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OB > intro to OB-Table 1 > Flashcards

intro to OB-Table 1 Flashcards

1
Q

What is the definition of preconception counseling?

A

Health of women and men during reproductive years

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2
Q

What issues should you address in women ages 15-44 in order to improve outcomes in event of pregnancy?

A
  • ID/stabilize chronic conditions
  • Minimize med risk
  • Maintain IZ
  • Address weight, nutrition, exercise
  • ID potential genetic disorders
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3
Q

What should be weight loss goal for obesity?

A

5-10% of baseline 6mo prior to pregnancy

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4
Q

What is the first change women will notice when preggo?

A

Breast tenderness

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5
Q

What are clinical S/S of a suspected preggo lady?

A

Fatigue, N/V, breast tenderness, frequent urination, missed menses

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6
Q

When is there enlargement and softening of the uterus?

A

6 weeks

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7
Q

What are PE findings in a newly preggo lady?

A

Congestion and bluish discoloration of the vagina (Chadwick sign)
Softening of the cervix (hegar sign)

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8
Q

How should you confirm a suspected pregnancy?

A

UCG and beta- HCG

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9
Q

What does a UCG measure?

A

hcg/alpha unit which overlaps w/LH structure

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10
Q

What does the Q/Q beta-hCG measure?

A

Beta subunit

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11
Q

What can you visualize on US at 5-6 wks?

A
  • embryonic cardiac activity at >4000 mIU/mL

- gestational sac (beta-hCG 5000-6000 mIU/mL)

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12
Q

What can TVUS detect at 3-4 wks gestation?

A

GA (beta-hCG 1000-2000 mIU/mL)

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13
Q

When can the Doppler detect fetal heart tones?

A

10-12 wk GA

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14
Q

What are the risks you want to assess during antepartum care?

A
  • advanced maternal age (>35) and or paternal age (>50)
  • hx of early preggo loss
  • previous IUP complicated by chromosomal abnormality
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15
Q

What are genetic testing options when assessing for risk?

A
  • carrier testing
  • CVS
  • Amniocentesis
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16
Q

What are the common chromosomal abnormalities we want to screen for?

A

Trisomy 21, fragile X, turner syndrome, klinefelter syndrome, and cri du chat

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17
Q

What weeks during the first trimester can you do screening? What tests are you going to do?

A

10-13 week GA

obtain beta-hCG and preggo associated plasma protein A ( PAPP-A) and a CVS

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18
Q

When during the second trimester do you screen? What tests do you run?

A

15-20wk GA
triple(no inhibin) or quad marker( AFP, estriol, hCG, and inhibin A marker)
-need maternal age, wt, ethnicity, and EGA
amniocentesis

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19
Q

What is the integrated 1st and 2nd trimester screen?

A

Combines PAPP-A plus triple or quad

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20
Q

What is nuchal translucency? What is it used for? When do you screen this?

A

Early US at initial prenatal visit

Fluid collection at the back of the neck used as a marker for Downs( 10-14wk GA)

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21
Q

What A/P needs to be addressed during the initial prenatal visit?

A

—RTC q 4 weeks until 28-30 weeks GA
—RTC q 2 weeks 28-30 to 36 weeks GA
—RTC q week >36 weeks GA

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22
Q

What initial labs do you want to run on the mother at the first prenatal visit?

A

CBC, glucose, blood type/Rh, urinalysis, Pap, STD: RPR/FTA, HIV, gc, chlamydia, hepatitis B

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23
Q

What are some common symptoms in preggo?

A 
—Headache
—Edema
—N/V
—Heartburn
—Constipation
—Fatigue
—Leg cramps
—Back pain
—Round ligament pain
—Varicose veins, hemorrhoids
—Vaginal discharge
24
Q

What should be done at all the subsequent antenatal visits?

A

BP, wt
Fundal ht
FHR ( tachy >160, brady

25
Q

Whats the scoop with Leopold?

A
26
Q

What are the goals of antenatal care?

A 
—Maternal state of health
—Favorable in utero fetal environment
—Placental positioning
—Fetal growth & development
—Healthy birth passage
—Successful L&D progression
27
Q

What is normal birth weight? Low? Very low? Extremely low?

A

—5.5 lbs = 2,500 grams or 2.5 kg; > 2,500 grams (> 5.8 lbs) = normal BW

28
Q

What is large for GA?

A

9lbs or 4800 grams or 4.8kg

MACROSOMIA- pathology counterpart

29
Q

What is low birth weight? Very? Extremely?

