Podcast
Questions and Answers
What is the approximate diameter of a term placenta?
What is the approximate diameter of a term placenta?
- 30-35 cm
- 5-10 cm
- 15-20 cm (correct)
- 40-45 cm
The intervillous space (IVS) in the placenta is filled with what?
The intervillous space (IVS) in the placenta is filled with what?
- Amniotic fluid
- Fetal blood
- Maternal blood (correct)
- Lymphatic fluid
What helps to compartmentalize and direct maternal blood flow through the placenta?
What helps to compartmentalize and direct maternal blood flow through the placenta?
- Intervillous space
- Septa (correct)
- Umbilical cord
- Chorionic villi
A functional unit of the placenta containing umbilical arteries and a vein is known as:
A functional unit of the placenta containing umbilical arteries and a vein is known as:
What is the outer layer of the blastocyst that comprises the trophectoderm called?
What is the outer layer of the blastocyst that comprises the trophectoderm called?
The yolk sac can be detected within the exocoelomic cavity (ECC) via ultrasound around which gestational age?
The yolk sac can be detected within the exocoelomic cavity (ECC) via ultrasound around which gestational age?
What is the most critical aspect of the maternal-fetal relationship during the first trimester?
What is the most critical aspect of the maternal-fetal relationship during the first trimester?
During pregnancy, fat content in the fetus is considered LOW around which gestational week?
During pregnancy, fat content in the fetus is considered LOW around which gestational week?
Which factor DOES NOT correlate with growth restriction, related to placental growth?
Which factor DOES NOT correlate with growth restriction, related to placental growth?
Which body system development is thought to be NOT important for overall fetal growth, but IS IMPORTANT for CNS development?
Which body system development is thought to be NOT important for overall fetal growth, but IS IMPORTANT for CNS development?
In normal cardiovascular development of the fetus, the heart begins as a contractile tube early in what week?
In normal cardiovascular development of the fetus, the heart begins as a contractile tube early in what week?
The Ductus arteriosus shunts blood one way to allow which ventricle to directly send output to the aorta?
The Ductus arteriosus shunts blood one way to allow which ventricle to directly send output to the aorta?
In normal cardiovascular development of the fetus, blood with the highest oxygen is delivered to which area?
In normal cardiovascular development of the fetus, blood with the highest oxygen is delivered to which area?
Throughout fetal heart development, FHR averages greater than what amount over resting adult HR?
Throughout fetal heart development, FHR averages greater than what amount over resting adult HR?
Fetal urine is the primary source of Amniotic Fluid (AF) between which weeks?
Fetal urine is the primary source of Amniotic Fluid (AF) between which weeks?
The fetal hepatic blood supply primarily comes from the _________.
The fetal hepatic blood supply primarily comes from the _________.
What is the principal substrate for oxidative metabolism within the fetal brain?
What is the principal substrate for oxidative metabolism within the fetal brain?
Which term describes the most acute consequence of developmental effects?
Which term describes the most acute consequence of developmental effects?
What is being described: the nutritional, hormonal, and metabolic environment provided by the mother permanently alters organ structure?
What is being described: the nutritional, hormonal, and metabolic environment provided by the mother permanently alters organ structure?
Small body size at birth, low weight gain in infancy, and rapid BMI gain in childhood are associated with?
Small body size at birth, low weight gain in infancy, and rapid BMI gain in childhood are associated with?
What type of visit is described as: aims to promote health before conception to reduce preventable adverse pregnancy outcomes?
What type of visit is described as: aims to promote health before conception to reduce preventable adverse pregnancy outcomes?
At reproductive health encounters, what two questions should all primary care NPs should ask to pt?
At reproductive health encounters, what two questions should all primary care NPs should ask to pt?
According to risk factors, what age is considered ideal for pregnancy?
According to risk factors, what age is considered ideal for pregnancy?
What is the term to describe greater than or equal to 35 years old at time of delivery?
What is the term to describe greater than or equal to 35 years old at time of delivery?
In regards to weight gain during pregnancy with a woman at term, around how much are they expect to gain from amniotic fluid?
