Women's Health: Pregnancy/Prenatal Care

Dizygotic

Fraternal twins; due to fertilization of 2 ova by 2 separate sperm

-Increasing maternal age and increasing parity are independent risk factors, and rates are higher among mothers of families with twins

Monozygotic

Identical twins; formed from the fertilization of 1 ovum that splits, increased risk of fetal transfusion syndrome and discordant fetal growth

-Considered a high risk pregnancy

Amnion

Layer of the placenta nearest to the fetus

Chorion

Outer layer of the placenta

Diamniotic/Dichorionic

Each fetus is surrounded by an amnion and chorion, may be two separate placentas or one “fused”

Diamniotic/Monochorionic

Each fetus will be surrounded by an amnion but only one chorion will surround the fetuses

Monoamniotic/Monochorionic

Twins share a common amniotic sac

Preterm delivery

What is the MCC of maternal morbidity with multiple gestations?

Twin-Twin Transfusion Syndrome

Development of a monochorionic gestation causes various vascular anastomoses between the fetuses, which causes net flow from one twin to the other

-Donor Twin: impaired growth, anemia, hypovolemia. Experiencing oligohydramnios

-Recipient Twin: hypervolemia, HTN, polycythemia, CHF. Experiencing hydramnios

-Tx: endoscopic intrauterine laser ablation of the anastomoses

MMR

What vaccine is contraindicated in pregnancy?

First visit

When should the initial OB labs be drawn- CBC, UA, hCG, ABO/Rh typing, RPR/VRDL, HepB, rubella and varicella titer, PAP, and gonorrhea/chlamydia?

8 weeks

When should the dating ultrasound be done?

NIPT

What screening can be done during the first trimester to reveal chromosomal abnormalities, as well as the sex of the baby?

AFP, inhibin-A, estriol, beta hCG

What are the four parts of the QUAD screen done at 15-20 weeks gestation?

20 weeks

When is the anatomy scan performed?

28 weeks

When should the patient undergo the 1hr GTT?

28 weeks

When should a fetal growth US and Rhogham be administered?

36 weeks

When should the group B strep swab be done?

TDAP

What vaccine should be updated in pregnant patients?

progesterone, sodium, embryo, blastocyst

Physiology of Pregnancy: General Overview

-After ovulation, there is a swift increase in ______________. Penetration of sperm causes massive influx of _______, which then causes depolarization and repels positively charged sperm. This prevents more sperm from entering the egg.

-An _______ is then formed. The fertilized egg travels down the fallopian tube to the uterus. It is now called a __________ and implants into the endometrium.

Ladin’s Sign

Uterus softening after 6 weeks

Hegar’s Sign

Uterine isthmus softening after 6-8 weeks

Piskacek’s Sign

Palpable lateral bulge of softening of uterus cornus 7-8 weeks

Gooddell’s Sign

Cervical softening due to increased vascularization around 4-5 weeks gestation

Chadwick’s Sign

Bluish discoloration of the cervix at 8-12 weeks gestation

hCG

During the first 12 weeks of pregnancy, the fertilized egg secretes what hormone to help maintain the corpus luteum until the placenta is fully formed?

Relaxin

Hormone that stimulates endometrial decidualization by promoting angiogenesis in the endometrium

-Secreted by the corpus luteum

-Vasodilator

Progesterone

Stimulates smooth muscle relaxation throughout the body and in the myometrium, maintaining the decidual layer of the endometrium

-Helps enhance the growth of milk producing cells in the glandular tissue of the breast

Estrogen

Promotes tissue growth and secretion of prolactin

-Stimulates proliferation of myometrial tissue, enhancing formation of gap junctions

-Increases the responsiveness to oxytocin

Amenorrhea

What is the first symptom of pregnancy?

Braxton Hick’s Contractions

Tightening or pressure experienced by pregnant women around 28 weeks

-Usually subside with walking, exercise, and hydration

-Do not cause cervical dilation

25

A positive pregnancy test results if a b-hCG is above what?

5 weeks

When do you see the gestational sac on ultrasound?

5-6 weeks

When can you see the yolk sac and fetal pole with cardiac activity on ultrasound?

10 weeks

When can you start listening for fetal heart tones on the doppler?

LMP - 3 mo + 7 days

What is Naegele’s rule?

Crown Rump Length

What is the most accurate first trimester US dating?

Engagement

Widest part of baby’s head has passed through the pelvic inlet

Descent

Baby’s head moves through bony part of the pelvis and reaches depth of pelvic cavity

Flexion

Baby’s head pushes against pelvic tissue, chin-to chest

Internal Rotation

Baby rotates head/body from side-side → front-back to navigate pelvic diameters

Extension

Occurs as head, face, and chin are born

External Rotation

Baby rotates 90 from face down to facing mom’s thigh

Expulsion

Delivery of entire fetus

10-13 weeks

When should a PAPP-A + free B-hCG + nuchal translucency ultrasound be performed?

Amniocentesis

What diagnostic test can be performed at 15-20 weeks gestation?

28 weeks

When should the TDAP vaccine be administered?

IV Penicillin

If the GBS swab is positive, what should be given during labor?

Down Syndrome

What diagnosis are these quad screen results indicative of?

-Low AFP

-Low unconjugated estriol

-High B-hCG

-High inhibin A

300

Advise pregnant patients to increase daily caloric intake by around how many calories?

0.4mg

How much daily folic acid should a pregnant patient take to prevent neural tube defects?

Increase, decrease

During pregnancy, cholesterol labs _______, while BUN and creatinine _______

Down Syndrome

What do these first trimester NIPT test results indicate?

-Low PAPP-A, high B-hCG, nuchal translucency > 3.5 mm

72 hours

RhoGAM should be given within how many hours of delivery if the infant is confirmed Rh-positive?

Fetal Demise

Fetal death after 20 weeks

Preterm Delivery

Birth of a live fetus between 20 weeks and 36 weeks + 6 days