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Flashcards in pregnancy Deck (41):
1

preggo dx

Fetal heart tones by ultrasound: 5-6 weeks
Fetal heart tones by Doppler: 10-12 weeks
Fundus above pubic symphasis: 12-15 weeks
Fundus at umbilicus: 20 weeks

2

Pregnancy: dating

Last menstrual period
Naegele’s rule: LMP + 7 days – 3 months
Eg LMP 1/11 + 7 days = 1/18 – 3 months = 10/18
Pregnancy wheel

PLUS ultrasound
First trimester: 1 week variation (most accurate)
Second trimester: 2 week variation
Third trimester: 3 week variation

3

HCG

Identical alpha subunit as: LH, FSH, TSH

Maintains corpus luteum  progesterone: 8-10 wks

-Elevated: multiples, hydatidiform moles, choriocarcinoma, Down syndrome
-Decreased: abnormal pregnancy, Edward syndrome, Patau syndrome

4

HCG secreted by ??

Secreted by syncytiotrophoblasts in the placenta
Double every 29-53 hours

Blood: within 1 week
Urine: within 2 weeks

Peak at 8-10 weeks
Around 60,000-90,000

5

slide 9

gestational landmarks

6

trimester definitions

First trimester: 0-12 weeks
Second trimester: 12-28 weeks
Third trimester: 28-42 weeks


7

term definitions

Full term: 37 weeks
Late preterm: 34 – 36 6/7 wks
Early term: 37 – 38 6/7 wks
Full term: 39 – 40 6/7 wks
Late term: 41 – 41 6/7 wks
Post term: ≥ 42 wks

Fetal “viability”: 24 weeks (can be resuscitated)

8

Initial laboratory tests:

Blood type
Rhesus type
Antibody screen
Hemoglobin/Hematocrit
Sickle cell screening?
Rubella immunity
Varicella immunity
Urinalysis and urine culture
STIs
Gonorrhea/Chlamydia
Syphilis (RPR)
Hepatitis B (HBsAg)
HIV
Cervical cytology

9

optional lab tests

Fetal aneuploidy screening
Invasive: CVS or amniocentesis
Noninvasive:
-“First trimester screening” (nuchal translucency (12wks, PAPP-A, HCG) ~90% sn
-Quad screen (2nd trim.: maternal a-FP, UC estradiol, HCG, ??) 60-70% sn.
-Cell free fetal DNA
Screening for CF, SMA
Fragile X

Tay-Sachs, Canavan dz, familial dysautonomia for Ashkenazi Jewish population

10

Ovulation--> Fertilization


Occurs in ampulla of fallopian tube
Occurs within 1 day of ovulation

11

Fertilization-->Implantation

Occurs in the wall of the uterus
Occurs within 6 days of ovulation

12

s/s preggo dx

labs??

imaging??

Amenorrhea
Nausea/vomiting
Breast tenderness
Urinary frequency/urgency
Fatigue
Vaginal cyanosis
Enlarged/globular uterus
Softened cervix

labs: HCG
imaging: U/S

13

prenatal visits

Q4 weeks – until 28 weeks
Q2 weeks – until 36 weeks
Q1 week – until delivery

14

every prenatal visit

Weight
BP
Fundal height
FHTs
Urine protein
Urine glucose

15

6-12 weeks ??

12 weeks ??

16-20 weeks??

20 weeks ??

Confirm dates
CVS

First trimester screening

AFP or Quad screen
Amniocentesis

Fetal anatomy ultrasound
Cervical length

16

24-28 Weeks

28 weeks?

35-36 wks?

41 wks?

