Exam Qs Oral Flashcards
Who to screen for gestational diabetes
Part of screening program = check all pregnant
- At 24-28 gw
- At time 0 min (lower than 5,6), 120 min (lower than 7,8) «5,6,7,8»
- 75 gram glucose
Define preeclampsia
- Original version: after 20 gw, hypertensive disorder (over 140/90) + proteinuria (300mg/24 hrs)
- Need hypertension + something else (not necessary with proteinuria in new definition)
Postpartum hemorrhage
4 T´s
- Tone: uterine atony is an exclusion diagnosis (after excluding the other T´s)
- Tissue
- Trauma
- Thrombin
Pregnant to emergency 30th gw and bleeding - DDx and what to do
- First: good morning (no anamnesis) + CTG (fast)
- Placenta previa or placental abruption
- How to check: First palpate uterus - outer examination/abdomen (if hard - abruption - surgery) (if normal - previa)
Presumptive, probable, definite signs of pregnancy
- Presumptive: signs we can have in pregnant, non-pregnant and men (nausea, vomiting)
- Probable: in pregnant and non-pregnant (physical changes, pregnancy tests - can be tumor)
- Definite sign: detecting fetus (US, CTG)
US screenings
5 screenings:
- Type 0: detect pregnancy
- Type 1: 11 gw +0 days - 13 gw+6 days, screen downs, malformations, detect pregnancy, size
- Type 2: genetic
- Type 3: IUGR
- Type 4: 38 gw, position, size, estimated weight etc
Stages of delivery
- First stage: dilation cervix (9 or 11 hrs, multiparous: half)
- Second: delivery of fetus (50-60 min, multi: half)
- Third: delivery placenta (5-15 min, should not be longer than 30 min)
- Fourth: artificial, 2 hrs observation
Delivery starts - signs
- Regular contractions (every 10 min or more often)
- Rupture of membranes
Folliculogenesis
Sperm & egg are both produced in 60-90 days - so the egg that is ovulated is produced 3 cycles before (after spontaneous abortion the whole system is at time zero, so therapy will give pregnancy earliest after 3 months)
Ovulation time
24 hrs after LH surge
Hormonogenesis
The hormones are produced by the follicles in the ovaries, so a person with ovaries, but no follicles in them, does not produce sexual hormones (e.g Turner syndrome)
Ovulation - chance of getting pregnant
- Sperm lives 48 hrs
- Egg should be fertilized within ~12 hrs after ovulation (max 24 hrs)
- So approximately a 3 days window of when intercourse leads to pregnancy
hCG (human chorionic gonadotropin) - pregnancy test
- Urine (yes/no)
- Serum to know when pregnancy happened - important in ectopic pregnancy, but still do urine tests in emergencies because faster results
Spontaneous abortion %
- 60-70 % of all pregnancies end in spontaneous abortions - many not recognized
- Clinically detected pregnancies - 10-15 % end in spontaneous abortion
Folic acid
- Daily requirement: 300-500 microgram
- To avoid neural tube defects
Dilution anemia in pregnany
Dilution anemia (lower Hgb, Htc) - normal during pregnancy («she´s not anemic»), true anemia is Hgb below 12 g/dl
Leukocytosis in pregnancy
Leukocytosis is normal 10000-16000
Proteins in pregnancy
Eat and drink as much proteins as possible - at least 65 g/day (for normal growth, development of fetus)
AFP (alphafetoprotein) in pregnancy
- Peak at week 13
- Screening at 16th week for NTD
Arterial blood pressure in pregnancy
Does not increase in normal pregnancy! (OBS preeclampsia)
Chadwick´s sign
Bluish discoloration of cervix, vagina and labia resulting from increased blood flow. Can be observed spprox 6-8 weeks after congestion as an early sign of pregnancy.
