General Flashcards by sree satwika bonda

What is booking visit?

It is the first antenatal visit when the patient is registered for antenatal care.

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Importance of booking

1.To identify and assess the risk factors
2. To give proper antenatal care
3. To identify women requiring multi speciality care

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Ideal visits for antenatal booking

Up to 28 weeks - once in 4 weeks
28-36 - once in 2 weeks
36-40 - weekly

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WHO guidelines for four visits

8-12 w : to confirm pregnancy, to calculate EDD, develop a birth and emergency plan

24-26 w: to assess the fetal and maternal well being, screening and prevention

32 w: assess the maternal and fetal well being

36-38 w: same as above

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Minimum antenatal booking

First trimester -1
Second trimester -1
Third trimester -3

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When should tetanus toxoid be given?

It is mandatory to immunize all pregnant women with tetanus toxoid

1st dose - 16-20 w
2nd dose - 4-6 w later

If a woman becomes pregnant within 3 years a single booster dose is given

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What is naegele’s rule?

To find EDD , add 9m and 7d or go back 3m and add 7d to the LMP ( first day of last menstrual period)

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What history should be elicited in the first trimester?

How and when was pregnancy confirmed?
Morning sickness, hyperemesis and any rx
H/o fever with rashes , any infection and drug in take
Folic acid intake
Exposure to irradiation
Bleeding pv
Dating scan and NT scan

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What history should be elicited in the second trimester?

H/o quickening, immunization
Anomaly scan
Iron calcium and folic acid
GCT

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What history should be elicited in the third trimester?

H/o fetal movements
Growth scan
Discharging or bleeding pv

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Duration of each trimester

1st- till 12weeks
2nd- 13-28weeks
3rd- upto 40 weeks

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What is Knane’s rule?

It is used for corrected EDD

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Degree of consanguineous marriage

1°- incest
2°- maternal uncle
3°- cousins

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What is the total wt gain during pregnancy?

9-12kg
1st trimester - 1kg
2nd trimester - 3-4kg
3rd trimester - 4-6kg

If wt gain more than 1/2kg/week, early manifestation of preeclampsia

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Causes and features of physiological anemia

Features
Disappears after 12h of rest
Present in dependent parts of the body
Causes
Pressure on IVC
Vasodilation due to progesterone
Cha

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Causes of striae garvidaram

Linear marks due to rupture of elastic fibers due to stretching which is recent

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Palpation of uterus

From pubic symphysis to umbilicus
1. Pregnancy is within pelvis till 12weeks, after which it becomes palpable per abdomen
2. First line of division to 16 weeks
3. Second line at umbilicus is 24 weeks

From umbilicus to xiphisternum it is divided into 3parts
1.First line of division above umbilicus is 28 weeks
2. Second line corresponds to 32weeks
3 . Level of xiphisternum 36weeks

The uterus must be palpated after dextrorotation due to the presence of sigmoid colon on left

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Conditions where the uterus is bigger than the period of amenorrhea

Wrong dates, full bladder, multiple pregnancy,polyhydramnios, big baby, vesicular mole

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Conditions where the uterus is smaller than the period of amenorrhea

Oligohydramnios, transverse lie, IUD, FGR, wrong dates, irregular conception

Leopold ‘s maoeuvers

4 obstetrics grips- 3 are done facing the patient

Fundal grip- fundus palpated with 2 hands to find which part is occupying the fundus
• if it is broad,soft, bulky not independently ballotable - breech occupying the fundus
• hard, round, independently ballotable foetal part

Umbilical grip
One hand is placed on each side of the uterus - when small nodules are felt:limb buds, uniform resistance: back of the fetus

Importance of the second pelvic grip

To confirm the finding of first pelvic grip
To check whether the head is engaged or not - if hands diverge: engaged, converge: unengaged
To find the attitude of head well flexed, deflexed or extended

• if sinciput is higher than occiput then well flexed head
• if occiput and sinciput in the same line then deflexed head
• if occiput Higher than sinciput then extended

Auscultation of fetal heart

In the cephalic presentation, the fetal heart will be heard below the umbilicus
Occipito- ant or post: fetal heart sound is heard in spino umbilical line

Breech position heart sound above the umbilicus

Transverse lie heart sound at the level of umbilicus

What is shelving sign?

