510 exam 2

progesterone

- softens cartilage on joints -vasodilates vessels to accomodate increased volume -relaxes smooth broncioles which leads to hyperventilation -smooth muscle relaxation delays gastric emptying time and motility -decreases esophageal tone and acid reflux -dilate ureters, urethra, and bladder increasing risk of UTI -hydronephrosis and increased intrauterine pressure - thyroid enlargement

estrogen and progesterone

-hyperpigmentation -affect plasma renin activity and aldosterone to increase sodium retention which increases water retention -modify metabolism and excretion of bilirubin

estrogen

-makes gums more vascular, edematous, and hyperplastic which can make them bleed -thickens vaginal mucosa -softens connective tissue -hypertrophies vaginal smooth muscle cells -this and increased lactobacilli cause mucosa to metabolize glycogen (byproduct is lactic acid) which decreases pH

edema

2/t impaired venous circulation and increased pressure in the lower extremities from enlarged uterus, occurs in 3rd tri recommend exercise, avoid prolonged sitting/standing, elevate legs, compression socks

amniocentesis

20-30 mL of amniotic fluid taken transabdominally. direct DNA test can identify genetic mutations. Amniotic fluid AFP test can be done for diagnostic purposes

HSIL

25-30% have high grade lesions, 2% have invasive cancer Must have colpo mosaicism/punctuation

36 wks

2500 grams (5 ½ pounds), CRL - 32 cm

early term

37-38.6 wks

full term

39.0-40.6 wks

late term

41.0-41.6 wks

post term

42.0+ wks

quad screen

AFP, hCG, estriol, inhibin A test for NTD, tri 18, 21 measure maternal serum levels of PAPP-A and hCG in relation to maternal weight and age, and gestational age, 80-90% accurate in detecting tri21 timing: 15-22 wks purpose: screen for trisomy 21, 18, and NTD

serum integrated screen

AFP, hCG, uE3, DIA, and h-hCG to test for NTD, tri 13, 18, 21 blood test 1 at 10-13 wks, 2 at 15-22 wks detects 88% of cases

penta screen

AFP, hCG, uE3, DIA, and h-hCG to test for NTD, tri 13, 18, and 21 15-22 wks detects 83% of cases

triple screening

AFP, unconjugated estriol (uE3), and hCG to test for NTD, tri 18 and 21 timing: 15-20 wks, maternal blood sample indications: all women, AMA, hx of genetic d/o purpose: low sensitivity detection of tri 21 (detect 69%) f/u: if +, u/s and amnio

triple screen

AFP, unconjugated estriol, and hCG timing: 15-20 wks procedure: blood test test for NTD, trisomy 18 and 21f

HBIG, hep B vaccine

All infants born to hepatitis B‐infected women should be given _________ and all unaffected infants should be given _______?

folding

As new cell forms, the embryo is forced to conform to available space. Structures of embryo fold to conform to space available

40 wks

CRL - 36 cm Avg weight 3400 g Fully developed

16 wks

CRL 12 cm, Weight 110 grams, Sex easier to discern, Fundus halfway between pubis symphysis and umbilicus

CO2

Content of ________ in fetal circulation is so much higher than in maternal circulation it easily diffuses from fetus

28 wks

Eyes open, Testes descend in scrotum, 90% chance of survival without physiological impairment

treponemal tests

FTA-ABS, TP-PA, EIA

20 wks

Fundus at umbilicus, Fetus moves every minute, Active 10-30% of the time, Most people have felt fetal movement, Fetus weighs more than 300 grams, Lenugo covers body, scalp hair is present

apoptosis

Genetically determined process of cell destruction. Responsible for lumen formation (trachea, gut) and disappearance of webbing between fingers and toes

bradley

Goal is unmedicated labor and delivery. Training techniques are directed toward the coach—husband-coached childbirth. Coach is educated in massage/comfort techniques to use during labor and delivery.

cefixime

If a provider consider it unlikely that a heterosexual partner of a pt with gonorrhea will access timely evaluatation and treatment with ceftriaxone, EPT with ___________ and azithromycin should still be considered, as not treating partiners is significantly more harmful than is the use of EPT for gonorrhea.

cotyledons

Irregular shaped segments of placenta separated by septa

syphilis

Leading cause of stillbirth and neonatal death in the developing world test timing: NOB, 28 wks, admission for labor

PAPP-A

Low value can indicate Down syndrome

integrated screening

NT+, AFP, hCG, uE3, DIA, h-hCG timing: 10-22 wks (blood test 10-13 wks, nt 11-14 wks, blood test 15-22 wks) purpose: screen for tri 21, 18, 13, and NTDs combines 1st tri NT measurement and 1st tri serum testing w/ 2nd tri quad screen reliability: 93-96% detection rate f/u: if + for tri21, refer to CVS for dx testing

sequential screen

NT+, AFP, hCG, uE3, DIAH, h-hCG to test for NTD, tri 13, 18, 21 blood test 1 10-13 wks, NT at 11-14 wks detects 95%

mammary souffle

Occurs near term or when mother is lactating; it's due to increased blood flow through the internal mammary artery

genital warts

Organism: Condylona accuminata sx: soft, fleshy, papillary, or sessile painless kertainized growths on genitalia tx: Patient applied: Imiquimod 3.75% or 5% OR Podofilox 0.5% solution or gel OR Sinecatechins 15% ointment Provider-Administered: Cryotherapy with liquid nitrogen or cryoprobe OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser or electrosurgery. OR Trichloroacetic acid or bichloroacetic acid 80-90% solution usually respond to tx w/in 3 mo Lesions may enlarge and destroy tissue. Giant condyloma may stimulate development of carcinomas.

chancroid

Organism: Heamophilus ducreyi Sx: ulcers in genital region tx regimens: Single dose therapy Azithromycin 1g orally once f/u: screen for HIV, follow up with practitioner within 3-7 days after treatment initiation.

truvada, descovy

PREP medications to lower chance of transmission

scabies

Permethrin (preferred in preg) 5% cream applied to all areas of the body from the neck down and washed off after 8-14 hours. Or Ivermectin 200ug/kg orally, repeated in 2 weeks. alternate: Lindane 1% 1oz of lotion or 30g of cream applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours.

pediculosis pubis

Permethrin 1% cr (Nix) rinse applied to affected area and wash off 10 mins Pyrethrins w/ piperonyl butoxide (RID) applied to area then washed off after 10 mins Alternate: Malathion 0.5% (Ovide) lotion applied for 8-12 hrs and washed off (strong odor, useful for resistant cases) Ivermectin (Stromectol) 250 µg/kg po w/ food, repeated in 2 wks. retreat in 1 wk if needed, resistance common in pregnancy do the same as permethrin and pyrethrin, but 2nd line is malathion and ivermectin

mosaicism

Presence of genetically distinct cell lines in the same individual

migration

Process where layers migrate to strategic locations along developing embryo by elongation and contraction of a cell. Problems that can develop if adhesion is disrupted is Hirschsprung disease from failure of neural crest cells to migrate.