«Mask of pregnancy»
Chloasma
Hormone responsible for bone and joint changes during pregnancy
Relaxin (source: corpus luteum, ovary, breast etc)
Normal weight gain during pregnancy
10-12 kg
Average length of labor
Nulliparous: 12-18 hours
Multiparous: 6-8 hours
Ruptured membranes without regular contractions first
Increased risk of infection
Stages of partuition
- Phase 0: uterine quiescence
- Phase 1: preparation for labour
- Phase 2: process of labor (1st, 2nd, 3rd)
- Phase 3: recovery
Principles of management of labor
- Diagnosis of labour
- Monitoring the process of labour
- Ensuring maternal well-being
- Ensuring fetal well-being (CTG)
Criteria for normal labour (8)
- Spontaneous expulsion
- Of a single (twins/triplets «not normal» labour)
- Mature fetus (gw 37 - 42)
- Presented by vertex
- Through the birth canal
- Within reasonable time (more than 3, less than 18 hours)
- Without complications to the mother
- Without complications to the fetus
3 P´s in progress of labour
- Power: uterus (myometrium)
- Passenger: fetus (head mostly)
- Passage: pelvis of the mother
Stages of delivery
- First stage: cervical dilation and effacement
- Second stage: birth
- Third stage: placental stage
- Fourth stage: postplacental stage
First stage of delivery
Cervical dilation and effacement
- Contractions (regular, stronger, more frequent, longer)
- Cervical dilation: latent phase (3 cm), active phase (3-10 cm)
Second stage of delivery
Birth, 2 phases:
- Propulsive phase (ful dilation and presenting part in pelvic floor)
- Expulsive phase (delivery of fetus)
Third phase of delivery
Placental stage (5-20min)
- 2 phases: Separation and expulsion
- Check if missing parts of placenta or if hemorrhage (150-250 ml is normal)
Considerations regarding fetal position in labor (4)
- Lie (longitudinal, transverse, oblique)
- Presentation (vertex, breech, transverse, face, brow, shoulder etc)
- Attitude or posture (ovoid mass)
- Position (left vs right)
Fetal lie
Relation of long axis of fetus to that of the mother
- Longitudinal (99 %)
- Transverse
- Oblique (unstable - always become longitudinal or transverse during labor)
Smallest diameter fetal posture
Suboccipitobregmatic diameter
Leopold maneuvers
- First maneuver
Palms at uterine fundus - should feel soft (butt of baby)
If hard: can be the head due to baby lying in breech presentation - Second maneuver
Palms on each side on belly - Third maneuver
Thumb and fingers at lower abdomen
Movable mass- the presenting part is not engaged
Differentiation between head and breech - Fourth maneuver
Examiner faces mothers feet - tips of fingers each hand exerts deep pressure in direction of the axis of the pelvic inlet
Feel if passes through pelvis(?)
Amniotomy
No spontaneous rupture of membranes, so we have to artificially rupture it - more rapid labour
Amnioscopy
- Check colour (urine like, brown, green, red) and amount of amniotic fluid
- Meconic amniotic fluid: can be due to hypoxic fetal state
True labour
- Regular contractions
- Intervals shorten
- Intensity increase
- Discomfort back/abdomen (?)
