Pregnancy III Flashcards
(219 cards)
1
Q
What is the purpose of antepartum fetal assessment?
A
Identifies individuals at risk for abnormality. First screening, then diagnostic testing if indicated.
2
Q
What are false positives and false negatives in screening?
A
Incorrectly identifying individuals as at risk or not at risk
3
Q
What is the difference between screening and diagnostic testing?
A
Screening identifies risk while diagnostic testing gives a precise diagnosis. Screening is done first before diagnostic testing.
4
Q
What is chorionic villus sampling used for?
A
Precise test for a given condition, it is a diagnostic test
involves taking a small sample of tissue from the placenta
5
Q
What is amniocentesis used for?
A
Diagnostic testing during pregnancy
6
Q
What is the purpose of screenings?
A
To look for abnormalities
7
Q
What are some examples of abnormalities that screenings can detect?
A
Trisomy 21
8
Q
What is the recommended course of action if someone comes back with a positive result from a screening?
A
Encouraged to do diagnostic testing, which is much more accurate
9
Q
What is the main difference between screenings and diagnostic testing?
A
Screening is done by everyone, diagnostic testing is not
10
Q
What can ultrasound obtain real-time images of?
A
Maternal structures, placenta, amniotic fluid, and fetus
11
Q
What are the two types of ultrasound for examining the structures like the heart?
A
Transabdominal and transvaginal
12
Q
When is transvaginal ultrasound usually used?
A
At 8-10 weeks of gestation and is used to confirm pregnancy (bc its harder to get it from the abdomen).
13
Q
Which trimester is the 1st trimester ultrasound performed in?
A
First trimester
14
Q
Which trimester is the 2nd trimester ultrasound performed in?
A
Second trimester
15
Q
What is the purpose of first trimester ultrasonography?
A
Confirm pregnancy, verify location, identify multiple gestations, determine gestational age, identify markers, determine locations of uterus, cervix, and placenta
16
Q
At what gestational age can the embryo be seen on ultrasound at the earliest?
A
5-6 weeks
17
Q
What does the heart rate on ultrasound indicate? At what gestational age is the fetal heart rate visible on ultrasound?
A
Health; 5 weeks
18
Q
What is the most accurate measure of gestational age?
A
the first trimester ultrasound
19
Q
What is used to determine gestational age and compare it with Niegels rule?
A
Crown to rump length which is taken at the first trimester ultrasound.
20
Q
What is the purpose of second and third trimester ultrasonography?
A
Confirm fetal viability, evaluate fetal anatomy, determine gestational age, assess serial fetal growth, compare growth of fetuses in multifetal gestations, locate the placenta, determine fetal presentation.
21
Q
What does second and third trimester ultrasonography evaluate in multifetal gestations?
A
Compare growth of fetuses
22
Q
What is the procedure for second and third trimester ultrasonography?
A
Transabdominal
23
Q
What are some things that are examined during second and third trimester ultrasonography?
A
Umbilical cord, blood flow, amniotic fluid volume, position of the placenta
24
Q
Which mothers may require further ultrasounds?
A
High risk mothers
25
What does chorionic villus sampling (CVS) test for?
Genetic abnormalities and chromosomal abnormalities.
26
What can amniocentesis identify?
Fetal abnormalities, fetal lung maturity status, infection
Chromosomal genetic or metabolic abnormalities
27
What may occur as a result of amniocentesis or cvs?
AF leaking and spotting
uterus cramping and discomfort (24 -48 hourds)
28
How is fetal well-being assessed?
Through methods like fetal movement counting, FHR, contraction stress test, and nonstress test
29
What is done if there are not enough accelerations in an nonstress test (NST), then fetal stimulation may be required?
vibroacoustic stimulation can be done before than however eating and drinking may be done in order to elecite 2 accerlerations in 40 minutes
30
What is a non-reactive NST?
goal is 2 accelerations in 40 minutes
but these are non invasive was to get to the goal
31
When can NSTs be started?
As early as 32 weeks
32
What is the Contraction Stress Test (CST)?