8

Progesterone produced by the ovary until_____ weeks when it starts being produced by the placenta

candidiasis

RX Butoconazole 2% cr (Gynazole -1) 5g intra-vag 1/night [single dose bio adhesive patch] single dose only * OTC Clotrimazole 1%, cr (Gyne-Lotrimin -7) 5g intra-vag 1/ night x 7-14 days or 3 days - treat complic VVC; alter: 2 doses of 150mg fluconazole, 72 hrs apart. OTC clotrimazole 2% cr (Gyne-Lotrimin-7 or clotrimazole-3) 5g intra-vag 1 / night x 3 days. OTC Miconazole 2% , 4% cr (Monistat -7 or -3) 5g intra-vag 1/ night x 7 days or 3 days OTC Miconazole 100, 200, 1200 mg supp (Monistat-7, -3, or -1) 1 supp intra-vag x 7 days, 3 days, or single dose. RX Terconazole 0.4% (45g); 0.8% (30g); (Terazole -7 or -3) 5g intra-vag 1/night x 7 days or 3 days RX Terconazole 80mg supp (Terazole-3) 1 supp intra-vag 1/ night x 3 days Oral: RX Fluconazole (Diflucan) 150mg po 1/night single dose. SE: alter hepatic func & D-D interactions.

trich, HPV, HSV-1, BV

STI's with higher STI transmission among WSW

intracervical insemination

Semen is inserted into the vagina. Can use either fresh or frozen semen. Semen can be inserted "unwashed." ICI "unwashed" sperm can live up to 24 hours. Insemination at home by couple in or provider's office.

diastasis recti

Separation of the longitudinal muscles of the abdomen (rectus abdominis) during pregnancy due to enlarging uterus

24 wks

Skin wrinkled, Fat deposition, Head comparatively large, Lots going on in lungs, alveolar development Viability (50%)

estrogen

Softens collagen fibers in cervix and ligaments, increases uterine blood flow, promotes growth of the uterus and breast glandular tissue, increases production of insulin-like growth factors, enhances myometrial contractility, increases myometrial sensitivity to oxytocin, may upregulate oxytocin receptors, thickens vaginal mucosa, hypertrophy of smooth muscle cells

intrauterine insemination

Sperm is inserted directly into the uterus. Most clinics will only use frozen sperm. Semen must be "washed" before being inserted. IUI "washed" sperm only live for 8-12 hours. Sterile procedure must be performed by provider.

hypnobirth

Teaches women how to use natural ability to give birth. Relaxation techniques and natural childbirth education enhanced by hypnosis.

lamaze

Techniques that focus mother's attention on breathing and relaxation exercises as well as massage. Perception of pain is lessened. Father or other support person's involvement is important.

decidua parietalis

The endometrium on the wall opposite the embryo

decidua basalis

The portion of the decidua on which the blastocyst rests forms a soft, spongy vascular bed known as this. it is the site of the future placenta. maternal macrophages and maternal natural killer cells migrate here

10%

The risk of fetal infection with hepatitis B is less than ____% when the mother's primary infection occurs early in pregnancy. Later in pregnancy, the risk increases to 90%.

ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

western blot

a positive ELISA test should be followed up with what?

cell proliferation

a rapid increase in number of cells by division and growth, usually precedes differentiation. Proliferation inhibition by teratogenic agents can cause defects.

trisomy 21

absence of fetal nasal bone

ductus venosus

absence of placental circulation closes this

HSV suppression

acyclovir 400 mg BID OR famvir 250 mg BID OR valacyclovir 1g daily

initial HSV outbreak

acyclovir 400 mg TID for 7-10 days OR famvir 250 mg TID 7-10 days OR valacyclovir 1g BID for 7-10 days pregnancy: acyclovir

recurrent HSV outbreak

acyclovir 400 mg TID x 5 days OR 800 mg BID x 5 days OR famvir 125 mg BID x 5 days OR valacyclovir 1g daily x 5 days pregnancy: acyclovir

48 hours

advise patients to avoid lubricants, vaginal medications, and semen for how long before a pap?

secondary syphilis

appear 4-10 weeks after infection, marks change from local to systemic infection. Rash on palm of hands and soles of feet and trunk, can be macular, papular, or psoriasiform. Patchy alopecia, condylomata lata, lesions of the mucous membranes, sx of systemic illness i.e. low grade fever, sore throat, hoarseness, malaise, headache, anorexia, generalized lymphadenopathy

transformation zone

area from where columnar cells originally started when someone was young to the current squamocolumnar junction, cells have been changing over time. Has gland openings, nabothian cysts, sometimes a fine white line or fine change in color on the cervix where that junction was

chlamydia

associated with an increased risk of preterm birth and premature rupture of membranes. Test Timing: NOB; repeat TOC(3-4 weeks)

gonorrhea

associated with preterm birth and it has also been linked to fetal growth restriction. Test timing: NOB; repeat TOC (2 weeks); 3rd trimester

4 kg, 500 g

at term how much do the fetus and placenta weigh together and how much protein do they contain

65

at what age should cervical cytology be d/ced in women w/ evidence of adequate prior screening results (3 consec neg cytology results or 2 consec neg contest results w/in previous 10 yrs w/ most recent in last 5 yrs and no hx of CIN2 or higher)

700-800 ml

average amount of amniotic fluid at term

fifths disease

avoid exposure to kids with rashes, can cause fetal hydrops if infected while pregnant dangerous if client becomes infected during 1st half of pregnancy or close to delivery immunize prior to pregnancy, wait 1-3 months before conceiving

listeriosis

avoid unpasteurized milk, soft cheese, shellfish, undercooked meat, poultry, fish, eggs, cold lunch meats, raw seafood risk of SAB if early in pregnancy, neonatal infection several wks after birth

nausea

begins at 6 wks, peaks 9-11 wks, subsides 12-14 wks, resolved by 20 wks

mammogenesis

begins early in pregnancy, breasts enlarge and lobules increase in size. nipples erectile, areola larger and darker, alveoli expand and proliferate

1000

c-section recommended for women with HIV and viral load higher than ______ copies/mL

lead poisoning

can cause poor fetal growth, developmental delays, and potentially impact sexual maturation and future fertility on female fetuses

syphilis

can cross placenta as early as 9 weeks gestation and cause fetal malformations and death. Transmission occurs between 16th - 28th week of pregnancy. Associated with preterm birth, LBW, congenital malformations. Penicillin G is the ONLY acceptable tx during pregnancy. If she is allergic desensitize per CDC guidelines. Monitor for Jarisch-Herxheimer reaction (occurs 2 hr after initiation, can cause fetal distress or PTL)

tertiary syphilis

can occur between 1-2 years after infection to 30+ yrs later, rare. Two forms: gumma (soft tissue granuloma tumors) and cardiovascular (aortic valve disease, AAA, coronary artery disease).

