Pregnancy Flashcards
(178 cards)
1
Q
Abruptio placentae presentation
A
- sudden onset vaginal bleeding
- contracted uterus
- painful
- 20% without bleeding (trapped between placenta and uterine wall)
- severe cases lead to hemorrhage and loss of life.
2
Q
High risk for abruptio placentae
A
- HTN
- preeclampsia
- cocaine use
- history of abruptio placentae
3
Q
Placenta previa complaints
A
- new onset painless vaginal bleeding
- worsened by intercourse
4
Q
Placenta previa presentation
A
- uterus soft and nontender
- if cervix not dilated –> strict bed rest
5
Q
What is administered if there is cramping with placenta previa
A
IV mag
6
Q
Placenta previa and vaginal insertion
A
anything in vagina is absolute contraindication
7
Q
Preeclampsia presentation
A
- sudden onset of severe recurrent headaches
- visual abnormalities
- pitting edema (face, eyes, fingers)
- sudden rapid weight gain
- new onset RUQ pain
- BP >140/90
- urine protein >+1
- decrease in urine output (oliguric)
- N/V –> encephalopathy
8
Q
Earliest time period that preeclampsia/eclampsia can occur
A
20 weeks
9
Q
Cure for preeclampsia/eclampsia
A
delivery of baby
10
Q
HELLP stands for
A
Hemolysis, Elevated Liver Enzymes, Low Platelets
11
Q
What is HELLP
A
serious but rare complication of preecmplsia/eclampsia
12
Q
HELLP presentation
A
- s/sx if preeclampsia with RUQ pain
- labs: elevated LFTs, elevated bilirubin, elevated LDH
- low platelets and Hgb/Hct
13
Q
Which lab value is expected to increase in pregnancy
A
- alk phos
- WBCs
- ESR
- Total T3
14
Q
Why is alk phos elevated in pregnancy
A
- due to growth of fetal bones
- higher in multiple gestation pregnancies
15
Q
Why are WBC’s elevated in pregnancy
A
- leukocytosis with neutrophilia normal if without s/sx of infection
- high throughout pregnancy
16
Q
When is ESR elevated in pregnancy
A
-elevated by 3rd trimester
17
Q
Why is total T3 elevated in pregnancy
A
- increased levels of thyroid binding globulin
- TSH, free T3, free T4 should remain unchanged
18
Q
Which lab value is expected to decrease in pregnancy
A
-Hgb and Hct
19
Q
Why is Hgb and Hct low in pregnancy
A
- hemodilution
- to rule out IDA, check MCV
20
Q
Where is serum AFP produced
A
- liver of fetus and mother
- majority of maternal AFP comes from fetus
21
Q
What does low AFP indicate
A
- possible DS
- order triple screen or quad screen
22
Q
What is the triple screen
A
- AFP
- hCG
- estriol
23
Q
What is the quad screen
A
- AFP
- hCG
- estriol
- inhibin-A
24
Q
What does high AFP indicate
A
- rule out neural tube defects or multiple gestation
- most common reason is pregnancy dating error
- Order triple/quad screen and US to r/o NTD
25
Prevention of NTD
- folic acid 400 mg per day
| - take prenatals when planning on getting pregnant
26
Gold standard for testing genetic disorders
fetal chromosomes/DNA
27
Which genetic disorder is most common among Jewish descent
- Tay-Sachs disease
| - no cure
28
Which genetic disorder is most common among whites
cystic fibrosis
29
Which genetic disorder is most common among AA
sickle cell anemia
30
When can CVS be done
10-12 weeks
31
When can amniocentesis be done
15-18 weeks
32
When is "doubling time" of hCG not used
after 12 weeks
33
Normal hCG levels
-hCG doubles every 48 hours during first 12 weeks
34
Ectopic pregnancy and hCG
- hCG lower than normal
| - increases slowly and does not double as expected
35
Inevitable abortion and hCG
- hCG decreases rapidly, no doubling
| - cervix dilates
36
When is GBS tested
- 35-37 weeks
| - swab vaginal introitus and rectum for C&S
37
What to do if GBS is positive
- intrapartum abx prophylaxis of PCN G 5 million units IV
| - followed by 2.5-3 million units IV every 4 hours until delivery
38
Which STD's to test for
- HBsAg
- HIV
- gonorrhea
- chlamydia
- syphilis
- HSV 1 and 2
39
Which titers to test for
- rubella
| - varicella
40
Category A drugs
- prenatal vitamins
- Insulin
- Thyroid hormone
41
Category B drugs
- antacids
- colace (stool softener, laxatives should not be used)
- analgesics (acetaminophen preferred)
42
Category B antibiotics
- PCN
- cephalosporins
- Macrolides
43
