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Flashcards in PREGNANCY Deck (48):
1

What is Goodell's sign

softening of the cervix

2

What is Chadwicks sign

Cervical cyanosis

3

What is Hegars sign

Softening of he cervicouterine junction

4

When do you start auscultating for fetal heart tones

10-12 weeks

5

When does fetal heart start functioning

8 weeks

6

How many weeks until fetal movement

18-20 weeks

7

How many weeks until you can do leopold maneuvers

after 20 weeks

8

How many weeks is the 1st, 2nd and 3rd trimester

first trimester- 0-12 weeks
Second trimester 13-27 weeks
Third trimester 28-40 weeks

9

What findings may be present for first trimester, by 8 weeks gestation?

Goodell's sign, Chadwicks sign, Hegars sign, breast enlargement. Fetal heart tones by 10-12 weeks

10

How many weeks is the fundus at the umbilicus?

at 20 weeks

11

When is it possible to do leopold maneuvers?

after 20 weeks

12

When does lightening occur?

May happen up tp 3-4 weeks prior to labor

13

When does the loss of the mucus plug occur?

prior to labor by approx 1 week

14

What tests do you run for a pregnancy?

urine or serum to confirm pregnancy
Quantitative titers performed on serum hCG only
Ultrasound
and first trimester screening

15

What tests do you run for first trimester or new visit?

U/A
Urine C&S
CBC
Blood group and Rh
Antibody screening
RUbella
HbsAg
Syphilis testing
HIV
PAP- regular PAP
Cervical cultures
STD
Ultrasound for unsure dates
Chronic villus sampling (CVs)

16

What is the second trimester tests

Amniocentesis at 15-20 weeks if family history of chromosomal abnormalities or advanced maternal age
Triple or quad screening
Ultrasound for fetal survey at 18-20 weeks
1 hour gtt at 20 week if family hx or patient weight >200lbs

17

What are included in the triple and quad screening

hCG, estriol and AFP in the triple
hCG, estriol, AFP and inhibin-A (more sensitive for down syndrome) in quad screening

18

What tests are done in the third trimester?

1 hour GTT at 28 weeks
RhoGAM for unsensitized Rh-negative mothers at 28 weeks
H&H at 28-36 weeks dependent on previous levels
NST/ biophysical profile as needed

19

What is the scheduling of prenatal visits

0-28 weeks: every 4 weeks
28-26 weeks: every 2 week
>36 weeks to delivery is weekly

20

What is Naegeles rule?

Estimated date of confinement. Based on first day of last menstrual period. 1 year -3 months +7days

21

What PE and and labs for every visit?

BP, weight, fundal height in cm, FHT, fetal movement, presentation, fetal lie/ position
Labs: Routine plus urine for protein, glucose, and ketones at each visit

22

What are the physical examine signs of a ectopic pregnancy

Tender adnexa with possible palpable mass
cervical motion tenderness
Uterine enlargement with he gars sign
Positive peritoneal signs/ vaginal bleeding

23

Definition of abortion

pregnancy termination prior to viability (24 weeks)

24

What are the medical forms of abortion

mifepristone (mifeprex), also known as RU 486= abortion
Prostaglandin (misoprostol) (drug used in NSAID induced prophylaxis)

25

Definition of PIH

BP>140/90 or rise in systolic >30mmHg of diastolic >15mmHg above established baseline on at least 2 occasion with readings six hours apart

26

Definition of preeclampsia

PIH+proteinuria+generalized edema after 20 weeks gestation

27

Definition of eclampsia

preeclampsia + seizure activity

28

Define HELLP syndrome

hemolysis elevated liver enzymes and low platelet count , DIC in pregnancy

29

Risk factors for PIH

pre-exitsting HTN, renal or CV disease
diabetes
lupus or autoimmune disorder
multiple gestations
Primigravida
Personal or family hx of PIH or preeclampsia
Maternal age at either end of time line

