, bleeding heavy
partial passage of products of conception
cervix open or closed

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16
Q

Delayed pregnancy loss (missed abortion or blighted ovum)

A

cervix closed
uterus small or appropriate for gestational age
amenorrhea may be only symptoms, FHT not heard

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17
Q

Early pregnancy loss medical management

A

oral or vaginal misoprostol for uterus less than 12 weeks.

4-16 hours to evacuate uterus

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18
Q

early pregnancy loss follow-up

A

1-2 weeks of pelvic rest
ovulation can return in 21 days, menses typically resumes in 6 weeks
no reason to wait to get pregnant again
follow up visit in 2 weeks- check for involution

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19
Q

fetal effects IUGR

A 
** second highest cause of perinatal mortality, after prematurity 
not ALWAYS SGA 
still birth
neonatal mortality
delayed effects of CP and adult disease
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20
Q

Symmetric IUGR

A

smaller number and size of cells
happens early pregnancy
commonly caused by genetic, infectious, teratogenic insults
CMV, rubella, or drugs like phenytoin or valproate
occurred during period of hyperplasia
less likely to respond to antenatal interventions

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21
Q

Asymmetric IUGR

A

uteroplacental insufficiency
chronic fetal hypoxemia and malnutrition in utero
fetal cell size is small but normal in number
associated with HTN, preeclampsia, diabetes, renal disease, and abnormal placentation

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22
Q

IUGR diagnosis

A

fundal height measurement off by more than 3cm
consecutive US measurements made 2 weeks apart
targeted US for anatomy scan and AFV ( aneuploidy?)

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23
Q

IUGR causes

A

Aneuploidy
non-aneuploidy syndrome
viral infections
placental insufficiency

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24
Q

IUGR management

A

serial growth US 3-4 weeks apart
AC provides best measurements
serial doppler flow studies weekly or bi-weekly
NST weekly or bi-weekly
BPP
AFI- declining is sign of worsening placental function

