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Medicine II > Pregnancy > Flashcards

Flashcards in Pregnancy Deck (98):
1

When does pregnancy begin?

first day of last menstrual cycle

2

fetal age at first missed menses?

3 weeks

3

gestational age at first missed menses?

5 weeks

4

pregnancy urine test

2 weeks after conception

5

serum pregnancy test

9 days after conception

6

how many weeks is an average pregnancy?

40 weeks (38-42 weeks normal)

7

first trimester

until 14 weeks

8

second trimester

until 28 weeks

9

third trimester

until delivery

10

What does compression of the IVC in supine position cause?

supine hypotention

11

supine

lying facing upwards

12

hypotention

abnormally low blood pressure

13

symptoms of supine hypotension

-feeling faint/dizzy
-vision "going grey"
- palor
- nausea
- drop in blood pressure from decreased venous return to heart
-decreased blood flow to uterus

14

What position helps with supine hypotention

left lateral tilt position
-sit patient up, fully recline chair and roll patient to left side

15

positioning of pregnant patient

-use semi-reclining position as tolerated
-encourage frequent position changes
-place small pillow under right side to tilt patient to the left

16

What is the total weight gain in pregnancy?

27.6 lbs

17

What is the ideal weight gain in in pregancy?

25-35 lbs

18

What are some significant cardiovascular changes with pregnant women?

increase in plasma volume and cardiac output (HR + SV)
or decrease in peripheral vascular resistance and BP

19

what are some respiratory changes in pregnant women?

increase in minute ventilation and tidal volume
-in 3rd trimester, supine position can impair respiratory function

20

in what trimester can supine position impair respiratory function?

3rd

21

Gastrointestinal changes in pregnant women

-gums can become hyperemic
-decreased motility of GI tract (constipation, reflux, heartburn)
-relaxed esophageal spincter (GERD and increased risk of aspiration esp in surgery (spinals/epidurals during cesareans help avoid)

22

hyperemia

increase of blood flow to different tissues in the body

23

gastrointestinal changes

nausea/vomiting (hyperemesis Gravidarum)
-70% experience in 1st trimester
-2% w/ hyperemesis

24

hyperemesis

surface enamel loss through acid-induced erosion
-1 tsp baking soda in 1 cup water- rinse after vomitting

25

Why should you avoid brushing right after vomiting?

can worsen already demineralized teeth

26

pregnancy periodontal disease

-affects 15% childbearing age
-up to 40% of pregnant women
-more common in low income women
-older age, smoking, diabetes increases risk

27

pregnancy gingivitis

-common (50-70%)
-hormones cause increased growth of gum capillaries -hypertrophy of gums
-inflammation: erythema and edema
-range from redder looking gums that bleed when brushing teeth to severe swelling and bleeding
-hormonal changes may cause shift in bacterial flora and increase susceptibility

28

pregnancy tumor

-pyogenic granuloma (not purulent)
-lobular capillary hemangioma

29

where can pregnancy tumors be found?

hands, arm, face

30

what percentage of pregnant women have pregnancy tumors

10%

31

What is pregnancy tumors often seen with

inflammatory gingivitis or area of local trauma/ irritation

32

pyogenic granuloma (pregnancy tumor)

-pedunculated outgrowth from interproximal gingiva
-anterior + maxillary
-smooth or lobulated red-purple mass
-early- vascular and bleeds easily
-later-less vascular, more collagenous and pink

33

pyogenic granuloma

mm to cm
-painless and soft

34

treatment of pregnancy tumor

most resolve after pregnancy, surgical excision if very bothersome?

35

periodontal disease

15% childbearing age women and 40% pregnant women

36

periodontal disease and preterm birth

- pathogen and proinflammatory cytokines spread via hematogenous transport

37

periodontal disease and preterm birth is associated with

CV disease, DM, respiratory function

38

2.8 fold increase risk of preterm birth with

maternal periodontal infection, intervention may not help

39

periodontal care in pregnancy

-VERY IMPORTANT
-GENERAL MATERNAL HEALTH MAINTENANCE
-STUDIES SHOW IT IS SAFE

40

no adverse serious medical events of adverse pregnancy outcomes for

-routine, essential dental care,
-nonsurgical periodontal care
-use of topical/ local anesthesia

41

is dental caries increased by pregnancy?

NO, pre-existing dental disease may become exacerbated due to pregnancy influences

42

teratogen

any agent or factor to which fetal exposure produces a permanent alteration in form or function of offspring

43

pre-implantation period

2 weeks from fertilization to implantation
-"all or none" period - death vs. injury w/ complete compensation

44

emybryonic period

-2nd through 8th week following conception
-organogenesis- structural malformations

45

fetal period

-9 weeks and beyond
-some organs still vulnerable (e.g. brain, heart)

46

determining teratogenicity

-timing of exposure
-duration of exposure
-route of administration
-concurrent exposure to other agents
-individual maternal + fetal metabolism
-placental transport

47

FDA category A

well controlled human studies show no fetal risk

48

FDA category B

animal studies show no risk but no human studies OR animal studies show risk but human studies show NO risk

49

FDA category C

animal studies show averse effects but no studies in women - benefits may warrant use

50

FDA category D

positive evidence of human risks but benefits may outweigh the risks

51

FDA category X

risks demonstrated and outweigh benefits

52

drugs contraindicated in pregnancy

alcohol
anticonvulsants
warfarin
ACE inhibitors
retinoids
androgens + DES
antineoplastic agents
antimicrobials

