Normal pregnancy/L&D Flashcards
(139 cards)
1
Q
pregnancy: normal cardiovascular changes
A
incr cardiac output 50% HOTN supine, dizziness incr pulse 10-18 incr S2 split (inspiration) JVD systolic ejection murmur S3 gallop
BP should be normal, diastolic murmur NOT normal
2
Q
pregnancy: NOT normal cardiovascular changes
A
diastolic murmur
BP should be normal
3
Q
pregnancy: normal pulm changes
A
incr O2 demand
compensated resp alkalosis (incr ventilation)
dyspnea
mucosal hyperemia (congestion, rhinorrhea)
4
Q
pregnancy: normal heme changes
A
incr plasma vol, RBC vol, coag factors
edema
physiologic anemia
leukocytosis
incr Fe needs (supplement 300 mg elemental Fe/day)
thromboembolism risk 2x (5.5x puerperium)
incr fibrinogen, FDP, 7, 8, 9, 10
5
Q
pregnancy: normal renal changes
A
incr PVR incr bladder tone (progesterone) decr bladder capacity incr RAA components urinary frequency stress incontinence nocturia
decr Cr, BUN
incr GFR
glucosuria NORMAL
(NOT normal: proteinuria)
6
Q
pregnancy: normal GI changes
A
progesterone= smooth muscle relax
decr LES: GERD
decr GI motility: constipation
decr GB: stones
morning sickness, N/V- first 4-8 wks pruritis (incr bile acid conc) diet cravings pica (no anemia?) ptyalism (excess salivation, can't swallow b/c N) olfactory aversions
ALP doubles NORMAL
incr lipids
7
Q
ACEI category
A
D, contraindicated in preg
8
Q
pregnancy: normal endocrine changes
A
thyroid enlarges
euthyroid
incr cortisol
incr aldosterone
incr hPL (human placental lactogen)
postprandial hyperglycemia
fasting hypoglycemia
incr insulin resistance
9
Q
pregnancy: normal MSK changes
A
lumbar lordosis
back pain
imbalance (progesterone= ligament laxity)
10
Q
pregnancy: normal skin changes
A
spider angiomas palmar erythema striae gravidarum **linea alba--> linea nigra **chloasma/melasma (mask of pregnancy) hair falling out postpartum
11
Q
pregnancy: normal breast changes
A
enlarge incr areola prominent montgomery glands colostrum (for 2 wks) **breast tenderness
12
Q
pregnancy: normal ophthalmic changes
A
blurred vision (6-8 wks postpartum gone)
13
Q
Chadwick’s sign
A
bluish vagina & cervix
pregnancy sign
14
Q
Hagar’s sign
A
softening of cervix (b/t fundus & cervix)
pregnancy sign
15
Q
quickening: nullipara
A
18-20 wks
16
Q
quickening: multipara
A
14-16 wks
17
Q
uterine growth: 12 wks
A
at symphysis pubis
fetal heart tones noted
18
Q
uterine growth: 14-16 wks
A
midway b/t pubis & umbilicus
19
Q
uterine growth: 20 wks
A
at umbilicus
quickening
20
Q
uterine growth: >20 wks
A
1 cm/wk gestation # cm = # wks long
21
Q
uterine growth: 38-40 wks
A
2-3 cm below below xiphoid process
22
Q
umbilical cord contains
A
1 vein
2 arteries
23
Q
placenta function
A
nutrients, waste elimination, gas exchange, hormone production
24
Q
fetal kidneys functional when
A
2nd trimester (lg amniotic fluid component)
25
fetal liver functional when
slow
at birth, coag factors not developed
vit K at birth!
