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EARLY PREGNANCY

EARLY PREGNANCY. DATING: FROM LMP 280 days Naegler’s rule Short cycle vs. long cycle. HEGAR’S SIGN - soft uterus CHADWICKS SIGN - blue cervix. Which of the following statements best describes the foramen ovale:. a) it shunts blood from right to left

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EARLY PREGNANCY

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  1. EARLY PREGNANCY DATING: FROM LMP 280 days Naegler’s rule Short cycle vs. long cycle HEGAR’S SIGN - soft uterus CHADWICKS SIGN - blue cervix

  2. Which of the following statements best describes the foramen ovale: a) it shunts blood from right to left b) it connects the pulmonary artery with the aorta c) it shunts deoxygenated blood into the left atrium d) it is an extra cardiac shunt e) it is functional after birth

  3. 100,000 doubling time 2 days Level 5,000 8 days 16 weeks 8 weeks progesterone ROLE - stimulate CL BHCG a sub unit similar to TSH LH FSH RIA + 8 days post conception Other uses Zone 2000-6000 Mole Ectopic Ovarian cysts Other placental hormones HPL = placental mass PROLACTIN “growth hormone” PROGESTERONE ESTROGEN

  4. ANTEPARTUM HISTORY AGE ( > 35 = AMNIOCENTESIS PURITY / GRAVIDITY MEDICAL HISTORY FAMILY HISTORY ROUTINE TESTS VAG. SWABS HIV ULTRASOUND IPS HB GROUP, RHESUS SICKLE, THAL, V.D.R.L. RUBELLA/chicken pox HEPATITIS URINE CULTURE 28 WEEK GLUCOSE SCREEN Grp B strep SPECIAL TESTS CVS AMNIOCENTESIS

  5. a FP SCREEN 16 WKS LEVEL > 2 . 5 MOM 2. . 5 - 2 . 9 > 5 LEVEL < 0 . 5 MOM 20 % RISK 70 % DOWN ‘ S RISK

  6. MSS AT 15 TO 19 WEEKS AFP, ESTRIOL, HCG AGE, WEIGHT RISK CALCULATION WITH ARBITRARY CUT-OFF DETECTS 60-70% OF DOWNS FIRST TRIMESTER 10 TO 14 WEEKS NUCHAL THICKNESS, BHCG, PAPP A INTEGRATED PRENATAL SCREEN MSS PLUS FIRST TRIMESTER DETECTS >90%, FALSE POSITIVE 2%

  7. All of the following hormones are products of placental synthesis or production except: a) human chorionic gonadotropin b) human placental lactogen c) prolactin d) progesterone e) estriol

  8. PLASMA H2O

  9. ANTENATAL CARE GENERAL EXAM PAP HISTORY / RISK FACTORS F IRST VISIT 4 weekly to 28 weeks 2 weekly to 36 weeks 1 weekly to delivery EACH VISIT CHECK: FUNDAL HEIGHT ( CMS ) 12 WKS = SYMPHYSIS 20 WKS = UMBILICUS 36 WKS = XIPHISTERNUM MATERNAL WEIGHT / SYMPTOMS BLOOD PRESSURE URINE PRESENTATION

  10. MATERNAL PHYSIOLOGY RBC PLASMA VOLUME 50 % CARDIAC OUTPUT- highest 1st hour after delivery HEART RATE 20 % STROKE VOLUME Placenta blood flow = 750 ml / min at term Tidal volume Residual volume G F R creatinine cc glycOSURIA “normal proteinura” 0.3 g/l

  11. All of the following factors are associated with an increased risk of perinatal morbidity except: a) low socioeconomic status b) low maternal age c) heavy cigarette smoking d) alcohol abuse e) exercise

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