umbilical artery

carry deoxygenated blood from fetus to placenta, anterior branches of the left and right internal iliac artery. there is two

hPL

cause insulin resistance (maternal hyperinsulinemia), initiates hyperplasia w/in beta cells of maternal pancreas so more insulin production can occur

BV

caused by dysbiosis of vaginal bacteria, replacement of vaginal lactobacilli with anaerobic microorganisms such as gardnerella vaginalis and prevotella streptococcus and bacteroids spp. sx: itching, dyspareunia, fishy odor, thin white homogenous dc, + whiff test, clue cells on microscopy, pH > 4.5

hyperlipidemia

caused by increased insulin resistance and estrogen stimulation during pregnancy

PID

caused by microorganisms that comprise the vaginal flora (esp. gonorrhea & chlamydia) sx: mucopurulent cervical discharge, WBCs on microscopy, fever, friable cervix, elevated ESR, elevated C-reactive protein, gc/ct cervical infection presumptive tx should be given in young sexually active women if they are experiencing pelvic/lower abdomen pain and no other cause is identified, and if they have cervical motion, or uterine or adnexal tenderness

heartburn

caused by progesterone induced relaxation of LES, slower emptying of gastric contents, smaller capacity stomach, appears in 3rd trimester

PID

ceftriaxone 250 mg IM single dose PLUS doxy 100 mg orally BIDx14 days with or without metronidazole 500 mg BID x 14 days if pregnant, hospitalize and tx with IV abx should improve w/in 3 days after initiation of tx. if not, hospitalize, assess antimicrobial regimen and additional diagnotics. if GC/CT PID, retest 3 mo after tx

yellow

chorioamnionitis can cause what color placenta

light placenta

chronic uteroplcental insufficiency, chromosomal anomalies, maternal tobacco use, and congenital infection are associated with

lungs

circulation to what is minimal because it is bypassed by the foramen ovale and ductus arteriosis

spiral arteries

coiled arteries that supply blood to the functional layer of the endometrium

spiral arteriole

coiled branches of uterine artery that develop in secretory phase of the menstrual cycle and into the pregnancy, empty into intervillous spaces and supply blood to placenta. remodeling done by cytotrophoblasts, if not done = preeclampsia

1st tri screening

combined test or nuchal translucency, PAPP-A, hCG, NT in relation to maternal weight and age and gestational age timing: 10-14 wks determines risk of trisomy 21, 18, or 13, (risk 1 in 100, 1 in 1000) procedure: blood test & ultrasound, 85-97% reliable if positive need more testing

fta-abs

confirmatory test for syphilis, does not distinguish active from treated disease as it remains positive after treatment

foramen ovale

connects the two atria in the fetal heart

amniotic fluid

consists of water, albumin, nitrogen compounds (urea, uric acid, creatinine), carbohydrates, lipids, electrolytes

intervillous space

contains moms blood derived from lacunae that formed in the syncytiotrohoblast during week 2 of develoment

second

danger signs in which trimester? Same as first trimester plus regular uterine contractions; pain in one leg or calf, often increased with foot flexion and redness, heat, and tenderness, or coldness, numbness, and whiteness; sudden gush of fluid that cannot be controlled by Kegel exercises; absence of fetal movement for more than 24 hours after quickening; facial swelling; or severe upper abdominal pain or headache with visual changes and/or photophobia.

first

danger signs in which trimester? Spotting or bleeding, cramping, painful urination, severe vomiting and/or diarrhea, fever higher than 100ºF, low abdominal pain located on either side or in the middle, lightheadedness, and dizziness, particularly if accompanied by shoulder pain.

third

danger signs in which trimester? same as previous, decrease in the daily fetal movement., umbilical cord in vagina

spiral arteries

deliver fresh blood into intervillous space

umbilical vein

delivers oxygenated blood from the mom to the fetus, one vein, largest umbilical cord

fetal respirations

depends on the following four factors: 1) adequate maternal blood flow 2) sufficient functional placental villi for gas exchange 3) adequate diffusion, facilitated diffusion, and active transport of gases nutrients and fetal waste 4) unimpaired fetal circulation through the placenta and umbilical cord

MSAFP

detects multiples, birth defects, neural tube defects

flatulence

develops in 1st trimester due to decreased GI motility and uterine displacement of intestines recommend exercise, caffeine, knee chest position

morula

develops into blastocyst which implants into the uterine lining at 6-7 days after fertilization

cranial-to-caudal

direction of development of embryo

familial dysautonomia

disease of nervous system that begins in infancy. unstable BP/temp, pain insensitivity, problems w/ speech and movement, difficulty swallowing, lifespan 30 yrs indications: ashkenazi jewish, 1/27 carriers amnio/CVS to diagnose

supine hypotensive syndrome

dizziness/syncope when suddenly standing or lying on back due to enlarged uterus impairing venous return occurs in 3rd tri

IgM

does not pass through placenta and means active infection

leg cramps

due to buildup of lactic acid and decreased blood flow, often during 2nd and third tri usually at night after a period of inactivity

chadwicks sign

due to vascularization increase in first trimester

rises, softens, increase

during pregnancy the diaphragm ______, the thoracic cartilage _______, and there is a(n) decrease/incraese in transverse diameter of thorax

hypercoaguable state

during pregnancy women have increased clotting factors, decreased fibrinolysis, decreased anticoagulant activity, increased factors 1,2,7, 8, 9 and 12, decreased protein S and activated protein C. this is called what?

increased, decreased, increases

during pregnancy, absorption of calcium is ________ and excretion is ______________, PTH __________ bone resorption

increased

during pregnancy, altered enzymes transport across villi results in (increased/decreased) absorption of vitamins

3rd

during which week of embryonic development do the mesoderm, the ectoderm, and the endoderm begin to undergo the dramatic transformations that form specific embryonic structures.

week 6

during which week of pregnancy do Limb differentiations, short webbed fingers and toe rays, face more distinct, jaw visible, nares and upper lip present. Heart development almost complete, circulation established, Liver prominent and producing blood cells, intestines enter proximal portion of umbilical cord

week 28

during which week of pregnancy does The crown-rump length is approximately 25 cm, and the fetus weighs about 1100 g. The thin skin is red and covered with vernix caseosa. The pupillary membrane has just disappeared from the eyes. Isolated eye blinking peaks at 28 weeks. The otherwise normal neonate born at this age has a 90-percent chance of survival without physical or neurological impairment.

week 24

during which week of pregnancy does The fetus now weighs approximately 630 g. The skin is characteristically wrinkled, and fat deposition begins. The head is still comparatively large, and eyebrows and eyelashes are usually recognizable. The canalicular period of lung development, during which the bronchi and bronchioles enlarge and alveolar ducts develop, is nearly completed. A fetus born at this time will attempt to breathe, but many will die because the terminal sacs, required for gas exchange, have not yet formed. By 26 weeks, nociceptors are present over all the body, and the neural pain system is developed.

