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Flashcards in Midterm Deck (30)
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1

PREGNANCY TEST:

Serum HCG 9 days off after ovulation
Urine from this period.
Quantitative HCG for complications (ectopic)
Serial b-HCG to see if numbers are rising or falling

2

VIABLE PREGNANCY?

TVUS @ 6 weeks
Looking for heartbeat

3

REASONS FOR 1ST TRIMESTER UltraSound

*Accurate date (so we know its not premature, growth rate, appropriate preperations)
*Uncertain conception date (irregular menses, unknown conception)
*Developmental abnormalities (early kicking, late heartbeat, uterine growth/size)

4

REASONS FOR AN ACCURATE DUE DATE

Genetic testing
Pre-maturity,
out of hospital birth,

5

CASE: PREGNANT VAGINAL BLEEDING IN BATHROOM, ASK WHAT?

Ask how long been going on?
Pad? Soaking pad?
Streak when wiping?
Color? Pink, Red, bright red, brown?
Size (dime?)
Cramping? w/ cramping is more significant
Bleeding is common, but talk about ddx.

6

CAUSES OF CERVICAL BLEEDING?

Cervicitis, vaginal lesions, polyps, threatened miscarriage, ectopic pregnancy, physiologic bleeding, intercourse, etc.

7

@ 7 WEEKS, WOULD US RULE IN/OUT SPONTANEOUS ABORTION?

6 weeks = heartbeat.
7 weeks should certainly see heartbeat.
Doppler = 10 weeks heartbeat

8

COMMON ETIOLOGIES FOR SPONTANEOUS ABORTION?

Chromosomal abnormality (e.g., abnormal cell division)
Progesterone deficiency
Trauma
Congenital (differs from chromosomal abn)
Invasive procedures
Uterine infection
Thrombophilia
Unknown

9

VAG BLEEDING W RLQ PAIN

DDX: appendicitis, diverticulitis, ectopic pregnancy, ovarian cyst, round ligament pain

10

WHERE DO MOST ECTOPIC REGNANCIES IMPLANT?

Fallopian tube.

11

INCREASED RISK OF ECTOPIC PREGNANCY

Tubal surgery, other tubal issues, DES exposure, infertility, previous PID, having IUD, previous STI infection (GC/US)

12

AT WHAT POINT OF GESTATION IS AN ECTOPIC PREGNANCY?

RUPTURE?

Dangerous S/sx's?

@ 6-8 weeks

@ 6-12 weeks

S/sx's= Internal bleeding, shock, death.. medical emergency

13

DX AND RULE OUT ECTOPIC

Repeated US and serum HCG.

14

TX OPTIONS (ECTOPIC PREG)

Methotrexate and surgery.

15

START TREATMENT (NEW PREGNANCY) When?

By doing what?

1st trimester (prevent miscarriage, n/v, preperations, relationship)
Prenatal panel: avorh, CBC, hepatitis, antibody screen, syphilis, HIV, urine culture, pap, gonorrhea, chlamydia, blood type testing (Rh- needs RHOGAM)

16

ADVICE (NEW PREGNANCY)
Avg weight gain

Avg weight gain 25-35lbs
Heavier then average weight might gain less
Gain about 1lb per week
Do not diet during pregnancy

17

NUTRITIONAL Advice (NEW PREGNANCY)

Increase protein to 60mg
Avoid raw fish
Take Prenatal vitamins
Avoid Heated deli meat
Eat quality food
Incorporate veggies

18

TERATOGENS, WHEN DOES IMPLANTATION OCCUR

1 week after fertilization

19

SMOKING DANGERS

Placental abrubtion, prematurity, stillbirth, decreased o2 to baby, SIDS, respiratory diseases in baby

20

NAUSEA MECHANISMS & Remedies

*Increased bHCG,
*Inc progesterone → causes digestive track changes,
*inc peristalsis,
*inc gastric secretions,

Resolves bc placenta takes over making hormones after 1st trimester.

Remedies: B6, K, C, ginger, mint, nux vomica, sepia, pulsatilla

21

HYPEREMISIS GRAVEDERIM, What is it?

Uncontrollable n/v

22

HYPEREMISIS GRAVEDERIM DDX:

Could be stomach flu, Appendicitis, Gall bladder disease, Kidney infection

23

SOB, FATIGUE, BAD LAB WORK INDICATING ANEMIA HELPFUL HERBS:

HERBS: rhumex, nettles, teraxicum

24

RISKS DT ANEMIA (LOOK UP MORE)

Post-partum hemorrhage,
A preterm baby
low-birth-weight baby
Postpartum depression
A baby with anemia
A child with developmental delays
A blood transfusion (if you lose a significant amount of blood during delivery)

25

When in life are we most susceptible to TERATOGENS?

weeks 5-10 fetal life during organogenesis
Neonate,
newborn,
adolescence,
breast feeding (LUTEAL PHASE)

26

OXYTOCIN (BEST WAY TO REALEASE)

Facilitate release during pregnancy: relax, dim lights, silence, not being watched

27

SLEEPY PT'S 1st TRIMESTER, Cause?

Progesterone

28

INSOMNIA Helping herbs

Valerian, chamomile,

*NO PASSIFLORA during pregnancy

29

FAS/FAE (FETAL ALCOHOLIC SYNDROME) DX:

Dec. in weight (Prenatal or postnatal)
Small head circumference,
flat nose,
cognitive impairment,
underdevelopment of genitalia
Brain Dfxn

30

Name 2 lab tests of new preg.

ADORH,
Blood typing (Rh-)=Rhogham
CDC
HIV
HEP A/b