False labour
- Irregular contractions
- Intervals remain long
- Intensity remains unchanged
- Discomfort is chiefly in lower abdomen
- Cervix does not dilate
- Discomfort usually relieved by sedation
Heart beat fetus
6 weeks
Naegele rule
Estimate expected delivery
- First day of last menstrual period + 7 days - 3 months
Crown-rump length
Best to estimate due date
- US first trimester
Hegar sign
- Softening in consistency of the uterus
- Uterus and cervix seem to be two separate
Piskacek sign
Softened prominence of uterus
Fetal surveillance
- HR: week 16-19
- US: from week 5-6
- Amniotic fluid
- Fetal movement: week 18-20
Fifth Leopold maneuver
Zangemeister maneuver
Obstetrical hemorrhage groups
- Early
- Late
- Antepartum
- Intrapartum
- Postpartum
Causes of early hemorrhage
- Molar pregnancy
- Ectopic pregnancy
Causes of late hemorrhage
- Abruptio placentae
- Placenta previa
- Postpartum hemorrhage (4 T´s - uterine atony most common)
Postpartum hemorrhage definition
- Losing over 500 ml after vaginal delivery
- Losing over 1000 ml after c-section
Indication induced abortion
- Non-medical: until 12th gw (18th if crime, misdiagnosis)
- Medical: until 20th gw (24th if laboratory delay)
Induced abortion techniques
Until gw 6
- Menstrual aspiration
- Medical abortion
Until gw 12
- Cervical dilatation
- Evacuating pregnancy
Second trimester
- Medical induction
- Oxytocin infusion
- Curettage
C-section vs forceps/vaccum
First stage of labor: c-section
Second stage of labor: forceps, vacuum - c-section is no longer an option
Cephalopelvic disproportion
Estimated fetal weight (4500 gr)
Height of mother (under 150 cm)
Prerequesite and contraindications of c-section
No absolute prerequesite - except that fetal head is not engaged (aka 1st stage labor)
No absolute contraindication
Anesthesia in labor
- Vaginal=epidural
- C-section=spinal
- Emergency c-section =intratracheal
Abdominal incision
- Vertical incision: lower median
- Suprapubic transverse incision: Pfannenstiel
Uterine incision
- Classical incision (corporal longitudinal): easier, but seldom used today because all forecoming pregnancies must be delivered by c-section due to rupture risk
- Transperitoneal cervical transverse (tct incision): mostly used today, least likely place to rupture in later pregnancy
HCG levels in different pregnancies
- hCG doubles every 2nd day in normal pregnancy
- Decreased hCG can be spontaneous abortion
- Steady slowly increasing hCG indicates extrauterine pregnancy
US ectopic tubal pregnancy
US ectopic pregnancy: tubal ring (donut) with flow around it
Polyhidromnia
Over 25 cm
Oligohydromnia
Less than 5 cm
Anhydromnia
Less than 3 cm
Size of fetus gw 12
Man fist
Size of fetus gw 26
At level of navel
Size of fetus gw 34
Between navel and xiphoid
Big belly causes
- Twins
- Big baby
- Polyhydramnios
Normal heart beat CTG
120-160 bpm
Decellerations CTG
Over 15 bpm for over 15 seconds = bad prognosis
Pearl index different contraceptives
- Oral contraceptive pill: 0.1 – 2.5
- Emergency contraceptive pill (postcoital): 0.5 – 2.5
- Intrauterine device: 0.5 - 5.0
- Operative methods (sterilisation): 0.3 – 6.0
- Condom: 3 - 28
Uterine fundal height
- 20: 2 fingers under umbilicus
- 24: Umbilicus
- 28: 2 f above umbilicus
- 32: 4 f above umbilicus
- 35: between xyphoid and umbilicus
- 36: 4 f below xy
- 37: 3 f below xy
- 38: 2 f below xy
- 39: 3 f below xy (descend)
- 40: 4 f below xy (decend/engage)
Normal weight newborn
2500-4290 gr
Normal length newborn
44-54 cm
Normal head circumference
32-38 cm
Normal abdominal circumference
17-24 cm
Average umbilical cord (length, diameter, helices)
- Length: 55 cm
- Diameter: 1-2 cm
- 11 helices
Abortion definition
Loss of fetus younger than 20 gw
Stillbirth definition
Delivery of dead fetus over 20 gw (or 350 gr if gw not known)
Neonate definition
0-28 days
- Early: first 7 days
- Late: 8-28 days
Infant definition
0-365 days
Early preterm
20-33+6
Late preterm
34-36+6
Postterm
Over 42 gw
6 fetal movements in labor
1) Descent
2) Flexion
3) Internal rotation
4) Extension
5) External rotation
6) Expulsion
Station: Floating
-5
Station: engaged
0
Station: crowning
+5
Smallest diameter fetal head (name)
Suboccipitobregmatic