week 20

during which week of pregnancy does fetus now weighs somewhat more than 300 g, and weight increases in a linear manner. From this point onward, the fetus moves about every minute and is active 10 to 30 percent of the time. The fetal skin has become less transparent, a downy lanugo covers its entire body, and some scalp hair has developed. Cochlear function develops between 22 and 25 weeks, and its maturation continues for six months after delivery.

week 36

during which week of pregnancy does the fetal crown-rump length averages about 32 cm, and the weight is approximately 2500 g. Because of subcutaneous fat deposition, the body has become more rotund, and the previous wrinkled facial appearance has been lost.

week 32

during which week of pregnancy has fetus has attained a crown-rump length of about 28 cm and a weight of approximately 1800 g. The skin surface is still red and wrinkled.

week 16

during which week of pregnancy is The fetal crown-rump length is 12 cm, and the weight is 110 g. By 14 weeks, gender can be determined by experienced observers by inspection of the external genitalia. Eye movements begin at 16 to 18 weeks, coinciding with midbrain maturation.

week 12

during which week of pregnancy is The uterus usually is just palpable above the symphysis pubis, and the fetal crown-rump length is 6 to 7 cm. Centers of ossification have appeared in most fetal bones, and the fingers and toes have become differentiated. Skin and nails have developed, and scattered rudiments of hair appear. The external genitalia are beginning to show definitive signs of male or female gender. The fetus begins to make spontaneous movements.

week 3

during which week of pregnancy is growth is rapid, development of mesoderm and trilaminar embryo, formation of neural tube (CNS), somites (bones and supporting structures), coelom (body cavities), primitive cardiovascular system

week 5

during which week of pregnancy is human like appearance, head growth rapid from brain development, further head flex and C-shape. Forelimbs develop, paddle-shaped hands with digital ridges, heart chambers form, five distinct areas of brain, cranial nerves present, retinal pigment and external ear appear

week 40

during which week of pregnancy is the average crown-rump length is about 36 cm, and the weight is approximately 3400 g.

week 7/8

during which week of pregnancy is the time of facial, organ system, and neuromuscular development. Head rounded, eyes open, eyelids develop and fused by 8th week (does not open until 25th week). Mouth, tongue, palate complete. External ear distinct, low set. Limbs distinct, flexion of elbows and wrist. Fingers longer and toes differentiated. Body covered by thin skin. Neuromuscular develop leads to movement (by u/s). GI and GU systems separate, kidneys achieved basic structure, internal genitalia differentiated, rectal passage complete, anal membrane perforated for open digestive system.

week 4

during which week of pregnancy is time of body building. Embryo becomes cylindrical and assumes C-shape due to transverse/longitudinal folding. Neural tube fuses days 21 to 28. Cranial are enlarges and in flexed position. Heart starts beating day 20 to 22. Day 26-small swellings are visible (arm buds) and day 28 (leg buds). The branchial arches (face, mandible, pharynx develop) become visible but not distinct.

decidual reaction

endometrial changes due to implantation

niemann-pick disease type A

enlarged liver and spleen, rare type A & B - need blood or skin sample biopsy to measure how much sphingomyelinase is in WBCs

ptyalism

excessive saliva often associated with n/v

gaucher disease screening

fat laden cells build up in spleen, liver, and bone marrow autosomal recessive indications: ashkenazi carrier testing or beta-glucosidase leukocyte BGL test to check enzyme activity

foramen ovale

favors circulation of most oxygen rich blood to the brain

non-linear

female sexual functioning complex and circuitous, affected by psychosocial issues reasons for engaging in sexual activity rather than drive

9-12

fetus begins to produce urine at ________ weeks gestation

corneal edema

fluid retention during pregnancy can lead to this ocndition in the eye

HBIG

for PEP, provides temporary protection from HBV infection, adjunct to hep B vaccine in a previously unvaccinated person

q3yrs x 20 yrs

for women w/ hx of CIN2,3, or adenocarcinoma in situ, total hysterectomy w CIN2+ in last 20 yrs how long should screening continue after spontaneous regression or appropriate management3q

lacunae

formed when syncytrophoblasts invade the endometrium and disrupt maternal endometrial capillaries, this is what the engulfed portions are called

circular model

four stages: seduction (desire), sensation (excitement and plateau), surrender (orgasm), reflection (resolution) pleasant and satisfying experiences = reinforcing effect

IgG

freely transports across placenta giving immunity to fetus

chorion

fuses into decidua vera forming this outer fetal membrane at 10-12 weeks

16, 18

gardisil protects against which types of hpv

gonorrhea

gram negative intracellular diplococcus sx: dysuria, abnormal vag discharge, bleeding tx: 250 mg ceftriaxone (or 400 mg cefixime) and 1 g oral azith

natural childbirth

grantly dick-read

2-7, 8-15

greatest risk of fetal harm for x-rays is between __________ weeks and ____________ weeks

brown

hemosiderin can cause what color placenta

relaxin and estrogen

hormones that increase laxity of ligaments

24 hours

how long can unwashed sperm live

8-12 hours

how long does washed sperm live

1 month

how long should oyu wait after rubella vaccine to conceive

18 days

how many days after fertilization does the brain start to develop

6-10 days

how many days after ovulation is the uterus ready for blastocyst invasion

200 mg

how many mg caffeine ok daily

5-15

how many mm is the uterine wall at term

10-14

how many weeks is nuchal translucency scan done

20-25%

how much does basal metabolic increase during pregnancy

bradley

husband-coached childbirth

heavy placenta

hydrops placentalis/fetalis, macrosomia infant of diabetic mother, beckwidth weidemann syndrome, and triploidy

maternal serum alfa fetal protein

identifies risk of open NTDs and chromosomal disorders in 2nd tri, maternal blood collected to measure serum levels screens for NTD, only for those who did 1st tri combined screen (bc combined test doesn't screen for NTD) timing: 15-22 wks reliability: 80%

cell free DNA testing (NIPT)

identifies trisomy 21, 18, 13, and sex chromosome aneuploidy perform 10 wks - term 99% detection rate maternal blood collected for small fragments of circulating fetal DNA if + do amnio or CVS not recommended routinely for low risk women

long, hypertwisted

if the umbilical cord is _________ or ________, the baby may have increased fetal activity, polyhydramnios, heart failure (increased distance to pump), increased risk of cord accident

short, flat

if the umbilical cord is _________ or ________, the baby may have poor fetal activity, neuromuscular compromise, oligohydramnios, limb/body wall complex, or gastroschisis

cotest, 3 yrs

in Women w/ ASC-US cytology and (-) HPV, what test should they have done next and when?

