Exam III Flashcards
(144 cards)
1
Q
What is recommended for preconception care in a female with chronic diseases?
A
use the fewest medications at the lowest dosages needed to control the disease
2
Q
What are the folate requirements?
A
- 400 mcg daily before pregnancy until 6-12 weeks postconception
- 4-55 mg folate daily 3 months before and 12 weeks after
3
Q
How long should a woman wait to conceive after coming off birth control?
A
2-3 cycles
4
Q
When should healthy changes be made prior to conception?
A
3 months to 1 year before conception
5
Q
At what dose can caffeine reduce fertility?
A
more than 300 mg of caffeine per day reduces fertility by 27%
6
Q
What is the MC serious disease to affect pregnancy?
A
diabetes
7
Q
In the 1st trimester, hypothyroidism is associated with ___?
A
cognitive impairment in children
8
Q
What is the MC neurologic disease to affect pregnant women?
A
seizure disorders
9
Q
Mothers are more satisfied with care from which providers?
A
midwifes and PCPs
10
Q
During what time of the pregnancy is there a heightened fetal vulnerability to teratogens?
A
the first 12 weeks
==>organogenesis
11
Q
When is air travel safe for pregnant moms?
A
safe until 4 weeks before EDD
12
Q
When should hot tubs and saunas be avoided?
A
during the first trimester
13
Q
What is maternal heat exposure during early pregnancy associated with?
A
neural tube defects and miscarriage
14
Q
What are the exercise recommendations for pregnant women?
A
- avoid activities that risk falls or abdominal injuries
- at least 30 min of moderate exercise
15
Q
What is associated with exposure to radiation during pregnancy?
A
- increased risk of miscarriages
- elevated risk of childhood cancers
16
Q
Lead exposure is associated with ___?
A
cardiovascular defects
17
Q
Using wood, coal or tires for cooking or heating is associated with ___?
A
neural tube defects
18
Q
What is one of the leading causes of neurodevelopmental deficits in children in the United States?
A
fetal alcohol spectrum disorder (FASD)
19
Q
What is the relationship of periconception smoking and congenital heart defects?
A
3x increased risk of congenital heart defects
20
Q
What are some risk factors associated with paternal smoking?
A
greater risk of developing leukemia in the childhood period
21
Q
What are some risks associated with periconception smoking?
A
- intrauterine growth restriction
- prematurity
- SIDS
22
Q
What are some contraindications of breastfeeding?
A
- maternal HIV infxn
- chemical dependency
- use of certain meds
23
Q
How much do caloric requirements increase in pregnancy?
A
340 to 450 kcal per day in the 2nd and 3rd trimesters
24
Q
What is the recommended weight gain in women with normal BMI?
A
~25-35 lbs
25
What is the RDI for calcium?
1000-1300 mg/day
26
What is associated with high vitamin A intake?
cranial-neural crest defects
27
What should vitamin A intake be limited to?
5000 IU per day
28
What is the recommended dose of vitamin D?
1000-5000 IU per day
29
Which artificial sweetener increases the risk of CA and can cross the placenta?
saccharin
30
What are some guidelines regarding caffeine consumption?
limit to 150-300 mg per day
31
Which herbal teas are safe in moderation?
- ginger
- citrus peel
- lemon balm
- rose hips
32
Which herbal teas should be avoided?
- chamomile
- licorice
- peppermint
- raspberry leaf
33
What are the characteristics of mild contractions?
begin 15 to 20 minutes apart and last 60 to 90 seconds
34
What characterizes "active labor"?
- strong contractions
- last 45 to 60 seconds
- occur 3 to 4 min apart
35
What is the "bloody show" and when does it happen?
days/weeks before labor, cervix softens, dilates releasing the mucus plug
36
What is effacement?
when contractions pull up and shorten the cervix
| ==>"polarity"
37
What does the first stage of labor consist of?
begins with the onset of regular contractions and ends with full dilation of the cervix
38
What is the latent first stage?
- dilates 0-3 cm
| - approx. 7-10 hrs
39
What is the active first stage?
-dilates from 4 to 7 cm
==>about 3-5 hrs
-should be at her "birthplace"
40
What is "transition"?
-last phase of the first stage
-dilates from 8 to 10 cm
==>about 30-90 min
-most physically & emotionally taxing phase
41
What does the second stage of labor consist of?
begins with full dilation of the cervix, descent, crowning & ends with birth of the baby
==>30 min to 3+ hrs
42
What is "labor down"?
- natural "lull" occurs
| - should rest during this time and not push
43
What are the mechanisms of birth?
aka: cardinal movements
- flexion
- descent
- internal rotation
- delivery of head
- restitution
- external rotation
44
What is the reference point for the fetal stations?
ischial spine = 0
==>above = -#
==>below = +#
45
What does the third stage of birth consist of?
begins with birth of baby and ends with birth of placenta
| ==>about 5-50 min
46
What can help with placental detachment?
breastfeeding
| ==>stimulates oxytocin which stimulates uterine contractions
47
What is Credes' Method?
used to identify placental detachment
48
With Credes' Methond, what does cord retraction indicate?
that the placenta has not detached yet
49
With Credes' Methond, what does it mean if the cord remains lengthened?
that the placenta has detached
50
What is the normal amount of blood loss during birth?