A test to see if the baby is well enough to handle normal labor; this occurs closer to term
33
What releases oxytocin? and how is this done for a CST?
Labor, breastfeeding, and sex. nipple stimulation and possibly IV oxytocin
34
How is the CST performed?
Through nipple stimulation or IV oxytocin
35
When is the CST typically done?
Only if we are concerned about the baby and closer to term
36
When is the CST contraindicated?
History of preterm labor, pregnancies that cannot be delivered vaginally
37
What does BPP tell us?
if baby is well oxygenated or not
38
What is a good BPP score?
8-10. –indicates good fetal oxygenation
39
What are the componets of the biophysical profile?
NST,fetal breathing, fetal movement, tone, and amniotic fluid (rate 0 = no and 2 = yes)
40
What does a BPP score of 6 mean?
Something is going on
41
What should be done if BPP score is 6?
Retest within 24 hours if amniotic fluid volume is appropriate if it is not good, consider delivery.
42
What BPP score indicates the need for delivery? what are some things you would need to prepare for?
0-4. associated with need to deliver... could be a still birth -prepare for rescue interventions
43
How does early loss of pregnancy affect mothers?
Feel alone and isolated because not a lot of people may know that they are pregnant.
44
What can be helpful for mothers experiencing perinatal loss?
validate feelings, encouraging them to name the baby, respect their wishes
45
What is the significance of the Cuddle Cot?
The Cuddle Cot provides families with more time to spend with their baby.
46
What are the therapeutic management options for hyperemesis gravidarum?
Diphenhydramine, Histamine-receptor antagonists (pepcid/zantac), Gastric acid inhibitors (nexium/prilosec), Metoclopramide (reglan), Pyridoxine/doxylamine
47
What is Hyperemesis Gravidarum?
Severe pregnancy-related nausea and vomiting
48
How long does Hyperemesis Gravidarum typically last?
Throughout the entire pregnancy
49
What are the common symptoms of Hyperemesis Gravidarum?
Dehydration and electrolyte imbalances
50
What is the cause of Hyperemesis Gravidarum?
Unknown, but thought to be related to pregnancy hormones
51
How is Hyperemesis Gravidarum diagnosed?
By ruling out other causes of severe nausea and vomiting
52
When might a pregnant woman with Hyperemesis Gravidarum be hospitalized?
If they are severely ill and require IV fluids and TPN
53
What medication is typically avoided during the first trimester in Hyperemesis Gravidarum?
Zofran, it can cause cleft palate and heart defects.
54
What should be monitored in Hyperemesis Gravidarum?
Intake and output
55
What conditions must exist for Rh incompatibility?
Mother is Rh-negative, and fetus is Rh-positive.
56
What are the potential negative effects of Rh incompatibility?
Negatively affects future pregnancies if not treated.
57
What is the treatment for Rh incompatibility?
Rhogam
58
At what time during pregnancy is Rhogam typically administered?
28 weeks and 72 after birth if mom neg and baby pos
59
What can happen if there is Rh factor incompatibility between the mother and the baby?
Birth defects or abortion
60
What is hypovolemia?
Decreased blood volume
61
How does hypovolemia affect the mother?
Can lead to decreased blood flow and oxygen delivery to organs
62
What does a complete abortion mean?
Abortion does everything and there is no retained tissue.
63
What does an incomplete abortion mean?
Something was left behind and a D&C may be needed.
64
What does a missed abortion mean?
Retains all the tissue and requires a D&C.
65
What does recurrent abortion mean?
Three or more occurrences of abortion, not necessarily successive.
66
What is the most important lab for abortion conditions?
CBC and H&H, but CBC is the most important; and misoprostol
67
How is an abortion (miscarriage) defined in terms of gestational age?
Less than 20 weeks
68
What is cerclage?
Procedure to stitch the cervix closed
69
When is cerclage recommended?
For women at risk of premature birth
70
How is cerclage performed?
Using stitches to secure the cervix or with the use of a band.
71
Is a cerclage considered a high risk pregnancy?
Yes
72
What is an ectopic pregnancy?
Implantation of a fertilized ovum outside of uterine cavity
73
Where do 97% of ectopic pregnancies occur?