RAAS

in pregnancy, increase Na+ retention which increases h2o retention; increased renal blood flow and GFR

cholinergic fibers

increase pelvic muscle contraction

ductus arteriosus

increased oxygenation of circulating blood causes constriction and functional closure of this

left atrium

increased pressure where causes functional closure of foramen ovale

goodell sign

increased vascularity, slight hypertrophy, hyperplasia, edema, softening of cervical tip due to influence of estrogen in first trimester

WBC

increases 5,000-12,000/mm3 without infection during pregnancy

erythropoietin

increases RBC production in pregnancy

sickle cell anemia

indication: african american, mediterranean, SE asian, middle eastern, western indian blood disorder that causes anemia, bone pain, and frequent infections

bloom syndrome

indication: ashkenazi autosomal recessive disease: short stature, sun-sensitive red rash, immune deficiency, insulin resistance, increased susceptibility to cancer diagnosis: carrier screening

canavan disease

indications: ashkenazi progressive fatal neuro disorder, myelin deterioration

mucolipidosis IV

indications: ashkenazi, 1/89 carriers neurodegenerative lysosomal storage disorder, autosomal recessive. moderate-severe psychomotor delay, muscle stiffness

fanconi anemia group c screening

indications: ashkenazi, dutch, japanese, saudi origin autosomal recessive timing: preconception ideally disease: characterized by physical abnormalities, bone marrow failure, pancytopenia, increased risk for malignancy

fragile x

indications: family history of unexplained developmental delay, autism, primary ovarian insufficiency

spinal muscular atrophy

indications: most common in caucasians but offer to everyone, 1 in 40 carriers autosomal recessive if + do CVS or amnio

cytotrophoblast

inner cellular layer of the trophoblast, single nucleated cells -- point of contact between maternal tissue and fetal cells. Form columns which anchor villi to the placenta. Change architecture of spiral arteries to accommodate increased blood flow to the uterus and they also secrete peptide hormones

collaborative reproduction

insemination procedure or ART, may be chosen when infertility tx or ART have been unsuccessful or is not possible example: donor sperm or donor oocytes

marginal insertion/battledore placenta

insertion of umbilical cord on edge of placental mass

30-70%

insulin sensitivity in late normal pregnancy is __________ lower than that of non-pregnant women

adhesion

interaction on one cell and complementary adhesion on membrane of another cell. Disruption can cause cleft palate or neural tube defects

endocervix

internal, canal-like, opens into the uterus consists of a single layer of columnar epitheliu

endocytosis

invagination in the surface of a cell that forms intracellular membrane-bound vesicles. involves engulfing of microdroplets of maternal plasma or small solutes (pinocytosis) or large particles (phagocytosis) by trophoblast cells. Substances in maternal plasma such as globulins (IgG), phospholipids, lipoproteins, and antibodies are transferred to the fetus or metabolized by the placenta. These mechanisms are necessary to transfer molecules too large for diffusion or for which no carrier transport exists to cross the placenta.

collaborative/3rd party assisted

involvement of a person who will not be raising the child, such as a sperm or egg donor or a surrogate mother. When this approach is used, one person may donate sperm or oocytes (genetic parent) and/or carry the pregnancy (gestational mother) for another person or couple who will raise the child (rearing parents).

facilitated diffusion

involves transport via protein transporters to move substances across the placental membrane. Glucose and possibly some oxygen are transported from maternal to fetal circulation via this mechanism Waste products such as lactate are transported from fetus to mother via this mechanism

circumvallate placenta

is a placenta with a double layer of membrane (chorion and amnion) that circles the edge of the placenta on the maternal side and appears as a whitish ring.

decidua capsularis

just above the area of trophoblast proliferation, initially covers the growing embryo.

angiogenesis

key to blood flow in placenta

hypnobirth

language of pregnancy, labor, and birth has been changed from the usual medical model terms to more positive, empowering terms. For example, uterine contractions are ''surges,'' ''coach'' is instead termed ''birthing companion,'' and membranes are ''released,'' not ''ruptured.'' HypnoBirthing does not teach methods of coping with labor pain—instead, it teaches deep relaxation, visualization, and self-hypnosis, and stresses that childbirth does not need to be painful.

trisomy 21

low PAPP-A, high hCG, >3 mm nuchal fold

hCG

maintains corpus luteum during early pregnancy to ensure secretion of progesterone, estradiol, estrone, and other substances until placental production is adequate, promotes implantation, promotes angiogenesis in uterine vasculature, stimulates thyroid production of thyroxine in the first trimester, suppresses myometrial contractions, promotes formation of syncytiotrophoblast during throphoblastic invasion. marker of fetal health -- high in trisomy 13 and 21, lower in 18

progesterone

maintains quiscent uterus (not contracting, reasonable amounts of activity)

tension

majority of headaches in pregnancy

single gene

marfan's, von willebrands, familial hypercholesterolemia, huntington's are examples of what type of disorder

thalassemia

may cause problems with bones, spleens, and heart indications: mediterranean (greek, italian), middle eastern, african, or asian descent CBC & hgb electrophoresis should be performed autosomal recessive

placenta

mechanisms by which substances are transferred across the ________: (primarily diffusion) simple (passive) diffusion, facilitated diffusion, active transport, pinocytosis, endocytosis, bulk flow, solvent drag, accidental capillary breaks, and independent movement

green

meconium can cause what color placenta

VEGF, PGF

mediate placental vasculature growth during pregnancy

antacids, h2 receptor antagonist, PPIs

medications to treat heartburn during pregnancy (from most to least used)

amnion

membrane that covers embryo, fills with amniotic fluid and expands to protect fetus

PLISSIT

method for assessing and discussing sexuality in health care settings

BV

metronidazole 500 mg orally BID x 7 days, or metronidazole gel 1 applicator at bedtime x 5 days during pregnancy, system antibiotics are necessary because topical antibiotics will not reduce prematurity sequalae from lack of access to upper genital tract

32 cm

minimum cord length for vaginal delivery

CF

most common in caucasian (1 in 2,500), offer to everyone sensitivity rate low depending on ethnicity

simple/passive diffusion

movement of a substance from higher to lower concentration or electrochemical gradients. it is generally limited to smaller molecules that can pass through pores in the cell wall. Substances that cross the placenta via this method include water, electrolytes, oxygen, carbon dioxide, urea, simple amines, creatinine, fatty acids, steroids, fat-soluble vitamins, narcotics, antibiotics, barbiturates, and anesthetics.

syncytiotrophoblast

multinucleate protoplasmic mass formed by fusion of cells. burrows into endometrium and remains in contact with maternal blood throughout gestation. Primary source of hCG

7 wks

neural tube closes at how many weeks gestation

ASC-US

nucleus <3x normal, doesn't meet LSIL classification 70% benign, 5-7% high grade lesion

LSIL

nucleus more than 3x normal and dark, no or few nuclear abnormalities 6% high grade most adolescents clear this

