Prenatal Care /Normal Pregnancy EOR 16%

What week do you do gestational diabetes screening?

*24-28 weeks* (between 2nd and 3rd)

What is the time period of a *fetus*?

10th week after LMP to delivery

What is the timing of visits?

12-27 wks q4 wks 28-36 wks q2ws 36-birth qWeekly

When is the first ob visit?

12wks

Where is final height at these weeks? 12wks 16wks 20 wks 38wks

12wks- above pubic symphysis 16wks- midway between pubs and umbilicus 20 wks- at the umbilicus 38wks= 2-3cm below the xiphoid process

When does fetal movement generally start? This is known as what?

16-20 weeks (quickening))--first fetal movements called quickening and described as flutters

Quickening occurs at?

16-20 wks

What weeks are first trimester? What weeks are 2nd trimentser? What weeks are 3rd trimester

1st- 1-12 wks 2nd- 13-27 wks 3rd-28- birth

During pregnancy, caloric requirement is increased by (_). During breastfeeding, it is increased by (_)

200 kcal/day 500 kcal/day

What is appropriate Weight gain ?

25-23 lbs

When do you screen for DM?

26-28 wks

What screening tests are done during third trimester?

28wks-birth 1. Gestational diabetes screening- 24-28 weeks) 2. Repeat antibody titer: in unsensitized Rh negative mothers followed by: * RhoGAM @ 28 weeks and withoin 72 hrs after childbirth) 3. Group B Streptococccus screening via vaginal-rectal culture) 4. Hemoglobin and Hematocrit @ 3t5 wks 5. Biophysical profile - look at variables: fetal breathing, fetal tones, amniotic fluid levels, NST (nonstress test), and gross fetal movements (2 pts eacH)

What is human placental lactogen?

Insulin antagonist produced during pregnancy Causing decrease In insulin sensitivity and increase in blood sugar levels

How do you assess the fetus and determine well being?

NST CST BPP mBPP Kick Counts

Mechanism of labor

NSVD C section Induction

Manifestations of hyperemesis gravidarum? How doyou manage it?

Nauseua/vomin, weight loss 5% or pre pregnancy weight, acidosis (from starvation), metabolic hypochloremaic alkalosis ( from vomiting) 1. Fluids, electrolyte repletion, multivations, early treatment includes high protein foods, small/fequent meals, avoid spicy/fatty foods. Total parenteral nutrition is severe 2. *Antiemetics; Pyridoxine (Bit B6) + /- Doxylamine 1st line.* Promethazine, dimenhydrinate

Monozygotic involves division of a single fertilized ovum and is *not influenced by mom's (_) or (_)* while Dizygotic is (_).

age heredity hereditary

During pregnancy, if temperatures have been charted, a persistent elevation of (_) occurs

basal body temperature

What must be the baseline fetal heart rate for non stress testing (NST)? What is a reactive test What is a nonreactive test? Prognosis and management for each?

baseline fetal heart rate must be b/t 120-160 Reactive test: Defintion:: >=2 accelaerations in 20 minutes increased fetal heart rate accelerations >=15bpm from baseline lasting >+15wseconds Progrnosis: Fetal well being Management: Repeat weekly or bi-weekly Nonreactive: No fetal heart accelerations or <15bpm for <15seconds Prognosis: Sleeping, immature, or comprosied feus Management: Vibratory stimulation, May try contraction streess

Hematology changes in pregnancy: Dilutional anemia due to increased plasma volume compared to RBC mass Hemoglobin lower from 13.3 to 12.1 g/dL WBC count increases progressively during pregnancy Cause unknown 12,000-16,000 by end of 3rd trimester > 20,000 during labor

blood changes

This is a hormone secreted by corpus luteum and placenta that causes relaxation of SI joints and pubic symphysis which allows passage of fetus through birth canal.

relaxin

CV changes that occur throughout pregnancy: 1. Heart (size ) increases by ()% 2. (PMI_) shifts laterally 3. Increased CO can cause (SYSTOLIC MURMUR_) and

size PMI systolic ejection murmurs split

Late decelerations in contraction stress test are strongly associated with what?

stillbirths neonatal compromise

What is a Ruptured Membrane? How do you know it has ruptured?

sudden gush of liquid or constant leakage of fluid

What is Para?