~250 ml
51
Excessive bleeding after birth should be taken as a sign of ___?
retention of placental parts until proven otherwise
52
Which placental types have a higher risk of tearing/retention?
- circumvallate
- succenturiate
- bipartite/tripartite
- duplex
53
What does the fourth stage of labor consist of?
begins with placental birth and ends with the recovery of the new mother
==>about 4-6 hrs
54
True or False: pain relief commonly results in mother satisfaction?
False
55
What are some recommendations for the use of warm water baths during labor?
- wait for active labor
- maintain water at or below body temp
- limit bath time to 1-2 hrs
56
Is a warm water bath the same as a water birth?
no, warm water baths are typically used as an analgesic tactic
57
When is water birth not recommended?
- maternal herpes
- breech baby
- multiple babies
- maternal bleeding or infxn dx
- preterm labor suspected
- preeclampsia
- severe meconium
58
How do sterile-water injections work?
causes a burning sensation that acts as a conterirritation
| ==>lasts 45-90 min
59
What are some positives concerning opioids compared to epidurals?
- lower oxytocin augmentation rate
- shorter stages of labor
- fewer cases of malpositioning
- fewer instrument-assisted deliveries
60
Opioid effects on infants
- resp. depression
- dec. alertness
- inhibition of sucking
- lower neurobehavioral scores
- delay in effective feeding
61
What are some benefits to delayed cord clamping?
- increased blood volume
- reduced need for blood transfusion
- decreased incidence of intracranial hemorrhage in preterm infants
- lower frequency of iron def. anemia in term infants
62
What are some symptoms that may identify serious complications of pregnancy?
- bleeding or spotting
- nausea, vomiting
- fatigue
- edema
63
How much does a HR increase at term?
10-30%
| ==>10-15 bpm
64
How does respiratory rate change?
increases ventilation by breathing more deeply not more frequently
65
What qualifies as gestational hypertension?
- systolic > 140 OR
| - diastolic > 90
66
What qualifies as preeclampsia?
- systolic > 160 OR
| - diastolic > 110
67
What is the MC cause of maternal death?
preeclampsia
68
What is the recommended weight gain for an underweight mother?
28-40 lbs
69
What is the recommended weight gain for an overweight mother?
15-25 lbs
70
What is the recommended weight gain for an obese mother?
no more than 11-20 lbs
71
What accounts for most of the weight gain in the 1st and 2nd trimesters?
maternal tissue
| ==>placenta, adipose deposits, amniotic fluid etc.
72
What accounts for most of the weight gained in the 3rd trimester?
fetal growth
73
How much weight from the total weight gained comes from fetal growth?
5-10 lbs
74
How much weight gain is expected in the 1st trimester?
3-6 lbs
75
How much weight gain is expected in the 2nd & 3rd trimester?
0.5 - 1 lbs/week
76
What are some maternal complications seen in obese women?
- gestational HTN/preeclampsia
- gestational diabetes
- cesarean delivery
- failure to initiate breastfeeding
77
When do stretch marks appear?
during the 2nd trimester
78
When do telangiectasias appear?
during the 2nd - 5th month
79
Other than skin stretching, what could be another potential cause of itching during pregnancy?
liver dysfunction resulting in ridding the body of toxins through the skin
80
What are the characteristics of PUPPS?
intense pruritic rash that starts on the abdomen and spares the periumbilical area as well as the face, palms and soles
81
What are some characteristics of Herpes Gestationis?
- rare autoimmune disorder of pregnancy
- not related to herpes virus
- intense pruritis
- palms and soles are frequently affected
82
What are Krukenburg Spindles?
increase in corneal epithelial pigmentation
83
What are some expected findings regarding the thyroid?
- enlarged thyroid due to hyperplasia of glandular tissue
| - increased vascularity may result in a bruit
84
What are some expected findings in the eye during pregnancy?
- ptosis
- corneal thickening/edema
- greasy tears due to lysosome
- subconjunctival hemorrhages
85
What are some expected findings the ENT examination?
- edema and erythema in nose and pharynx
- red tympanum
- reddened, swollen gums
- epistaxis
86
What are some expected findings in the thorax during pregnancy?
- diaphragm rises as much as 4 cm
- lower ribs flare
- transverse diameter increases 2 cm
- chest circumference increases 5-7 cm
- costal angle >103 degrees
87
When would dyspnea become a concern?
If it is accompanied by dizziness, lightheadedness etc.
| ==>CV concerns
88
How is the apical impulse changed?
moves up and 1-1.5 cm lateral
89
How much does blood volume increase?
40-50%
| ==>mainly due to plasma volume increase
90
How much does cardiac output increase?
40-50%
| ==>highest by 24 weeks (2nd-3rd tri)
91
What are some heart sound changes seen during pregnancy?
