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Pregnancy Flashcards

1
Q

Abnormally high AFP can indicate ___?

A

Neural tube defect

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2
Q

Abnormally low AFP can indicated___?

A 
Down's syndrome
abdominal wall defect
esophageal and duodenal atresia
renal and urinary tract anomalies
turner syndrome
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3
Q

Abnormally low estriol can indicate___?

A

Down’s syndrome

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4
Q

What is HCG?

A

hormone produced in the placenta

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5
Q

When do the levels in HCG rise?

A

4-16 weeks of pregnancy then gradually lessen

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6
Q

Abnormally high HCG can indicate____?

A

Down syndrome

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7
Q

Where is estriole produced?

A

by placenta

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8
Q

When is estriol detected in blood?

A

9th week of pregnancy

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9
Q

What does an abnormally low level of estriole indicate?

A

Down Syndrome

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10
Q

Where is Inhibin A produced?

A

fetus and placenta

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11
Q

Abnormally high inhibin A can indicated____

A

Down’s syndrome

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12
Q

Abnormally low level of inhibin can indicate?

A

Trisomy 18

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13
Q

What are the Triple/Quadruple screen?

A

AFT,Estriol,Ihibin A hCG

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14
Q

What syndrome is indicated when hCG, estriol and AFP are all low?

A

Edwards Syndrome

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15
Q

When is NFTU done?

A

Nuchal fold translucency Ultrasound is done between 11-14 weeks gestation

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16
Q

If nuchal fold is thicker than normal can indicated

A

Down’s syndrome

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17
Q

If NFTU is VERY HIGH? 99%?

A

congenital heart disease

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18
Q

When is CVS done?

A

9-11 weeks

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19
Q

When is amniocentesis done?

A

15-18 weeks

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20
Q

Why is amnio done in 30 weeks?

A

fetal lung maturity

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21
Q

Non Invasive Prenatal Testing-NIPT-when done?

A

after 9 weeks of pregnancy

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22
Q

What does NIPT screen for?

A 
trisomy 13-patau syndrome
trisomy 18-edwards
trisomy21-downs sydrome
triplody and microdeletion
sex chromosome deletion
baby's rh blood type and gender
has very high specificity
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23
Q

When is glucose challenge done?

A

24-28 weeks-1 hr glucose results>135 mg/dl >3 hr GTT

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24
Q

When is Vaginal Group B strep done?

A

35-37 weeks

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25
Q

When is Hgb and Hct done?

A

initial, then 24-28 weeks. If anemic, every 4-6 weeks to evaluate for iron replacement

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26
Q

When are STI’s tested?

A

initial, prior to EDC and wet mount as needed

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27
Q

What are presumptive-subjective signs of pregnancy?

A 
nausea
vomiting
urinary frequency
fatigue
perception of fetal movement
amenorrhea
breast changes
increased skin pigmentation
abdominal straie
stretch marks
linea negra
chloasma
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28
Q

What are probably-objective pregnancy signs?

A

abdominal and uterine enlargement
Hegar’s signs: softening of lower uterine segment palpate manual exam
Chadwicks signs-bluish discoloration of vaginal mucosa
Goodells signs-softening of cervix
Braxton Hicks contraction-4th month
Ballottment
Pregnancy test-HcG-blood or urine

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29
Q

What are positive signs of pregnancy?

A 
Absolute confirmation of pregnancy
detection of fetal heartbeat
perception of fetal movement by examiner
visualition of fetus bu U/S
6 week sac by U/S
8 week fetal plate and cardiac activity by U/S
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30
Q

Chadwick, Hegar and Goodells signs-presumptive, probably or positive?

A

probable

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31
Q

How often are visits from 28-37 weeks?

A

every two weeks

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32
Q

What is documented at every pregnancy visit?

A

weight, B/P, fundal height, FHT, fetal movement, urine for protein glucose and ketones and pregnancy problems, if any

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33
Q

Which vaccinations are contraindicated?

A

MMR

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34
Q

which vaccinations should be received during pregnancy?

A

Dtap and inactivated bacterial vaccines

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35
Q

What is Rubin’s pregnancy task?