Safest antidepressant to use with pregnant women
-Sertraline (Zoloft)
44
Antihypertensives for pregnant women
- Methyldopa
- CCB (Procardia)
- Labetalol (Normodyne)
45
Which antibiotics are safe for pregnant women
- Amoxicillin,
- other PCN
- cephalopsorins
46
NSAID's and pregnancy
- avoid in third trimester; blocks prostaglandins
- either B or C depending on type of NSAID and which trimester
- Can cause premature labor
47
Category D drugs
- ACEI, ARB
- FQs
- Tetracyclines
- NSAIDs
- Sulfa drugs
48
Why are ACEI/ARBs contraindicated in pregnancy
- fetal renal abnormalities
- renal failure
- hypotension
49
Why are FQs C/I
- fetal cartilage development
| - C/I pregnant, lactating, or <18 years old
50
Why are tetracyclines C/I
-stains growing tooth enamel
51
Why are sulfa drugs C/I
- risk of hyperbilirubinemia
| - displaces bilirubin from albumin
52
Which vaccines are C/I in pregnancy
- MMR
- oral polio
- Varicella
- FluMist
53
What to do if patient received live vaccine and wants to become pregnant
-advise not to get pregnant in next 4 weeks with MMR or 3 months with varicella and shingles
54
Is chronic hyperglycemia considered a teratogen
Yes
| -increases risks of NTD and craniofacial defects
55
What foods to avoid during pregnancy
- soft cheeses (blue cheese, brie)
- uncooked meats
- raw milk
- raw shellfish or oysters
- cold cuts, uncooked hot dogs
56
Are hot tubs okay to use during pregnancy
No
| -avoid hot tubs, saunas, or excessive heat
57
Is coffee okay during pregnancy
- 8 oz/day is okay
| - do not consume too much -- premature labor
58
Normal weight gain for normal weight patients
-total of 25-35 lbs
59
Weight gain for underweight patients
-total 28-40 lbs
60
Weight gain for obese patients
-11-20 lbs
61
Expected weight loss after delivery
-15-20 lbs in first few weeks
62
Palpation of fetus by HCP
positive sign of pregnancy
63
US and visualization of fetus
positive sign of pregnancy
64
Fetal heart tones auscultated
positive sign of pregnancy
65
What method is used to detect FHT in 10-12 weeks
Doppler
66
What method is used to detect FHT in 20 weeks
fetoscope/stethoscope
67
Goodell's sign
Probable sign
- cervical softening
- 4 weeks
68
Chadwick's sign
- probably sign
- blue coloration of cervix and vagina
- 6-8 weeks
69
Hegar's sign
- probable sign
- softening uterine isthmus
- 6-8 weeks
70
Enlarged uterus
probably sign
71
Ballottement
- probable sign
| - when fetus is pushed, it can be felt to bounce back by tapping the palpating fingers inside the vagina
72
Uterine or blood pregnancy tests
Probable sign
73
Presumptive signs of pregnancy
- amenorrhea
- N/V
- breast changes
- fatigue
- urinary frequency
- slight increase in body temperature
- quickening: mother feels baby's movement for the first time (16 weeks)
74
When can quickening begin
16 weeks
75
Fundal height at 12 weeks
rises above symphysis pubis
76
Fundal height at 16 weeks
between symphysis pubis and umbilicus
77
Fundal height at 20 weeks
at umbilicus
78
Fundal height between 20-35 weeks
-number of weeks +/-2 cm
79
What to do if fundal height not in range
order US
80
Heart changes during pregnancy
- shifts anteriorly and toward left
- rotates toward a transverse position as the uterus enlarges
- HR increased by 15-20 bpm
- S3 normal
- wide S1 split may be heard
- in 3rd: split S2 may be heard
- systolic ejection murmur (grade 2-4) over pulmonary and tricuspid is common
- mammary souffle heard over breasts
- CO increases by 30-50%
- SVR reduced
81
Normal heart sounds in pregnancy
- S3
- Split S1
- Split S2
- systolic ejection murmur
- mammary souffle
82
Preload and afterload
- preload increases
| - afterload decreases
83
Blood pressure changes
- decrease and continues to decrease
- mothers previously HTN may be able to get off meds during pregnancy
- begins to increase again during 3rd trimester
84
How to avoid orthostatic hypotension
- lay on left lateral position
| - pressure on vena cava causes this
85
Coagulation state during pregnancy
- hypercoagulable
| - especially after labor
86
Thyroid changes
-enlarged
87
GI changes
- decreased peristalsis for progesterone
- constipation
