Intro to OB Flashcards

Question

Removal of IUD

Answer 1

Remove on last day of a normal period. | Have one more period and then conceive.

Answer 2

Days are numbered. “Day 1” = first day of a normal menses. | When next period begins, the “count” starts over – first day of that period = “day 1”.

Answer 3

The ovum is “fertilizable” for only about 22-23 HOURS after ovulation. Ideally, ovulation takes place into a “rich sperm environment” (ampulla of tube) → 0 hours from ovulation to fertilization. Sperm likely “live” in oviduct for ~72 hours. Sperm are “in” the oviduct within minutes.

Answer 4

Daily ejaculation, for most men, will gradually reduce overall sperm count. Ovulation, in the “ideal” cycle = day 14, but few women have “perfectly-timed” cycles. Therefore (!)………. Recommend: Coitus every OTHER day from about days 10-20. This (1) enhances chances of conception AND (2) reduces risk of an “OLD EGG” being fertilized. (OLD → greater miscarriage risk.)

Answer 5

Lube kills sperm. | “Male retention” – after ejaculation, he “stays inside” for short interval.

Answer 6

Shettles’ criteria Alter vaginal environment to “favor” one type of sperm over the other – “tilt” odds by 5-10% Agar gel “swim-up” Special cases – for example… FHx hemophilia – try to avoid male baby

Answer 7

OK to do OTC – but no insurance coverage. OTC – wait until about 5-7 days “late”. Better = have patient come to office/clinic for testing ~~ 7 days “late”. This gives opportunity for office staff (even physician if available) to assess early risk factors and be sure patient is on FA.

Answer 8

If had preconception appointment, at 6-7 weeks. If unplanned or no pre-appointment, at 5-6 weeks or ASAP after + Pg test. If risk factors – ASAP after + test. NOB appt should take ~~ one HOUR: Comprehensive H&P, labs, counseling, answering questions, start “prenatal record”, risk assessment. (OK, if low-risk, for “extender” [= NP, PA] to do this, with physician appointment ~~ 1 week later.)

Answer 9

Both MUST be dealt with Pre-conception. “Safe” dose of EtOH = NONE. This is your BEST CHANCE to prevent FAS = Fetal Alcohol Syndrome! HgbA1C should be ~~ 5-6% before conception > 7-8 % = doubles risk of anomalies 11-12% = very high risk

Answer 10

Consult with Bd Cert Medical Geneticist

Answer 11

REFER TO “NEXT UP” LEVEL OF CARE: YOU = PCP………………REFER TO OB/GYN YOU = OB/GYN………..REFER TO MFM (MFM – Maternal Fetal Medicine, aka a “Perinatologist”)

Answer 12

8 weeks US – ensure single, viable (gives also the most-reliable EDC) The most “complete” history you’ve ever done Physical exam Lab work – ABO, Rh, Ab sceen, rubella titer, RPR, CBC, Urine C&S, GC & chlamydia, Pap, TSH, HIV, HBsAg Start PN record Risk assessment Q&A

Answer 13

BP, weight, UA (S,P,N) ** Use Doppler to find FHT’s Fundus is @ SP Genetics background finalized

Answer 14

``` BP, weight, UA Fundus ½ way between SP and umbilicus FHT’s with DT Hematocrit (Hct) or hemoglobin Order US for ~~ 19 weeks ```

Answer 15

``` BP, weight, UA ** Review US from 19 wks Counsel pt to choose physician for baby FHT’s with DT and FS Begin FH measurements Fundus @ umbilicus, FH = ~~20 cms Cms = weeks (+ or – 2cm) until ~~ 34 weeks ```

Answer 16

You need a “good” EDC to work from Calculate the “final EDC” from the ~ 8 week US in most cases - use the “CRL” LMP, LNMP, 19 week (or later) US = OK, but not as good “The later the worse” for US to tell EDC “Clinical sizing” can be WAY OFF NEVER change the EDC w/o compelling reason

Answer 17

``` BP, weight, UA Measure FH FHT’s w/ DT Register for prenatal classes **Vaccines? (influenza + pertussis) ```

Answer 18

``` BP, weight, UA FHT’s w/ DT FH = ~28 cm Consider SVE - ? Prem. Dilation **Test for GDM (1 hr BS) Hct Begin L&D counseling ```

Answer 19

``` Optional in normal case BP, weight, UA FHT’s w/ DT FH ~ 30 cms L&D counseling ```

Answer 20

``` BP, weight, UA FHT’s w/ DT FH = ~~ 32 cms Begin Leopold’s maneuvers L&D counseling ```

Answer 21

``` BP, weight, UA FHT’s w/ DT FH begins to “lag” Leopold’s to check lie/presentation L&D counseling, Q&A ```

Answer 22

``` BP, weight, UA FHT’s with DT FH lags ** Leopold’s Hct ** GBS culture SVE to check cervix status L&D discussion ```

Answer 23

``` BP, weight, UA FHT’s w/ DT FH – lags Leopold’s SVE L&D discussion Discuss future BCM (birth control method) ```

Answer 24

``` BP, weight, UA FHT’s w/ DT FH – lags Leopold’s SVE L&D discussion WTC (when to call) ```

Answer 25

``` BP, weight, UA FHT’s w/ DT FH – lags Leopold’s SVE Q&A ```

Answer 26

``` BP, weight, UA FHT’s w/ DT FH – lags Leopold’s SVE “Post-dates” planning Q&A ```

Answer 27

10 lbs before 20 weeks and one pound per week from 20 – 40 weeks Total = 30 lbs Advice varies, depending on where patient started Weight loss is NEVER advised

Answer 28

= Sonogram Abbreviate as “US” May be “TVUS” = transvaginal US OR, “transabdominal US”

Answer 29

~~ TVUS @ 8 weeks for viability, dates, fetal number “Transabdominal” @ 19 weeks for “anatomy scan” – may tell fetal gender Any others, in normal case, are for “marketing” purposes/souvenirs

Answer 30

Sac + embryo + FHT’s = likely viable Misshapen sac, no embryo, no FHT’s = likely non-viable May be used serially in conjunction with QHCG levels TVUS – standard of care

Answer 31

``` For the “at-risk” patient TVUS @ 12 – 22 weeks Look for shortening or “funneling” MAY (MAY) show risk for preterm birth Cerclage - debatable ```

Answer 32

Transabdominal method IUGR (intrauterine growth RESTRICTION) Used serially Watch abdominal circumference, AFV = amniotic fluid volume Macrosomia (large!)? Near EDC. OK to do it, but notoriously unreliable for EFW.

Answer 33

``` TVUS if < 12 weeks, then transabdominal Diagnosis Growth concordancy (are we learning to share?) ```

Answer 34

``` (transabdominal, TVUS in 2nd trimester) Abruption of the placenta = “Abruptio” May show if very large separation Not reliable Placenta previa - May “migrate” - Can follow serially - Assess that it’s “only” a previa ```