# of births (>20wks) including viable and nonviable birts (ex.stillbirths) . Multiple gestations (ex.twins) count as 1.

What is Gravida?

# of times pregnany (regardless if carried to term)

How do you use Naegele's rule to calculate EDD?

*1st day of last menstrual period, plus 7 days, minus 3 months) LMP:: 8/7/16 EDD:: 5/14/17

What is and when do you do *Amniotomy* for induction of labor?

*Amniotomy* (artificially ruptureing the membrane with a small hook) can be done if the cervix is partially dilated and there is effacement of the cerrvix

How and when do you do *early induction*?

*Early Induction*: used in women with unfavorable cervices to promote cervical ripening --*Prostaglandin gel* placed directly on the cervix (ex. Cervidil) --Balloon catheter or laminaria

What physical exam findings/signs would you see with pregnancy with CERVIX changes?

*Goodell's sing*-cervical softening due to increased vascularization at ~4-5wks *Chadwick's sign*-bluish coloration of the cervix & vulva at ~8-12 wks

Indications and Contraindications of Induction of Labor?

*Indications*: vaginal delivery when prologed labor may lead to complications for either mother or the fetu and those risks are greater than continuing the pregnancy *Contraindications:* sitatiosn in which the risks of indcvtion of vaginal delivery are greater than c-section delviery:: prior uterinr rupture, priot c-section, active genital herpes infection, umbilical cord prolapse, placenta previa or vasa pevevia, transverse fetal lie.

What physical exam findings/signs would you see with pregnancy with UTERUS changes?

*Ladin's sign*-utereus softening after 6 weeks *Hegar's sign*- uterus isthmus softerning after 6-8 wks *Piskaceck's sign*-palpable lateral bulge or softening of the uterine cornus at 7-8 wks gestaon

How and when do you do *later induction*? !!!!!

*Later induction*: performed when the cervix is dilated <1cm with some effacement --*IV Oxytocin (Pitocin)* (*uterotonic agent*). Monitor uterine activty and fetal heart rate.

NOT ON LIST: When and what is post partum depression?

*Major depression 2weeks-12 month s poastpartum* Postpartum Blues: Onset: 2-4 days postpartum Duration: revolves within 10 days Clinical manifestation: mild insomnia, anhedonia, fatigue, depressed mood, irritability. No thoughts of harming baby Management: None (self limited) Postpartum depression: Onset: 2 weeks-2months postpartum Duration: 3-14 months Clinical manifestation:Irritability, sleep, and mood disturbances, eating changes, anxiety. *May have thoughts of harming baby* Management: May need antidepressants

How do you diagnose pregnancy?

*Serum b-HCG*- serum quantitative can detect pregnancy as early as 5 days after conception *Urine b-HCG*- can detect pregnancy 14 days after conception. Increased Serum Progesterone

Nutritional requirements during pregnancy?

+ 300 calls Increase folic acid (0.4mg) calcium (1200) and iron supplement 400 micrograms (0.4 mg) of folic acid daily for at least 1 month before pregnancy and during pregnancy

Respiratory changes in pregnancy?

02 consumption increases to meet metabolic demands of fetus Enlarging uterus interferes with lung expansion Increase minute ventilation Increase RR decrease CO2

Prenatal Care should be initiated by (_) weeks gestation.

10

FHR detected at?

10-12 weeks

Starting what week can you hear fetal heart tone? Normal range for fetal tones?

10-12 wks fetal heart tone via doppler. Normal 120-160

What screening tests are done second trimester?

1. Triple screening 2. Inhibin-A 3. Ultrasound 4. Amniocentesis 5. Gestational Diabetes screening

What screening/tests do you do in first trimester?

1.. Maternal blood screening --Down syndrome screening -- Uterine size and gestation 2. Ultrasound 3. Chorionic Villus Sampling

What do you offer amniocentesis?