- audible splitting of S1 and S2
- S2 may be heard after 20 weeks
- grade II systolic ejection murmur
92
Where is the systolic ejection murmur most typically heard?
over the pulmonic area
93
What happens to BP during the 2nd trimester?
it decreases but returns to pre-pregnancy in the 3rd trimester
94
What is the best position for a pregnant mom to sleep in?
left lateral recumbent position
95
How early can colostrum begin?
as early as the 6th week gestation
96
What is Naeglele's Rule?
add 7 days to the first day of the last normal menstrual period and count back 3 months
97
How is fundal height measured?
- empty bladder
- supine
- from upper part of pubic symphysis to superior fundus
- recorded in cm
98
When is the fundal height most accurate?
between 20-30 weeks
99
What is the expected fundal growth?
1 cm per week
100
Where would the 40 week fundal measurement fall?
at the 36 week due to the baby dropping
101
What is a hydatidiform mole?
tissues that aren't differentiating but are multiplying
102
What is the MC presenting symptom in a complete hydatidiform mole?
vaginal bleeding
103
What are some other findings in a complete hydatidiform mole?
- hypermesis
- preeclampsia
- large for date uterus
- hyperthyroidism
104
What is a serious complication of a hydatidiform mole?
cancer transformation
| ==>mets MC to local tissues, lung or brain
105
What is a follow up test done with a hydatidiform mole?
bHCG tested monthly for 6-12 months
106
What classifies as a spontaneous abortion?
pregnancy loss at less than 20 weeks gestation
107
What is a "threatened abortion"?
a pregnancy complicated by bleeding before 20 weeks gestation
108
What is an "inevitable abortion"?
cervix has dilated but products of conception have not been expelled
109
What accounts for the majority of spontaneous abortions?
chromosomal abnormality (49%)
110
What finding decreases the likelihood of a spontaneous abortion?
fetal heartbeat identification decreases risk from 50% to 3%
111
What is the likely cause of vaginal bleeding in the 2nd or 3rd trimester accompanied by no pain?
placenta previa
112
What is the MC cause of an abruptio placentae?
HTN
113
What is the 2nd MC cause of an abruptio placentae?
trauma
114
What is abruptio placentae?
separation of the placenta after the 20th week of gestation
115
What is the presentation of an abruptio placentae?
- vaginal bleeding
- abdominal or back pain w/ uterine tenderness
- fetal distress
- abnormal uterine contractions
- premature labor
116
What is polyhydramnios?
abnormally high level of amniotic fluid
| ==> >2000 mL
117
What is the MC presentation of preeclampsia?
HTN and proteinuria
118
What are some paternal specific risk factors?
- first-time father
| - previously fathered a preeclamptic pregnancy
119
What may be given during labor in preeclamptic patients?
magnesium sulfate
==>prevent seizures
==>can also slow labor
120
What does HELLP stand for?
- Hemolysis
- Elevated Liver enzymes
- Low Platelet count
121
What is eclampsia?
sever complication of preeclampsia
| ==>new onset of seizures in a woman with preeclampsia
122
What are the 4 major things a mom can do to prevent gestational diabetes?
- don't smoke/non-smoker
- physical activity
- healthy eating
- pre-pregnancy BMI <25
123
When is the initial screening for gestational diabetes done?
at 24-28 weeks
| ==>50g, 1 hr glucose challenge test
124
What is normal for the gestational diabetes screening?
<130/140 mg/dL
125
What is the recommended diet for gestational diabetes?
meets pregnancy needs but restricts carbs to 35-40% of daily Cal
126
What is involution?
process where the uterus is transformed form pregnant to non-pregnant state
127
What is puerperium?
time after birth to about a few weeks after (~6 weeks)
128
What are the 3 types of lochia?
```
-lochia rubra (1-3 weeks)
==>red
-lochia serosa
==>brownish red
-lochia alba
==>yellow
```
129
What is the MC type of lochia?
type 1
| ==>prolonged breastfeeding
130
What does type 2 lochia consist of?
- prolonged rubra phase
| - short or no breastfeeding
131
What does type 3 lochia consist of?
- two rubra phases
| - variant of type 2
132
When does thyrotoxicosis typically occur?
1-4 months postpartum
133
When does hypothyroidism typically occur?
4-8 months postpartum
134
What are some lab test findings associated with thyrotoxicosis?
decreased TSH
135
What are some lab test findings associated with hyppthyroidism?
increased TSH
136
What effects does progesterone have the the MSK system?
- alters vascular supply
| - decreases smooth muscle tone
137
What effects does estrogen have the the MSK system?
relaxes joint capsule
138
What effects does relaxin have the the MSK system?
allows pelvis to open
139
"Morning sickenss" should be evaluated further if it begins when?
after 9 weeks of gestation
140
Which hormone may be linked to LBP?
progestin
141
Pain with IN ilium
- opposite glut medius
- inguinal pain
- anterior thigh pain
142
Pain with EX ilium
- ipsi glut medius
- medial knee
- back of thigh
143
What should you adjust if you have a P sacrum accompanied by either an AS, IN or ASIN?
adjust sacrum
144
What should you adjust if you have a P sacrum accompanied by either a PI, EX or PIEX?
adjust ilium
