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Women's health > normal pregnancy/L&D (16%) > Flashcards

normal pregnancy/L&D (16%) Flashcards

1
Q

when is serum hcg detectable? urine?

A

serum- 5 days s/p conception

urine- 14 days

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2
Q

what is ladins sign

A

uterus softens s/p 6wks

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3
Q

what is hegars sign

A

uterine isthmus softens s/p 6-8wks

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4
Q

what is piskaceks sign

A

palpable lateral bulge/softening of uterine corpus 7-8wks

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5
Q

what is goodell’s sign

A

cervical softening d/t inc vascularity s/p 4-5wks

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6
Q

what is chadwick’s sign

A

bluish color of cervix + vulva 8-12wks

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7
Q

timeline of cervical/uterine changes in 1st trimester

A 
goodells (4-5wks)
ladins (6wks)
hegars (6--8wks)
piskaceks (7-8wks)
chadwicks (8-12wks)
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8
Q

when can you first hear fetal heart tones? heart beat?

A

10-12wks (tones- doppler)

5-6wks (beat- US)

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9
Q

what is a normal fetal HR

A

120-160

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10
Q

when can fetus be seen on pelvic US

A

5-6wks

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11
Q

when does mom start feeling fetal movement and what is this called

A

QUICKENING

16-20wks

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12
Q

what is included in “para” (P)

A 
# of pregnancies carried to 20wks
multiple gestations = 1
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13
Q

fundal height measurements

A

12wks- above pubic symphysis
16wks- btw pubic symphysis + umbilicus
20wks- at umbilicus
38wks- 2-3cm below xiphoid

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14
Q

naegele’s rule

A

EDD

1st day of LMP + 7D - 3mo

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15
Q

freq of prenatal visits

A

<28wks- q4wks
28-36wks- q2wks
>36wks- q1wk

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16
Q

routine tests during 1st prenatal visit

A 
BP
blood type + Rh, CBC, random glucose
UA (glucose + protein)
HBsAg, HIV, syphilis, rubella titer
sickle cell + CF
pap smear
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17
Q

3 markers for down syndrome in 1st trimester

A

free hcg- abnormally high/low
PAPP-A- usu low
nuchal translucency- US @ 10-13wks (inc thickness)

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18
Q

when is chorionic villus sampling offered

A 
10-13wks
if prior child w chromosomal abn
maternal age >35
abn 1st or 2nd trimester maternal screening tests
prior pregnancy losses
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19
Q

what is triple screening and when is it done

A

wks 15-20
checks AFP, hcg, estradiol
screens for trisomy 21, trisomy 18, open neural tube defect/multiple gestation

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20
Q

results of triple screen for trisomy 21

A

AFP- low
hcg- high
estradiol- low

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21
Q

results of triple screen for trisomy 18

A

AFP- low
hcg- low
estradiol- low

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22
Q

results of triple screen for neural tube defect/multiple gestation

A

AFP- high
hcg- n/a
estradiol- n/a

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23
Q

what is inhibin-A and what can it indicate

A

high levels in 2nd trimester may indicate chromosome abn

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24
Q

when can you do amniocentesis and what are the indications

A 
15-18wks
prior child w chromosomal abnormality
mom >35yo
1st/2nd trimester abnormal screening
abnormal US
prior pregnancy losses
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25
Q

when should you screen for gestational diabetes

A

24-28wks

26
Q

gestational diabetes values (GTT)

A

fasting <95
1hr <180
2hr <155
3hr <140

27
Q

what should be done in the 3rd trimester for unsensitized Rh negative moms

A

repeat antibody titers + rhogam @ 28wks + within 72h s/p birth

28
Q

when should you screen for GBS

A

32-37wks

29
Q

when should Hgb + Hct be checked

A

35wks

30
Q

5 variables of biophysical profile

A 
fetal breathing
fetal tones
amniotic fluid levels
NST
gross fetal movements
31
Q

point values of biophysical profile

A

each category = 2pts, 10pt total

32
Q

what is a reactive NST vs nonreactive

A

reactive- 2+ accelerations in 20min; inc FHR >15bpm from baseline lasting >15sec
nonreactive- no FHR accelerations or <15bpm from baseline lasting <15sec