2nd trimester - usually done 15-18weks May be offered to women includoing those with a prior child with a chromosomal abnormality, maternal age >35y, abnormal 1st or 2nd trimester screening test, abnormal ultrasound,; prior pregnancy loss. (same indications as CVS)

With regards to exercise, ACOG recommends (_) or more of moderate exercise per day

30

G/C screening and Group P strep cultures are taken at (_)

32-36 weeks

When do you culture for GBS?

36 wks

How matny stages of labor are there?

4

Routine Visits for Prenatal Care 1. Every (_) weeks from 0-32 weeks 2. Every (_) weeks from 32-36 weeks 3. Every week from (_) weeks

4 2 36

When can you detect pregnancy via pelvic US?

5-6 wks

Recommended to exclusively breastfeed for the first (_) months of life

6

Indications for induction

>39 wks GA Chorioamnioitis PROM Eclampsia Fetal demise

Progressive (_) enlargement during pregnancy. At 16-22 weeks, growth may appear more rapid as uterus rises out of pelvis and into abdomen. As the uterus enlarges, it rotates to the right

Abdominal

Preterm?

Infant weighing less than 500 g or delivered at or beyond 20-36 weeks

We can use this to : Diagnose fetal chromosomal anomalies, fetal lung maturity, infection Deliver medications to fetus Treat polyhydramnios

Amniocentesis

How do you calculate APGAR score? What criteria?

Appearance (skin color changes): 2= *Pink baby (no cyanosis) 1= *Acrocyanosis: body pink, blue extremeties* 0= Blue- gray, pale all over Pulse: 2= >=100 1= <100 0= 0 Grimace (reflex irritability): 2= pulls away, sneezes, or coughs 1= grimaces feebly 0= no response to stimulation Activity (muscle tone): 2= flexes arms and legs, resists extension 1=some flexion 0= none Respiration: 2= strong, crying (nml 40-60breeathmin) 1= weak, irregular 0=n absent

Common complaint, particularly in 3rd trimester due to center of gravity shifts leading to increased strain on lower back

Back Pain

Mild exercise may release endorphins and reduce back pain Gentle massage Heating pads Physical therapy Acetaminophen (Tylenol) for mild pain Muscle relaxants for severe pain

Back Pain treatment associated with pregnancy

What routine tests do you do during first prenatal visit?

Blood pressure, blood type &Rh, CBC, UA (glucose & protein), random glucose, HBsAg (for Hep B infection) HIV & syphilis, rubella titer, screening for sickle cell and cystic fibrosis, Pap smear

Occasional irregular contractions without cervical change = (_) (_) can lead to increased contractions. Regular contractions should be considered preterm labor and should be assessed

Braxton Hicks Dehydration

When can Chorionic villous samploing (CVS) be done? WHo is it offered to? hat are advantages and disadvantages?

CVS can be done around 10-13 weeks. May be offered to women includoing those with a prior child with a chromosomal abnormality, maternal age >35y, abnormal 1st or 2nd trimester screening test, abnormal ultrasound,; prior pregnancy loss. Advantage: allows for option early termination of pregnancy if abnormalities are found disadvantage: performing it increases risk of spontanous aborton

Blue discoloration of cervix Congestion of pelvic vasculature causes bluish or purplish discoloration of vagina & cervix

Chadwick's Sign

What is bluish discoloration of cervix called?

Chadwick's sign

AKA "mask of pregnancy" Skin darkening over forehead, nose, or cheek bones

Chloasma or Melasma

Unclear as to the pathophysiology-perhaps increased levels of ACTH which shares the same precursor with MSH or maybe changes in estrogen

Cholasma/Melasma

This may begin after 16 weeks gestation?

Colostrum Secretion

Evaluates FHR in response to uterine contractions > 34 weeks gestation Baseline FHR obtained IV Oxytocin or nipple stimulation

Contraction Stress Test

What do you monitor during L&D?

Contractions and FHR

An ultrasound at less than 12 weeks will show a (_) which is *most accurate to determine gestational age*

Crown Rump Length (CRL)

Variable Decelerations

D/t cord compression

Early Decelerations

D/t head compression Nadir in line with peak of contraction

Late Decelerations.