At term when the head gets engaged, there is forward falling of the uterus and when the women sits , the examiner can keep the hand on the fundus

Symphysiofundal height

Measurement taken after emptying the bladder and correcting the dextrotation
It is measured from the highest point of uterine fundus to the highest point of pubic symphysis.

From 20-36 weeks ,SFH corresponds to gestational age in weeks ± 2cm

If SFH <4cm of the normal : suspect FGR , oligohydramnios, wrong dates, IUD and transverse lie

What is mc Donald's rule

To assess the gestational age Height of the fundus in centimetres × 2/7 = duration in lunar months In weeks 8/7

What triple and quadruple test?

AFP, unconjugated estriol and beta HCG In quadruple along with inhibinA

What is a denominator?

It is the fixed bony prominence which comes in contact with various of the pelvic

Engaging diameter in face presentation

Sub mento bregmatic

Presenting diameter in vertex presentation

Sub occipito-bregmatic 9.5

Engaging diameter in brow presentation

Vertico-mental diameter

What is engagement?

The greatest engaging diameter passes through the pelvic brim and presenting part will be at the level of ischial spines

What is a show?

It is the release of mucous plug from the cervical canal with blood due to dilatation and effacement of cervix

What is episiotomy?

It is a surgical incision involving the perineum and posterior vaginal wall in the second stage of labour, to enlarge the passage and expedite the delivery.

Timing of episiotomy

During the crowning of head at vulva and doesn't retract with contraction In breech it is given when the breech is climbing

Types of episiotomy

Medial lateral and mediolateral Most commonly used mediolateral - done after giving local infiltration with 1% xylocaine

How is episiotomy repaired?

In lithotomy position, it is repaired in three layers 1st layer- vagina mucosal : catgut suture 2nd layer- muscles: it is opposed and dead space is obliterated 3rd layer- skin and subcutaneous layer

What are the advantages of mediolateral episiotomy?

Reduce the trauma to perineum Incision can be extended

Role of dating scan

To establish whether intra or extra uterine pregnancy Viable or not Number of gestational sacs- single or multiple CRL- 7-12 weeks after tht the efficacy decreases Associated adnexal mass and uterine anomaly Nt scan- more than 3mm strong marker for chromosomal anomalies

Anomaly scan

Done from 18-20weeks of gestation Most structural anomalies can be identified and MTP is allowed till 20 weeks For placental localisation Amount of liquor Baseline fetal biometery

Presentation

Part of the fetus that lies in the lower portion of the uterus. Most common cephalic followed by breech

Attitude

The relation of fetal parts to one another, commonest is universal flexion

Lie

The relation between the long axis of the fetus to the long axis of uterus

Denominator

Is the fixed bony point which comes in contact with various quadrants of pelvis. Sacrum in breech Occiput in vertex Mentum in face Acromion in shoulder

Mechanism of labour

Engagement - when the bi parietal diameter has passed through the pelvic brim and is at ischial spines Descent - secondary to uterine contractions in first and second stage of labour Flexion- when the head descends to the pelvic floor and resistance from pelvic side walls is felt Internal rotation- the shape of the pelvis, direction of muscle fibers will help rotate the head into anterioposterior position Extension - the head is delivered by extension, first bregma then face and chin in succession over the posterior vaginal opening and perineum Restitution - as soon as the head escapes from vulva aligns with shoulder - neck untwisting External rotation - to deliver the shoulder undergo internal rotation bringing bisacrominal diameter into ant-post diameter of pelvis and external rotation of head

Advantages of mediolateral episiotomy

Reduces injury to perineum Can be extended