A

Two of the four tasks are directed toward the outer world during pregnancy on behalf of her child: ensuring safety and acceptance of her unborn child. The other two tasks are directed toward the formation of the maternal role and relationship: developing the capacity to give and binding‐in to the as yet unborn child.

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36
Q

what is ideal weight gain for pregnancy?

A

25-35 pounds

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37
Q

What is ideal weight gain for 1st trimester?

A

5 lbs

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38
Q

What is ideal for weight gain in second and 3rd trimester?

A

.8-1 lb weekly

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39
Q

how many calories over norm should be added during pregnancy?

A

300 cal

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40
Q

How many calories should be added during breastfeeding?

A

500

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41
Q

how much calcium daily?

A

1000-1200

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42
Q

how much protein for pregnancy daily?

A

60-70 gm/daily

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43
Q

What is caffeine limit during pregnancy?

A

1200 mg-one 12 oz cup of coffee

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44
Q

how much folic acid daily?

A

30 mg daily

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45
Q

What are the warning signs to call provider about during 1st trimester?

A

abdominal pain, vaginal bleeding, passage of tissue, syncope

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46
Q

What is assessed during second second trimester

A

fetal movement quickening

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47
Q

when does quickening start?

A

16-20 weeks

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48
Q

what are the s/s of preterm labor?

A

infection, ischemia, unknown causes, abdominal pains
or cramping. low backache, change in vaginal discharge, diarrhea
pelvic pressure, contractions-or something not right

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49
Q

3rd trimester-what is done?

A

repeat VDRL ad Hgb, reevaluate antibody screen titer
Rh d immune globulin (RhoGam) to unsensitized Rh mother at 28 weeks
review s/s of alvor
perform cervical assessment
assess fetal lie and presentation during 36-40 weeks

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50
Q

Group B guidelines CDC 2020

A

PG w GBS bacteriuria, 10K colony forming units and women w previous affected infants receive intrapartum anbx prophylaxis and no need to be screened 3rd trimester
pg with asymptomatic gbs bacteriuria tx w 3-7 day course anbx to prevent pyelonephritis
al other pg women recto-vagina gbs screening 35-37 weeks
all women + for GBS should receive intrapartum prophylaxis at time of labor or PROM

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51
Q

1st line tx for GBS

A

Penicillin G 5 million followed by 2.5 million units every 4 hours until birth

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52
Q

What are the fetal well being tests?

A 
BPP-biophysical profile-real time U/S +NST to assess
fetal movement
fetal tone
fetal breathing
amniotic fluid
fetal heart rate
 score is a total of possible 10
8-10 is normal
if 6-repeat
if less, abnormal and consider delivery
Contraction stress test-CST
NST
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53
Q

What is reactive NST?

A

Non stress test is reactive and appropriate heart rate acceleration as opposed to non reactive NST which is an absence of appropriate heart rate acceleration of 40 minutes-add testing

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54
Q

What is a positive CST?

A

late decelerations following 50% or more of contractions deliver or do further testing

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55
Q

Negative CST

A

no late or variable decelerations-observe mother and fetus

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56
Q

Equivocal CST

A

late decelerations in <50% of contraction. repeat in 24 hours or do biophysical profile

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57
Q

What can be given for nausea?

A

B vitamin 10-25 mg po tid
if no relief, add dyoxylamine succinate-unisom 12.5 mg po qid or after meals only
wheat germ molasses, brewers yeast

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58
Q

if giving IV hydration, what do we add to normal saline/

A

100 MG THIAMINE TO FIRST IV LITER OF FLUIDS

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59
Q

therapeutics for constipation

A

citrucel 1 tbs in 8 oz water 1-3x daily
metamucil 1 tsp and same as above
fibercon 1-2 tabs and same as above

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60
Q

stool softener recommendations?

A

docusate sodium 50-100 mg 1 tab po daily or BID
senekot 1 tab @HS MOM
glycerin suppositories
hi fiber-dried fruit, prune juice, whole grains
hot liquid, more liquids and exercise

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61
Q

what is pityalism?

A

increased salivation

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62
Q

PPI during pregnancy?

A

aciphex, nexium, or prevacid

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63
Q

h2 blockers during pregnancy?