D/t ureteroplacental insufficiency Put pt in LLD

What triple screening results would indicate Down syndrome (aka ______)?

Down syndomr e(Trisomy 21) Low A-FP High b-HCG Low estradiol

What maternal blood screening tests re done in 1st trimester? What are the markers?

Down syndrome screening (3 markers) *high b low a=downs 1. *Free -bHCG*- abnormally high or low indicative of abnormalities 2. *PAPP-A)- usually low with fetal down syndrome 3. Nuchal translucancy- ultrasound at 10-13 weeks- increased thicknesss is abnormal Uterine size and gestatioin- if abnormal, chorionic villous sampling (CVS) or amniocentesi can be offered around 1-13 weeks

What does T1 screening assess for?

Downs NT increased BHCG increased PAPP-A decreased

During pregnancy, striae or stretch marks can occur over breasts and abdomen. why?

Due to separation of underlying collagen tissue

Cardinal movement of labor

Engagement Descent Flexion Internal rotation Extensions External rotation Explosion

(_) causes dilation, instability, proliferation, & congestion of blood vessels

Estrogen

Major features: growth retardation, facial dysmorphology, CNS deficiencies

Fetal Alcohol Syndrome

This is a non-invasive procedure; evaluates fetal well-being. What are the two components?

Fetal US (fetal movement, tone, breathing and amniotic fluid volume) Non Stress Test

Neural Tube Defects such as Spina Bifida or Anencephaly are associated with what deficiency during pregnancy?

Folic Acid

GP(tpal) example?

G6P(4024) 6 pregnancies 4 full term 0 premature 2 abortions 4 living children

What extra do you do at 28 wks?

Give rhogam

This is *softening of the cervix* that occurs during pregnancy

Goodell's Sign

CDC: screen all pregnant women for vaginal and rectal (_) colonization between 35-37 weeks Antibiotic treatment at delivery for positive screens

Group B Strep

High a-FP would indicate what?

HIGH a-FP indicate *open neural tube defects ex spina bifid (or multiple gestatioN)

CV changes that occur throughout pregnancy: 1. CO (_) by 40% initially due to increase in SV then maintained by increase in HR 2. Maternal (_) progressively increases during pregnancy. 3. Systemic vascular resistance (SVR) (_) and (_) decreases

HR decreases BP

This is *softening and widening of the body or isthmus of the uterus* that is compressible on bimanual examination. Occurs at 6 to 8 weeks.

Hegar's Sign

What is softening of cervix called?

Hegars sign

Explain heartburn in pregnancy?

High levels of progesterone (>25) result in smooth muscle relaxation therefore LES relaxes causing regurgitation causing heartburn

Renal system in pregnancy?

Hydronephrosis VCUR Glycosuria - increased GFR leads to sugar in tubules that cannot be completely reabsorbed

Define Fetal position

In cephaic presentation occiput is the reference point OA is the best OP is the worst

During pregnancy, GFR will (_) by 50% early and maintained which leads to (_) and (_) *DECREASE* by 25% probably due to progesterone and relaxin

Increase BUN Creatinine

KICK COUNTS: Maternal perception of at least 10 distinct fetal movements within 2 hours is reassuring. Once counts are achieved, counts can be discontinued for the day. Decreased activity should be reported

KICK COUNTS

Cause is unknown; possible decreased calcium and elevated phosphorus

Leg Cramps

Examiner places both hands on each upper quadrant to determine fetal part in fundus Palpation of paraumbilical area to differentiate fetal spine Suprapubic palpation using thumb and fingers of dominant hand to determine presenting part and station Examiner faces mother's feet. Using tips of fingers, pressure is exerted in the direction of the pelvic inlet

Leopold's Maneuvers

Increase in vaginal discharge due to estrogen stimulation

Leukorrhea

Darkening of a vertical band down middle of abdominal skin (darkening of linea alba) Due to increase in melanocyte stimulating hormone

Linea Nigra of Pregnancy

Center of gravity changes leading to a shift in posture and lower back strain

Lordosis associated with pregnancy

Advantage of amniocentesis? disadvantage?

