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Obstetrics > General Obstetrics and Pregnancy > Flashcards

General Obstetrics and Pregnancy Flashcards

1
Q

What is the most common first symptom of pregnancy? What other symptoms are present early in pregnancy?

A

Amenorrhea; however, in pts with irregular menses, amenorrhea may be missed.

Other symptoms include breast tenderness, nausea and vomiting.

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2
Q

In a pt with nausea and vomiting whose LMP was 6 weeks ago, what is the next step in management?

A

Beta-HCG (pregnancy test) should be done first in all symptomatic women of childbearing age.

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3
Q

What causes morning sickness? When can it happen in pregnancy?

A

Morning sickness is caused by an increase in beta-HCG produced by the placenta.

It can occur until weeks 12-14 in pregnancy.

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4
Q

When is the future child considered an embryo? A fetus? An infant?

A

Embryo: fertilization to 8 weeks
Fetus: 8 weeks until birth
Infant: birth to 1 year old

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5
Q

In terms of dating methods, what is the developmental age? What is the gestational age? How do they compare?

A 
Developmental age (DA): number of days since fertilization
Gestational age (GA): number of days/weeks since the last menstrual period; it is usually 2 weeks longer than the DA.
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6
Q

What is the Nägele rule?

A

The Nägele rule is an estimation of delivery date using the following formula:
Estimated day of delivery = LMP - 3 months plus 7 days

*subtracting 3 months = adding 9 months

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7
Q

What are the lengths of each trimester (with respect to DA and GA)?

A

First: fertilization until 12 weeks (DA) or 14 weeks (GA)
Second: 12(DA)/14(GA) weeks until 24 weeks (DA) or 26 weeks (GA)
Third: 24(DA)/26(GA) weeks until delivery

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8
Q

How many weeks determine each term?

A

Pre-viable: fetus born before 24 weeks
Preterm: fetus born between 25 and 37 weeks
Term: fetus born between 38 and 42 weeks
Postterm: fetus born after 42 weeks

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9
Q

What are gravidity and parity? How are they broken down to describe a pregnant pt?

A

Gravidity is the number of times a person has been pregnant.

Parity is what happens to each pregnancy. This is broken down into 4 numbers:

  1. Full-term births
  2. Preterm births
  3. Abortions (both spontaneous and induced)
  4. Living children (if a woman has a multi-gestation pregnancy, one birth results in two living children)
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10
Q

What is quickening?

A

The first time the mother feels fetal movement.

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11
Q

What is the Ladin sign? When does it occur?

A

Softening at the midline of the uterus anteriorly at the junction of the uterus and cervix; felt at 6 weeks GA (first trimester).

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12
Q

What is the Chadwick sign? When does it occur?

A

Blue discoloration of the vagina and cervix; occurs at 6-8 weeks GA (first trimester).

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13
Q

Which of the following is one of the first signs of pregnancy on physical exam? When can it be felt?

  • Quickening
  • Goodell sign
  • Ladin sign
  • Linea nigra
  • Chloasma
A

The Goodell sign is softening of the cervix that is felt first at 4 weeks.

*Quickening is a symptom, not a sign.

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13
Q

What are telangiectasias / palmar erythema? When do they occur?

A

Small blood vessels / reddening of the palms.

They occur in the first semester.

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15
Q

What is the linea nigra? When does it occur?

A

A hyperpigmented vertical line that appears on a pregnant woman’s abdomen (2/3 of cases) from the pubis to the umbilicus or xiphoid process; due to increased melanocyte-stimulating hormone made by the placenta, which also causes melasma and darkening of the nipples; occurs in the first few months of pregnancy (second trimester).

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16
Q

A woman presents to the office for her 6th pregnancy. She has had 2 abortions, 2 children born at term, and a set of twins born at preterm. What is the pt’s gravidity and parity?

A

G6P2124

Since the pt has been pregnant 6 times, you need to assume from the info that 1 unmentioned pregnancy resulted in a preterm birth because the twins only count as 1G.