A

axid, pepcid,zantac,tagament

64
Q

What is PAPP-A test?

A

protein produced by the placenta in early pregnancy. Abnormal levels are associated with an increased risk for chromosome abnormality

65
Q

uterine size at 12 weeks

A

fundus at symphysis pubis-orange

66
Q

uterine size at 16

A

fundus midway between symphysis pubis and umbilicus-grapefruit

67
Q

uterine size at 20 week

A

fundus at umbilicus-honey dew

68
Q

uterine size over 20 weeks

A

abdominal measurement of fundal height

69
Q

When does auscultation of FHT begin?

A

8-12 weeks

70
Q

What is the difference between the tripe and quad screen?

A

Inhibin A added

71
Q

When is ultrasound done during pregnancy?

A

18-20 weeks

72
Q

Normal Hcg level when first pregnant?

A

5-50 mlu

73
Q

What is RIA fir>

A

quantitative result of HCG with levels as low as 5mlu/ml tand doubles til it reaches 10000 mIU/mg

74
Q

high AFP, and all other hormones are normal can indicated

A

open spina bifida

75
Q

what is a threatened abortion

A

suggests miscarriage might take place before the 20th week of pregnancy

76
Q

what are the s/s of threatened abortion?

A

vaginal bleeding with absent or minimal pain
closed, long cervix
positive pregnancy signs/symptoms

77
Q

What is spontaneous abortion?

A

spontaneous expulsion of products of conception

78
Q

What is a missed abortion?

A

when embryo or fetus has died, but a miscarriage has not yet occurred
The pregnancy is lost and the products did not leave the body

79
Q

What is septic abortion?

A

when the lining of the uterus and any remaining products of conception become infected
occurs when the tissue from a missed or incomplete miscarriage becomes infected
the infection of the uterus carries risk of spreading the infection and is a grave risk to the life of the woman-septicemia

80
Q

What is an inevitable abortion?

A

symptoms of miscarriage cannot be stopped and miscarriage will occur
vaginal bleeding-moderate to profuse with pain
cervical dilation and or effacement
symptoms of pregnancy may be decreased or absent

81
Q

what is an incomplete abortion?

A

when only some of products of conception leave body
moderate to perfuse vaginal bleeding for several weeks
may pass tissue
painful uterine cramping, contractions
symptoms of pregnancy may be absent

82
Q

what is complete abortion

A

all products of coception leave the body
PROFUSE BLEEDING
PASSAGE OF TISSUE AND LARGE CLOTS
ABDOMINAL CRAMPING OR UTERINE CONTRACTIONS

83
Q

Diagnostics of vaginal bleeding in 1st trimetester

A

HCG 1500-2000
transvaginal ultrsonography should detect a viable IUP hcg level over 3000
Transabdominal ultrasonography should visualize a viable IUP
cbc with diff and platelets
blood type/cross match, RH status
PT PTT, firinogen
Doppler U/S fetal heart tones?10-12 weeks
U/S-transvaginal
abdominal shoulder pain?

84
Q

What is Kleihauer-Betke Test

A

Kleihauer–Betke (“KB”) stain, Kleihauer test or Acid elution test, is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.

85
Q

What is abruptio placenta

A

Placental abruption is the separation of the placenta from the uterine lining. This condition usually occurs in the third trimester but can occur any time after the 20th week of pregnancy.

86
Q

what are s/s of abruptio placenta?

A 
sudden onset of dark red vaginal bleeding or no bleeding hypertonic uterus-rigid and tender
abdominal pain mild-severe
back pain maybe
check fetal heart tones
labor progression
87
Q

What is placenta previa?

A

a condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery of a baby.

88
Q

s/s of placenta previa?

A 
painless vaginal bleeding spotting to frank  blood
gush of fluid-sudden vaginal bleeding
uterus is soft and non-tender
may have cramping or uterine conractions
check fetal heart tones
89
Q

treatment for placenta previa

A 
maintain 02
maternal positioning to avoid vena cava compression
iv fluids
vital signs, FHR and uterine activity
consult/refer to physician
contractions: may start mag sulvate iv
c-section delivery
90
Q

What is ectopic pregnancy

A

fertilized egg implants in the tissue outside of the uterus and the placenta, and the fetus begins to grow there

91
Q

s/s of ectopic pregnancy

A

amenorrhea or irregular vaginal bleeding
abdomEn/pelvic pain
unilateral or generalized pain
vertigo and syNcope possible
shoulder pain with irritation of phrenic nerve
lower back pain
hemodynamic changes in vital signs (SHOCK)

92
Q

What are the findings in an abdominal exam for ectopic pregnancy?