Fallopian tube
74
What are the consequences of a ruptured ectopic pregnancy?
Severe pain, internal bleeding, and significant cause of maternal death
75
How is ectopic pregnancy diagnosed?
Ultrasound
76
What are the treatment options for ectopic pregnancy?
Methotrexate (is a cancer drug that can help inhibit cell replication and only is used if this is caught early enough (8 -10 weeks) (90% success rate)), salpingectomy
77
What should be done if an ectopic pregnancy ruptures?
Prevent hypovolemic shock
78
What is gestational trophoblastic disease?
like a bunch of bubbles or cysts
- Hydatidiform **mole** trophoblasts develop abnormally
- Characterized by proliferation and edema of the chorionic villi
79
What is the difference between complete and partial hydatidiform mole?
Complete: no fetal tissue, Partial: fetal tissue present
80
What are the treatment options for hydatidiform mole?
D&C, oxytocin
81
What is the biggest complication of a hydatidiform mole?
Bleeding leading to hypovolemia
82
What should moms avoid after a hydatidiform mole so that we can monitor for carcinoma?
Pregnancy for 6-12 months minimum
83
What can extremely high HcG levels indicate?
Presence of hydatidiform mole trophoblasts
84
What should be watched for in hydatidiform moles?
Malignant changes or cancer
85
What is placenta previa?
Implantation of the placenta in the lower uterus
86
What is the difference between placenta previa and low lying placenta?
Placenta previa involves implantation of the placenta in the lower uterus, while low lying placenta refers to a placenta that is near the cervix but not covering it. placenta previa is completely covering the cervix.
87
What is a common symptom of placenta previa?
Pain LESS bright red bleeding
88
What are the delivery restrictions for placenta previa?
No vaginal delivery, no SVE (sterile vaginal examination), pelvic rest
89
What is the implantation location in placenta previa?
Lower part of the uterus
90
What is a low lying placenta?
Within 2 cm of the cervical opening
91
What should be avoided with placenta previa?
Vaginal delivery, sterile vaginal exam, sex, tampons, swimming, oxytocin
92
What should be done if bright red bleeding occurs?
Get an ultrasound to rule out placenta previa
93
What treatment is given for placenta previa before 34 weeks?
Corticosteroids to help mature the lungs
94
What can cause improper implantation in placenta previa and increase risk for placenta previa?
previous scar (fibroid removal, previous C-section)
95
What is abruptio placentae?
Separation of a normally implanted placenta before the fetus is born
96
What are the causes of abruptio placentae?
cocaine, meth, trauma, hypertension, alcohol
97
What are the symptoms of abruptio placentae?
Bleeding, board-like abdomen, abdominal tenderness, tachycardia, late decels
98
What is the management approach for abruptio placentae?
Depends on severity: conservative (bedrest, medications) or aggressive (delivery, possible cesarean section, blood transfusion)
99
What is the hallmark sign of abruptio placentae?
board-like abdomen and Port wine (bleeding with amniotic fluid)
100
What can happen with partial abruptio of the placenta?
Concealed bleeding that can seal back up
101
What needs to happen if there is a complete abruption of the placenta?
The patient needs to go into labor
102
For marginal or partial abruption, what intervention may be considered first instead of a c-section?
Tocolytics to stop the process of labor
103
What are some potential complications of a abruptio placentae (placental abruption)?
Blood transfusion, fluids, possible hysterectomy
104
What are some signs and symptoms of fluid volume deficit (FVD) in terms of abruptio placentae (placental abruption)
Pale, cool skin; low BP; tachycardia
105
What are some hypertensive disorders of pregnancy?
Gestational hypertension, Preeclampsia, Eclampsia, Chronic hypertension, Chronic hypertension with superimposed preeclampsia
106
What is gestational hypertension?
High blood pressure that develops after 20 weeks of pregnancy without the presence of proteinuria (elevated protein in the urine)
Systolic pressure of ≥140 mm Hg or a diastolic pressure ≥90 mm Hg without proteinuria occurring after 20th week gestation
107
What is preeclampsia?