26
fetal liver developed when
6 wks
27
fetal IgG passive immunity gone when
12 wks fetus makes IgG, M, D, E
28
pregnancy sign: timing of softening and enlargement of uterus
6 wks after LMP
29
enlarged uterus palpated timing
12 wks
30
urine HCG pos when
4 wks after 1st day of LMP (next menses due)
| best 1st AM void
31
serum HCG more sensitive vs. urine
| levels?
initially double q 42-72 hrs
32
transvaginal US timing
3-4 wks
33
US timing
5-6 wks
34
fetal heart sounds timing
12 wks
| doppler device/fetoscope
35
abnormal HCG from expected stage?
ectopic
36
HCG day 23
100
37
HCG day 28
250
38
HCG day 35
1000
39
gestational age
1st day LMP -to- estimated date of delivery
1st day LMP + 7 days - 3 mo
40
routine prenatal visit: initial
| what do they perform
6-8 wks after LMP
```
pelvic exam, PAP
GC/chlamydia cultures
CBC, blood type, Rh
Hep B, syphilis, HIV, rubella, varicella
GTT if high risk (obese, PCOS, FH)
```
41
routine prenatal visits frequency
initial: 6-8 wks after LMP
8-28 wks: q 4 wks
28-36 wks: q 2-3 wks
>36 wks: q wk
42
every visit entails
```
BP
wt (gain 4 lbs/visit)
UA (glucosuria NORMAL, proteinuria NOT normal)
fundal ht (tape measure >20 wks)
fetal HR (NORMAL 110-160)
```
43
options if breech
breech ok before 34 wks
external cephalic version (manipulate)- not if mult, uterine anomaly
Csection
44
purpose of 20 wk US
```
confirm intrauterine
gestational age
mult gestations?
confirm cardiac activity
nuchal transparency= Down's, chromosomal abnorm- US sooner
```
45
1st trimester (10-13 wks)- high risk findings (old mom)
US nuchal transparency
| plasma protein A (Downs)
46
```
quad screen (special test in high risk moms, old age)
what it includes, what it means
```
decr MS-AFP
decr estriol
incr HCG
incr inhibin A
=trisomy 21 (Downs), trisomy 18 (Edwards), chromasomal abnom
47
incr MS-AFP (maternal serum) means
neural tube defects
spina bifida
(tetralogy of fallot, anencephaly)
48
Downs screening 1st and 2nd trimester
1st trimester: PAPP-A (preg assoc plasma protein A)
nuchal transparency
2nd trimester: Quad testing
49
GBS at 32-36 wks
| prophylaxis?
PCN G IV 5, then 2.5 q 4 hrs until delivery
PCN allergy: clindamycin, erythromycin
50
LGA causes
incorrect assessment gest age
mult preg
lg fetus
polyhydramnios (excess amniotic fluid)
51
SGA causes
incorrect assessment gest age
IUGR
intrauterine fetal demise
oligohydraminios (little amniotic fluid)
52
folic acid requirement
0.4 mg folic acid
53
travel/flying counsel
fly up to 36 wks
54
sexual activity counsel
not limited
55
smoking in pregnancy Sx
IUGR
low birth wt
mortality
56
morning sickness Tx
crackers, lay in bed, hard candy
pyridoxine (vit B6)
antihistamines (benadryl, dramamine, doxylamine)
antiemetics (phenergan, compazine)
DON'T USE ZOFRAN!
57
hyperemesis gravidarum Tx
corticosteroids
| IVF
58
GBS testing when?
32-36 wks
59
false contractions (Braxton Hicks contractions) description
shorter, not as painful, not progressive, resolve with fluids/movement/analgesics
60
lightening definition
baby's head poked out into pelvis
61
blood show definition
effacement, thinning cervix
62
desired presentation and lie
longitudinal, cephalic
63
effacement of cervix starts when
1 wk prior to delivery
64
full 10 cm dilation- what do you see?
membrane starting to come through
65
fetal stations definition
baby's head vs. ischial spines and pelvis
66
station 0 (where, dilation, effacement)
at level of spines
3-4 cm dilated
70% effacement
aka "engagement"
67
dilation of cervix starts when
days before delivery
68
movements of labor
1. engagement (station 0) days-wks before delivery
2. head flex
3. descent
4. internal rotation, face down
5. extension of neck, head delivered
6. external rotation, face up
7. expulsion
69
fetal monitoring during labor
- intermittent doppler monitor (1st stage q 30 min, 2nd stage q 15 min)
- electronic fetal monitoring
70
2nd stage of labor aka
"pushing" stage
bear down
full cervical dilation
71
length of 2nd stage of labor
primigravid: 30min-3hrs
multiparous: 5-30 min
72
modified ritgen maneuver when?