33
Q

what does a reactive NST mean

A

fetal well being

repeat NST weekly/biweekly

34
Q

what does a nonreactive NST mean

A

sleeping, immature or compromised fetus

try vibratory stimulation or contraction stress test

35
Q

what is a contraction stress test

A

measure fetal response to stress @ times of contraction

36
Q

what is a negative contraction stress test

A

no late deceleration in presence of 3 contractions in 10min

fetal well being

37
Q

what is a positive contraction stress test

A

repetitive late decelerations in presence of 3 contractions in 10min
worrisome, prompt delivery

38
Q

how much folic acid should pregnant woman take and when is it most effective

A

800mcg/day

2mo prior to pregnancy + 1mo after conception

39
Q

what foods contain folic acid

A

green leafy veggies, oranges, cantaloupe, milk, banana, grains + organ meats

40
Q

what vitamins should be avoided in excess in pregnancy

A

fat-soluble (ADEK)

41
Q

how much caffeine should be max/day

A

500mg

42
Q

how many calories should pregnant women get

A

15%+

2200

43
Q

how much protein should pregnant women get

A

10-30g+

75g total

44
Q

how much iron should pregnant women get

A

30-60mg.day

45
Q

how much calcium should pregnant women get

A

1200mg/day

46
Q

average wt gain during pregnancy

A

25-35lbs

47
Q

maternal complications of multiple gestations

A

preterm labor
spontaneous abortion
preeclampsia
anemia

48
Q

fetal complications of multiple gestations

A 
IUGR
placental abn
breech 
umbilical cord prolapse
preeclampsia
49
Q

what is lightening

A

fetal head descends into pelvis -> baby feels lighter to mom

50
Q

what are the cardinal movements of labor

A

engagement- fetal presenting part enters pelvic inlet
flexion- flexion of head to allow smallest diameter to present into pelvis
descent- passage of head into pelvis (lightening)
internal rotation- fetal vertex moves from occiput transverse position to position where sagittal suture is parallel to anteroposterior diameter of pelvis
extension- vertex extends as it passes beneath pubic symphysis
external rotation- fetus externally rotates after head is delivered so shoulder can pass

51
Q

stages of labor

A

I- onset (True regular contractions) to full dilation of cervix
II- full cervical dilation to delivery
III- postpartum until placenta delivers
IV- 1-2h s/p delivery when mom is assessed for complications

52
Q

what are the 2 phases of stage I of labor

A

latent- cervix effacement w gradual dilation

active- rapid cervical dilation (usu at 3-4cm)

53
Q

what are the 2 phases of stage II of labor

A

passive- complete dilation to active maternal expulsive efforts
active- active maternal expulsive efforts to delivery of fetus

54
Q

what are the 3 signs of placental separation in stage III of labor

A

gush of blood
lengthening of umbilical cord
anterior-cephalad movement of uterine funds (becomes globular + firmer)

55
Q

what is considered a normal vs critical APGAR score

A 
normal = 7+
critical = 3 or less
56
Q

what is the puerperium period

A

6wks s/p delivery

57
Q

effects on uterus in puerperium period

A

at level of umbilicus after delivery
involution s/p 2days
descends into pelvic cavity after 2wks
normal size after 6wks

58
Q

what is loch serosa

A

pinkish/brown vaginal bleeding esp PP days 4-10

usu resolves by 3-4wks PP

59
Q

when does breast milk come in

A

PP days 3-5

bluish-white

60
Q

if mom is not breastfeeding when does menses return

A

6-8wks PP

Women's health (7 decks)

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