In regards to weight gain during pregnancy with a woman at term, around how much are they expect to gain from amniotic fluid?
According to study, how much weight loss can improve conception with someone trying to conceive?
According to study, how much weight loss can improve conception with someone trying to conceive?
Women should avoid this with toxoplasmosis, found in cat feces.
Women should avoid this with toxoplasmosis, found in cat feces.
How little of the pregnancy timeline must there be dietary counseling and focus on, specifically?
How little of the pregnancy timeline must there be dietary counseling and focus on, specifically?
If the Rubella vaccine status is non-immune, when should receive the vaccine?
If the Rubella vaccine status is non-immune, when should receive the vaccine?
Approximately how much increase in kcal/day are pregnant women expected to consume more than normal?
Approximately how much increase in kcal/day are pregnant women expected to consume more than normal?
HCP says a pt should eats salmon, sardines, anchovies, flax seed and walnut oils which fatty acid?
HCP says a pt should eats salmon, sardines, anchovies, flax seed and walnut oils which fatty acid?
What is the increased protein intake recommendation in pregnant women (from nonpregnant adult amount) to?
What is the increased protein intake recommendation in pregnant women (from nonpregnant adult amount) to?
What levels must be measured regarding patients and what has happened to their pregnancy that is very specific?
What levels must be measured regarding patients and what has happened to their pregnancy that is very specific?
A standard pregnancy typically lasts for how long?
A standard pregnancy typically lasts for how long?
Naegele's rule determines estimated due date, but is based on what?
Naegele's rule determines estimated due date, but is based on what?
In early pregnancy, what is the most reliable method for determining gestational age?
In early pregnancy, what is the most reliable method for determining gestational age?
What is important to do to protect against rubella with the MMR vaccine?
What is important to do to protect against rubella with the MMR vaccine?
How long should someone wait to conceive after receiving the MMR vaccine?
How long should someone wait to conceive after receiving the MMR vaccine?
When is the whooping cough vaccine recommended?
When is the whooping cough vaccine recommended?
Pregnant women are more likely to have severe illness from what illness?
Pregnant women are more likely to have severe illness from what illness?
When is the flu vaccine recommended to receive each year?
When is the flu vaccine recommended to receive each year?
Elevated TSH and Free T4 can be found in labs in what condition?
Elevated TSH and Free T4 can be found in labs in what condition?
When does the initial perception of fetal movement 'quickening' typically occur in first-time pregnancies?
When does the initial perception of fetal movement 'quickening' typically occur in first-time pregnancies?
What does Chadwick's sign indicate in pregnancy?
What does Chadwick's sign indicate in pregnancy?
At how many weeks gestation the fundus of the uterus is at the umbilicus?
At how many weeks gestation the fundus of the uterus is at the umbilicus?
Which common discomfort of pregnancy is caused by increased joint relaxation from pregnancy hormones?
Which common discomfort of pregnancy is caused by increased joint relaxation from pregnancy hormones?
Nasal stuffiness and epistaxis result from what physiologic change in pregnancy?
Nasal stuffiness and epistaxis result from what physiologic change in pregnancy?
What causes heartburn during pregnancy as the uterus increases?
What causes heartburn during pregnancy as the uterus increases?
What can contribute lower calcium contribute to?
What can contribute lower calcium contribute to?
Increased renal plasma flow and GFR affect what symptom?
Increased renal plasma flow and GFR affect what symptom?
Breast discomfort is due to what?
Breast discomfort is due to what?
Dilation of ureters and renal pelvic occurs by what month of pregnancy?
Dilation of ureters and renal pelvic occurs by what month of pregnancy?
Decreasing BUN and Creatinine means?
Decreasing BUN and Creatinine means?
What position improves renal function?
What position improves renal function?
Decreased GI mobility causes what?
Decreased GI mobility causes what?
In first trimester ultrasound, what detail provides better imagery or more detail?
In first trimester ultrasound, what detail provides better imagery or more detail?
What is evaluated from a first-trimester US?
What is evaluated from a first-trimester US?
What is the term that is used to measure embryo and fetus used to determine gestational age?