Lower risk of fetal loss not available until 2nd trimester

a protein that is naturally produced by the liver of the fetus, is present in the amniotic fluid, and crosses the placenta into the mother's blood

MSAFP

At term, averages 15 beats/min higher than non-pregnant state

Maternal Heart Rate

Enlargement of sebaceous glands of areola

Montgomery's Tubercles

Has completed ≥ 2 pregnancies to ≥ 20weeks

Multipara

This is associated with higher maternal morbidity and mortality rates. Also associated with higher risk of preterm labor, hemorrhage,UTI and preeclempsia. It is important to ID this early on and establish more frequent prenatal visits in the third trimester

Multiple Gestation

History of assisted reproduction *Uterus larger than expected for dates* *Excessive maternal weight gain* - not explained by edema or obesity *Elevated AFP* Multiplicity of small parts Auscultation of *two separate fetal heart rates that differ by >8 bpm*

Multiple Gestation Clinical Findings

What is Stage 1 of labor? What are the two phases in this stage and what characterizes them?

Onset of labor (true regular contractions) to *fll dilation of cervix (10cm)* *Latent phase*- cervix effacment with gradual cervical dilation *Active phase*-rapid cervical dilation (usually beginning @ 3-4 cm)

This is secreted by the *posterior* pituitary and is responsible for milk ejection as well as plays a role in uterine contractions

Oxytocin

Induction via

Oxytocin (Pitocin) Prostaglandin E2 (Cervidil, Prepidil) Prostaglandin E1 (Misoprostol) Mechanical

We do a (_) in the 1st or 2nd trimester as they are high risk at this point

PPD

This is secreted by the *anterior* pituitary and readies the breast tissue for lactation

PRL

Cravings and eating non-food items (starch, clay, cornstarch, coal, soap, toothpaste, ice) what do we need to evaluate?

Pica Evaluate weight and hemoglobin (anemia)

Delivered > 42 weeks

Post-term

What is Stage III of labor?

Postpartum to *delivery of the placenta* 0-30 minutes usually (average 5) *3 signs of placental seperation*: *1. gush of blood* *2. lengthening of the umbilical cord* *3. anterior-cephalic movement* of the uterine *fundus becomes globular and firmer)* PLacental expulsion: due to downward pressure of the retroplacental hematoma, uterine contractiosn

Contraindications for induction

Previa Malpresentstion Active HSV/HIV Pelvic structural anomaly Umbilical prolapse Advanced cervical cancer

Woman who is pregnant for the first time

Primigravida

Has delivered only once Fetus born alive or dead with an estimated length of gestation of > 20 weeks

Primipara

causes relaxation of smooth muscle which has an effect on GI, CV and GU systems

Progesterone

GI Changes during Pregnancy: 1. (_) will cause *relaxation of LES leading to GERD* and *Delayed gastric emptying* 2. Organs willl become (_)

Progesterone Displaced

When assessing UA for pregnant women, we look at what several things?

Protein- possible preeclampsia Glucose- possible DM Leukocyte Esterase- possible UTI

Excessive salivation associated with severe N/V Generally subsides by 12-14 weeks Women often carry tissues to spit

Ptyalism

Maternal awareness of fetal movement Occurs 18-20 weeks in primigravida Occurs 14-16 weeks multigravida

Quickening

Two or more fetal heart rate increases in 20 minutes Accelerations increase by 15 beats for 15 seconds Related to fetal movement

Reactive, or normal, Non stress test

Post treatment of Amniocentesis?

RhoGAM is Rh negative

This occurs late in 2nd trimester or early 3rd trimester and manifests as *sharp, unilateral or bilateral groin pain* that is *self limited* and relieved with *warm compresses or acetaminophen (Tylenol®)*. Why does it occur?

Round LIgament Pain secondary to *rapid expansion of uterus and stretching of round ligament*

When can you detect pregnancy via urine BHCG?

S/p 14 days

When can you detect pregnancy via serum BHCG?

S/p 5 days

Stage 3 of labor

Separation of placenta (< 30 min) Signs: Gush of blood Rise of fundal height Umbilical cord lengthening

What is the treatment of GERD associated with pregnancy?

