Green PANCE book- OB Flashcards
start at the first day of last menstrual period, go back 3 months and add 7 days
how to determine due date
The initial prenatal visit should occur how many weeks after LMP (last menstrual period)
6-8 weeks
pregnant women should be examined every ___ weeks until the 32nd week
4 weeks
pregnant women should be examined every ___ weeks up to 36 weeks of gestation
2 weeks
A woman should be examined every ___ week from 36 weeks till the end of gestation
1! every week!
fetal heart tones should be examined at…
10 weeks (9-12 weeks)
check fundal height starting at….
20 weeks
normal fetal HR
120-160 bpm
Quickening or the first awareness of fetal movement usually occurs at…
18-20 weeks (first pregnancy)
14-18 weeks (multiple pregnancies)
Backache Increasing varicosities Heartburn Hemorrhoids Bleeding gums Profuse salivation Fatigue
associated with healthy pregnancy
abnormally low PAPP-A and abnormally high B-hCG indicated increased risk of…
Trisomy 21 and other genetic disorders
Ultrasound can detect fetal HR as early as _____ weeks after LMP
5-6 weeks
Bluish discoloration of vagina and cervix seen in pregnancy
Chadwick’s sign
Softening between funds and cervix in pregnancy
Hegar sign
Amenorrhea N/V Breast tenderness Quickening (fetal movement) -nullipara: 18-20 weeks -multipara: 14-16 weeks Easy fatigue Urinary frequency
Symptoms of pregnancy
Chadwick sign Increased basal body temp Skin changes (melanoma, linea nigra) Hegar sign Uterine growth
Signs of pregnancy
At 12 weeks pregnant, uterus is palpable above…
pubic symphysis
and fetal heart sounds heard
At 14-16 weeks pregnant, uterus is midway between…
pubic symphysis and umbilicus
At 20 weeks, uterus is at level of…
umbilicus
20-38 weeks, height of uterine funds corresponds roughly (+/-2 cm) to weeks of…
gestational age
38-40 weeks, gravid uterus is about 2-3 cm below the
xiphoid process
A catheter or needle is used to biopsy placental cells
*avail 10-14 weeks gestation
Chorionic villus sampling (CVS)
Withdrawal of amniotic fluid via needle under ultrasound guidance
*avail 15-18 weeks gestation
Amniocentesis
External doppler monitor, along with an external stress gauge for uterine contractions (together called the non stress test) is used….
near term to monitor fetal well being!
*third trimester screening
Implantation of a pregnancy anywhere but the endometrium
*more than 95% occur in fallopian tube
Ectopic pregnancy
Most common cause of ectopic pregnancy is occlusion of the tube secondary to….
adhesions
Hx of previous ectopic implantation Previous salpingitis (caused by PID) Previous abdominal or tubal surgery Use of IUD Assisted repro
risk for ectopic pregnancy
Unilateral adnexal pain
Amenorrhea or spotting
Tenderness or mass on pelvic exam
also….dizziness or syncope as well as GI distress
Ectopic pregnancy
Severe abdominal or shoulder pain associated with peritonitis, tachycardia, syncope or orthostatic hypotension
Rupture ectopic pregnancy
if serial increases of hCG are less than expected, what should be suspected?
Ectopic pregnancy
_______ _______ is diagnostic in 90% of ectopic gestation
transvaginal ultrasonography
methotrexate can be used in the tx of
ectopic pregnancies
the termination of pregnancy, by any means, before 20 weeks gestation
abortion
Spontaneous, premature expulsion of the products of conception
Spontaneous abortion
80% of spontaneous abortions occur during the…
first trimester
50% of these associated with genetic abnormalities
Smoking, infection, maternal systemic dz, immunologic parameters, drug use
Risk factors for spontaneous abortion
Spectrum of diseases arising from the placenta and include complete and partial hydatidiform moles, placental site invasive moles, trophoblastic tumors and choriocarcinomas
*divided into benign and malignant forms
Gestational trophoblastic disease (GTD)
complete molar pregnancies are most common form of GTD
A hydatidiform mole (also called a molar pregnancy)
benign or malignant?
Benign
complete molar pregnancies are the most common form of GTD
Characterized by an empty egg and the appearance of “grape like vesicles” or a “snow storm pattern” on ultrasound
Complete hydatidiform moles
What is present in partial hydatidiform moles?
a fetus!