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25
Recommended fluid intake in pregnancy
3L/day or 8-12 8oz glasses a day
26
Caloric intake in pregnancy
No extra calories first trimester 2nd- 340/day 3rd- 450/day
27
Fats in pregnancy diet
20-35% DHA (omega 3) is super important for brain and eye development may prevent preterm birth
28
pregnancy fish recommendations
consume 2 servings (12 oz) of fish per week supplement with fish oil if fish is not eaten NO shark, swordfish, king mackerel, tilefish canned chunk light tuna has less mercury and can eat 2x/week, limit albacore to 6oz per week remove skin and surface fat from fish before cooking
29
Carbs in pregnancy
175g/day | complex carbs
30
Protein in pregnancy
71g/day high-protein diets should be avoided meat, fish, poultry eggs, dairy products, tofu, soy, legumes, nuts, seeds
31
Iron in pregnancy
``` first trimester- requirements reduced needed in second, peaks in end of third 27mg/day (found in PNV) heme iron- found in meat is better non-heme in plants and ferrous sulfate take with vitamin c tannins decrease absorption ```
32
Calcium in pregnancy
``` 1000mg/day 19-5- years old 1300mg/day 14-18 milk, yogurt, cheese more fat, less calcium fortified like orange juice and calcium ```
33
Vitamin D
600-4000IU | achieve circulating level of 40-60ng/ml
34
Weight gain recommendations
Underweight 28-40 or 1-2lbs per week normal 25-35 or 1-2 lbs per week overweight 15-25 1/2-2/3 per week obese BMI >30 11-20 1/2 lb per week
35
Off limits cheeses in pregnancy
Raw milk cheeses | goats milk, chevre, queso fresco, brie, camembert, danish blue, gorgonzola, roquefort
36
449 rule
1gm fat= 9 calories 1gm carb= 4 calories 1gm protein= 4 calories
37
obesity is linked with....
increased risks for pregnancy complications such as GDM, preeclampsia, NTDs, oomphalocele, and cardiac anomalies; obesity doubles the risk of stillbirth, and neonatal death
38
Endometrium post partum
day 1: decidual necrosis is sloughed off as lochia day 7: necrotic and viable tissue at placental site, non-necrotic helps reconstruct endometrium day 16: endometrium fully restored
39
Uterus sizes post partum
immediately: 1000g 1 week: 500g 2 weeks: 300g 6 weeks: 100g
40
Uterine involution post partum
immediately: uterus at the level of the umbilicus 1-2 hours: uterus between umbilicus and sympthesis 12 hours: 1 cm above umbillicus 24 hours: 1 cm below umbillicus 3 days: 3 cm below 7 days: at symphesis 14 days: in pelvis (non palpable)
41
Lochia postpartum
Rubra: 1-3 days pp bright red Serosa: 4-10 alba: 10 days.. last 24 to 36 days pp
42
Cervix postpartum
2-3 days cervix regains shape (maybe still 2-3 cm) 7 days: uterus 1cm 3rd week- vagina gets rugae back 6 weeks- pelvic floor strength
43
Urinary tract postpartum
returns to normal dilation between 2nd and 8th week postpartum
44
Weight loss postpartum
immediate 10-13lbs infant, placenta, amniotic fluid, blood loss may not have weight loss until 1-2 weeks because of fluid retention labor may increase anti-dieuretic homrone after labor- leading to fluid retention EBB phase- fluid retention Flow phase- dieuresis at 4-7 days pp
45
Hair loss pregnancy
hair in anegen phase (growth) due to estrogen in postpartum it goes through the catagen phase
46
definition of PPH
1000ml blood loss or blood loss with s/s of hypovolemia within first 24 hours
47
secondary PPH
24h- 12 weeks postpartum
48
PP depression
can be diagnosed at any time during pregnancy ACOG recommends we screen all women at least once 1 in 7 women affected by perinatal depression
49
Pelvic floor
supports the pelvic organs facilitates movement of the fetus towards the pelvic girdle maintain optimal intra-abdominal pressure helps baby be born head-first
50
Levator ani muscles/pelvic diaphram
``` Pelvic diaphram: levantor ani: puborectalis pubococcygeous iliococcygeous ``` other: coccygeous
51
Puborectalis
``` part of levator ani! encircles anal rectal junction interwoven with external anal sphincter Innervated by: S3 S4, levator ani nerve function: inhibit defication ```
52
pubococcygeus
floor of pelvic cavity, pelvic floor part of levator ani! innervated by S3 S4, functions: control urine flow, contract during orgasm
53
Illiococcygeus
part of levator ani! innervated by Pudendal nerve! function: lift/closes anus
54
coccygeus
``` posterior to levator ani arieses from spine of ischium also sacro-spinus ligament innervated by: S4, S5, s3-s4 funciton: ppulling coccyx after defication, closes in back outlet of pelvis ```
55
Urogenital diaphragam
deep transverse perineum | sphincter urethrae
56
deep transverse perineum
innervated by pudendal nerve | function: fixate the central tendon of the perinum, suppport to pelvic floor, last drops of urine.
57
external urethral sphincter
innervated by deep branch of perineal nerve | functions: constricts urethra
58
External anal sphincter
innervated by fourth sacral and pudendal nerve (rectal branch) functions: keep anal canal closed, fix central point of perineum
59
Bulbospongiosis
innervated by deep branch of perineal nerve (branch of pudendal nerve) functions:clitoral errection and orgasm
60
Ischiocaverneosis
innervated by perineal nerve | compresses the crus of clitoris
61
superficial transverse perineum
``` goes across perineal space anterior to anus attach to tuberosity of ischium insert at central tendon of perineum innervated by perineal nerve fixation of central tendon of perineum support of pelvic floor ```
62
Obturator Internus
attach to torcanter nerve to obturator internis, L5, S1, S2 laterally rotates the femur
63
Piriformis
gluteal region lateral rotator group originates from sacrum
64
Round Ligament
lateral cornu of the uterus, through broad ligament, into inguinal canal, ends in connective tissue of labia majus in the perineum
65
Chronic HTN definiton
greater than 140/90 before 20 weeks gestation, or persisting after 12 weeks postpartum severe= 180/110
66
CHTN management
``` 24 hour urine protein, creatinine EKG opthamalogy exam growth scan 28, 32, 36 weeks twice weekly nst beginning at 32 weeks delivery by EDC ```
67
CHTN med guidelines
Do not treat BP if under 160/105 and no evidence of end organ damage if using anti HTN agent- maintain BPs 120/160 - 80/105 safe HTN meds - labetolol - nifedipine, norvasc - methyldopa Do NOT USE ACE
68
GHTN and mild PEC without severe features | management
fetal kick counts Bp measurement and BPP 2x per week weekly office visit and lab assessment (LFT, CBC, platelets) growth scans every 3-4 weeks (20, 28, 32, 36)
69
pregnancy related HTN
BP decrease with nadir in mid second trimester | increases in third trimester
70
PEC without severe features criteria
BP greater than 140/90 after 20 weeks gestation with PROTEINURIA greater than 300mg in 24 hours 1+ protein on dipstick protein creatinine ratio of greater than 0.3
71
preeclampsia with severe features
Bp greater than 160/110 with proteinuria if no proteinuria.. signs of END ORGAN DAMAGE - thrombocytopenia platelets less than 100 - impaired liver function (ALT (7-56), AST (10-40)) - creatinine 1:1, or oligouria <500 in 24 hours - pulmonary edema - new onset headache
72
Eclampsia
- not related to degree of proteinuria - most occur first 48 hours - greater than 48-72 hrs post partum, think of other causes
73
HELLP syndrome
``` Hemolytic anemia ( s. on peripheral blood smear, elevated liver enzymes low platelets) ```
74
Vasa previa management
c section at 34 36 weeks | management 3x week NST 28 weeks
75
problems with circumvallate nutrients
abruption, IUGR, preterm birth | decreased supply of nutrients
76
Risk factors for accreta
``` placental previa pervious c/s (scarring) s/s: similar to previa, bleeding? hematuria with placenta percreta AFP elevated US/MRI ```
77
risks for previa
``` short interval prior D&C prior c/s smoking ama infertility AFP elevated ```
78
complications from previa
``` hemorrhage preterm birth stillbirth perinatal mortality and morbidity low birth weight/IUGR neonatal respiratory distress ```
79
GDM blood sugars
``` before breakfast 60-90 before 60-105 1 hr post parandial <130 2 hour post parandial <120 night >60 ```
80
post partum 2 hour
less than 140 | more than 200.. diabetes
81
pregnant 2 hour
fasting less than 92 1 hour less than 180 2 hour less than 153
82
Rubins 4 tasks
Safe passage: finds way to ensure safe passage and birth Acceptance: relationships, behaviors, siblings Binding into the child: stop seeing them as separate giving of oneself: most complex and demanding
83
lederman 7 dimensions of maternal development
``` acceptance of pregnancy identification of a mother role relationship with her mother relationship with partner preparation for labor fear of loss of control in labor fear of loss of self esteem in labor ```

Antepartum (4 decks)

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