Blueprints Ob and Gyn Ch 1
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- 7 signs of pregnancy
- 1) Chadwick's sign; 2) Goodell's sign; 3) Ladin's sign; 4) breast swelling and tenderness; 5) development of the linea nigra from umbilicus to pubis; 6) telangiectasias; 7) palmar erythema
- Specific functions of hPL
- 1) lipolysis --> increases circulating FFAs; 2) insulin antagonist --> diabetogenic effect (increased insulin levels and protein synthesis)
- Third trimester routine tests:
- 1) Hct; 2) RPR; 3) GLT; 4) repeat gonorrhea and chlamydia; 5) CXR if PPD+; 6) IP GBS Cx
- Changes during pregnancy: BUN
- decrease by 25%
- Cause of bloating and constipation during pregnancy:
- decreased motility of the bowel
- What organ produces hCG?
- placenta
- Goodell's sign
- softening and cyanosis of the cervix at or after 4 wks
- How early and at what bHCG levels may you see the gestational sac on US?
- at 5 wks or bHCG 1500-2000
- Changes during pregnancy: total lung capacity
- decreases by 5% (due to elevation of diaphragm)
- Function of hCG
- maintains progesterone production by the corpus luteum
- Which organ produces progesterone during pregnancy?
- early pregnancy: corpus luteum; later pregnancy: placenta
- General function of hPL
- ensures constant nutrient supply to the fetus
- Estrogen production during pregnancy:
- maternal adrenal glands produce estrogen precursors --> converted by placenta to estrogen
- How early and at what bHCG levels may you see the fetal heart on US?
- at 6 wks or bHCG 5000-6000
- WBC count during labor
- can increase to >20
- Changes during pregnancy: PaO2
- increased
- Another name for hPL
- human chorionic somatomammotropin (hCS)
- Changes during pregnancy: tidal volume
- increases by 30-40%
- Definition: developmental age
- age of a fetus in wks and days measured from date of fertilization
- Second trimester
- 12-24 to 28 wks
- What percentage of pregnant women will experience morning sickness?
- >70%
- What is the acceptable discrepancy btw US and LMP dating by trimester?
- 1st: 1wk; 2nd; 2wks; 3rd: 3wks
- Cause of drop in BP during pregnancy:
- elevated circulating progesterone levels
- What are peak levels of b-HCG in a pregnant woman and when does this occur?
- 100,000 mIU/ml at 10 wks
- Is gestational age greater or less than developmental age?
- greater
- 2 causes of esophageal reflux during pregnancy
- 1) prolonged gastric emptying times; 2) decreased tone of GES
- Definition: parity
- the number of pregnancies that led to a birth beyond 20 wks GA
- First trimester
- 0-12 wks
- Chadwick's sign
- bluish discoloration of vagina and cervix
- How do u confirm dx of pregnancy?
- ultrasound
- Effect of increased aldosterone levels during pregnancy
- increased sodium resorbtion
- Exact dating of pregnancy
- LMP + 280days
- When does quickening begin to occur?
- 16-20 wks
- Definition: estimated date of confinement (EDC)
- estimated date of delivery (EDD)
- b-HCG levels in the 3rd trimester:
- decrease from peak and level off at 20,000-30,000
- 4 sxs of pregnancy
- 1) amenorrhea; 2) n/v; 3) breast pain; 4) quickening - fetal movement
- Changes during pregnancy: BP
- decrease in systolic (5-10mmHg) and diastolic (10-15mmHg) that nadirs at 24 wks followed by slow return to prepregnancy levels at term
- Changes during pregnancy: WBC
- increases to mean of 10.5
- Name 4 nutrients which are required in larger amounts during pregnancy:
- 1) protein; 2) iron; 3) calcium; 4) folate
- At what point should n/v resolve during pregnancy?
- 14-16 wks gestation
- Changes during pregnancy: rbc volume
- increases by 20-30%
- General fxn of progesterone:
- relaxation of smooth muscle
- Changes during pregnancy: Hct
- decreases
- Definition: fetus
- conceptus from 8wks to birth
- How accurate is crown rump length in dating fetus in first tm?
- within 3-5 days
- First trimester routine tests:
- urine pregnancy test (if pt uncertain) + 1) Hct (CBC) 2) blood type and screen; 3) rapid plasma regin (RPR), 4) rubella Ab screen; 5) HepBsAg ; 6) gonorrhea Cx; 7) chlamydia Cx; 8) Pap smear; 9) UA and UCx; 10) VZV Abs (if no h/o chix pox); 11) HIV offered
- Changes during pregnancy: PaCO2
- decreased (from 40mmHg to 30mmHg)
- Second trimester routine tests:
- 1) MSAFP/ triple screen; 2) ultrasound; 3) amniocentesis in AMA pts
- Cause of morning sickness:
- elevated levels of: 1) estrogen; 2) progesterone; 3) hCG
- Third trimester
- 24 to 28wks - birth
- What change in the kidneys during pregnancy leads to increased rates of pyelonephritis?
- kidneys increase in size --> ureters dilate
- Changes during pregnancy: GFR
- increases by 50%
- Changes during pregnancy: SVR
- decreases --> fall in arterial BP
- Definition: preterm
- infant delivered btw 24-37 wks
- Changes during pregnancy: minute ventilation
- increase in Vt with constant respiratory rate increases minute ventilation by 30-40%
- At what gestational age should the initial visit occur?
- btw 6 to 10 wks
- Changes during pregnancy: plasma volume
- increases by 50%
- Definition: postdate/ postterm
- infant delivered after 42 wks
- At what time can you start to detect fetal heart sounds by doppler US?
- 10 wks
- Definition: embryo
- conceptus from fertilization to 8 wks
- Definition: gestational age
- the age of a fetus in wks and days measured from the first day of LMP; = DA + 2 wks
- Changes during pregnancy: CO
- increases by 30-50%
- Definition: term
- infant delivered btw 37-42 wks
- Why do plasma sodium levels remain normal throughout pregnancy?
- because of the simultaneous increase in GFR
- Changes during pregnancy: creatinine
- decrease by 25%
- Definition: previable
- infant delivered at <24 wks
- Common pulmonologic sxs during pregnancy:
- dyspnea (60-70%)
- Healthy weight gain during pregnancy
- 20-30 lbs
- What organ produces human placental lactogen( hPL)?
- placenta
- Definition: gravidity
- the number of times a woman has been pregnant
- Name 2 skin changes that occur during pregnancy secondary to increased estrogen levels:
- 1) spider angiomata; 2) palmar erythema
- Ladin's sign
- softening of the uterus after 6 weeks
- Nagele's rule
- LMP - 3mos + 7days
- Name 5 areas which become hyperpigmented during pregnancy
- 1) nipples; 2) umbilicus; 3) abdominal midline; 4) perineum; 5) face
- Changes during pregnancy: aldosterone
- increase secondary to activation of RAAS
- What is the most accurate means of dating in the first half of the first tm?
- crown rump length
- Doubling time of hCG during early pregnancy
- every 48 hrs
- What is the cause of skin hyperpigmentation during pregnancy?
- increased levels of alpha-melanocyte stimulating hormone
- Changes during pregnancy: platelets
- slight decrease (100, 000 - 150,000)