2nd stage of labor
prevent tears
push up against infant chin
73
perineal tearing 1st degree
vaginal laceration
| perineal skin torn
74
perineal tearing 2nd degree
vaginal laceration
perineal skin torn
+perineal muscle torn
75
perineal tearing 3rd degree
vaginal laceration
perineal skin torn
perineal muscle torn
+external anal sphincter torn
76
perineal tearing 4th degree
```
vaginal laceration
perineal skin torn
perineal muscle torn
external anal sphincter torn
+complete external anal sphincter torn
+rectal mucosa torn
ALL THE WAY
```
77
2 normal NB head findings
molding (shift cranial bones)
caput succedaneum (edema scalp)
-resolve in 24 hrs
78
3 classic signs of placenta separation
- uterus rises in abdomen
- gush of blood
- lengthening umbilical cord
79
3rd stage of labor definition
placenta delivery, within 30 min infant delivery
80
risks postpartum uterine hemorrhage
rapid/protracted labor
enlarged uterus (polyhydramnios, lg fetus, mult gest)
chorioamnionitis (inflamm membr)
81
4th stage of labor definition
2hrs postpartum
82
labor induction drugs
oxytocin: stim contractions
misoprostol (prostaglandin): cervical ripening
rupture membranes
83
indications for C section
```
placenta previa
abruptio placentae
prolapse of umbilical cord
uterine rupture
breech
```
84
relative contraindications for vaginal birth after C section (5)
- Hx high/classic C section
- previous uterine rupture
- OB complications
- 2 prior uterine scars + no vaginal deliveries
- no vaginal birth at home after C section
85
indications for no resuscitation in NB
full term, CLEAR AMNIOTIC FLUID (no meconium), spontaneous breathing/crying, good muscle tone
86
Apgar signs (5)
```
Appearance (color)
Pulse (HR)
Grimace (reflex activity response to stim)
Activity (muscle tone)
Respirations
```
87
Apgar: color 0, 1, 2
blue/pale, acrocyanotic, pink
88
Apgar: HR 0, 1, 2
absent, 100
89
Apgar: reflex activity response to stim 0, 1, 2
none, grimace, cry/active WD
90
Apgar: muscle tone 0, 1, 2
limp, some flexion, active motion
91
Apgar: respirations 0, 1, 2
none, weak cry/hypoventilation, good crying
92
meds given within 1 hr delivery to NB
erythromycin (gonococcal ophthalmia)
| vit K1 0.5-1 mg (prevent hemorrhagic dz of NB)
93
puerperium period
6-8 wks after birth
94
initial postpartum exam time
4-6 wks after
95
lochia
sloughed off endometrium, clots expelled, discharge
heavy 1st few days
resolves over several wks
96
cervix back to 1 cm when?
1 wk
97
ovarian function returns when?
nonlactating 3 wks
| lactating 6 mo
98
uterus normal size (involution) when?
6 wks
99
cardiovascular system postpartum
incr HR resolves in 1 hr
| incr plasma vol normal in 2-3 wks
100
renal system postpartum
incr GFR normal in several wks
urinary retention (edema around urethra)
stress incontinence normal in 3 mo
101
highest risk for postpartum hemorrhage when?
