Intro to OB Flashcards
FHT/ FHR SVE SSE PIH DT FS FOC
FHT or FHR = fetal heart tones / rate SVE = sterile vaginal exam SSE = sterile speculum exam PIH = pregnancy-induced hypertension DT = Doptone (doppler) FS = fetoscope FOC = father of child MOC = mother of child
ROM AROM PROM PPROM SROM BOW IBOW BBOW
ROM = rupture of membranes AROM = artificial ROM PROM = premature (prior to onset of labor) ROM PPROM = Pre-term PROM (<37 weeks) SROM = spontaneous ROM BOW = “bag of waters” IBOW = intact BOW BBOW = “bulging” BOW
FH GDM IDM UC GBS TOCO
FH = fundal height (in cm – SP to top of fundus) – only valid after 20 weeks GDM = gestational diabetes IDM = infant of a diabetic mother UC = uterine contraction GBS = group B beta-hemolytic streptococcus TOCO = tocodynamometer – records UC’s
CX NST CST VTX BPD EFW
CX or Cx = cervix NST = non-stress test CST = contraction stress test VTX or Vtx = baby’s occipital region Vtx can also mean baby is coming “head first” BPD = biparietal diameter EFW = estimated fetal weight
EDC EGA QHCG LBW IOL LGA/ SGA
EDC = estimated date of “confinement” = the “due date”
EGA = estimated gestational age (in weeks)
QHCG = quantitative human chorionic gonadotropin
LBW = low birth weight (<2500 gm)
IOL = induction of labor
LGA, SGA = large/small for gestational age
SOOL
FLM
IAI
SOOL = spontaneous onset of labor FLM = fetal lung maturity IAI = intraamniotic infection - chorioamnionitis
The days and weeks
Weeks gestation = COMPLETED weeks from the first day of the LNMP
Accepted notation is to use a “sevenths” fraction: 31 weeks, 5 days = 31 5/7 weeks
Verbally, this is usually stated as “31 and 5”
Leopold’s
Leopold’s maneuvers
Used to determine LIE and PRESENTATION
(palpation of the baby)
Clinical jargon - station
“Station” = baby’s head relative to ischial spine 0 = at the spine -1, -2, -3, -4 = cm ABOVE the spine \+1, +2, +3, +4 = cm BELOW the spine “Descent” = of baby’s head
Clinical jargon - cervix
Dilation or “dilatation” = 0 to 10 cms 10 cm = “fully dilated” Practice in paper bag w/ plastic model Measure your own fingers (mine – index + middle = 3 cms)
“Effacement” = expressed as a %
Degree of thinning or shortening of cervix
Normally, not in labor, cx = 2+ cms in “length” (= 0 % effaced)
“Effaces” all the way to “paper thin”
Jargon - positioning
LIE = vertical, oblique, transverse – it’s about the whole baby
PRESENTATION = what part is “presenting” = “coming first”. Vtx = usual. Also: breech, hand, brow, face
POSITION = orientation of presenting part – if Vtx, is baby “facing” up, down, sideways, e.g.
ROA, LOA, OA, ROP, LOP, ROT, LOT
Baby head landmarks
anterior fontanelle:
- metopic suture (north)
- coronal suture (east)
- sagittal suture (south)
- coronal suture (west)
posterior fontanelle:
- sagittal suture- north
lambdoid sutures- east/west
birth planning statistics
< 50% are “intended”
Fewer still are truly “planned”
50+% of births in Colo are under Medicaid
questions to ask at first encounter
Is patient sexually active? “Are you involved with a sexual partner?”
Using a birth control method (“BCM”)?
If no BCM – “Do you want to become pregnant?”
If no – assist with decision on BCM
If “yes” or “I’m fine with it if it happens” –
Pre-Conception Appointment
OK to do with another service, BUT a separate appt is MUCH BETTER
This is a consult only – no exam. Billable!
Invite the (proposed) father!!!!
Providing this service is YOUR RESPONSIBILITY if you are a PCP or an Ob/Gyn.
March of Dimes will be HAPPY.
Trial lawyers will be UNHAPPY.
Standardized Format
Same discussion takes place with all encounters. Extras are added on individual basis. Use a questionnaire and a pre-developed document. (ACOG)
This becomes part of the Medical Record. “You see here, Mr. Lawyer, I did, in fact, tell your client to stop smoking – and why.”
Review the past (and male stuff)
Current state of health – BOTH partners
Past health issues – BOTH
Male – mumps early teens, trauma, meds, substances, his family history
Sorry, dude, smoking weed DOES interfere with your swimmers!
Review the past- female
Trouble getting Pg in past?
Prior OB history?
Include miscarriages and terminations. If she is a G4P0040 (4 miscarriages) - red light.
OB complications? (pre, delivery, PP)
Health – thyroid, obesity, diabetes, hypertension, lupus, renal disease, heart, pulmonary – this is basically a “ROS” with these highlights.
Is she seeing another physician for chronic condition? If yes – consult him/her ALSO.
Diet
Exercise (avoid high-impact)
Substances (tobacco, rec drugs, ALCOHOL)
Meds: Rx, supplem, OTC
Plans to travel? (a very BAD IDEA)
ethnicity and birth issues
Ashkenazi Jews (Tay-Sachs) African-American (sickle cell anemia) Northern European (cystic fibrosis)
preconception Lab work
TSH Rubella immunity CF carrier status Hgb electrophoresis (HgbS in A.A. popul) Consider doing HIV Ab Other, specific to patient – e.g. if diabetic you need a HgbA1C, FBS, renal functions
Substances, Meds- preconception
Discontinue EVERYTHING, PREFERABLY PRIOR TO CONCEPTION.
Exception is a needed Rx provided by you or another physician. Counsel as to risk. Is there an alternative? Example is anti-seizure meds.
FOLIC ACID (FA)
Supplement of 400 mcg daily
Reduces risk of certain anomalies by as much as 50%. (spina bifida)
Begin BEFORE CONCEPTION - these anomalies occur within DAYS of conception.
FA = water soluble – can’t have “too much”.
OTC PNV’s (OTC prenatal vitamins).
Keep a calendar
Record “Day ONE” of each menses.
Dating is EDC = 40 “completed” weeks from day one of LNMP.
Self-pregnancy test – record date/result.