A

masses:softness and tenderness
abdominal wall distention
rebound tenderness

93
Q

What are the symptoms of a patient who has ectopic pregnancy?

A

sudden acute localized pain with signs of internal henorrhage-rupture of fallopian tube
palpate uterine size
chadwicks
hegars
pelvic: tender adnexa with palpable mass-positive cervical motion tenderness

94
Q

Diagnostic tests for ectopic pregnancy

A

pregnancy test serum b hcg, serial tests
cbc, platelet, type and crossmatch, Rh, PTT
transvaginal U/S IU gestational sac with hCG at 1500MIU/ml
Transabdoinal U/S IU gestation sac with hCG at 6000 IU/ML
Doppler U/S for fetal heart tones>10-12 weeks
endometrial histology, laproscopy

95
Q

Management of ectopic pregnancy

A 
chemotherapeutic agent
methotrexate injection
rhogam
tylenol, ibuprofin
mild pain meds
cbc
monitor  bleeding
serial hcg
repeat ultrasound as needed
96
Q

What happens with serial hcg during ectopic pregnancy

A

rises slowly or plateaus

97
Q

what happens with serial hcg with IUP

A

level doubles every 2.7 days

98
Q

What happens with complete abortion serial hcg levels?

A

levels fall quickly

99
Q

PIH-what are triad of symptoms

A

hypertension in 1st semester-U/S for gestational trophblastic disease (Molar pregnany-also known as hydatidiform mole — is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta)
Edema
Proteinuria-urinary excretion of .3g protein or greater in 24 hour urine specimin
can include brisk DTR or clonus

100
Q

What is the hallmark of PIH?

A

Generalized vascular endothelial damage

101
Q

What is the increase of systolic mm hg and diastolic with PIH

A

30 mm hg systolic and 15 mm hg diastolic over baseline or BP at fist prenatal visit

102
Q

in order to diagnose pre eclampsia what is blood pressure?

A

150/90 two separate visits 6 hours apart or bp greater or equal to 140/90 after 20 weeks gestation

103
Q

What is eclapsia

A

convulsions in patient with preeclampsia

104
Q

what is considered mild hypertension?

A

140/90 on two occasions 6 hours apart

1-2+ on dipstick on two specimins in absence of UTI or at least 300 mg of protein in a 24 hour urine sample

105
Q

what are other symptoms of preeclapsia

A 
headache unrelieved by alagescs
epigastric pain 
severe heart burn
nausea and vomiting
edema-generalized and sudden weight gain
visual disturbances-blurred vision, pailledema, vessel narrowing
deep tendon reflexes-clonus
Small fundal height for gestational age
IUGR
oligohydraminosis a condition in pregnancy characterized by a deficiency of amniotic fluid. It is the opposite of polyhydramnios.
proteinuria/oliguria
106
Q

what is HELLP syndrome

A

severe hypertension-multiple organ involvement

107
Q

s/s of hellp syndrome

A

hemolysis
elevated liver enzymes
low platelets

108
Q

what are symptoms?

A

general malaise
epigastric pain
abnormal coagulation profile

109
Q

Eclampsia-complications?

A

fetal demise,
grand mal seizures
placental abruption
pulmonary edema

110
Q

physical exam with hypertension? what to look for

A

Did patient gain more than 2 lbs per week?
auscultate lungs
inspect pedal, hand and facial edema
can she wear rings and shoes?
check fundal height
palpate abdomen for hepatosplenomegal, and RUQ tenderness
observe bilateral lower edema and pitting edema
percuss liver enlargement
perform neurologic exam-hyperreflexia

111
Q

What are the diagnostic tests for pregnancy induced hypertension?

