OB Midterm Study Guide - Pregnancy Adaptations

Exam 1 study guide N6306 Physiologic adaptations to pregnancy: 1. What changes does the uterus undergo? Uterine size increased to 20 times that of a non-pregnant uterus. Weight increase from 70g to 1,100g. Capacity increased from 10mL to 5,000mL. (80% of that to ute...

Exam 1 study guide N6306 Physiologic adaptations to pregnancy: 1. What changes does the uterus undergo? Uterine size increased to 20 times that of a non-pregnant uterus. Weight increase from 70g to 1,100g. Capacity increased from 10mL to 5,000mL. (80% of that to uteroplacental) Blood flow to uterus is 500-600mL/min at term 2. What is the impact of hormones on smooth muscle? Estrogen, progesterone, and prostaglandins cause smooth muscle relaxation 3. What causes edema in the lower extremities? How can this be relieved? Increased venous pressure and decreased blood flow to extremities due to compression of iliac veins and inferior vena cava. Il standing or walking help believe it. 4. What causes nasal and sinus congestion? Vascular engorgement due to hormones 5. What changes in lab values might occur as a result of adaptations of the cardiovascular system? Increase in: o RBC count by 30% o RBC volume by 18-33% o Plasma volume by 50% o WBC count 6. What is supine hypotensive syndrome? When the patient sits up and becomes HYPOtensive down 7. What causes heartburn and how might this be improved? Increased progesterone levels slow stomach emptying and relax the esophageal sphincter I lat small more frequent meals 8. Which two hormones are responsible for physiologic changes in pregnancy? Estrogen & Progesterone 9. What causes cessation of the menstrual cycle? Increased levels of estrogen and progesterone 10. What causes low blood pressure in pregnancy? Due to decrease in peripheral vascular resistance 11. What is Naegele’s rule and how one calculated an estimated due date for a pregnancy? 1. First fay of Last menstrual cycle 2. Subtract 3 months Exam 1 study guide N6306 3. Add 7 days 4. Add 1 year = Due date 12. What happens to the renal system in pregnancy and why are urinary tract infections more common? Increased renal blood flow of 50%-805 in the FIRST trimester, then decreased. Increased progesterone causes relaxation of smooth muscles. Ureters become elongated with decreased motility, leading to decreased bladder tone and INCREASED bladder capacity. All this leads to urinary frequency and incontinence, which lead to increase rick of UTI 13. What causes nausea and vomiting in pregnancy? Increased levels of hCG and altered carbohydrate metabolism 14. In the musculoskeletal system what are clinical signs and symptoms of softening joints? Altered gait Low back pain or pelvic discomfort Shifting of center of gravity – results in changes in posture and walking style 15. What physiologic changes may lead to striae gravidarum? Increased action of adrenocorticosteroids leads to cutaneous elastic tissues becoming fragile Genetics: 1. What is dominant inheritance and what are the dominant genes we addressed in lecture? Only one copy of the dominant allele is required to express the trait o Dominant Genes include:  Huntington’s Disease  Chromosome 4 2. What is recessive inheritance what recessive genes did we discuss in lecture? Both (recessive) alleles must be present to express the trait o Recessive Genes include:  Sickle Cell Anemia  Chromosome 11 3. What is X-linked inheritance and what example(s) did we discuss in class? Gene is only located on the X-chromosome o X-linked diseases:  Hemophilia  Duchenne’s Muscular Dystrophy Exam 1 study guide N6306 Antenatal testing 1. What is chorionic villus sampling and when should it occur? Aspiration of placental tissue for chromosomal, metabolic, or DNA testing. Performed between 10-12 weeks, cannot detect neural tube defects. o In the 2nd trimester for fetal weight and gestational age o In the 3rd trimester for biophysical profile 2. What is amniocentesis and when should it occur? Needle is inserted through the maternal abdominal wall to obtain a sample of amniotic fluid Done between 15-20 weeks Used for genetic testing, fetal lung maturity, hemolytic disease of the fetus, intrauterine infection, treatment of polyhydramnios. 