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Flashcards in OBSTETRICS Deck (117)
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1

Changes in thyroid hormone observed during pregnancy

Since TBG increases, total T4 will increase but free T4 remains unchanged. TSH will also decrease slightly during early pregnancy but remains within normal limits.

2

Why is metabolic alkalosis seen during pregnancy?

PCO2 decreases to about 30 mm Hg which makes sense because mom wants to release more oxygen to baby.

3

Tidal volume changes in pregnancy

Tidal volume increases 40% with associated increase in minute ventilation due to stimulation by progesterone.

4

Glucose-related changes during pregnancy

Non-diabetic hyperinsulinemia with associated mild glucose intolerance.
Production of human placental lactogen contributes to glucose intolerance by interfering with insulin activity

5

Treatment of GERD during pregnancy

CAlcium carbonate. H2 blockers and PPIs are also safe. The only thing that is NOT safe is milk of magnesia (recall magnesium induces tocolytic effects)

6

At what gestational age is physiologic anemia of pregnancy most apparent?

Second trimester due to greater increase in plasma volume as compared to BC mass.

7

When should anemia in pregnancy be treated with oral iron?

If Hb falls below 11 in first or third trimesters OR when less than 10.5 in second trimester.

8

What is Goodell's sign?

Softening and cyanosis of cervix at 6 weeks gestation

9

What is Chadwicks sign

Bluish discoloration of the vagina due to vascular congestion at 8-12 weeks gestation

10

What is Hegars sign

Softening of the uterus at 6 weeks gestation

11

Folic acid requirement in all women of childbearing years

.4 mg daily

12

IF previous child wit neural tube defect, recommended folic acid intake?

Starting the mont prior to pregnancy, 4 mg daily.

13

When do you do Group B strep screening?

36 weeks gestation. Thats because its only good for 4 weeks.

14

Increased nuchal translucency

Down syndrome
Turner syndrome
Congenital heart defects

15

MCC of abnormal quad screen

Incorrect dating

16

Serum AFP is only valid if performed during what window

16-18 weeks gestation

17

High aFP

Increased risk of neural tube defects or multiple gestations

18

Low aFP

Increased risk of trisomies 21 and 18

19

Low PAPP-A
Elevated hCG
Elevated nuchal traslucency

Trisomy 21

20

Very low PAPP-A, very low hCG, increased nuchal translucency

Trisomy 18

21

Very low PAPP-A, low hCG, increased nuchal translucency

Trisomy 13

22

Low AFP, uE3
High hCG, Inh A

Trisomy 21

23

Low AFP
VERY LOW uE3, hCG

Trisomy 18

24

Which test has lowest false-positive rate for non-invasive tests in pregnancy

Full integrated test. US measurement of nuchal translucency, serum measurement of pregnancy-associated plasma protein A in first trimester and quad screen in second trimester

25

What does the quad screen consist of

Maternal serum aFP
Estriol (uncojugated)
hCG
Maternal serum inhibin A

26

Which screening test is performed in all pregnant women at 16-18 weeks gestation

Quad screen

27

Which screening can determine karyotype

Amniocentesis

28

When is chorionic villi sampling performed

Early detection of chromosomal abnormalities in higher risk patients (advanced age, hx of children wit genetic defects)

29

What are the indications for percutaneous umbilical blood sampling/cordocentesis

Second and third trimester when karyotype results are required within a few days
Diagnosing fetal hyper- or hypothyroidism
Diagnosing and managing fetal thrombocytopenia

30

Nagele's rule

LMP + 7 days - 3 months + 1 year = estimated delivery date.