- heartburn
88
Skin changes
- linea nigra
- nipples and areolas darken
- melasma
- striae gravidarum
- telogen effluvium
89
What is telogen effluvium
during postpartum period, hair loss may accelerate
| -temporary
90
Renal system changes
- kidneys enlarge
- renal pelvis dilated (physiologic hydronephrosis)
- GFR higher d/t high CO and renal blood flow
91
ENT changes
- nasal congestion
| - epistaxis
92
T/F varicose veins become more severe during pregnancy
true
93
Edema and pregnancy
-peripheral edema normal
94
Naegele's rule
- not useful with irregular cycle
| - LMP+9 months+7 days
95
Why does cholasma/melasma occur
-high estrogen level
96
Gravida
number of pregnancies
97
Term
number of deliveries after 37 weeks
98
Preterm
number of delivers between 20-38 weeks
99
Abortion
number of deliveries before 20 weeks
100
Living
number of living children
101
Postpartum period
right after delivery and up to 6 weeks
102
Sign of atony
-soft boggy uterus with heavy vaginal bleeding
103
How long does uterine involution take
about 6 weeks
104
Is it normal for postpartum women to have contractiosn
- yes
| - especially 2-3 days after delivery
105
Rh-incompabtability disease
- Rh- mom
- Rh + fetus
- mom develops antibodies against Rh+ fetus
106
When should RhoGAM be given
- give to ALL Rh- mothers even if they terminate
- 300 mcg IM at 28 weeks
- 2nd dose within 72 hours after delivery
107
What happens if RhoGAM is not given
-fetal hemolysis and fetal anemia in future pregnancies
108
Coombs test
- detect Rh antibodies in mother (indirect)
- detect in infant (direct)
- conducted in early pregnancy
109
How is RhoGAM effective
- decreases risk of isoimmunization of maternal immune system
- destroys fetal Rh-positive RBCs that have crossed the placenta
110
Can GDM lead to T2DM
-yes
111
Risk for GDM
- history of GDM in previous pregnancies
- obesity
- Asian, native American, Pacific Islander, AA, Hispanic
- macrosomic infants (>9 lbs)
- >35
112
When should GDM be evaluated
- screen at first visit if hx of GDM or with risk factors
| - if not high risk: screen at 24-28 weeks
113
When is GDM typically diagnosed
second to third trimster
114
A women with diabetes in first trimester has what
T2DM
115
One-step method for diagnosing GDM
- 75 g oral GTT
- overnight fast of at least 8 hours, test in AM
- fasting: >92
- 1 hour: >180
- 2 hour: >153
- if any one value is elevated --> GDM
116
Preprandial target
<95
117
1 hour postmeal target
<140
118
2 hour postmeal target
<120
119
A1C goal
6-6.5
120
Preferred medication for GDM
- insulin
- only if unable to control sugars with diet and exercise
- need to inject 3-6 times per day
- ACOG endorses use of glyburide or metformin; FDA does not endorse its use
121
GDM follow-up
test for GDM 6-12 weeks postpartum and at least every 3 years after
122
UTI and pregnancy
-high risk of preterm birth and LBW
123
Does UTI need to have a confirmatory test after treatment during pregnancy
YES
| -repeat UA and C&S 1 week after completing abx treatment
124
Macrobid and sulfa drugs should be avoided during which trimester
3rd
125
Safe antibiotics to give for UTI in pregnancy
- Augmentin
- Amoxicillin (high resistance, not first choice)
- Cephalexin
- Fosfomycin
126
What classification is given for UTI in pregnancy
-Complicated UTI
127
Spontaneous abortion
miscarriage
| -<20 weeks
128
Threatened abortion
vaginal bleeding with closed cervix
| -most of these will result in an ongoing pregnancy
129
inevitable abortion
- cervix dilated and unable to stop
| - will be aborted
130
Complete abortion
- vaginal bleeding with cramping
- placenta and fetus completely expelled
- cervical os will close and bleeding stops
131
Incomplete abortion
- vaginal bleeding with cramping
- products remain in uterus
- cervical os dilated
- treat with D&C and antibiotics
132
Classic triad of preeclampsi
- HTN (>140/90)
- proteinuria (>+1)
- edema that occurs after 20 weeks and up to 4 weeks postpartum
133
Colostrum
day 1-2
-thick yellow breastmilk
contains maternal antibodies
134
Mature breast milk
by 3rd to 4th day
| -contains fat, sugar, water, protein, antibodies