3. What are methods of ensuring fetal well-being in pregnancy? Nonstress test (NST) Daily fetal movement counts (FMC) Vibroacoustic stimulation (VAS) Contraction stress test Amniotic fluid index (AFI) Biophysical profile Modified Biophysical profile 4. What is the difference between a diagnostic test and a screening test? Screening test are used to identify individuals who are not affected by a disease of abnormality Diagnostic tests: identify a disease or provide information that aids in diagnosis; o Used to identify structural or functional anomalies or birth defects in the fetus 5. What is included in a biophysical profile? Ultrasound assessment of fetal status along with an NST (nonstress test). Exam 1 study guide N6306 Diagnosing pregnancy: 1. Presumptive signs Amenorrhea: Absence of menstruation Nausea and vomiting Breast changes Fatigue Urinary frequency Quickening 2. Probable signs: Uterine growth and abdominal growth Skin changes/hyperpigmentation o Melasma o Linea Negra o Darkening of nipples & areola Positive pregnancy test 3. Positive signs: Auscultation of the fetal heart (10-12wks) Observation and palpation of fetal movement (after 20wks) Sonographic visualization of fetus (cardiac movement at 4-8wks) 4. Hormone(s) detected in a urine pregnancy test: Looks for hCG (Human Chorionic Gonaotropin) Preconception and prenatal care: 1. What are components of an initial prenatal visit? Comprehensive health and risk assessment Current pregnancy history Complete physical examination Determine EDD Nutrition assessment, including 24-hour diet recall Psychosocial assessment Assessment for intimate partner violence 2. What does teratogenesis mean? Developmental defects caused by exposure to toxic substances while in utero 3. Which topics in terms of prenatal education should be addressed depending on the trimester? (Examples) a. Pain relief in labor b. Postpartum care c. Early discomforts of pregnancy Exam 1 study guide N6306 d. Breastfeeding e. Signs of labor f. Parenting and infant care 4. How is an obstetric history documented according to GTPAL? G: Number of times pregnant T: Number of term infants P: Number of preterm infants (twins count as 1) A: Number of abortion (spontaneous or induced) L: Number of currently living children 5. When should an individual anticipate screening for gestational diabetes? 2nd trimester 6. When is GBS screened for in pregnancy? 3rd trimester 7. How is infertility defined? The inability to conceive and maintain pregnancy after 12 months of unprotected sexual intercourse o 6 months for women older than 35 years old Pregnancy and fetal development: 1. Where does fertilization occur in the reproductive tract? Within one of the two fallopian tubes 2. What structures are specific to the fetal circulatory system? Ductus venosus: connects the umbilical vein to the inferior vena cava Foramen ovale: opening between the right and left atria Ductus arteriosus: connects the pulmonary artery with the descending aorta 3. What is the function of the placenta and how is it formed? Formed from both fetal and maternal tissue o Fetal side: chorionic membrane; develops from trophoblasts o Maternal side: decidua basalis; prevents maternal & fetal blood from mixing Function: o 1. Metabolic gas exchange o 2. Hormone production o 3. Human chorionic gonadotropin (hCG) o 4. Human placental lactogen (hPL) 4. What is the function and anatomy of the umbilical cord? Connects the fetus to the placenta  Exam 1 study guide N6306 Consists of 2 arteries (deoxygenated blood) and 1 vein (oxygenated blood). 5. What is the function of amniotic fluid? Cushions the fetus Prevents fetus from adhering to amniotic membranes Allows freedoms of movement Provides consistent thermal environment 6. At what gestational ages is a pregnancy considered in the embryonic phase? Implantation to 8 weeks 7. When can fetal heart tones be auscultated? 10-12 weeks 8. How is fundal height measured in pregnancy and what anatomical marker on the body usually corresponds to 20 weeks gestation? At 20 weeks gestation, fundal height is at the umbilicus 9. At what gestational age is a pregnancy considered term? 39 weeks 37 weeks - Preterm = Before term = 37 weeks 38 % weeks Early - - 39 % weeks 40 weeks - Full term = - 41 % weeks 41 weeks Late term : - - termwas a -post o (13wks) 2nd Trimester= 1S-28wks 3rd Trimester = 29-40(llwks)