..but the fetus is nonviable
Abnormal vaginal bleeding
Uterine size greater than dates
Hyperemesis gravidarum (excessive vomiting)
Preeclampsia like symptoms before 20 wks
presentation of complete or partial molar pregnancy
Tx of benign or low risk tumors vs malignant GTD tumors
Benign….chemo
Malignant..chemo with or without radiation or surgery
what can happen 1/80 births
twins
*prenatal visits should occur more frequently!
2/3 of twins are…
dizygotic (or fraternal)
..formed by the fertilization of 2 ova
Fam hx
Those taking fertility drugs
Mothers above average weight and height
African american women
more likely to have dizygotic (fraternal) twins
These types of twins occur randomly and are associated with fetal transfusion syndrome and discordant fetal growth
Monozygotic twins (fertilization of 1 ovum)
Most common complications of multiple gestation…
spontaneous abortion or preterm birth
preeclampsia and anemia more likely also
Carbohydrate intolerance of variable severity that is only present during pregnancy
Gestational diabetes
lifetime risk increased by 50% to developing diabetes later
Preeclampsia
Hyper acceleration of general diabetic complications
Traumatic births (including shoulder dystocia)
Maternal complications with gestational diabetes
Macrosomia
Prematurity
Feal demie
Delayed fetal lung maturity
Fetal complications with gestational diabetes
Obtain a random glucose on all pregnant women during the….
first prenatal visit!!
..repeat at 24-48 weeks
Managed with diet and exercise
*must check blood glucose levels daily
Management of gestational diabetes
Delivery of a viable infant before 37 weeks gestation
*most common cause of neonatal deaths not resulting from congenital abnormalities
Preterm labor
- Developmental delays
- Cerebral palsy
- Lung disease
More likely in low birth weight infants
Smoking, cocaine use, uterine malformations, cervical impotence, infections, low pre pregnancy weight
Increase risk of pre term labor
Defined as regular uterine contractions (greater than 4-6 per hour) between 20-36 weeks gestation and the presence of 1 or more..
- dilation greater of 2cm or greater on presentation
- dilation of 1cm or greater on serial exams
- cervical effacement of greater than 80%
Preterm labor
A length of 2 cm at 24 weeks gestation increases risk to deliver _________
prematurely
Rupture of the amniotic membranes before the onset of labor at or beyond 37 weeks of gestation
premature rupture of membranes (PROM)
*90% of women will go into spontaneous labor after PROM
Chorioamnionitis and endometritis increased risk of….
premature rupture of membranes (PROM)
Abnormal labor, which occurs when the cervix fails to dilate progressively over time and the fetus fails to descend
Dystocia
3 P’s that can cause abnormalities in labor/delivery
- Pelvis..sometimes pelvis not lg enough!
- Powers..refers to the strength of contractions that are needed to dilate the cervix
- Passenger..refers to the baby. The bigger the baby (esp the head), the more difficult
What drug can you give if contractions are inadequate
Oxytocin (Pitocin)
What is the leading indication for C sections?
Dystocia
The birth of the fetus through an incision in the abdominal and uterine walls (about 32% of deliveries in US)
C section
- repeat C sections
- dystocia
- failure to progress
- breech presenation
- fetal distress
most common causes of C sections
Greater chance of thromboembolic events, increased bleeding and development of infection
Risks of C section
A low transverse uterine incision is usually made because of…
decreased blood loss associated with it!
This is considered when prolongation of pregnancy might expose the mother or fetus to complications and when vaginal delivery is not contraindicated
Induction of labor
Prostaglandin gel put directly on cervix
..is this used for early or late induction?
EARLY
Oxytocin (Pitocin) given IV
..is this used for early or late induction?
LATE
Artificially rupturing the membranes with a small hook to induce labor
Amniotomy
Blood loss requiring transfusion or a 10% decrease in hematocrit between admission and the postpartum period
Postpartum hemorrhage
third leading cause of maternal mortality in advanced gestation
Occurs less than 24 hours after delivery and is associated with abnormal involution of placental site, cervical or vagina lacerations and retained portions of placenta
Early postpartum hemorrhage
Occurs more than 24 hours after delivery to 6 weeks post part and most commonly caused by sub involution of uterus, retained products of conception or endometritis
Late postpartum hemorrhage
- Initially, uterine massage and compression
- Establish IV access and prepare blood components
- Use IV oxytocin if early
**may require surgical intervention depending on severity
Management of postpartum hemorrhage