High blood pressure that develops after 20 weeks of pregnancy with or without proteinuria (elevated protein in the urine)..
108
What is eclampsia?
Severe preeclampsia that is accompanied by seizures or coma.. that cannot be attributed to other causes
109
What is chronic hypertension?
High blood pressure that was present before pregnancy or that develops before 20 weeks of pregnancy or continuing beyound 12 weeks postpartum
110
What is chronic hypertension with superimposed preeclampsia?
Chronic hypertension with new-onset proteinuria or worsening hypertension during pregnancy
111
What are the preventive measures for preeclampsia?
Early and regular prenatal care, aspirin
112
What are the signs and symptoms of preeclampsia?
Hypertension, proteinuria, edema (sudden, pitting), headaches, visual disturbance
113
What are the components of therapeutic management for preeclampsia?
Activity restrictions, blood pressure monitoring, weight monitoring, fetal assessment
114
What are some of the diagnostic tests used for preeclampsia?
NST, BPP, CBC, CCUA, CMP, LDH, Uric Acid, 24-hr urine protein
115
How can proteinuria be detected?
Dip stick test showing 2+ or more protein or 24 hour protein of 300 mg
116
What is the only cure for preeclampsia?
Delivery of the baby because it resolves after the delivery of the baby
117
Who should take low-dose aspirin after their first trimester?
Pregnant women at risk for preeclampsia
118
What are some factors that put pregnant women at high risk for preeclampsia?
Chronic high blood pressure, diabetes, kidney disease
119
What are the diagnostic criteria for preeclampsia with severe features?
Systolic > 160, Diastolic > 110 on two occasions at least 15 minutes apart while on bedrest; Platelets < 100,000 (thrombocytopenia)
120
What signs and symptoms may indicate preeclampsia with severe features?
Pulmonary edema, headache unrelieved by meds, RUQ pain (possible reffered right shoulder [aom, epigastric pain, blurred vision, and small amounts of dark urine, postive clones
121
What laboratory test results may be abnormal in preeclampsia with severe features?
Elevated AST, ALT
122
What medications are used to treat preeclampsia?
Magnesium (- 4 to 6 g over 15 to 30 min for loading dose
- 1 to 2 gram for maintenance dose per hour) and labetalol
123
What precautions should be taken for a patient with preeclampsia?
Left side lying, seizure precautions, decrease stimuli
124
What is the recommended management for hypertensive disorders of pregnancy?
Bed rest, fetal monitoring, antihypertensive medication, anticonvulsant medications, magnesium sulfate
125
What medications are used for antihypertensive treatment?
Labetalol, Hydralazine, Nifedipine
126
What medication is used for preventing seizures?
Magnesium sulfate
- 4 to 6 g over 15 to 30 min for loading dose
- 1 to 2 gram for maintenance dose per hour
127
What are the signs of recovery in a patient with hypertensive disorders of pregnancy?
Diuresis, decreased proteinuria, normal blood pressure and labs
128
What is the loading dose of magnesium sulfate?
4-6 g over 15-30 min
129
What is the maintenance dose of magnesium sulfate?
1-2 g per hour
130
What are the signs of magnesium toxicity?
Lethargy, absent reflexes, CNS depression, resp depression
131
What should be monitored in a patient on magnesium sulfate?
Strict I&O (at least 30mL/hr)
132
What is the antidote for magnesium toxicity?
Calcium gluconate
133
When do half of eclamptic seizures occur?
During birth or 48 hours post delivery
134
Can a patient with thrombocytopenia have an epidural?
No
135
A woman's blood volume severely reduced in eclampsia…
leading to increasing risk for poor placental perfusion
136
What should be monitored in a woman with eclampsia?
Ruptured membranes, signs of labor, or abruptio placentae
137
How would you describe the seizures in eclampsia?
Tonic clonic, lasting for approximately 1 minute
138
What happens during the post stage of the seizures in eclampsia?
Transient muscle movements
139
What complications can occur in eclampsia?
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) and DIC (Disseminated intravascular coagulation)
140
What signs of labor should be monitored for in eclampsia?