What is the term that is used to measure embryo and fetus used to determine gestational age?
Around what time frame is nuchal translucency assessed?
Around what time frame is nuchal translucency assessed?
What is being examined during a detailed anatomic survey at 18 weeks?
What is being examined during a detailed anatomic survey at 18 weeks?
When is a limited ultrasound typically performed?
When is a limited ultrasound typically performed?
Pregnancy is considered a hypercoagulable state due to what?
Pregnancy is considered a hypercoagulable state due to what?
What blood part is decreased due to dilution?
What blood part is decreased due to dilution?
Heart sounds become functional, and there is an increase in what type of condition of pregnancy?
Heart sounds become functional, and there is an increase in what type of condition of pregnancy?
When does cardia output increase in pregnancy?
When does cardia output increase in pregnancy?
At what point (weeks) of gestation does cardiac output peak?
At what point (weeks) of gestation does cardiac output peak?
When does cardiac output usually return to pre-pregnancy levels following delivery?
When does cardiac output usually return to pre-pregnancy levels following delivery?
There is an increase by a total of about 1g during the pregnancy - but what is it an requirement?
There is an increase by a total of about 1g during the pregnancy - but what is it an requirement?
In regards to body movements, what does the indicator CNS function include:
In regards to body movements, what does the indicator CNS function include:
What is the main fuel source?
What is the main fuel source?
A pregnancy can result in progressively increasing what?
A pregnancy can result in progressively increasing what?
How many weeks should someone obtain new eyeglasses or contacts?
How many weeks should someone obtain new eyeglasses or contacts?
According to Naegele how many days long are typical pregnancies?
According to Naegele how many days long are typical pregnancies?
According to Naegele, one must go back on months how many when trying to determine estimated due date?
According to Naegele, one must go back on months how many when trying to determine estimated due date?
What is the main focus of genetic testing?
What is the main focus of genetic testing?
Testing for what should be considered when weighing if a patient would be a candidate would be for genetic testing?
Testing for what should be considered when weighing if a patient would be a candidate would be for genetic testing?
Genetic testing should be linked to what?
Genetic testing should be linked to what?
What does genetic counseling aim to address?
What does genetic counseling aim to address?
What is the first step in Genetic Testing: Direct Detection of Abnormal Genes by DNA Testing?
What is the first step in Genetic Testing: Direct Detection of Abnormal Genes by DNA Testing?
What is a main point regarding chromosomal analysis?
What is a main point regarding chromosomal analysis?
One must ensure with obtaining samples for testing is that....
One must ensure with obtaining samples for testing is that....
What is a potential option for parents whom do not wish to harm a fetus?
What is a potential option for parents whom do not wish to harm a fetus?
Select is autosomal inheritance.
Select is autosomal inheritance.
If something is not a good indicator of something because is not seen in what is it?
If something is not a good indicator of something because is not seen in what is it?
What factor about pregnancy has to do with gestational diabetes?
What factor about pregnancy has to do with gestational diabetes?
Which term best describes the condition during which a woman has new sensitivity with her skin and pigment after and while being pregnant?
Which term best describes the condition during which a woman has new sensitivity with her skin and pigment after and while being pregnant?
There is thought from what element that changes the uterus that makes one have heartburn
There is thought from what element that changes the uterus that makes one have heartburn
There are some contraindications with vaccines but which one MUST be avoided?
There are some contraindications with vaccines but which one MUST be avoided?
During prenatal appointments, there is a lab draw with certain markers with trisomy testing - so does one know this marker is increased?
During prenatal appointments, there is a lab draw with certain markers with trisomy testing - so does one know this marker is increased?
During early pregnancy - how does the fetal body get its iron stores if it isn't very able to get enough right away?
During early pregnancy - how does the fetal body get its iron stores if it isn't very able to get enough right away?
Which vitamin helps the support of forming needed materials such as red blood?
Which vitamin helps the support of forming needed materials such as red blood?
What part may show early in exam findings that could be cause or can increase issues if there is a loss?
What part may show early in exam findings that could be cause or can increase issues if there is a loss?