A

CBC, platelets, liver function tests, (ast/sgot/alt/sgpt/ldh)
coagulation studies, fibrinogen, PT, PTT
renal function tests (serum uric acid, serum albumin, serum creatinine, BUN, collect 24 hour urine-protein and creatinine clearance,
fetal evaluation, (NST AND BPP-BIWEEKLY)
u/s to rule out IUGR, oligohydraminios (Intrauterine growth restriction )

112
Q

what is the classic triad of hypertension during pregnancy?

A

hypertension, edema, proteinuria

113
Q

Can a pregnant patient take ACE ARBS or diuretics during pregnancy?

A

no because oftetrogenic effect

114
Q

What does the ACOG recommend for previous preeclampsia pregnancy?

A 
low dose aspirin, 81 mg
calcium supplementation if low calcium
hospitalization if client worsens
magnesium sulfate-seizure prphylaxis
monitor reflexes
monitor input and output
115
Q

what is therapeutic mgso4 level?

A

4-7 mg

116
Q

what are the s/s of magnesium toxicity?

A

nausea, thirst, flushing, oliguria
depression of reflexes
calcium gluconate at bedside for magnesium toxicity

117
Q

when does magnesium sulfate stop?

A

24 hours after delivery

118
Q

What is first line antihypertensives for diastolic BP over 110mg?

A

hydralazine, or labetalol or nifedepine

119
Q

What are contraindications in antihypertensive drugs and pregnant drugs with asthma?

A

no labetalol

120
Q

what can enhance fetal lung maturity prior to delivery in patients with severe hypertension?

A

steroids

121
Q

What are the cervical ripening agents?

A

prostaglandins or Misoprostol and/or oxytocin induction of of labor

122
Q

What is the treatment for hypertensive disorder during pregnancy?

A

narcotics for severe headacht relief
NO DIAZEPAM for seizures r/t newborn thermoregulation problems
delivery is only cure

123
Q

What is diabetes mellitus related to especially during pregnancy

A

older than 40 yo and overweight
peripheral insulin resistance\increased hepatic production of glucose
relative pancreatic insufficiency of insulin production

124
Q

what is the white classification of diabetes in pregnancy?

A
  • increase insulin resistant is r/t secretion of human placental lactogen and placental growth hormone
  • using insulin prior to pregnancy may need to double their insulin requirements during pregnancy
  • elevated levels of circulating estrogen, progesterone and rolactin may diminish peripheral sensitivity to insulin during pregnancy
125
Q

What are complicating factors of pregnancy diabetes mellitus

A

increased body weight
increased fat deposition
higher caloric intake
diminished physical activity can decrease insulin sensitivity during a normal pregnancy

126
Q

What are risk factors for gestational diabetes?

A 
history of previous GD pregnancy
large for gestational age infant>4100 gm
BMI .28 kg\m2
25 years and older
family history of type 2 diabetes
preious unexplained fetal demise
polycystic ovarian syndrome
127
Q

when should women be tested for gestational diabetes?

A

between 24-28 weeks

If hi risk, immediately and if normal retest at 24-28 weeks

128
Q

what are some therapeutic strategies during pregnancy?

A

daily glucose monitoring

nutrition counseling

129
Q

How is diagnosis of gestational diabetes made?

check page 12 for serum glucose results

A

Diabetes mellitus screening_measure plasma or serum glucose
-two step-1 hour 50 gm non fasting oral GTT
-130 mg/dl or> is 90% sensitivity
-140 mg/dl or > is 80% sensitivity
3 hour diagnostic 100 gm OGTT on another day after an overnight 8 hour fast
-3 hour gtt
3 day COH-LOADING DIET
- eat at least 150 g COH daily prior to the test date
NPO except water 10-12 hours prior to the test and until the test is complete
FBS is drawn first
100G GLUCOSE LOAD GIVEN
blood then drawn at 1 hour, 2 hours, 3 hours

130
Q

what is the preferred hemoglobin a1c in pregnancy?

A

< 6 %

131
Q

What is diagnostic criteria of gestational diabetes?

A

fasting equal or > 92 mg/dl
1 hour equal or >180
2 hour equal or > 153
3 hour equal or > 140 mg

132
Q

what percentage of carbs should compromise less than daily caloric intakes for GD

A

less than 50%

133
Q

how many servings of protein is recommended for gestational diabetes?