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16
Q

What is chloasma? When does it occur?

A

The “mask of pregnancy” is a hyperpigmentation of the face most commonly on the forehead, nose and cheeks; it cam worsen with sun exposure.

Chloasma occurs at 16 weeks (second trimester)

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17
Q

What is the best initial test to determine pregnancy? What is the confirmatory test?

A

Best initial: beta-HCG

Confirmatory: ultrasound

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19
Q

What does a urine pregnancy test detect? What about a serum pregnancy test?

A

Both detect beta-HCG

20
Q

When can a gestational sac be seen on US? How does this correlate to beta-HCG level?

A

Gestational sac can be seen on US at 5 weeks GA or when beta-HCG > 1500 IU/mL.

21
Q

What are the cardiovascular physiological changes in pregnancy?

A
  • Increase in cardiac output (increase in HR)

- Slightly lower BP (lowest point occur at 24-28 weeks)

22
Q

What are the GI physiological changes in pregnancy?

A
  • Morning sickness: occurs any time throughout the pregnancy and is caused by increased estrogen, progesterone, and beta-HCG produced by the placenta.
  • GE reflux: LES has decreased tone.
  • Constipation: motility in the large intestine is increased.
23
Q

What are the renal physiological changes in pregnancy?

A
  • Increase in the size of the kidney and ureters increases the risk of pyelonephritis from compression of the ureters by the uterus.
  • Increase in GFR (secondary to 50% increase in plasma volume); this leads to a decrease in BUN/creatinine.
24
Q

What are the hematologic physiological changes in pregnancy?

A
  • Anemia (secondary to 50% increase in plasma volume).

- Hypercoagulable state

25
Q

Why is pregnancy a hypercoagulable state?

A

Pregnancy is a hypercoagulable state because:

  • Increase in fibrinogen
  • Venous stasis
  • NO increase in PT, PTT, or INR
26
Q

How often should pts be seen in the first trimester? When can US be used to determine gestational age? What else is US used for at this time? What other tests are done?

A

Pts should be seen every 4-6 weeks in the first trimester.

Between weeks 11-14, US can be done to confirm the gestational age AND to check for nuchal translucency.

Blood tests, Pap smear, and gonorrhea/Chlamydia tests are done as well.

27
Q

When can fetal heart sounds be heard?

A

At the end of the first trimester.

28
Q

What is a first trimester screening?

A

First trimester screening is a noninvasive evaluation to identify risks of chromosomal abnormalities. It is a combination of blood tests and ultrasounds that evaluates the fetus for possible Down syndrome.

29
Q

Can beta-HCG level, pelvic exam, fundal height, and/or LMP be used to determine gestational age? Why or why not?

A

None of these is an accurate test:

  • Beta-HCG is unreliable because it can be increased in twins or decreased in early abortions.
  • Pelvic exam and fundal height may change with multiple gestations.
  • A pt’s account of LMP is unreliable as it is often inaccurately remembered.

*Ultrasound is the most accurate method of establishing GA.

30
Q

What are visits in the second trimester used for?

A

Second semester visits are used to screen for genetic and congenital problems.

31
Q

What are a triple and quad screen and when are they done?

A

A triple screen includes:

  • Maternal serum alpha fetoprotein (MSAFP)
  • Beta-HCG
  • Estriol

A quad screen adds inhibit A to the triple screen.

These test are done at 15-20 weeks.

32
Q

Besides the triple and quad screen, what other tests are done during the second semester?

A
  • Auscultation of the fetal heart rate.

- Routine US for fetal malformation at 18-20 weeks.

33
Q

When is quickening felt? Why is it felt at a different time in some women?

A

Quickening (feeling fetal movement for the first time) occurs at 16-20 weeks. Multiparous women feel the quickening earlier than primiparous women.

34
Q

How often are office visits in the third trimester?

A

In the third trimester, visits are every two weeks until week 36. After 36 weeks, there is a visit every week.