Small, frequent meals avoid lying down within an hour of eating Antacids, H2 blockers, PPIs

What is the most accurate way to date a pregnancy?

Sonographic measurement of crown to rump in T1

These will blanch when compressed and appear on the face, neck and arms. They are common during the 2nd and 3rd trimester. Thought to be due to (_)

Spider Telangiectasia estrogen

What is the recommended intake of folic acid during pregnancy? when should they start?

Start one month prior to pregnancy 400mcg daily

Occur in 90% by 3rd trimester More common in younger women, larger babies, higher BMI

Striae

What is stage 4 of labor?

The perido 1-3 hours after delivery where mother is assesssed for compliations

What is Stage II of labor? What are the two phases in this stage and what characterizes them?

Time from cervical dilation until delivery of the fetus *Passive phase*- complete cervical dilation to active maternal expulsive efforts *Active phase*- from active maternal expulsive efforts to delivery of the fetus

Monochorionic?

Twins share the same placenta more complications than if they were dichorionic

Pregnant women have an Increased risk of complicated UTI's (ex. pyelonephritis) due to urinary stasis from compression of ureters and progesterone mediated smooth muscle relaxation

UTI

What is the quad screen and when is it preformed?

Unconjugated estriol AFP BHCG Inhibin A Edwards (Trisomy 18 - all decreased) Downs (BHCG, Inhibin A increased) @16-20 weeks

Detection time for this is, on average, 2 weeks after conception?

Urine Pregnancy Test

This is a *QUALITATIVE* test that is *MOST COMMON* as it is affordable and reliable. Typically, should be done with first morning void as this is the time with the highest hCG concentration.

Urine Pregnancy Test

When is APGAR score done? What is normal vs low?

Usuauly done at 1 and 5 minutes after birth. Repeated at 10 minutes if abnormal. *Score from 1-10*: >=7 =normal, 4-6 fairly low, <= critically low

When is a contraction stress test POSITIVE? What is this positive result associated with?

When late decelerations are consistent and present with more than 50% contractions increased incidence of intrauterine death, low 5 minute Apgar scores, intrauterine growth restriction

What is the time period of an *embryo*?

conception through 10th weeks after LMP

Pregnant women can often experience (_) due to decreased bowel motility. What is the treatment?

constipation increased fluids stool softeners bulking agents

What is true labor?

contractions of the uterine fundus with radiation to lower back and abdomen . Regular and painful contractions of the uterus causes cervical dilation and fetus expulsion

What week can pelvic ultrasound start detecting fetus?

detect fetus at 5-6 weeks (and heartbeat)

What is intrapartum?

during labor and delivery (onset of labor to end of 3rd stage of delivery)

Compression of inferior vena cava and pelvic veins by uterus can lead to increased hydrostatic pressure in lower extremities- causing (_). How do we treat?

edema elevation of LE sleep on side

Pulmonary Changes in Pregnancy: 1. Diaphragm- as uterus enlarges, diaphragm (_) 2. URT - tissue (_) and capillary (_) in response to estrogen. Leads increase risk of (_) and epistaxis 3. Tidal Volume will (_)

elevates by 4cm edema congestion rhinitis Increase

What is lightening?

fetal head descending into the pelvis causing a change in the abdomen's shape and sensation that the baby has become "lighter"

On ultrasound in 1st trimester, when is fetal heart tones heard? When is heartbeat heard? Via what imaging?

fetal heart tones heard around 10-12 weeks by doppler Heartbeat at 5-6 weeks via ultrasound of fetus

What is internal rotation

fetal vertex moves form occiput transverse postition to a positon where teh saggital suture is parralel to the anterioposterior diameter of the pelvis Cardinal movements of labor

What is external rotation?

fetus externally rotation after the head is delivered so that the shoulder can be delivered Cardinal movements of labor

What is flexion?

flexion of the head to allow the smallest diameter to present to the pelvis Cardinal movements of labor