Gestational Diabetes screening

Rh0 (D) Immune Globulin
Tdap

GBS screening

Antepartum fetal testing

17

patient education: diet

Folic acid: 0.4mg/day
Weight gain:
BMI 30: 11-20 lbs

18

patient education: caffeine and foods to avoid

Caffeine: 200-300mg/day
Avoid: Raw meat, Raw fish, Unpasteurized cheese, Deli meat, Fish with high mercury level
Thoroughly wash fruits/veggies
-to avoid Toxoplasmosis, Listeriosis, Brucellosis

19

pt education: etOH and smoking

Alcohol: Fetal alcohol syndrome: growth restrictions; facial, skeletal and cardiac abnormalities; CNS dysfunction
Cigarette smoking:
Placental abruption
Placenta previa
PROM, PTD
Low birth weight

20

drug use

Cocaine: PROM (prem. rupture of membranes), PTD, abruption, IGUR, neurobehavioral deficits, SIDS
Amphetamines: PROM, PTD, abruption, IGUR, neurobehavioral deficits, SIDS
Opioids: IUGR, PTD, fetal death

21

radiation

Excessive radiation
-less than 0.05 Gy (5 rads): no problem, carcinogenesis? (unclear)
-0.05 – 0.50 Gy (5-50 rads): unknown
-First 14 days: “all or nothing”: 1 Gy kills 50% of embryos
-14 days – 20 weeks
Possible malformations, mental retardation or growth restriction more than 0.1-0.2 Gy
-Ultrasound/MRI: no problem

22

other things to avoid

Excessive heat (hot tubs/saunas)
Radiation or chemical hazards
Cat litter/feces

23

Rhesus alloimmunization: IF Rh0 (D) negative mother has Rh0 (D) positive fetus

Fetal red cells enter the circulation
Rh0 (D) antibodies are formed
These antibodies can cause hemolytic disease for subsequent Rh0 (D) positive fetuses

24

Rh0 (D) immune globulin = concentrate of antibodies against Rh0 (D) antigen

Destroy fetal Rh0 (D) positive cells
Mother does not form antibodies
300 mg
Lasts 12 weeks

25

travel

Okay to travel up to 32 weeks

Do not travel to endemic areas of yellow fever or malaria

26

teratogen chart

25

27

NO live virus vaccines:


MMR
Yellow fever
Small pox
Varicella

28

Should vaccinate:

Hep B
Influenza
Tdap

29

OMM

-Increasing lumbar lordosis
-Anterior pelvic tilt due to center of gravity shifting anteriorly
-Strained lower back muscles can lead to Unlevel sacral base, Unequal length of the LE
-Interstitial edema increases Carpal tunnel syndrome, Myofascial dysfunction
more slide 27

30

physiologic changes in pregnancy

listen

31

labor

painful contractions and cervical change

32

stage 1 labor

begining to contract: gets to 10 cm
18-24 hours

33

stage 2 labor

complete dilation to baby out
3 hours w. epidural, 2 hrs w.out

34

stage 3 labor

baby out to placenta out
less than 30 min, if more get it out

35

labor dystocia

Protracted labor (taking too long)
Arrest of dilation
Protracted second stage (taking too long while pushing)
Arrest of descent
Retained placenta

Management:
Oxytocin augmentation
Amniotomy
Fetal rotation
Operative delivery (pull the baby out)

36

cervical change

Dilation (cm), effacement (%), station (cm) (where head of baby is)
(eg 5/90/-1)

37

cardinal movements

Engagement/Flexion
Internal rotation
Extension
External rotation (restitution
slide 32

38

OA vs "sunny-side up"

want to be OA, face down

39

Tocometer: measures ??

contractions
-Intrauterine pressure catheter (IUPC): direct measurement of contraction force
-Montevideo units (MVU): area under the curve x10 minutes

40

Doppler: measures ??

fetal heart tones (FHTs)
-Fetal scalp electrode (FSE): attaches to baby’s scalp for more accurate FHTs

41

FHTs

-Baseline: 110-180
-Variability:
Absent
Minimal: less than 5bpm
Moderate: 5-25bpm
Marked: more than 25bpm
-Accelerations: 15 beats above baseline x15 seconds
-Decelerations
Early
Late
Variable
Prolonged