35
Q

What are Braxton-Hicks contractions? When do they occur? What if they become regular?

A

Braxton-Hicks contractions occur during the third semester. They are sporadic contractions that do NOT cause cervical dilation.

If contractions become regular, the cervix should be checked to rule out preterm labor before 37 weeks. Preterm labor opens the cervix, but Braxton-Hicks do not.

*Beginning at 37 weeks, the cervix should be examined every visit.

36
Q

What four tests are done during the third trimester?

A
  • CBC
  • Glucose load
  • Cervical culture for gonorrhea and Chlamydia
  • Rectovaginal culture for group B strep
37
Q

When in the third trimester are cervical cultures for gonorrhea and Chlamydia done? What do you do if the culture is positive?

A

Cervical cultures for gonorrhea and Chlamydia are done at week 36. If positive, treat with pregnancy-safe abx.

38
Q

When in the third trimester is CBC done? What is the treatment if abnormal?

A

CBC is done at 27 weeks. If Hb

39
Q

When in the third trimester is glucose load done? What does the test involve? What is the next step if abnormal?

A

Glucose load test is done at weeks 24-28. It involves fasting or nonfasting ingestion of 50g of glucose with a serum glucose check done at 1 hour. If glucose > 140 at one hour, perform an oral glucose tolerance test.

Glucose tolerance test: Check fasting serum glucose then have pt ingest 100 g of glucose and check serum level at 1, 2, and 3 hours. Elevated glucose during any two of these tests is gestational diabetes.

40
Q

How, why, and when is chorionic villous sampling done?

A

In chorionic villous sampling, a catheter is placed into the intrauterine cavity to aspirate chorionic villi from the placenta. It can be done transvaginally or transabdominally. It obtains the fetal karyotype.

It is performed at 10-13 weeks in advanced maternal age or known genetic disease in a parent.

41
Q

How, why, and when is amniocentesis done?

A

In amniocentesis, a needle is transabdominally placed into the amniotic sac to withdraw amniotic fluid. It obtains the fetal karyotype.

It is performed at 11-14 weeks in advanced maternal age or known genetic disease in a parent.

42
Q

How, why, and when is fetal blood sampling done?

A

In fetal blood sampling, a needle is transabdominally placed into the uterus to get blood from the umbilical cord to obtain a blood sample. It is done in pts with Rh isoimmunization and when a fetal CBC is needed.

*There are no specific parameters on when this is done.

43
Q

How quickly does beta-HCG level rise during pregnancy? When does it peak? What happens to the level afterwards?

A
  • In the first trimester, beta-HCG level doubles every 48 hours for the first 4 weeks.
  • It peaks at 10 weeks GA, and will typically drop in the second semester.
  • In the third semester, it will slowly rise again to a level of 20,000-30,000 IU/mL.
44
Q

What is a nonstress test (NST) used for? What is a reactive NST?

A

The NST allows the physician to check for fetal well-being while still in the uterus. It measures fetal movements and assesses fetal heart rate.

A reactive NST is defined as:
- Detection of 2 fetal movements
- Acceleration of fetal heart rate > 15 bpm lasting 15-20 seconds over a 20-minute period.
A reactive NST shows the fetus is doing well, and no further testing is needed.

45
Q

What is done if the NST is nonreassuring (not reactive)?

A

If the NST is not reactive, the fetus could be sleeping. Vibroacoustic stimulation is done to wake it up.

46
Q

What does the biophysical profile (BPP) consist of? How is a score calculated?

A

BPP:

  • NST
  • Fetal chest expansions (count episodes of fetal chest expansion; normal is one or more episodes in 30 minutes)
  • Fetal movement (count fetal movements; normal is more than 3 in 30 minutes)
  • Fetal muscle tone (fetus flexes an extremity)
  • Amniotic fluid index (volume of amniotic fluid based on sonogram)

Each category is worth 2 points; a BPP of 8-10 is normal, 4-8 is inconclusive, and below 4 is abnormal.

Obstetrics (3 decks)

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