Is there one important aspect for building for the placenta with access?
Is there one important aspect for building for the placenta with access?
What hormone increases when pregnant related to increase of tiredness with early term of pregnancy?
What hormone increases when pregnant related to increase of tiredness with early term of pregnancy?
Flashcards
Presumptive Signs
Presumptive Signs
Physiologic changes indicating pregnancy, based on patient's experience. Subjective symptoms.
Probable signs
Probable signs
Physiologic and anatomic changes detected by an examiner. Objective findings.
Positive Signs
Positive Signs
Signs directly attributable to the fetus, detected and documented by an examiner.
Amenorrhea
Amenorrhea
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Nausea/Vomiting
Nausea/Vomiting
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Quickening
Quickening
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Hegar's Sign
Hegar's Sign
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Goodell's Sign
Goodell's Sign
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Chadwick's Sign
Chadwick's Sign
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Melasma (Chloasma)
Melasma (Chloasma)
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Linea Nigra
Linea Nigra
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Gestational Diabetes (GDM)
Gestational Diabetes (GDM)
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Gestational Hypertension
Gestational Hypertension
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Placenta Previa
Placenta Previa
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Biophysical Profile (BPP)
Biophysical Profile (BPP)
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Ectopic Pregnancy
Ectopic Pregnancy
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Amniocentesis
Amniocentesis
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Chorionic Villus Sampling (CVS)
Chorionic Villus Sampling (CVS)
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Oligohydramnios
Oligohydramnios
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Polyhydramnios
Polyhydramnios
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Non-Stress Test (NST)
Non-Stress Test (NST)
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Gestation
Gestation
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Estimated Due Date (EDD)
Estimated Due Date (EDD)
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Calculating a Due Date
Calculating a Due Date
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Vaccines During Pregnancy
Vaccines During Pregnancy
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1st Trimester
1st Trimester
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Screening for Genetic Issues
Screening for Genetic Issues
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Evaluate uterus and adnexal region
Evaluate uterus and adnexal region
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Biparietal diameter
Biparietal diameter
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Placental Anatomy
Placental Anatomy
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Substrate
Substrate
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Amniotic Fluid Volume (AFV)
Amniotic Fluid Volume (AFV)
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Gestational programming
Gestational programming
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Preconception care
Preconception care
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Interconception care
Interconception care
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N / V
N / V
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Initial Visit
Initial Visit
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Use in 1st trimester
Use in 1st trimester
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PUPS
PUPS
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Genetic History
Genetic History
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Deletions
Deletions
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Screening
Screening
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Ultrasound
Ultrasound
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Induction
Induction
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Study Notes
- Presumptive signs of pregnancy are physiologic changes that might indicate pregnancy, including amenorrhea, breast changes, elevated BBT, ptyalism, vaginal mucosa color changes, fatigue, nausea/vomiting, urinary frequency, hyperpigmentation of skin, and fetal movements felt by the woman
- Probable signs are maternal physiologic and anatomic changes detected by an examiner, including abdomen/uterus enlargement, palpation of fetal outline, uterine changes (Hegar's sign, McDonald's sign, Piskacek's sign), cervical changes (Goodell's sign, Chadwick's sign), and positive pregnancy test
- Positive signs are directly attributable to the fetus, as detected by an examiner
- These include ultrasound verification of the embryo or fetus and auscultation of fetal heart tones/cardiac activity
Common Discomforts of Pregnancy
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Backache can occur with increased joint relaxation due to progesterone and relaxin, difficulty with ambulation, and an enlarging uterus
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Skin changes include palmar erythema and increased pigmentation
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Increased pigmentation can result in chloasma, linea nigra, darkening of areola, striae of abdomen, and angiomas
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Constipation can occur with delayed gastric emptying due to hormones and expanding uterus
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Dyspnea can occur due to increased estrogen, progesterone, and uterus growth
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Edema can occur due to decreased blood and increased circulatory volume returning
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Epistaxis can be due to Estrogen, antihistimines and dry air