Ruptured membranes
141
What fetal heart rate monitor findings are associated with eclampsia?
Bradycardia, decelerations, and possibly tachycardia
142
What diagnostic tests may be conducted for eclampsia?
Ultrasound and x-ray
143
What is the common management approach for eclampsia?
Delivery of the baby
144
What is HELLP Syndrome?
Hemolysis, Elevated Liver enzymes, Low Platelets
145
What are the symptoms of HELLP Syndrome?
RUQ abdominal pain, n/v, severe edema, elevated AST & ALT, jaundice, thrombocytopenia
146
What are the therapeutic management options for HELLP Syndrome?
BP control, seizure prevention, corticosteroids, induction, IV therapy, blood replacement
147
What should you avoid doing if a patient has HELLP syndrome?
DO NOT palpate the abdomen
148
What is a potential risk if you palpate the abdomen of a patient with HELLP syndrome?
Liver rupture
149
What are concurrent conditions in pregnancy?
Conditions that occur alongside pregnancy
150
What are examples of concurrent conditions in pregnancy?
Hypertension, gestational diabetes, preeclampsia
151
What is the impact of concurrent conditions on pregnancy?
Increased risk for complications
Preterm birth, low birth weight, maternal health issues
152
Why is it important to manage concurrent conditions during pregnancy?
To minimize risks to both the mother and baby
153
What happens to insulin release in early pregnancy in terms of diabetes mellitus?
Insulin release in response to serum glucose levels accelerates and there is little change in maternal metabolic need
154
What may pregnant women with diabetes experience in early pregnancy in terms of diabetes mellitus?
Hypoglycemia
155
What happens to fetal growth in late pregnancy in terms of diabetes mellitus?
Fetal growth accelerates
156
What happens to placental hormone levels in late pregnancy in terms of diabetes mellitus?
Placental hormone levels rise
157
What effect do the placental hormones have on insulin?
Hormones create resistance to insulin
158
What are the potential glucose abnormalities that can occur during pregnancy?
Early: Hypoglycemia, Late: Hyperglycemia
159
What symptoms might indicate hypoglycemia in pregnant women?
Nausea/Vomiting
160
Why is maintaining normal maternal glucose levels essential during birth?
To reduce neonatal hypoglycemia
161
What happens to the need for additional insulin postpartum?
It falls
162
What is encouraged postpartum for women with diabetes?
Breastfeeding
163
How does breastfeeding help women with types 1 and 2 diabetes mellitus?
It helps lower the amount of insulin needed
164
What happens to the need for insulin in women with gestational diabetes mellitus after birth?
They usually need no insulin
165
Does gestational diabetes go away after birth?
Yes
166
Are women with gestational diabetes at increased risk of developing diabetes later in life?
Yes
167
What are some complication of diabetes mellitus?
Cardiovascular disease, kidney diease, nerve damage
168
What is Type 1 diabetes?
Insulin deficient
169
What is Type 2 diabetes?
Insulin resistant
170
What is gestational diabetes (GDM)?
Glucose intolerance during pregnancy
Insulin resistance during pregnancy
171
When does gestational diabetes start and end?
During pregnancy and ends after delivery
172
What is the glucose challenge test used for?
Screening for gestational diabetes
173
What is the recommended timing for the glucose challenge test?
24 to 28 weeks of pregnancy
174
What is the glucose solution dose used in the glucose challenge test?
50 g
175
What is the cutoff value for an abnormal glucose challenge test result?
>140 mg/dL
176
What test is done if the glucose challenge test result is abnormal?
3-hour oral glucose tolerance test
177
What are the fasting and postprandial glucose cutoff values for gestational diabetes diagnosis in the oral glucose tolerance test?
Fasting: 95 mg/dL, 1-hour: 180 mg/dL, 2-hour: 155 mg/dL, 3-hour: 140 mg/dL
178
Is fasting required for the glucose challeges test?
No fasting is required
179
When do moms have to fast for the glucose tolerance test?
Before they come for the tolerance test
180
What are the recommended caloric intake levels for non-obese and obese individuals with gestational diabetes?