Dyspaurenia

occur 20+ wks recommend sexual position changes to accommodate larger uterus, user water based lubes

spider nevi

occur 8-20 wks tiny dilation blood vessels that present as small bright red dots on trunk, extremities, and face increase in estrogen levels during pregnancy and increase in intravascular pressure lead to promotion of vasodilation and development of this

variscosities

occur in 2nd/3rd tri 2/t venous distension from increased venous pressure and dilation most common in legs and vulva

urinary frequency

occurs in 1st and 3rd trimester due to decreased bladder capacity and mechanical pressure from enlarging decrease fluid intake at night

dyspnea

occurs in 1st tri, worsens 2nd-3rd due to enhanced sensitivity to co2 and hypoxia

increased libido

occurs in 2nd trimester when hCG decreases and estrogen and progesterone lvls rise to support growing fetus. estrogen increases vag lubrication and blood flow to vulva which causes what

taste/smell distortion

occurs in first tri due to fluctuations with HCG hormone

dizziness

occurs in late 2nd/3rd tri, Normal physiological changes of decreased systemic vascular resistance leading to vasodilation and venous pooling. Decrease in CO and a decrease of blood flow to the brain.

lactogenesis

occurs in middle of pregnancy when alveoli epithelial cells change into secretory epithelium

exocytosis

occurs on the opposite side of the cell with fusion of the vesicle to the membrane and release of the vesicles' contents.

constipation

occurs throughout pregnancy due to decreased motility from increased progesterone

organogenesis

organ formation that takes place during the first two months of prenatal development

hep A

organism: RNA virus transmission: fecal-oral sx: fatigue, nausea, ab pain, anorexia, low fever, jaundice, ab tenderness, hepatomegaly

proctocolitis

organism: campylobacter sp, shigella sp, entamoeba histolytica, lgv serovars of ct sx: anorectal pain, diarrhea, abdominal cramps, inflammation of colonic mucosa extending to 12 cm above anus

lymphogranuloma venereum

organism: chlamydia trachomatis (subtype) sx: unilateral painful inguinal lymphadenoapthy or pelvic pain, nontender genital lesion, rectal infection tx: doxy 100 mg BID x 21 days in pregnancy: erythromycin 500 mg QID x 21 days or azith 1g once a week x 3 wks

epididymitis

organism: gc/ct, e.coli in MSM (insertive partner) acute: unilateral testicular pain & tenderness, hydrocele, palpable swelling, epididymis, tender/swollen spermatic cord chronic: >6 wks of discomfort exam: MB/GV stain of urethral secretions demonstrating >2 WBC, + leukocyte esterase test on first void urine, >10WBCs in first spun urine tx: ceftriaxone 250 mg IM AND doxy 100 mg BID x 10 days in MSM do ceftriaxone and levofloxacin 500 mg daily or ofloxacin 300 mg BID x 10 days f/u: return if not improved in 72 hrs

proctitis

organism: gc/ct, t. pallidum, and HSV sx: inflammation of rectum, anorectal pain, tenesmus, rectal discharge tx: ceftriaxone 250 mg IM + doxy 100 mg BID x 7 days if associated with gc/ct, retest in 3 mo

enteritis

organism: giardia lamblia occurs in ppl who have oral-anal contact sx: diarrhea, abd cramps

urethritis

organism: gonococcal urethritis typically, but can also be chlamydia sx: painful, burning, frequent urination, discharge from urethra tx: azith 1g or doxy 100mg BID x 7 days

granuloma inguinale

organism: gram neg klebsiella granulomatis sx: painless, slowly progressive ulcerative lesions on genitals, highly vascular and bleed. extragenital infx can occur w/ extension of infection to pelvis or to intra-abdominal organs, bones, or mouth. lesions can develop infections diagnosis: visualization of dark-staining donovan bodies on tissue crush preparation or biopsy tx: azith 1g orally once per wk or 500 mg daily for 3 wks until healed

syphilis

organism: spirochete treponema pallidum exam: chancre & + dark field microscopy of exudate VDRL confirmed with treponemal test, passive particle agglutation assay, various enzyme immunoassays, or chemiluminescence immunoassays

chorionic villi

originates form vascular cytotrophoblast. columns of cells that appear close to 3rd week of gestation during proliferation of cytotrophoblast layer. mediates passage of nutrients, waste products, and gases between mom and fetus

flagyl

other name for Metronidazole

trophoblast

outer cells of the blastocyst that secrete enzymes that allow implantation. eventually form placenta and chorion

sciatica

pain in pelvis and butt which radiates down back of lower extremity, sudden/severe pressure on sciatic nerve from joint laxity elicitied by twisting/lifting/moving leg 3rd trimester, unilateral recommend side lying position on contralateral side from affected leg

birthing from within

pam england, "mindfulness" and awareness, not necessarily aiming for unmedicated childbirth

syphilis

parenteral penicillin G 2.4 million units IM single dose is best tx for syphilis, (3 doses 1 wk apart for late latent syphilis). Alternative for nonpregnant patients are doxy 100 mg orally BID x 14 days or tetracycline 500 mg QID x 14 days f/u VDLR/RPR at 6 mo & 1 yr, should decline fourfold

embryonic period

period of organogenesis that occurs between 2-7 wks following fertilization. Embryonic disk is well defined, body stalk differentiated to become umbilical cord

striae gravidarum

pink of red streaks during pregnancy as the dermis is stretched. Silvery white streaks may be present from previous weight changes or pregnancy

1/6

placenta weight compared to fetus

kyphosis

places pressure or traction on nerves in arms which can lead to numbness and tingling of the fingers, often occurs at night

iron deficiency anemia

plasma volume increases and this expansion exceeds the increase in red cell mass leading to physiologic hemodilution. this has a + effect on placental perfusion with the blood becoming less viscous, and there is a decrease in conc. of plasma proteins

tay sachs

population: ashkenazi, french canadian, cajun when: 2nd tri -- CVS/amnio caution: in pregnant women/taking OC's --> do leukocyte testing bc serum testing may have increased false-pos rate

T4, TSH

pregnancy causes an increase in _______ and decrease in ______ (thyroid-wise)

increased, dyspnea, 30-40, increased, thoracic

pregnancy is associated w/ __________ minute ventilation and pulmonary blood volume which can contribute to sensation of ___________. tidal volume increases by ___________%, and vital capacity is _________. Breathing is switched from abdominal to _______

morphogenesis

process in which cells and cell groups take on specific form, shape, and function

trophoblast

produce idoleamine dioxygenase (IDO) which decreases tryptophan levels and therefore T cell activity and therefore decreased immune response

protein

products of conception, the uterus, and maternal blood are relatively rich in what?

hemorrhoids

progesterone induced relaxation of vein walls in rectum along with enlarged uterus cause venous congestion appears any time but usually 3rd tri

reduced insulin sensitivity

progesterone, placentally derived growth hormone, prolactin, cortisol, cytokines such as tumor necrosis factor, and hormones derived from central adiposity, particularly leptin and its interplay with prolactin all contribute to what?

hPL

promote fetal growth by altering maternal protein, carbs, and fat metabolism. regulates glucose availability for fetus, Stimulates IGF-1 production and increases insulin resistance Enhance lipolysis--critical in the fasting state Possible prolactin like role, & Stimulates production of growth hormones

fornices

protrusion of the cervix into the vagina divides the vaginal vault into four of these - anterior, a posterior, and two lateral

