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76 Cards in this Set
- Front
- Back
Goals of preconception counseling include:
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- optimize maternal health prior to pregnancy
- minimize adverse health effects for mother and fetus - Assess genetic disorders - update immunizations - control or stabilize chronic diseases |
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What is Naegele's rule?
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Estimate the EDD (Estimated date of Delivery) by adding 7 days to first day of LMP, subtract 3 months, and add 1 year.
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Risk factors for genetic disorders include:
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- advanced maternal age (>35)
- advanced paternal age (>50) - Prior preg with trisomy - Hx of early preg loss - ethnicity |
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Down Syndrome is a trisomy of chromosome ____
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21
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Trisomy 18 is known as ___ syndrome and has what survival rate?
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- Edward's syndrome
- 5-10% survival at 1 year |
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Patau syndrome is a trisomy of chromosome ___ and has what survival rate?
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- Trisomy 13
- 20% (80% die 1st year) |
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What is Hegar sign?
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Palpable softening of the uteus at the isthmus.
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___ is softening of the cervix/ isthmus and is an early diagnostic sign of pregnancy.
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Hegar's sign
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What is Chadwick's sign?
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- Increased vascularity throughout the pelvic region causes the vagina to take on a bluish color in early pregnancy
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During the first PN visit, a pt should be assessed for what risks?
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- ectopic pregnancy
- inc. blood pressure - dehydration - leukorrhea vs STI - bleeding, - leaking amniotic fluid |
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An abdominal ultrasound can detect gestational sac and fetal cardiac activity at what gestational age.
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5-6 weeks
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WHat labs should you order on the initial PN visit?
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- cbc, syphilis, HIV, glucose, antibody screen, rubella, varicella, Rh &ABO
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What are leopold maneuvers? What age do they become useful?
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- 4 maneuvers to identify fetal presentation after 28 weeks gestational age
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Describe expected fundal height at the following intervals:
- 16 wks - 20 wks - 36 wks |
: 16 = 1/2 way between pubis and umbilicus
20 = umbilicus 36= xyphoid |
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Define the following abbreviations:
- LGA - SGA - IUGR - NTD |
- LGA = large for gestational age
- SGA = small for gestational age - IUGR = intrauterine growth restriction - NTD = neural tube defect |
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Fetal heart tones may be heard as early as ____
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10-12 weeks EGA
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If a RH - mother has a RH+ baby, ___ must be given at __ weeks and within ____ hours of delivery to prevent future problems.
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1. Rhogam
2. 28 weeks 3. within 72h of delivery |
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Which hormone is responsible for maintaining the corpus luteum, and also is used to detect pregnancy?
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Serum hCG
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What effects does progesterone have during pregnancy?
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- embryo implantation
- endometrial support - mammary glands - increased gastric reflex |
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What is the function of the hormone relaxin during pregnancy?
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- relaxes pubic symphysis and joints
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Describe the changes of the thyroid gland during pregnancy.
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- stays normal in size
- effects of estrogen result in fluctuations of free T3 and T4 - is reciprocal with B-hCG in first trimester |
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Describe the effects of estrogen on the pituitary gland during pregnancy.
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- result in enlargement and stimulation of lactotrophs
- increased melanocyte stimulation (hyperpigmentatio - melasma) - increase prolactin and ACTH levels |
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Describe the effects of estrogen on the adrenal and hepatic systems during pregnancy.
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- induces hepatic synthesis of cortisol bindding globulin (increases serum cortisol)
- increased aldosterone synthesis - decreased DHEA |
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How are gasses exchanged across the placenta?
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simple diffusion
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Glucose metabolism in the placenta occurs with ____ whereas amino acids require ____
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1. glucose = facilitated diffusion
2. active transport = amino acids |
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Which immunoglobulin can pass across the maternal placenta? What is the significance of this?
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IgG
- allows for passive immunity from mother to child |
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What are striae gravidarum? What are risk factors? What can minimize? what can diminsh them after the fact?
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- stretch marks
- risks: genetic and ethnic disposition - minimize/prevent: circulation/massage, topical creams - remove/diminish: topical creams, retinoids, dermabrasion, laser |
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What ethnicities are at greatest risk for stretch marks?
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Caucasian
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The most rapid change in the maternal breast occurs when?
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1st 8 weeks
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What changes occur around the nipple during pregnancy?
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- enlargement
- ductal growth - increased blood flow - production of colostrum in last trimester |
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What GI changes should be expected during pregnancy?
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- inc. appetite
- blunted sense of taste - food/odor aversions - food cravings (PICA? ) - Constipation - Hemorrhoids |
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Why are hemorrhoids more likely during pregnancy?
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- increased portal venous pressure due to fetus in abdominal cavity
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CV changes in pregnancy include:
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- heart shifts up and left, apex shifts laterally
- Increased CO (inc HR, SV, and blood volume with decreased peripheral resistance) |
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The uterus consumes what percent of CO by the end of pregnancy?
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Increases from 2% to 20%
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Uterine blood flow increases by ____ compared to non-pregnant levels.
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20-40 times
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What physiologic changes occur in the lungs as a result of pregnancy?
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- 20% inc oxygen consumption
- Increased insp capacity - decreased lung capacity d/t elevated diaphragm |
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- Progesterone during pregnancy affects the lungs what way?
