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Questions and Answers
What is Chadwick's sign?
What is Goodell's sign?
Softening and cyanosis of the cervix at or after 4 weeks.
What is Ladin sign?
Softening of the uterus after 6 weeks.
How much does cardiac output increase during pregnancy?
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Why does systemic vascular resistance (SVR) and arterial blood pressure decrease in pregnancy?
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How does pregnancy affect tidal volume and total lung capacity?
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What is nausea in pregnant patients due to?
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How does pregnancy affect glomerular filtration rate (GFR)?
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What is the change in red blood cell (RBC) volume during pregnancy?
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When does hCG double during early pregnancy and when does it peak?
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What produces hCG which maintains the corpus luteum in early pregnancy?
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What does the corpus luteum produce during pregnancy?
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What skin changes occur in pregnancy?
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What is the increased caloric need in a pregnant patient?
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When should pregnancy testing be done?
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What is considered the most sensitive pregnancy test?
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What is Naegele's rule?
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What does GP(TPAL) stand for?
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When should first and following pregnancy visits be scheduled?
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What is the diagnosis of placenta previa?
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What is the treatment for placenta previa?
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What accounts for 20% of antepartum hemorrhage?
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What are the complications of placenta previa?
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What is abruptio placentae?
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What is the most common cause of third trimester bleeding?
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What are some risk factors for abruptio placentae? (Select all that apply)
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What is the primary cause of abruptio placentae?
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What are the symptoms of abruptio placentae?
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What is the typical presentation of abruptio placentae?
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What are the physical exam findings of abruptio placentae?
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What is a couvelaire uterus?
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How is abruptio placentae confirmed?
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What is the treatment for abruptio placentae?
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What is augmentation in the context of contractions?
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Study Notes
Signs of Pregnancy
- Chadwick's Sign: Bluish discoloration of the vagina and cervix.
- Goodell's Sign: Softening and cyanosis of the cervix occurs at or after 4 weeks gestation.
- Ladin's Sign: Softening of the uterus noted after 6 weeks of pregnancy.
Hemodynamics and Cardiac Changes
- Cardiac output (CO) increases by 30-50% during pregnancy.
- Systemic vascular resistance (SVR) and arterial blood pressure (BP) decrease, mainly due to elevated progesterone levels; systolic BP drops by 5-10 mmHg and diastolic BP by 10-15 mmHg, peaking at week 24.
Respiratory Changes
- Tidal volume increases by 30-40% during pregnancy.
- Total lung capacity decreases by 5% due to diaphragm elevation.
Nausea and Hormonal Changes
- Nausea in pregnant individuals is attributed to increased levels of estrogen, progesterone, and hCG, typically resolving by 14-16 weeks.
Renal Function
- Glomerular filtration rate (GFR) increases by 50% in early pregnancy, influenced by RAAS activation increasing aldosterone levels.
- Red blood cell (RBC) volume also rises by 20-30%.
hCG Levels
- Human chorionic gonadotropin (hCG) doubles every 48 hours during early pregnancy, peaking between 10-12 weeks, then declining and stabilizing after week 15.
- The placenta produces hCG, which helps maintain the corpus luteum during early pregnancy.
Nutritional Requirements
- Caloric needs increase to 300 calories/day during pregnancy and 500 during breastfeeding, with heightened requirements for protein, iron, folate, and calcium.
Prenatal Care Guidelines
- Pregnancy tests should be conducted 14 days after the last sexual intercourse in women with irregular cycles or unknown last menstrual periods.
- Serum tests are the most sensitive for pregnancy detection.
- Naegle's rule is utilized to estimate due dates: LMP - 3 months + 7 days.
Components of Pregnancy Visits
- Initial prenatal visits occur between 6-10 weeks, with regular follow-ups scheduled every 4 weeks until 32 weeks, biweekly until 36 weeks, and weekly thereafter.
- A comprehensive history taken includes current pregnancy symptoms and previous obstetric history.
Monitoring Fetal Development
- Fundal height is assessed starting at 20 weeks; it corresponds roughly to gestational age.
- Fetal cardiac activity can be detected as early as week 6, and by week 5, the fetal yolk sac should be visible.
Screening and Tests
- Initial visit tests include complete blood count, blood type, rubella immunity, sexually transmitted infections, urine analysis, HIV screening, and early aneuploidy screening.
- Second-trimester testing typically includes MSAFP/triple or quad screen and obstetric ultrasound.
- Third trimester tests are often hematocrit, glucose tolerance tests, and group B strep cultures.
Complications in Multiple Gestation
- Increased risks include spontaneous abortion, preterm birth, and fetal complications such as growth restriction or congenital anomalies.
- Types of twins include monozygotic (identical) and dizygotic (fraternal), with specific monitoring required for conditions like twin-twin transfusion syndrome.
Abortion and Ectopic Pregnancy
- Spontaneous abortion is defined as pregnancy termination before 20 weeks, with risks including smoking, infection, and systemic diseases.
- Ectopic pregnancies occur outside the uterus, primarily in the Fallopian tubes, often due to tube occlusion.
Placenta Previa and Abruptio Placentae
- Placenta previa involves abnormal placenta position, causing bleeding and risks for the fetus, often diagnosed via ultrasound.
- Abruptio placentae is the premature separation of the placenta from the uterine wall after 20 weeks, presenting as severe abdominal pain and bleeding.
Management and Complications
- Treatment for complications like ectopic pregnancy may include methotrexate and careful monitoring; surgical intervention may be necessary.
- Routine monitoring for gestational trophoblastic disease includes hCG levels, with complete and partial moles exhibiting different symptoms.
Key Takeaway Points
- Pregnancy entails significant physiological changes across multiple systems, emphasizing the need for careful monitoring and management.
- Understanding signs, symptoms, complications, and appropriate interventions is critical for ensuring maternal and fetal health.
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Description
Test your knowledge on important signs and physiological changes in women's health during pregnancy with these flashcards. Learn about Chadwick's sign, Goodell's sign, and more. Perfect for medical students and practitioners!