135
Which babies need vitamin D supplement
- all breastfed infants need vitamin D within first few days
| - formula fed only need iron-fortified formulas which contain vitamin D
136
How often do newborns nurse
-8-12 times/24 hours
137
What can be used on the nipple to protect it from skin breakdown
-lanolin
138
Maternal benefits of breastfeeding
- stimulates uterine contractions
- increase bonding (oxytocin)
- speeds up weight loss
- lowers risk of breast/ovarian cancer
- delay ovulation if breastfeeding exclusively
139
fetal health benefits of breastfeeding
- lower rate of infection
- lower rate of asthma and allergies
- does not need any extra fluids
- lower risk of SIDs and obesity
140
Sore nipples are common and will typically resolve by when
common in 1st week, less pain after 2nd week
141
Common cause of mastitis
Staph aureus
142
Prevention of mastitis
- frequent and complete emptying of breast and proper breastfeeding technique
- breast engorgement and poor technique increases risk
143
Mastitis with low risk of MRSA treatment
- Dicloxacillin 500 mg or cephalexin
| - do not use sulfas during newborn period
144
Mastitis with high risk of MRSA
- Bactrim or clindamycin
- continue to breastfeed on affected side
- if abscess, order US, I&D may be needed
- cold compress, Tylenol
145
Newborn complications of chlamydia positive mother
- trachoma (conjunctivitis of newborn)
| - PNA
146
When is test-of-cure needed for chlamydia positive mothers
after 3 weeks of completed treatment
147
In women who do not breastfeed, when will they typically start to ovulate
-39 days postpartum
148
oral contraception for postpartum women
-progestin-only pill Micronor
149
other contraceptive options postpartum
-IUDs, Nexplanon, Depo-Provera, barrier methods
150
Which hormone is contraindicated postpartum and with breastfeeding
-estrogen
151
Folic acid dose to take before pregnancy
-0.4 mg daily
152
Folic acid dose to take during pregnancy
1 mg daily
153
Nausea in pregnancy treat with
- Diclegis
| - Doxyalmine (antihistamine) and Pyridoxine (B6)
154
T/F, urine and blood tests are about equally accurate
true
155
Risk factors for ectopic pregnancy
- Previous ectopic pregnancy
- tubal pathology
- current IUD use
- previous cervicitis
- PID
- etc.
156
When should pregnant women not go on a plane
after 36 weeks
| earlier if history of preterm labor
157
Cramping during pregnancy without bleeding
- due to hormonal changes and growing uterus
- usually normal
- encourage rest and fluids
158
F/u until 28 weeks
every 4 weeks
159
F/u until 29-36 weeks
every 2 weeks
160
F/u after 36 weeks
every week
161
First trimester
0-14 weeks
162
Second trimester
14-28 weeks
163
Third trimester
after 28 weeks
164
two-step GDM screening
- screening: 50 g nonfasting, check in 1 hour
- if 140 or more, rule out GDM
- order 100 g OGTT
- any 2 indicates GDM
- fasting: >95
- 1 hour: >180
- 2 hour: >155
- 3 hour: >140
165
Low back ache early in pregnancy may indicate what
preterm labor/abortion
166
How often should a healthy fetus move
3-5 times per hour
167
Kick counts
- start at 28 weeks
- lie on left side for 30 minutes after eating
- record when she feels a kick and at what time
168
PPROM nitrazine testing
- 7-7.7
| - vaginal pH more acidic
169
Fern test
-fluid swabbed and dried, amniotic fluid appears like a fern
170
Postpartum blues typically resolve by
2 weeks
171
Why are COC's not used during postpartum
-milk flow could be compromised by COC
172
When can COC be used after childbirth without other risk factors and is not breastfeeding
3 weeks
173
Inhibin A is elevated with
DS
174
AFP is low with
DS
175
Patient with previous history of births with NTD should take how much folic acid?
4 mg at least 1 month before conception and 3 months during gestation
176
Medication used to prevent preeclampsia
-low dose ASA
177
High risk for preeclampsia
- history of preeclampsia
- multifetal gestation
- renal disease
- autoimmune disease
- type 1 or 2 DM
- chronic HTN
178
Moderate risk for preeclampsia
- nulliparity
- obesity
- family history of preeclampsia
- >35
- personal risk factors