30

Testing for PIH

BP surveillance
CBC, LFTs, 24 hour urine for protein, Cr and clearance
NST after 32-34 weeks PRN
Ultrasound PRN, usually for lag in fetal growth as a result of PIH

31

Management of PIh

Rest at home, if condition worsens bed rest in left lateral position
Fetal surveillance: NST, US and kick count

32

s/sx of Preeclampsia

sudden weight gain
Progression from digital and mild facial edema to generalized edema
Frontal or occipital headaches
Visual disturbances with worsening condition (pre-sz)

33

What are the physical findings with preeclampsia

1) HTN >140/90 or >30/15 above established baseline
+2)Proteinuria- Trace to +1 on a voided sample; progressing to +2 with worsening condition
+3) Edema- nondependent edema >1+ progressing pretibial edema>3-4+. Worsening facial and generalized edema
+4) weight gain- greater than 2 lbs per week or 6 lbs in 1 month. Lagging fundal height
Reflexes WNL or progressing to 3-4+ with worsening condition

34

S/SX of eclampsia

PIH+pre-eclampsia+seizure
MAy have prodromal symptoms of severe, unrelenting headache, epigastric or RUQ pain worsening, visual changes, including spotty vision, blurriness or blindness
2) BP consistently >160/100
3) tonic-clonic seizures
4) oliguria, may progress to anuria
5) fetal distress in utero

35

S/SX of HELLP syndrome

Pre-eclampsia +plus N/V, jaundice, extreme fatigue
Hepatomegaly
Tenderness to pain in RUQ, extending to gastric area
Jaundice
Possible ascites

36

definition of placenta pre via

mal-implantation of the placenta in the lower uterine segment

37

Definition of placenta abruptio

separation of the placenta from the uterine wall, completely or partially

38

risk factors in placenta pre via

previous c-section or uterine surgery
Multiparity
Malpresentation (breech or transverse lie)
Hx of placenta pre via

39

risk factors of abruptio placentae

trauma, previous abruptio, chronic HTN/ pre-eclampsia/ eclampsia, cocaine use, ETOH or smoking, uterine tumor or structural abnormality

40

S/SX of placenta pre via

Bleeding is PAINLESS
MAY OCCUR AFTER ANYTHING PUT IN THE VAGINA
May have no precipitating factor
No evidence of contractions
No uterine tenderness
Often little to no fetal compromise unless bleeding is severe or other cause of distress exists

41

S/SX of abruptio placentae

SEVERE ABDOMINAL PAIN
BRIGHT RED blood is heavy if unconcealed
May be minimal to moderate bleeding if abruption is concealed
uterus is rigid in abruption
shock
fetal distress/ absent FHTs

42

Characteristics of placenta pre via

cervical os may be partially, completely or magically covered
Bleeding usually occurs in the late second to early third trimester often precipitated by vaginal intercourse

43

Characterisitcs of abruptio placentae

2nd or third trimester, initiated by number of factors. Hemorrhage may be sudden and life threatening to baby and mother. May lead to DIC

44

Management of placenta pre via

No bimanual exam, speculum exam only to determine extent of bleeding nothing in the vagina
Hospitalization, NST
If fetus is mature, expect delivery

45

Definition of premature labor

contractions after 20 weeks but before 37 weeks gestation which result in the dilation and or effacement of the cervical os; contractions may not be perceived as painful

46

Risk factors of premature labor

Hx of preterm delivery
Genital or urinary tract infections
Multiple gestations
Low income
Poor weight gain, poor nutrition
Drug use, especially cocaine
Smoking
Uterine structural abnormalities
Cervical trauma
Adolescent or advanced maternal age

47

S/sx of premature labor

uterine cramping that is intermittent or constant
LBP constant to intermittent
Uterine contractions 10-12 minutes apart
spotting or change in vaginal discahrge
Cervical dilation or shortening

48

what s risk of ectopic in general population?
using or have used an IUD?
tubal sx?
prolapsed intervetebral disc?

2%
9%
15%
15%