A

—

30
Q

What is the pathology counterpart for SGA?

A

IUGR

31
Q

What are EGA specific tests and when are they performed?

A

—Labs 28-32 weeks: CBC, 1 hour glucose challenge, Rh status
—Labs 32-36 weeks: Group B strep
—Leopold maneuvers for fetal presentation > 34 wks EGA
—Term & post-term: non-stress test (NST), contraction stress test (CST) & biophysical profile (BPP)

32
Q

When is the third trimester?

A

28-42 wks

33
Q

What is happening in the 3rd trimester?

A

Fetal kick counts: indirect measure of fetal activity
FHR patters on NST
BPP
Dopler US of umbilical artery for placental blood flow
Assess fetal lung maturity for surfactant

34
Q

What is the best way to measure the fetus well being?

A

BPP!

35
Q

What is the BPP?

A

Biophysical profile

  • amniotic fluid index, measures fluid pockets and volume of fluid
  • fetal breath movement
  • fetal tone (>/=1 episode extremity extension with 30 minutes)
  • GBM, >/=3 gbm in 30 min
  • NST, bradycardia 80-100= non-reassuring, 160 tachy
36
Q

What is a reassuring score on the BPP?

A

8-10

if 6 repeat score or deliver baby if term

37
Q

What is the appropriate wt gain in pregnancy?

A

—Underweight: 28-40 lbs.
—Normal: 25-35 lbs.
—Overweight: 15-25 lbs.
—Obese: 11-20 lbs.

38
Q

In regards to exercise, what should women do if they don’t typically exercise?

A

Walking program

39
Q

What should women not do exercise speaking?

A

Avoid supine position & crunches d/t placental blood flow & inferior vena cava compression; caution w/weight lifting

40
Q

What are absolute CI for exercise in pregnancy?

A

lung dz, severe heart dz, incompetent cervix, multi-fetal gestation, vaginal bleeding, placenta previa, preterm labor, ROM, HTN dz of IUP

41
Q

What are relative CI for exercise in pregnancy?

A

unevaluated arrhythmia, poor control DM type 1 & HTN, extremes of weight, IUGR, poor control seizures or hyperthyroid, chronic bronchitis

42
Q

Should you be super preggo in a plane?

A

No that’s so dumb

CI in the last month

43
Q

When is sexual activity restricted in pregnancy?

A

—No restricted coitus unless contractions, bleeding, previa

- don’t forget to change the positions up

44
Q

What are maternal and newborn benefits from breastfeeding?

A

—Maternal benefits ‭ ‬Uterine involution, economic, bonding, some BCM effect, facilitate wt loss —Newborn benefits Immunity, nutrition, bonding

45
Q

How much radiation should you limit fetal exposure to?

A
46
Q

When does radiation have the most major effects on the fetus?

A

> 10 rads: 1st 2 weeks after fertilization, > 25 rads 1st trimester or
100 rads 2nd & 3rd trimesters

47
Q

Why should you not drink booze while preggo?

A

FAS
IUGR, stunted growth post-birth, FTT, facies: low set ears, mid-facial hypoplasia, microcephaly, mental retardation, learning disorders

48
Q

What does nicotine do to the fetus?

A

IUGR, LBW, fetal death

49
Q

What effects do illicit drugs have on the fetus?

A

SAB, preterm labor, neonatal withdrawal, birth defects

50
Q

What is the time frame for effects from teratogens in utero?

A
  • 1st 14 days = ‘all or nothing’ effect,
  • 14-60 days - organ/structural abnormalities
  • remaining IUP time – IUGR, cognitive and/or CNS anomalies
51
Q

What category of pharmaceuticals is ok in pregnancy?

A

Category A!
B might be ok….animal studies ok and no harm to women who used them
C: not adequate study and harm in animals
D: risk, only use if benefit outweighs the harm
X: CI

52
Q

What is the new FDA medication classification for teratogen exposure?

A

PLLR- pregnancy and lactation labeling rule

53
Q

What has to be included for pregnancy?

A

—Available drug exposure registries
—Risk summary statement
—Pertinent clinical considerations
—Details on gathered pertinent data

54
Q

“ “ lactation?

A 
—Risk summary
—Bioavailability 
—Effect on infant
—Effect on milk production
—Details on gathered pertinent data
55
Q

What do drugs for both men and females of reproductive potential need under the PLLR?

A

—Need for BCM &/or pregnancy testing w/drugs known to have adverse developmental effects
—Relevant data on fertility or pre-implantation viability effects on

OB (11 decks)

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