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Flashcards in Exam Qs Oral Deck (91)
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1

Who to screen for gestational diabetes

Part of screening program = check all pregnant
- At 24-28 gw
- At time 0 min (lower than 5,6), 120 min (lower than 7,8) «5,6,7,8»
- 75 gram glucose

2

Define preeclampsia

- Original version: after 20 gw, hypertensive disorder (over 140/90) + proteinuria (300mg/24 hrs)
- Need hypertension + something else (not necessary with proteinuria in new definition)

3

Postpartum hemorrhage

4 T´s
- Tone: uterine atony is an exclusion diagnosis (after excluding the other T´s)
- Tissue
- Trauma
- Thrombin

4

Pregnant to emergency 30th gw and bleeding - DDx and what to do

- First: good morning (no anamnesis) + CTG (fast)
- Placenta previa or placental abruption
- How to check: First palpate uterus - outer examination/abdomen (if hard - abruption - surgery) (if normal - previa)

5

Presumptive, probable, definite signs of pregnancy

- Presumptive: signs we can have in pregnant, non-pregnant and men (nausea, vomiting)
- Probable: in pregnant and non-pregnant (physical changes, pregnancy tests - can be tumor)
- Definite sign: detecting fetus (US, CTG)

6

US screenings

5 screenings:
- Type 0: detect pregnancy
- Type 1: 11 gw +0 days - 13 gw+6 days, screen downs, malformations, detect pregnancy, size
- Type 2: genetic
- Type 3: IUGR
- Type 4: 38 gw, position, size, estimated weight etc

7

Stages of delivery

- First stage: dilation cervix (9 or 11 hrs, multiparous: half)
- Second: delivery of fetus (50-60 min, multi: half)
- Third: delivery placenta (5-15 min, should not be longer than 30 min)
- Fourth: artificial, 2 hrs observation

8

Delivery starts - signs

- Regular contractions (every 10 min or more often)
- Rupture of membranes

9

Folliculogenesis

Sperm & egg are both produced in 60-90 days - so the egg that is ovulated is produced 3 cycles before (after spontaneous abortion the whole system is at time zero, so therapy will give pregnancy earliest after 3 months)

10

Ovulation time

24 hrs after LH surge

11

Hormonogenesis

The hormones are produced by the follicles in the ovaries, so a person with ovaries, but no follicles in them, does not produce sexual hormones (e.g Turner syndrome)

12

Ovulation - chance of getting pregnant

- Sperm lives 48 hrs
- Egg should be fertilized within ~12 hrs after ovulation (max 24 hrs)
- So approximately a 3 days window of when intercourse leads to pregnancy

13

hCG (human chorionic gonadotropin) - pregnancy test

- Urine (yes/no)
- Serum to know when pregnancy happened - important in ectopic pregnancy, but still do urine tests in emergencies because faster results

14

Spontaneous abortion %

- 60-70 % of all pregnancies end in spontaneous abortions - many not recognized
- Clinically detected pregnancies - 10-15 % end in spontaneous abortion

15

Folic acid

- Daily requirement: 300-500 microgram
- To avoid neural tube defects

16

Dilution anemia in pregnany

Dilution anemia (lower Hgb, Htc) - normal during pregnancy («she´s not anemic»), true anemia is Hgb below 12 g/dl

17

Leukocytosis in pregnancy

Leukocytosis is normal 10000-16000

18

Proteins in pregnancy

Eat and drink as much proteins as possible - at least 65 g/day (for normal growth, development of fetus)

19

AFP (alphafetoprotein) in pregnancy

- Peak at week 13
- Screening at 16th week for NTD

20

Arterial blood pressure in pregnancy

Does not increase in normal pregnancy! (OBS preeclampsia)

21

Chadwick´s sign

Bluish discoloration of cervix, vagina and labia resulting from increased blood flow. Can be observed spprox 6-8 weeks after congestion as an early sign of pregnancy.

22

«Mask of pregnancy»

Chloasma

23

Hormone responsible for bone and joint changes during pregnancy

Relaxin (source: corpus luteum, ovary, breast etc)

24

Normal weight gain during pregnancy

10-12 kg

25

Average length of labor

Nulliparous: 12-18 hours
Multiparous: 6-8 hours

26

Ruptured membranes without regular contractions first

Increased risk of infection

27

Stages of partuition

- Phase 0: uterine quiescence
- Phase 1: preparation for labour
- Phase 2: process of labor (1st, 2nd, 3rd)
- Phase 3: recovery

28

Principles of management of labor

1. Diagnosis of labour
2. Monitoring the process of labour
3. Ensuring maternal well-being
4. Ensuring fetal well-being (CTG)

29

Criteria for normal labour (8)

1. Spontaneous expulsion
2. Of a single (twins/triplets «not normal» labour)
3. Mature fetus (gw 37 - 42)
4. Presented by vertex
5. Through the birth canal
6. Within reasonable time (more than 3, less than 18 hours)
7. Without complications to the mother
8. Without complications to the fetus

30

3 P´s in progress of labour

- Power: uterus (myometrium)
- Passenger: fetus (head mostly)
- Passage: pelvis of the mother