Flashcards in Midterm Deck (30)
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
TVUS @ 6 weeks
Looking for heartbeat
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)
REASONS FOR AN ACCURATE DUE DATE
out of hospital birth,
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?
Cramping? w/ cramping is more significant
Bleeding is common, but talk about ddx.
CAUSES OF CERVICAL BLEEDING?
Cervicitis, vaginal lesions, polyps, threatened miscarriage, ectopic pregnancy, physiologic bleeding, intercourse, etc.
@ 7 WEEKS, WOULD US RULE IN/OUT SPONTANEOUS ABORTION?
6 weeks = heartbeat.
7 weeks should certainly see heartbeat.
Doppler = 10 weeks heartbeat
COMMON ETIOLOGIES FOR SPONTANEOUS ABORTION?
Chromosomal abnormality (e.g., abnormal cell division)
Congenital (differs from chromosomal abn)
VAG BLEEDING W RLQ PAIN
DDX: appendicitis, diverticulitis, ectopic pregnancy, ovarian cyst, round ligament pain
WHERE DO MOST ECTOPIC REGNANCIES IMPLANT?
INCREASED RISK OF ECTOPIC PREGNANCY
Tubal surgery, other tubal issues, DES exposure, infertility, previous PID, having IUD, previous STI infection (GC/US)
AT WHAT POINT OF GESTATION IS AN ECTOPIC PREGNANCY?
@ 6-8 weeks
@ 6-12 weeks
S/sx's= Internal bleeding, shock, death.. medical emergency
DX AND RULE OUT ECTOPIC
Repeated US and serum HCG.
TX OPTIONS (ECTOPIC PREG)
Methotrexate and surgery.
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)
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
NUTRITIONAL Advice (NEW PREGNANCY)
Increase protein to 60mg
Avoid raw fish
Take Prenatal vitamins
Avoid Heated deli meat
Eat quality food
TERATOGENS, WHEN DOES IMPLANTATION OCCUR
1 week after fertilization
Placental abrubtion, prematurity, stillbirth, decreased o2 to baby, SIDS, respiratory diseases in baby
NAUSEA MECHANISMS & Remedies
*Inc progesterone → causes digestive track changes,
*inc gastric secretions,
Resolves bc placenta takes over making hormones after 1st trimester.
Remedies: B6, K, C, ginger, mint, nux vomica, sepia, pulsatilla
HYPEREMISIS GRAVEDERIM, What is it?
HYPEREMISIS GRAVEDERIM DDX:
Could be stomach flu, Appendicitis, Gall bladder disease, Kidney infection
SOB, FATIGUE, BAD LAB WORK INDICATING ANEMIA HELPFUL HERBS:
HERBS: rhumex, nettles, teraxicum
RISKS DT ANEMIA (LOOK UP MORE)
A preterm baby
A baby with anemia
A child with developmental delays
A blood transfusion (if you lose a significant amount of blood during delivery)
When in life are we most susceptible to TERATOGENS?
weeks 5-10 fetal life during organogenesis
breast feeding (LUTEAL PHASE)
OXYTOCIN (BEST WAY TO REALEASE)
Facilitate release during pregnancy: relax, dim lights, silence, not being watched
SLEEPY PT'S 1st TRIMESTER, Cause?
INSOMNIA Helping herbs
*NO PASSIFLORA during pregnancy
FAS/FAE (FETAL ALCOHOLIC SYNDROME) DX:
Dec. in weight (Prenatal or postnatal)
Small head circumference,
underdevelopment of genitalia