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- increases maternal sensitivity to CO2,
- results in increased ventilation and relative respiratory alkalosis - kidneys increase excretion of bicarb to compensate. |
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The renal physiologic changes during pregnancy include:
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- kidneys enlarge
- inc. residula volume and decreased bladder tone - increased renal plasma flow by 75% - this increases GFR by 50% and promotes Na loss - Decreases BUN, Cr, Uric Acid - Increases CrCl - Inc urinary glucose secretion - no change in protein loss |
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The recomended total weight gain for a single pregnancy is between ___ lbs dependign on BPI.
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- between 15-40lbs
- LOW BMI should gain MORE |
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By what amounts should a pregnant women increase her diet each day?
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- 300 extra calories
- 5-10g protein - 15mg iron - 250mg Ca - 400-800 folic acid |
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Prenatal multivitamins should contain at least ___ g of folic acid
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400 mcg
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Guidelines regarding exercise in pregnancy suggest:
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- Women exercising regularly before pregnancy can continue mild to moderate exercise three days a week
- Those who didnt' should engage in moderate exercise for 30+ mins most days of te week |
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Why does supine hypotensive syndrome occur?
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- because the baby is compressing the vena cava and preventing blood from reaching the heart
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What classifies gestational hypetension?
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- SBP >140, DBP >90, occring first after week 20 without proteinuria
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What is the difference between gestational hypertension and preeclampsia?
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- the presence of proteinuria
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What is hyperemesis?
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Excessive vomiting during pregnancy.
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What is the difference between conception age and menstrual age?
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Conception age is weeks since day of conception. SInce the exact day of conception is usually unknown, weeks since the first day of the last period is used - this is menstrual age
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During which trimester should you gain the most weight? The least?
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Most = second
Least = first |
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A woman with a low BMI (<19.8) should gain about how many lbs in pregnancy?
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28-40
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A woman with a Normal BMI (19.8 - 26) should gain about how many lbs in pregnancy?
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25-35lbs
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A woman with a high BMI (26-29) should gain about how many lbs in pregnancy
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15-25
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A woman with an obese BMI (>29) should gain about how much wieght in pregnancy?
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~15lbs
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What is the average range of weight gain for women carrying twins?
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35-45lbs
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Young adolescent females (<2 years from menarche) should try to gain weight on what end of the spectrum? What other group has as special exceptioN
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- Young should gain on high end of range for BMI
- short women should gain on low end of range for BMI |
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Which vaccines are recommended and safe during pregnancy?
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- tetanus, influenza, pneumococcal, meninococcal, hep B
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First-trimester weight loss is due to ___ and should not exceed ___
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- nausea and vomiting
- not to exceed 5% prepartum weight |
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The word used to describe darkened pigmentatons round the forehead and cheeks, across the nose, or jaw
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- melasma or chloasma
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A pt is >24 wks pregnant with facial edema, you suspect __
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gestational hypertension
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Venous hum and systolic or continuous mammary souffle are (common/ uncommon) in pregnancy
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Common
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Where is mammary souffle heard?
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- late in pregnancy, 2nd or 3rd intercostal in parasternal areas (systolic or systolic and diastolic)
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What occurs with the PMI in pregnancy?
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- moves slightly higher around the 4th intercostal space
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The mother will typically feel fetal movements around ___ weeks, and an examiner around ___ weeks.
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- mother: 18-20
- examiner: 24 |
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What should you consider if you cannot feel fetal movements at 24 weeks.
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- error in calculating gestation
- fetal death or morbidity - false pregnancy |
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Irregular uterine contractions may occur after ___ weeks and are (normal/abnormal). Regular contractions before ____weeks suggest ___
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1. 12 weeks
2. normal 3. 37 weeks 4. preterm labor |
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For weeks 20-32 , where should fundal height be?
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- measurement in cm should roughly equal weeks of gestaton
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Multiple gestation should be suspected if fundal height is _____
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more than 4cm higher than expected.
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If fundal heighs is 4cm+ higher than expected, you should suspect what?
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- multiple gestation
- large fetus - extra amniotic fluid - uterine leiomyoma |
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If fundal height is lower than expected, consider __
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- missed abortion
- transverse lie - growth retardation - false pregnancy |
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Lack of audible fetal heart by doppler after ____ weeks suggestas what?
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1. 10 weeks
2. fetal demise or false pregnancy |
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FHR is usually ___ in early pregnancy, ___ by term, and should ___ with fetal movement in late pregnancy.
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1. 160s
2. 120-140 3 increase |
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FHR that drops noticeably near term with fetal movement could indicate ___-
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poor placental circulation or decreased amniotic fluid
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In the third trimester, you should expect what with fetal heart rhytm?
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- variance of 10-15 beats per minute over 1-2 mins.
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Absence of beat-to-beat variability in the third trimester needs _
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investigation with FHR monitor
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The pregnant cervix should look how?
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- bluish or violet in color
- deep rugae - increased milky-white discharge |
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Describe each of Leopold's maneuvers.
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1. upper pole - palpate upper abdomen to determine what body part is upper (usually buttocks)
2. sides - place one hand on each side of abdomen to capture fetus between... ID which side is fetal back. 3. lower pole - use palmar surfaces palpate area just above symphysis. feel for head (smooth, firm, rounded surface) or buttock 4. confirmation of presenting part- one had on lower pole, one on upper - compare to confirm which is head or buttcok |
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If when doing the 3rd leopold maneuver the hands touch, it means ____, if they don't it means ___
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touch = not descended yet
don't touch = fetus descended into pelvis |