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Symptoms of pregnancy?
- -missed period
- -fatigue
- -frequent urination
- -Fatigue
- -N/V
- -breast tenderness
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How to calculate pregnancy due date?
- Nargele’s Rule
- -3 months from LMP +7 days
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Every pregnant woman should be screened for what safety concern in their first trimester?
Domestic Violence (3x higher if pregnancy unattended)
Risk Factors: <35 yrs, smoke, alcohol, history, single
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How should a pregnant patient who has asymptomatic bacteriuria be handled?
Culture & treat aggressively with abx, check monthly until delivery
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How often should hCG double?
Every 48-72hrs during the first 12 weeks
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Rubella immunity in pregnant patients?
If not immune not needed.... can be given after delivery
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Goal TSH in pregnant patients?
< 2.5
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All women should have what lab work done at first visit?
- -confirm pregnancy (blood)
- -CBC (MCV <80 may suggest thalassemia but may be delusional)
- -U/A
- -Blood type
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When is the most common time for a pregnant women to have symptoms that are concerning for an ectopic pregnancy? What are some symptoms?
- 6-8 weeks
- -low grade fever, abdominal pain, Vaginal bleed
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Approximate weight gain during pregnancy?
Around 30 lbs.... Low BMI gain more, High BMI gain less
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How much exercise should a pregnant lady get a day?
At least 30 min of moderate exercise
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When is cramping during pregnancy concerning?
Cramping that continues to worsen or is associated with bleeding (some cramping is normal due to growing fetus)
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When can flu vaccine be given to pregnant mother?
Anytime
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When should Tdap be given to pregnant female?
Third trimester (27-36 weeks where baby is immune)
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When should your pregnant patient return to clinic?
- q4 wks until 28 wks
- q2 wks 29-36 wks
- Qweek after 36
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Screening for gestational diabetes:
Fasting glucose > ____
A1C >____
Random BG ____
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How many BG must be abnormal on 3 hour OGTT screening for gestational diabetes?
2 out of 4
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What is McDonald’s Rule?
Fungal Height should be within 2 cm of gestational age
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Most common chromosomal abnormality in live births
Trisomy 21 (Downs)
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Most common sex chromosome in girls, loss part or all of an X chromosome, short state square chest, etc.
Turner Syndrome
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When should RhoGam (anti D immune globulin) be given to a Rh negative mother?
2 Times: RhoGAM 300mcg 28 weeks & 72 hours prior to delivery
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Signs of preterm labor:
- -diarrhea
- -increased uterine activity
- -bleeding
- -low/full back ache
- -cramps
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How often should a healthy fetus move?
3-5 times in an hour
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First line drug for pregnant pt with UTI?
Macrobid
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Safe med category for pregnant women?
- A & B
- (PNC, Cephalosporins, Macrolides, Nitrofurantoin)
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Cervical softening is what sign?
Goodell’s Sign
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Blue discoloration of the cervix & vagina is what sign?
Chadwick’s sign
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Softening uterine isthmus is what sign?
Hegar’s sign
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What are the 3 positive signs of pregnancy?
- -palpation of fetus by HCP
- -Ultrasound & visualization of fetus
- -Fetal Heart tones
The rest are probably signs
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A positive beta hCG may also present in what 2 other conditions?
- -Molar Pregnancy
- -Ovarian Cancer
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What do we know about Blood pressure in pregnant women?
Decreased in the first and 2nd trimester, returns to normal in the 3rd
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What 2 anti hypertensive agents can be used in pregnancy?
- -Labetolol (Normodyne)
- -Methyldopa (Aldomet)
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When does the heart murmur occur during pregnancy: systolic or diastolic?
Systolic Flow Murmur
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Cholesma/melasma is due to high _______ levels
Estrogen
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Painless BRIGHT Red vaginal bleeding without uterine tenderness in a pregnant female makes you concerned for what?
Placenta Previa
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Very painful dark colored vaginal bleeding that is intermittent with hypertonic, hard tender uterus makes you concerned for what in a pregnant pt?
Placenta Abruptio
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Where should the fundi be at 12 weeks?
Above Symphysis Pubis
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At how many weeks is the fundi between the symphysis pubis & umbilicus?
16
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When should the fundi be at the umbilicus?
20 weeks
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Askenazi Jews (European Jews) should be screened for what?
Tay-Sachs Disease (rare inherited disorder that destroys nerve/brain cells)
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Gravida/Para/Abortus means?
- Gravida (# of pregnancies)
- Para (# of births > 20 wks no matter outcome)
- Abortus (# of births lost > 20 wks)
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Which test detects presence of Rh antibodies in the mother and the infant that is done as part of the labs early in pregnancy?
Coombs Test
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UTI is defined as what number colony forming units?
100,000 (CFU) or 10^5
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What type of noises may be heard in a breastfeeding baby?
Swallowing noises (especially in younger babies)
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What noises heard during breastfeeding are abnormal?
Clicking noises (advise mother to use her index finger to pull down baby’s chin so that baby’s lower lip will be outside the mouth) -proper latch no noise will be heard
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A mother complains of sore nipples from breastfeeding, what should she be advised?
To continue breastfeeding, it is a normal symptom. DO NOT supplement with formula.
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What is the classic triad of preeclampsia?
- Hypertension
- Edema (weight gain)
- Proteinuria
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What is HELLP Syndrome?
- Hemolysis
- Elevated Liver (enzymes)
- Low Platelets
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Low Alpha Fetal Protein levels could be indicated of what?
What test should you order if AFP levels are low?
Downs Syndrome
-follow it up with a triple screen test (AFP, hCG, & estriol)
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