3-5, 45-60

provider should be called during labor once contractions are ________ minutes apart and lasting _________ seconds, or once membranes are ruptured

lamaze

psychoprophylaxis

lamaze

psychoprophylaxis increase confidence in giving birth by focusing on how to cope with labor pain. Natural childbirth, breathing techniques used to enhance relaxation and decrease perception of pain, communication skills, evidence based, comfort measures, information about prenatal procedures, breastfeeding encouraged.

wright method

psychoprophylaxis but with less active breathing than Lamaze

insomnia

recommend warm baths, avoid caffeine, exercise, regulate room temp, antihistamines such as bandryl or unisom (occasional use)

HPV vaccine

recommended at age 11-12 but can receive from 9+. 2 doses 6 mo apart (if done <5 mo apart, need 3 doses) those who get at age 15-26 need 3 doses (0, 1-2, and 6 mo) not recommended for 26+, case by case

0.88g/kg/d

recommended protein intake in pregnancy

4+

recurrent candidiasis is how many times per year?

amniocentesis

risks of this genetic test include: pregnancy loss (1/1000), spotting, amniotic fluid leakage, intraabdominal viscus injury or hemorrhage, fulminant sepsis

PUBS

risks of this genetic test: 1.6% fetal loss rate, bleeding from cord puncture, fetal bleeding, umbilical cord hematoma, maternal-fetal hemorrhage, fetal bradycardia

trich

routine screening for this condition is only recommended for women with HIV bc coinfection leads to PID

CVS

sample from placenta aspirated transabdominally or transcervically, outer trophoblastic layer is obtained (same genetic makeup as fetus)

cytology

sampling of cells

histology

sampling of tissues

round ligament pain

seen in late 1st/2nd trimester shooting pain after sudden movement, sharp knifelike pain in lower abdomen or one side (typically right) extending to gorin area acute onset brought by rising from a chair quickly, lasts seconds to minutes

scabies

severe itching of groin, between fingers, and in the body folds, itching bilateral, worse at night small linear or curved burrows, exorciations surrounding papules

dual control

sexual responses involve an interaction between sexual excitatory and sexual inhibitory processes

psychosexual method

sheila kitzinger, chest breathing and simultaneous abdominal release

hep C

single stranded RNA spread through bodily fluids sx: fatigue, fever, abd pain, n/v/a, jaundice, dark urine, clay stools screen those at high risk and born between 1945-1965 tx: interferon & ribavirin w/ or w/out protease inhib risk of transmission to fetus 6%, no way to reduce trans

palpitations

skipped or extra beat, sinus tachy due to increased blood volume and pulse -- occurs at any time during pregnancy

isthmus

small constricted region of the uterus that lies above the internal os of the cervix, lies between body of the uterus and the cervix

hegar's sign

softening of the lower uterine segment

decidua

source of prolactin which is present in large amounts in amniotic fluid

hep B

spread with bodily fluids, usually sexual sx: fever, fatigue, anorexia, n/v, ab pain, dark urine, clay stool, joint pain, jaundice vaccine can be given w/in 24h of exposure increased risk of developing liver failure, liver cancer or cirrhosis.

braxton hicks

start during 2nd trimester when muscle fibers in uterus tighten and relax drink water, relaxation techniques, change positions

leukorrhea

starts in first trimester r/t increased pelvic blood flow clear to white w/ mild odor, watery or viscous, estrogen causes secretions to be more acidic

breast enlargement

starts in first trimester, discomfort resolves in second tri but size is same recommend: avoid caffeine or methylxantines

progesterone

supports endometrium to provide an environment conducive to fetal survival. prepares endometrium for implantation, promotes systemic vasodilation, has anti-inflammatory actions to protect throphoblast from being rejected, supports decidualization within the endometrium, prevents myometrial contractility, inhibits uterine production of prostaglandins, supports mammary growth for lactation, withdrawal at term leads to uterine contractions

HIV

sx: fever, sore throat, fatigue, weight loss, infections test: ELISA, if - it could be due to exposure w/in last 3 mo

trich

sx: itching, malodorous discharge, abdominal discomfort exam: pear shaped protozoa w/ 5 flagella, highly motile. frothy, yellow green dc, strawberry cervix pH > 4.5, + whiff, mobile ______ on slide Special considerations r/t pregnancy: Increased risk for preterm birth, increased risk for prelabor rupture of membranes, low birth weight, vertical transmission of HIV. Transmission of trich to fetus is rare but can happen. increased risk of HIV acquisition (3x) retest w/in 3 mo

HSV

sx: tingling, burning, painful ulcers, fever, malaise, HA, myalgia, dysuria IgG blood test can reveal subtype Recurrent infection during pregnancy pose little risk during prenatal period, but a primary outbreak is associated with small increase in fetal abnormalities and larger risk for intrapartum transmission. Prophylactic administration of acyclovir beginning at 36 weeks gestation may lower incidence of asymptomatic shedding and outbreaks at term.

candidiasis

sx: vag itching, dyspareunia, thick curdy dc, swollen vag, 1-2mm satellite lesions exam: lack of lactobacilli on wet mount, hyphae and pseudo hyphae w/ ns/KOH prep causes: Nonbreathable clothes/ in very humid or warm living condition, hormone change during preg, OCPs, DM, immunosuppress- HIV, corticosteroids, sex partner, overgrowth of normal flora, but contagious

true

t/f: Syphilis (including congenital syphilis), gonorrhea, chlamydia, chancroid, HIV infection, AIDS, Hep B, & Hep C are reportable diseases in every state

true

t/f: fetal circulation is a low pressure system, and the placenta is a low resistance circuit

true

t/f: in women with - cytology and + HPV cotest older than 30, they should either 1: have repeat cotest in 12 mo and if ASC-US or higher or HPV is still positive have a colpo. if not, cotest in 3 yrs 2: genotype testing for HPV-16 and HPV-18, if positive = colpo

CF, SMA, CBC

the bare minimum of genetic screening

expedited partner therapy

the clinical practice of treating the sex partners of pts diagnosed with GC/CT by providing prescriptions or medications to the pt to take to his/her partner without the health care provider first examining the partner. To prevent adverse outcomes from drug allergies, the clinician should provide information with the prescription about potential side effects and an allergy warning.

hep B

the following are treatments for what disease: Peg-IFN-2a (adult) IFN-a-2b (children) Lamivudine, Telbivudine, Entecavir, Adefovir, Tenofovir need regular monitoring to prevent liver damage and hepatocellular carcinoma

orgasm

the following enhance ________: norepinephrine, oxytocin and this decreases it: serotonin

excitement

the following increase ________: a-MSH, dopamine, norepinephrine, oxytocin and the following decrease it: prolactin, serotonin

vasocongestion

the following increase ________: cholinergic fibers, nitric oxide, norepinephrine, PGE1, VIP and these decrease it: prolactin, serotonin, sympathetic fibers

desire

the following increase _________: a-MSH, dopamine, estrogen, oxytocin, progesterone, testosterone the following decrease it: prolactin, serotonin

sensation

the following increase _________: dopamine, estrogen, testosterone and this decreases it: prolactin, serotonin