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Heartburn can occur due to hormonal, progesterone and or mechanical factors
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Elimination of spicy and high acid foods with smaller meals can help
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Sleep in semi-Fowlers can help with symptoms of heart burn
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Antacids and Histamine Receptor inhibitors and protein pump inhibitors can be used in treatment
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Hemorrhoids can result from pressure from growing uterus
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Insomnia can be caused by increased estrogen and progesterone levels, and uterus putting pressure on the diaphragm causing shortness of breath and discomfort
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Leg Cramps can occur with lower calcium and changes in blood circulation
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Nausea and Vomiting can occur from the hCG hormone, hormones and delayed gastric emptying
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Round ligament pain can occur with stretching of the uterus which acetaminophen, heat and the knees may help
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Varicosities can occur in feet as full leg support and rest can help
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Typically the worst in the first and third trimesters; unclear if hormonal the and just discomfort later in pregnancy
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Urinary Frequency typically occurs in the 1st and 3rd trimester and causes kidney and bladder tone which causes infection
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Initial OB visit occurs 6-8 weeks after one missed menses
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Components at each visit include urinalysis, labs, Group Beta Strep test
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Health guidance in pregnancy includes travel, work, dental care, exercise, sex, immunizations, vaccines, nutrition,genetic screening, medication safety, labs
Genetic Testing Lectures
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Record personal and family medical history and family history of personal disorders heritable genetic disorders
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Complete and record maternal and paternal age and ethnic origin; genetic conditions can be more common in selected ethnic groups
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If indicated, consider referral to a clinical geneticist for genetic counseling
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Genetic counseling involves preparing patients to be offered counseling, to provide counseling, and to identify risk factors plus offer carrier screening
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Chromosome abnormalities include disorders autosomal such as trisomy 21, 13 and 18: Trisomy occurs during maternal meiosis and is associated with maternal age effect
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Chromosome abnormalities Structural include and can be Translocations, deletions, duplications of cri du chat, Williams, Prader-Willi, Angelman, Smith-Magenis
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Sex chromosome abnormalities include Turner syndrome and Klinefelter Syndrome (XXY)
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Screening Aneuploidy is when a person has one or few chromosomes above or below the normal number
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Screening is NOT equivalent to definitive testing
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First Trimester Screen between 10 and 13 weeks for Nuchal Translucency as well as Serum free B- hCG and analytic pregnancy associate plasma protein A
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Quadruple Screen between 15 to 23 weeks: includes ultrasound only US when required, hCG, AFP, and inhibin A; age and other factors, provides a Down Syndrome risk estimate
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Triple Screen includes hCG and AFP without nuchal folds - and is therefore less effective for down syndrome.
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Integrated and step wide testing: integrated at each stage.
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Cell Free DNA: Performed early 10 weeks; screen for defects & genetic sex
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Ultrasound Second trimester: a lack of standardization in measurements makes it impact the use of ultrasound but also the ultra sound picture through mothers that are obese
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Prenatal genetic diagnosis includes Amniocentesis in week 16
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Prenatal Genetic diagnosis includes Chorionic Villus sampling for early results
Physiology of Pregnancy
- Cardiac output increases 30-50 percent
- HR and Stroke volume increase as well
- BP decreases in the 2nd trimester and may return to normal in the third
- Average blood volume expands 40–50%. Hemoglobin is lowered by dilution
- Patients need 100 g of iron as diet is inadequate
- Kidney and renal functions increase - with water dilated
- CO2 is lower, and renal blood flow and GFR increase
- Thyroid normalizes as estrogen decreases bonding from thyroid binding globulin
- Estrogen, progesterone, melanocyte - pigmentation happens
- Bone turnover is high, and pregnancy has reversible loss
- Cornea thickens. Decreased intraocular pressure. Can't used lenses
- Last period to know is 40 week period
- Naegele's is period minus 3 months add 7 days
- Return visits each 4 before 28 then each 2 until 38 then each week until delivery
- In pregnancy: avoid 1 month after MMR vaccine
- Tdap during 27-26 weeks is best.
Trimester Discomforts
- N/V and urinary frequency are common first trimester discomforts
- Heartburn and ankle edema are common second and third trimester issues
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