1st 24 hrs
102
pt mgmt postpartum
- ambulation encouraged
- breast engorgement uncomfortable, will resolve
- mastitis
- stool softeners
- perineum care: oral analgesics, local anesthetics (benzocaine spray), sitz baths
103
wt loss postpartum
2 lb/mo
104
sexual activity postpartum
in ~2wks
105
oral contraception while lactating?
yes. progesterone only (minipill)
- exclusively breastfeeding: start in 6 wks
- partially breastfeeding: start in 3 wks
106
breastfeeding benefits
- decr AOM, resp infections
- decr diarrhea
- decr SIDS
- decr atopic/allergic dz
- decr juvenile diabetes
- decr hospital admissions
107
breastfeeding contraindications
HIV, chemo, illegal drugs
| Li, tetracycline, methotrexate, radioactive
108
hormones released in breastfeeding
oxytocin, prolactin
109
colostrum when?
first 5 days lactation
110
mother's minimum calorie requirement (breastfeeding)
1800 calories/day
111
RF for PPD and postpartum psychosis
younger, Hx mental disorders, DEPRESSION DURING PREGNANCY
112
postpartum blues definition, onset, duration, Tx
sad/anxious/angry/insomnia/tearful
starts 2-4 days, for 1-2 wks
no Tx
113
PPD Tx
antidepressant, psychotherapy
114
postpartum psychosis Tx
antidepressant, antipsychotics
115
when to start checking fundal ht
20 wks
116
when to start checking fetal heart tones
10 wks
117
normal fetal HR
120-160 bpm
118
1st trimester screening
- preg-assoc plasma protein A (PAPP-A) (low= trisomy 21)
- free beta-HCG (high= trisomy 21)
- US: EDC, mult gestations
- nuchal translucency screening at 10-13 wks (pos= trisomy, Turners)
- chorionic villus sampling at 10-13 wks
119
US fetal heart activity detected when
5-6 wks after LMP
120
indications for nuchal translucency / chorionic villus sampling / amniocentesis
>35 y/o, Hx chromosomal abnorm child/parent/FH, abnorm 1st/2nd trimester mom screening
-neural tube defect risk- amniocentesis
121
2nd trimester screening
estriol, AFP, inhibin A, US, amniocentesis
122
trisomy 21
low estriol, low AFP, low preg-assoc plasma protein A (PAPP-A)
high inhibin A, high free beta-HCG, pos nuchal translucency
123
estriol, AFP, inhibin A in trisomy 21
low estriol, low AFP, high inhibin A
124
US purposes
- fetal viability
- growth vs. gestational age
- placenta status/location
- amniotic fluid level
- lethal malformations
- f/u abnorm blood screening tests
125
amniocentesis when?
15-18 wks
126
3rd trimester screening
- gestational diabetes
- Rh repeat Ab titers
- vaginal culture for GBS
- H/H
- NST (non-stress test)
- US
- biophysical profile
127
GBS vaginal-rectal culture when?
35 wks
128
gestational diabetes screening when?
24-28 wks
129
H/H pregnancy screening when?
35 wks
130
CVS (chorionic villus sampling) when?
10-13 wks (1st trimester screening)
131
nuchal translucency when?
10-13 wks (1st trimester screening)
132
how to monitor fetal well-being
nonstress test (NST): doppler monitor, external stress gauge for uterine contractions
133
normal NST
reactive
- 2 accelerations of fetal HR in 20 minutes (incr 15 bpm baseline HR for 15 sec)
- absence of decelerations
134
decelerations definition
decr fetal HR 15 bpm OR 15 sec OR slow return to baseline
135
accelerations definition
incr fetal HR 15 bpm for 15 sec
136
bad sign in fetal HR
late decelerations
137
biophysical profile (BPP)- 5 parameters
NST, amniotic fluid level, gross fetal movement, fetal tone, fetal breathing
-each parameter 2 points, total of 10 points
138
biophysical profile when, purpose
- late in pregnancy
| - monitor fetal well-being
139
GBS test when
32-36 wks