BV

the following is a new treatment for this condition secnidazole 2g single dose for adult women, granules sprinkled on pudding/applessauce. its flavorless

genetic counselor

the following patients should be referred to whom? AMA, high risk ethnic heritage, + family hx of genetic disorder, multiple relatives w/ same disorder, malformations or birth defects of self or family members, congenital blindness or deafness in family, extremely tall or short stature for family member, developmental delays of family members, recurrent (2+) pregnancy losses of 1st degree relatives, environmental exposure to teratogens or infertility

ectocervix

the part of the cervix that projects into the vagina and is lined with a layer of squamous epithelial cells and columnar epithelial cells

succenturiate lobe

the placenta has an accessory lobe or cotyledon separate from the primary placental mass.

decidua

the thick layer of modified mucous membrane that lines the uterus during pregnancy and is shed with the afterbirth. protects endometrium and myometrium from uncontrolled invasion by trophoblast cell mass and acts as a physical barrier and produces cytokines to promote trophoblast attachment to protect the endometrium during the period when trophoblast cells migrate out of the placenta to the maternal spiral arteries

trophoblast

there is less __________ invasion in preeclampsia and IUGR

hCG, TSH, total thyroxine

this hormone stimulates the thyroid which causes a decrease in ______ and increase in ________ (subclinical hyperthyroidism)

anatomy scan

timing: 18-22wks indications: estimate GA, detect fetal anomalies reliability: 44-89%

ectoderm

transforms into CNS, PNS, epidermis (hair, nails, sebaceous glands), epithelium of sensory organs, nasal and oral cavities, salivary glands, adrenal medulla, parts of the pituitary gland

mesoderm

transforms into Connective tissue, muscle tissue, skeleton (bone), cardiovascular, lymphatics, urogenital structures (gonads and kidney), serous lining of body cavities (peritoneum, pleural, pericardium)

endoderm

transforms into Epithelium of the digestive system (EXCEPT mouth and anus), liver and pancreas, respiratory system (including alveolar cells of the lung), thymus, thyroid, parathyroid, and pancreas

pediculosis pubis

transmitted via towels, linens, and other objects small punctate lesions and bluish macules

36

travel ok during pregnancy until how many weeks

protozoa

trich is not a bacteria or virus, it is a

chloasma

triggered by an increase in estrogen that stimulates the production of melanin can start in 1st tri but typically 2nd or 3rd

chlamydia

tx: azith 1g PO single dose or doxy 100 mg PO BID x 7 days in pregnancy always use azith

trich

tx: flagyl 2g PO x 1 for pregnant and nonpregnant

percutaneous umbilical blood sampling

ultrasound directed fetal blood sampling for cytogenetic or molecular analysis timing: 18+ weeks indications: fetal malformation detected during 2nd and 3rd trimesters, HOWEVER placental biopsy is safer easier and faster. may still be used to help clarify chromosome mosaicism detected in cultured amniotic fluid cells or chorionic villi or for prenatal eval of fetal hematologic abnormalities. Can assess anemia from Rh/antigen isoimmunization. also for blood factor abnormalities like hemophilia/von willebrand, and nonimmune hydrops fetalis

nuchal translucency

ultrasound to check for aneuploidy and certain cardiac defects, diaphragmatic hernias, skeletal dysplasia, and other genetic syndromes. > 3 mm of fluid retention = increased risk of trisomy 21, 18, and 13. between around 70% accurate. with serum markers it is more accurate.

backache

upper - 1st tri due to incraesed breast heaviness lower - 20+ wks due to relaxation of sacroiliac ligaments and lordosis, and weight of enlarged uterus

active transport

uses energy-dependent carrier systems and other protein transporters to move substances against concentration or electrochemical gradients. Amino acids, potassium, water-soluble vitamins, calcium, phosphate, iron, and iodine cross the placenta via this mechanism

AGC

usually from endocervix or endometrium 50% squamous lesions 15% have adenocarcinoma on biopsy

uterus

uterine and ovarian arteries supply blood to what

12 wks

uterus is at symphysis pubis, CRL 6-7 cm, Fetus weighs 8-14 grams, Fingers and toes differentiate, Hair appears, External genitalia begin to show signs of male/female gender, Uterus is size of grapefruit, Seatbelt education, IPV

hep B

vaccination for this disease is done 3 IM injections, 2nd and third dose are at 1 and 6 months

ASC-H

very abnormal looking cells, but very few present or nucleus doesn't meet criteria for high grade lesion 20-50% have high grade lesion, send to colpo

linea nigra

visible by 20 wks or it may faintly present from a previous pregnancy and begin to darken in the first trimester hyperpigmented vertical line on lower abdomen, caused by increased estrogen effect being magnified by the higher levels of progesterone during pregnancy

HSV

what STI can cause neonatal respiratory distress, irritability, jaundice, seizures, shock, and death

21-29

what ages should be tested q3yrs with cervical cytology

30-65

what ages should have cotest q5 yrs or conventional cytology q3 yrs

AP

what diameter does uterine growth occur in while isthmus of uterus becomes soft

cervical cancer

what do the following increase risk of? Smoking Immunodeficiency Multiparity (repeated cervical trauma) Other STIs (inflammation and increased HPV exposure risk) Chronic inflammation (more microabrasions) Multiple partners (more chances for exposure) Long-term oral contraceptive use (increases T-zone exposure; estrogen promotes cellular maturation) Genetic predisposition DES

breastfeeding

what drops maternal triglyceride levels but increases HDL-C

hCG, hPL, estrogen, progesterone

what hormones are created by the placenta

doxycycline

what medication should NOT be given to pregnant women with chlamydia

autosomal recessive

what type of disorders are CF, sickle cell, tay sachs, PKU, & b-thalassemia

6, 11

what type of hpvs give warts

2-8

what weeks are the most sensitive periods in pregnancy for fetal development due to organogenesis

15-24 (16-18)

when can amniocentesis be done

10+ weeks

when can cfDNA/NIPT. be done

10-13 weeks

when is CVS performed

vaginal cuff

where cervix once was and where vaginal walls are sewn together, if pt had hysterectomy for cancer do pap smear here

squamocolumnar junction

where squamous cell meets columnar cell. As columnar cells slowly become squamous cells through a process known as metaplasia, this moves in toward the os and eventually up into it

saccharin

which artificial sweetener crosses the placenta?

CVS

which genetic test has the following risks: infection, bleeding, miscarriage (1/455), limb deformities before 9 weeks contraindicated in case of maternal blood group sensitization

progesterone, relaxin, hCG

which hormones increase aqueous outflow and decrease episclera pressure

16

which hpv are anal and cervical cancer associated with

A

which vitamin supplement may be harmful in pregnancy?

alcohol

women taking metronidazole must avoid this