53

antimicrobials contraindicated in preganncy

tetracycline + sulfonamides

54

anticonvulsants contraindicated in pregnancy

phenytoin
carbamezepine
valproate
trimethadione
phenobarbitol

55

tetracyclines (doxy + monocycline)

yellow-brown discoloration of deciduous teeth

56

antibiotics with potential toxicity

sulfonamides (Bactrim)
nitrofurantoin (Macrodantin, macrobid)
tetracyclines

57

sulfonamides (bactrim)

-mixed data about teratogenicity
-displace bilirubin from protein binding sites
-theoretical concern hyperbilirubinemia near delivery

58

nitrofurantoin (macrodantin, macrobid)

mixed data about teratogenicity

59

ACOG says sulfonamides and nitrofurantoins safe in

2nd/3rd trimester but avoid in 1st unless it's the only option

60

antibiotics that are safe to use

penicillin
cephalosporins
erythromycin
clindamycin

61

analgesics in pregnancy

salicylates (aspirin)
indomethacin

62

salicylates (aspirin)

-potent PG inhibitor
-theoretical concern premature closure of ductus arteriosus
-no cases found when studied for preeclampsia prevention

63

indomethacin

-constriction of ductus arteriosus & pulmonary HTN
-decreased fetal urine output

64

analgesics in pregnancy

-acetaminophen safe to use
-narcotics safe to use (oxycodone, codeine)
-avoid aspirin use
-ibuprofen and naproxen (fair evidence of safety, avoid 1st and 3rd trimesters

65

when should you avoid ibuprofen and naproxen?

1st + 3rd trimesters

66

are local anesthetics safe to use in pregnancy?

yes!

67

general anesthesia

-non are teratogens
-if crosses CNS of mother, it will cross the placenta + depress CNS of fetus
-GI transit time is prolonged so risk of aspiration increased

68

nitrous oxide

-safe for pregnant women but
-chronic exposure (occupational) w/out proper scavenging of exhaleed gases assos with: reduced fertility + increased in miscarriages

69

X-rays in pregnancy

no single diagnostic X-ray procedure results in radiation exposure to a degree that would threaten the well-being of the developing pre-embryo, embryo or fetus

70

which radiologic tests are very safe in pregnancy?

-those that don't involve ionizing radiation like ultrasound and MRI

71

what radiation exposure is safe?

72

fetal exposures of CXR (2 views)

.02-.07

73

fetal exposures of skull film

.004

74

fetal exposures of CT scan head or chest

75

fetal exposures of CT abdomen

1-2

76

fetal exposures of daily background

.036

77

radiologic tests that are NOT SAFE in pregnancy

radioactive iodine for therapeutic purposes: 1 crosses placenta
2 affects fetal thyroid
3 especially if used after 10-12 wks
4 contraindicated in pregnancy
5 treat patients AFTER delivery

78

nuclear medicine tests to use cautiously

1 radiopaque contrast agents for CT/X-rays
-no problems in nursing babies
2 paramagnetic contrast agents for MRI
3 radionucleotide testing for V/Q, thyroid, bone and renal scans

79

fetal risks of high dose radiation exposure

-embryonic death
-teratogenic effects
-carcinogenesis
-genetic effect or germ cell mutations
-?? adverse genetic effects on future generations
-intrauterine growth restriction

80

embryonic death

-high-dose radiation before implantation
- most likely lethal to embryo
-animal studies
-"all or none" phenomenon in early embryonic development

81

teratogenic effects

-data from atomic bomb survivors
-growth restriction
-microcephaly
-mental retardation
-CNS effects greatest if exposed 8-15 wks
-threshold may be 20-40 rad

82

fetal risks of high dose radiation exposure- carcinogenesis

-unclear risk but probably small
-estimated 1-2 rad fetal exposure may increase incidence leukemia by 1.5-2
-estimated 1 in 1000 cases per rad
-background risk is 1 in 3000
nonirridiated sibs also have higher incidence

83

principles for radiographic testing in pregnancy

-no radiologic test performed unless medically necessary
-if testing indicated, shield the fetus and limit exposure
-do not put patient at risk by avoiding indicated test
-highest risk for fetus during organogenesis (3-10 weeks)

84

dental care in 1st trimester

evaluate dentition, perform established dentistry regimen

85

dental care in 2nd trimester

any routine or major necessary procedures

86

dental care in 3rd trimester

continue established maintenance programs; perform major procedures as required

87

all essential dental treatments can be maintained

routine extractions, periodontal treatment, restorations, continuation of orthodontic treatment, placement of movable and fixed prosthesis, placement of crowns

88

what is best left till postpartum period

elective surgery

89

how long should infants be breasted?

6 mos

90

how long should breasfeeding continue

until 1 yrs of age with supplementation of solid foods after 6 mos.

91

benefits of breastfeeding

-colostrum helps digestive system
-antibodies help immune system
-lower risk of asthma, obesity, allergies
-protein/fat better used than those in formula
-less gas, feeding problems, constipation
-less SIDS- sudden infant death

92

breastfeeding contraindicated

taking antineoplastic, thyrotoxic and immunosuppressive agents
-receiving radioactive isotopes
-undergoing chemotherapy or radiation therapy

93

safe meds for breastfeeding

antibiotics, antihistamines, nasal decongestants , analgesics, IV contrast agents

94

which antibiotics are safe for breastfeeders

penicillins, cephalosporins, macrolides, aminoglycosides

95

nasal decongestants

may reduce milk supply

96

analgesics safe for breastfeeders

tylenol, NSAIDS (no ASA), opiates (may cause sedation)

97

primary contraceptive methods

female sterilization, male sterilization, oral contraception, injectables/implant/patch, condom, others

98

hormonal contraceptives

supresses midcycle surge of LH from pituitary so ovulation does not occur
-supresses FSH secretion during folicular phase