Non-obese: 30-35 kcal/kg/day. Obese: 25 kcal/kg/day.
181
What is the recommended amount of exercise for individuals with gestational diabetes?
30 minutes/day, 5 days/week of moderate intensity exercise.
182
What are the target blood glucose levels for fasting and postprandial measurements?
Fasting: <95, Postprandial: <140 @ 1 hour, <120 @ 2 hours.
183
What are the two pharmacologic treatment options for gestational diabetes?
Insulin and metformin
184
Which medication is preferred for treating gestational diabetes and why?
Insulin because it does not cross the placenta.
185
What fetal surveillance tests are commonly used for gestational diabetes?
BPP, NST, CST, kick counts.
186
What dietary advice should be given to the patient?
Avoid simple sugars and eat high protein with frequent small snacks
187
When will the patient come in for NST by 32 weeks in terms of glucose control?
Twice a week
188
When might the patient come in for NST earlier, at 28 weeks?
If blood glucose is not controlled
189
What are some maternal risks associated with obesity?
Obstructive sleep apnea, Gestational HTN, Preeclampsia, GDM, Preterm labor, Prolonged pregnancy, Induction of labor, Cesarean birth
190
What are some fetal risks associated with obesity?
Perinatal death, Macrosomia, Congenital malformations, NICU, childhood obseity, shoulder dystocia, hypoglcemia
191
What are some possible complications with the mom in terms of diabetes mellitus?
Risk of preeclampsia, hydramnios, macrosomia, shoulder dystocia, spontaneous abortion
192
What is considered obese according to BMI?
BMI over 30.0
193
What comorbidity can pregnancy exacerbate in obese patients?
Hypertension
194
What are some risks associated with obesity during pregnancy?
Increased risk for infection, c-section, and induction of labor
195
What are some ways to manage diabetes and sleep apnea?
Monitor and educate about nutrition
196
What should be done before diagnosing diabetes and sleep apnea?
Rule out existing conditions
197
What are some common types of anemia?
Iron-deficiency anemia, folic acid deficiency anemia (megaloblastic), sickle cell disease
198
What is the most common type of anemia?
Iron-deficiency anemia
199
What is one of the most common problems of pregnancy?
Iron deficiency anemia
200
What can supplemental iron cause?
Constipation and black stools
201
What can pregnant women take to avoid constipation caused by iron supplements?
Stool softener
202
What are good sources of iron?
Meat, red meat, fish, green leafy vegetables
203
What is the role of folic acid in the body?
Essential for cell duplication and red blood cell development
204
Which types of food are good sources of folic acid?
Grains, beans, peanuts, green leafy vegetables
205
Should all newborns be treated with antiretroviral therapy if risk for HIV?
Yes
206
Is breastfeeding recommended for infants born to HIV-positive mothers?
No
207
What should be done for the infant bath after birth?
Provide infant bath ASAP because bathing the infant decreases transmission of HIV from mother to baby?
208
What are the risks of COVID-19 during pregnancy?
Severe disease, preterm birth, fetal demise, preeclampsia
209
Is COVID-19 infection common in utero?
Rarely infected in utero but can be affected after birth
210
What is the recommendation for a pregnant woman with HIV and a viral load above 1000 copies/mL?
C-section at 38 weeks
211
Why is a C-section recommended for HIV-positive pregnant women with high viral load?
To reduce the risk of transmitting HIV to the baby
212
Can mothers with low viral load have a vaginal birth?
Possibly
213
What may high-risk newborns with COVID receive?
Monoclonal antibodies
214
What is the basis for treatment of COVID in newborns?
CDC data
215
Is breastfeeding and rooming in still encouraged?
Yes
216
What is the leading cause of life-threatening perinatal infections in the US?
Group B streptococcus (GBS)
217
When is the vag/rectal swab performed for Group B streptococcus (GBS)?
At 36-37 weeks gestation
218
What is the first line treatment for GBS?
Penicillin and the alternative is cephazolin if they have a nonlife threatening penicillin allergy
219
How long should the antibiotic be given to the mother before she goes into labor?
at least four hours