A

2-3 servings daily

134
Q

What is the glucose monitoring level for fasting?

A

<90 mg/dL

135
Q

what is glucose monitoring 1 hour post prandial?

A

less or = to 130 mg/dL

136
Q

what is glucose monitoring preferred for two hours post prandial?

A

120mg/dL

137
Q

What diabetes medications is safe and commonly used for GD

A

metformin and glyburide

138
Q

what are guidelines for insulin therapy?

A

FBS > 95
1 HOUR post prandial BG >140
2 hour post prandial BG > 120

139
Q

When does weekly BPP testing begin for GD (Gastrointestinal Pathogen Panel)

A

32-34 weeks depending on glucose control

140
Q

when does NST startd for GD?

A

32 weeks depending on glucose control

141
Q

how often is U/S done for GD?

A

4-6 weeks

142
Q

What should practitioner evaluate at visit?

A

fetal growth, fetal weight, malformations,(polyhydramniosis a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm.)

143
Q

what are the fetal effects of GD?

A

macrosomia;
- birth asphyxia dystocia, brachial plexus
-fracture of the clavicle and humerus
-increase need for forceps delivery and C/S
+develop neonatal hypoglycemia (glucose <40 mg/dL)
+respiratory distress syndrome, hypocalcemia and hyperbilirubinemia
+congenital malformation-seen in infants with mothers who had poor glycemic control at conception and throughout first trimester
+seen in type 1 and 11 diabetes?
ventricular and atrial septal defects
transposition of the great vessels
gi atresias, neural tube defects
urinary tract malformations
+association between 1st trimeter spontaneous abortions and DM

144
Q

What is the problem with patient with GD and ph of pregnancy says mild alkalosis?

A

patient may still be in DKA with a pH of 7.4 or greater

pregnant patient can be hyperglycemis with a serum bG of only 200mg/dL

145
Q

how to treat Diabetic ketoacidosis during pregnancy?

A

ICU admission
insulin
fluids and volume monitoring
fetal heart monitoring-may have uterine contractions but dont treat unless cervical dilation is evident

146
Q

post partum treatment for GD

A

self monitor-FBS AND TWO HOUR POST PRANDIAL BS X 7 DAYS
evaluate for DM FBS> 120 mg/dL
2 hour post prandial BS> 160mg/dL
test at least every 3 years afterwards

147
Q

when is eye exam done for GD?

A

prior to conception and during 1st trimester

148
Q

how does pregnancy asthma present?

A

dyspnea
productive/nonproductive cough
tight chest symptoms- worse at night

149
Q

what will the NP find during physical assessment of pregnancy asthma?

A 
rapid pulse
high blood pressure
increased respiratory rate
chest: diminished breath sounds
wheezing, rhonchi, prolonged expiratory phase,
maybe utilizing accessory muscles
150
Q

complications of asthma during pregnancy

A

hyperemesis, preeclampsia and hemorrhage
neonatal mortality
premature birth

151
Q

Diagnostic for pregnanyc asthma

A

leukocyte count with differential may show eosinphilia
Pulmonary function test-obstructige pattern
peak flow meter
chest x-ray-pnuemonia

152
Q

TX for asthma during pregnancy

A

02 (paO2 level < 60 mm/hg or 95% O2 saturation)
fetal monitoring
give beta agonist-albuterol via nebulizer as needed
terbuline-2 inhalations every 4 ho urs up til 8 inhalations daily-if regular daily use, additional daily meds needed
Cromolyn-2 inhalations 4x daily
inhaled eclomethasone/budesonide
immunomodulators: singulair, xolair
oral theorphylline
oral predisone if all fail: 1 week of 40mg daily then 1-2 weeks tapering

153
Q

what is the mainstay of treating exacerbations of asthma during pregnancy?

A

beta adrenergic agonists

154
Q

How to treat moderate persistent asthma during pregnancy?

A

beta adrenergic agonist cobined with an inhaled anti inflammatory agent or inhaled corticosteroid is recommended

155
Q

how is severe asthma treated in pregnancy?

A

oral corticosteroids and beta agonists are recommended

pregnancy (2 decks)

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