Killed virus, toxoid or recombinant vaccines are typically administered during pregnancy ACOG recommends (_) vaccine and (_)

flu hep b

This has a weak stimulating effect on thyroid due to its alpha subgroup is similar to TSH Leads to a slight increase in T3 and T4 and a slight decrease in TSH in early pregnancy

hCG

First trimester labds and diagnostic testing: 1. confirm pregnancy with (_) 2. Evaluate H/H and WBC with (_) 3. Determine Blood type and (_) factor

hCG CBC Rh factor

What is the rule of 10s?

hCG during pregnancy diagnosis: =100 at time of missed menses =100000 at 10 weeks aka peak =10000 at term

This complaint is expected 1st trimester. However, suspect preeclampsia in 2nd and 3rd trimesters

headaches

Congestion of pelvic vessels combined with increased abdominal pressure and constipation can lead to (_). What is the treatment?

hemorrhoids Symptomatic with topical anesthetics and steroids for pain and swelling.

Pulmonary Changes in Pregnancy: 1. (_)ventilation 2. thoracic circumference (_)

hyper increases by 6cm

Pregnancy is considered a (_)coagulable state with an increase in (_) events. There is an elevation of (_) and clotting factors and iron requirements increase due to fetus and placental use of iron. Prenatal vitamins with iron are commonly given

hyper thromboemoblic fibrinogen

GI Changes during Pregnancy: 1. Salivation will (_) 2. Gums become hypertrophic, hyperemic, spongy and friable 3. Bile (_) increases risk of (_)

increase stasis gallstones

How do we prevent hemorrhoids in pregnancy?

increased fluids fiber stool softeners

To treat the constipation, (_) should be used with caution and avoided in the (_) trimester due to risk of preterm labor from either (_) or (_)

laxatives 3rd stimulation of contractions, deyhydration which will stimulate contractions

1st and 2nd trimester weight gain is (_) 3rd trimester weight gain is from the (_)

maternal fetus

When is triple screening done? What does it include?

measured at *15-20wks* 1. a-fetoprotein (aFP) 2. B-HCG 3. estradiol

Foods to limit during pregnancy: 1. Fish due to (_) 2. (_) as it can be associated with miscarriage etec. 3. soft (_) that are unpasteurized

mercury exposure caffeine cheese

What is morning sickness? What is hyperemesis gravidarum (HEG)

nasuea and/or vomiting up until 16 weeks HEG: *severe, excessive form of morning sickness* (nausea/vomiting). associated with weight loss and electrolyte imbalance. Develops during 1st/2nd trimester (persists >16 weeks gestatioN)

Does striae have prevention with emollients or oils? What happens post-partum?

no over time, it will fade and pale atrophic lines but do not resolve

Biophysical Profile Scoring: 8-10= 6= 2-4= 0=

no cause for concern ambiguous, repeat test in 24 hours concern for hypoxia or acidosis, immediate delivery immediate delivery

Best time to travel during pregnancy is between 14 and 28 weeks. It is often prohibited after (_)

o 36 weeks

What is bloody show?

passage of blood-tinged mucus late in pregnancy. occurs when cervix begins thinning (effacement)

What is descent?

passage of the head into the pelvis (commonly called "lightening") Cardinal movements of labor

Severe edema of face and hands may indicate (_)

preeclempsia

Vaginal, cervical, and uterine changes Abdominal (uterine) enlargement Intermittent uterine contractions (Braxton Hicks) Pelvic ligament discomfort The above are (_) signs of pregnancy

probable

What is the treatment for leg cramps associated with pregnancy?

symptomatic- leg massage, flexion of fett. Avoid pointing toes when stretching as it will lead to a gastroc cramp

What happens to the kidneys during pregnancy?

they increase in size and ureters dilate. This leads to an *increased risk of pyelonephritis*

When do you give Rhogam? Who do you give it to?

unsensitized Rh negative mothers at 28 weeks and within 72 hrs after childbirth

Due to increased bladder circulation and pressure from enlarging uterus, (_) will result

urinary frequency

What is extenson?

vertex extends as it passes beneath the pubic symphysis Cardinal movements of labor

What is engagement?

when the fetal presenting part enters the pelvic inlet Cardinal movements of labor