Flashcards in OBSTETRICS Deck (117)
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.
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.
Tidal volume changes in pregnancy
Tidal volume increases 40% with associated increase in minute ventilation due to stimulation by progesterone.
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
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)
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.
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.
What is Goodell's sign?
Softening and cyanosis of cervix at 6 weeks gestation
What is Chadwicks sign
Bluish discoloration of the vagina due to vascular congestion at 8-12 weeks gestation
What is Hegars sign
Softening of the uterus at 6 weeks gestation
Folic acid requirement in all women of childbearing years
.4 mg daily
IF previous child wit neural tube defect, recommended folic acid intake?
Starting the mont prior to pregnancy, 4 mg daily.
When do you do Group B strep screening?
36 weeks gestation. Thats because its only good for 4 weeks.
Increased nuchal translucency
Congenital heart defects
MCC of abnormal quad screen
Serum AFP is only valid if performed during what window
16-18 weeks gestation
Increased risk of neural tube defects or multiple gestations
Increased risk of trisomies 21 and 18
Elevated nuchal traslucency
Very low PAPP-A, very low hCG, increased nuchal translucency
Very low PAPP-A, low hCG, increased nuchal translucency
Low AFP, uE3
High hCG, Inh A
VERY LOW uE3, hCG
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
What does the quad screen consist of
Maternal serum aFP
Maternal serum inhibin A
Which screening test is performed in all pregnant women at 16-18 weeks gestation
Which screening can determine karyotype
When is chorionic villi sampling performed
Early detection of chromosomal abnormalities in higher risk patients (advanced age, hx of children wit genetic defects)
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