Physiology of Pregnancy

Question 1

What at what point does an embryo become a fetus

Answer 1

8 weeks (cardiac activity?)

Question 2

Defn of grand multip

Answer 2

parity >/= 5

Question 3

What is Charwicks sign

Answer 3

blue discoloration of cervix (early sign of preg)

Question 4

What is goodell sign

Answer 4

softening of cervix (early sign of preg)

Question 5

What is hegar/ladin sign?

Answer 5

softening of uterus

Question 6

What is naegele’s rule

Answer 6

EDC = LMP + 1yr -3m + 7d

Question 7

What are indications for US

Answer 7

uncertain gestational age
size/date discrepencies
multiple gestations

Question 8

uterus at
pubic symphysis = __ wks
umbilicus = ___ wks
xiphoid process = ___ wks

Answer 8

12
20
36

Question 9

How can heart sounds change in preg?

Answer 9

split S1
S3
systolic murmur (2/2 inc BV)

Question 10

What is avg materanl HR when baby is at term

Answer 10

108 bpm

Question 11

how does BP change in preg

Answer 11

dec 2/2 to dec in scr (2/2 effecrts of progesterone/vasodil substances being produced)

Question 12

acid base state in preg + why?

Answer 12

compensated repiratory alkalosis

Bohr effect, inc RR inc CO2 gradient to inc gas exchange with fetus

Question 13

Tidal volume inc or dec in preg

Answer 13

increase (dec in FRC) (also dec FRC due to elevated diapragm)

Question 14

What is the cause of morning sickness?

Answer 14

elevated E/P/hCG

Question 15

how do kidneys change in pregnancy?

Answer 15

they enlarge, ureters dilate (R>L), hydronephrosis, GFR increased by 50%

Question 16

what causes ureters to dilate/hydronephrosis

Answer 16

progesterone and compression by enlarging uterus

Question 17

is preg a hypercoagulable state?

Answer 17

yes! inc E2

Question 18

why are preg women anemic

Answer 18

dilutional,there is an inc in plasma volume > inc RCV

** but still need inc Fe bc they are making more RBCs

Question 19

What is the signaling for increased intravascular volume during pregnancy

Answer 19

inc renin –> inc angiotensin –> inc Na retention –> retain fluid to inc intravascular volume

Question 20

when does hCG peak?

Answer 20

~10 weeks (doubles every 48 until this point)

Question 21

What is responsible for maintianing fetal nutrition? Effects on mom?

Answer 21

hPL: inc maternal lipolysis and dec glc uptake by mom (anti-insulin effect) which allows for more glc to be available for fetus

–> mom in diabetogenic state with glucosuria and ketonuria

Question 22

change in posture late in preg

Answer 22

hyperlordosis

Question 23

Skin changes in preg? cause?

Answer 23

spider angiomata and palmar eryethema (2/2 inc E)

linea nigra and melasma/chlosasma (2/2 inc MSH)

Question 24

How does PTH change in preg? Why?

Answer 24

increases, to cause inc Ca abs and vit D for growing fetal bones

Question 25

changes in TSH, T3/4 during preg

Answer 25

transient dec TSH nc hCG is structurally similar to TSH tp the pit gland dec production Total T3/4 increases because thyroid binding globilin increases, howevere free T3/4 remains normal

Question 26

vits/minerals/diet changes needed in preg

Answer 26

inc kcal, folate, iron, vit C, omega 3 FA | dec vit A (teratogenic), calcium (still need but it chalates Fe)

Question 27

what are braxton-hicks contractions?

Answer 27

irreg contractions w/o cervical dilation

Question 28

how to manage GERD in preg

Answer 28

antacids , PPIs or H2 blockers if severe

Question 29

What is round ligament pain + Tx?

Answer 29

shooting pelvic pain due to round ligament stretching, Tx is tylenol + warm compress

Question 30

Tx for varicose veins in preg

Answer 30

elevate legs + compression stockings

Question 31

management for hyperemesis gravidarum

Answer 31

NPO x 3 days, IVFs + anti-emics, if very severe give doxylamine/unisom (1st gen antihistamine)+ vit B6

Question 32

management of hemorroids in preg

Answer 32

topical steroids, fiber, stool softeners, sitz baths

Question 33

how often should preg pt be seen in office during preg

Answer 33

1x in first trimester q4wk until 28 weeks q2wks until 36 qwk until delivery

Question 34

When is Rh status checked? how it it interpreted

Answer 34

before 28 wks, if Rh- give rhogam at week 28 and postpartum (if baby Rh+)

Question 35

how to manage baby if mom is HBsAg +?

Answer 35

infant HBIG anf HBV vaccine

Question 36

What is the biobyphysical profile (BPP)? What are the components? How it scored/interpreted?

Answer 36

prenatal US evaluation to assess baby" The BPP has 5 components: 4 ultrasound things +NST. The NST evaluates fetal heart rate and response to fetal movement. ``` The five discrete biophysical variables: Fetal movement Fetal tone Fetal breathing Amniotic fluid volume Fetal Heart Rate ``` BPP >8: normal BPP =6: get CST** see next card BPP <4: deliver

Question 37

What is CST/OCT

Answer 37

CST/OCT (ctx stress test/oxytocin challenge test): give oxytocin, look for 3 ctx/10 min w/o late decels **assessed if baby can tolerate labor