Intro to Obstetrics Flashcards
Define the following terms: stillbirth IUFD neonatal death term preterm post-term
Birth: complete extraction or expulsion of a fetus from the mother
Stillbirth: no signs of life at birth > 20wks, doesn’t happen anymore.
Intrauterine Fetal Demise (IUFD): No cardiac activity in a fetus > 20 weeks
Neonatal death: death before 28 days of life
Term: 37-42 weeks (260-294 days)
Preterm: 37 completed weeks (before 259th day)
Post-term: 42 weeks and beyond (>295d)
define the following terms:
gravidity or gravid
parous or parity
Gravidity or Gravid
=Pregnant
Parous or Parity
=Delivered
Define the following terms: nulligravid primagravid primapara primip
Nulligravid: woman who is not now or ever been pregnant
Primagravid: pregnant with first pregnancy
Primapara: woman who has delivered once past the state of viability
“Primip”: short for Primapara. It is NOT a woman who is pregnant for the first time
Define the following terms: multipara nullipara parturient puerpera
Multipara: woman who has delivered 2 or more past the state of viability
Nullipara: never completed a pregnancy beyond 20 weeks
Parturient: woman who is in labor
Puerpera: woman who has just delivered
Describe the TPAL nomenclature:
T= term P= preterm birth A= abs, sab, or ectopics L= living children
What does the TPAL system not take into account?
- Route of delivery
- Distinction between spontaneous abortion, elective termination, or ectopic
- Twin deliveries with death of a child
What are presumptives that a woman may be pregnant versus probables?
Presumptives: Nausea and/or vomiting Fatigue Disturbance in urination Amenorrhea Breast changes Discolored cervical epithelium Increased skin pigmentation
Probables: Enlargement of abdomen Change in uterine size/shape Change in cervix Braxton Hicks contractions Physical outline of fetus \+ hCG test
Why is an hCG test only a probable that a woman may be pregnant? what do you need to confirm?
Definitive evidence of pregnancy:
FHTs identified
Fetal movement noted by examiner
Ultrasonographic or x-ray confirmation
What is the most important aspect of obstetrical care?
the assignment of an accurate EDD because every management care decision is based on this date
What are three dating parameters?
- history
- exam
- u/s
What are two components of the history that allow for dating?
- naegele’s rule
2. quickening
What is naegele’s rule?
from the FDLMP, add 7 days, and subtract 3 months to calculate the EDC
What is quickening?
in the prima gravid patient, fetal movement is usually noted at 20 weeks. In the primarparous patient, this occurs at 18 weeks.
What components are including in the exam for dating of the fetus?
- uterine size- 1st trimester
- fundal height
- fetal heart tones
What components are including in the U/S for dating of the fetus?
- first trimester (plus/minus 7 days)
- second trimester (plus/minus 14 days)
- third trimester (plus/minus 3 weeks)
Can an U/S be used to assign the EDD in the 3rd trimester?
No, it is not accurate
What should be included at the initial pre-natal visit?
- Risk assessment to include genetic, medical, obstetrical and psychosocial factors
- Physical examination
- Charting – ACOG record
- Laboratory tests
- Assignment of due date
- Patient education
What labs are indicated at the initial visit?
Hemoglobin Urinalysis Urine culture Blood group Rh Antibody screen Rubella status Varicella Syphilis screen Pap smear if >/= 21 HBsAg testing HIV Drug screen* GC/Chlamydia* Cystic fibrosis screen* **if indicated
How often should ever visit take place?
What should happen at every visit?
Visit intervals: every 4 weeks until 28, then q 2 wk until 36 wk, then weekly
Each visit: BP, wt, +/-UA, Fundal ht, FHT, FM, PTL risks, symptoms and focused assessment
What screenings should take place during pregnancy
11w0d – 13w6d: First trimester screen
15-20w6d weeks: MSAFP with quad screen
24-28 weeks: screen for gestational diabetes mellitus, give anti-D immune globulin
35-37 weeks: screen for GBS
What is aneuploidy screening?
screening for fetal chromosome abnormalities
1. first trimester screen (11w-13w6d)
Nuchal translucency
PAPP A (pregnancy associated plasma protein-A)
Free ß-hCG
2. second trimester screen (quad screen) AFP (alpha-fetoprotein) hCG Inhibin-A Estriol (E3)
There is now new non invasive prenatal testing that uses cell free fetal DNA from mom’s blood. Can be tested 10 weeks after gestation. However, it is only being used for high risk populations at this time.
what is the fundal height?
is a measure of the size of the uterus used to assess fetal growth and development during pregnancy. It is measured from the top of the mother’s uterus to the top of the mother’s pubic bone in centimeters. Fundal height roughly corresponds to gestational age in weeks between 16 to 36 weeks for a vertex fetus.
Record at every visit.
Fundus usually measures 20 cm at 20 weeks to the umbilicus. One cm /week until 36-37 weeks. 4 cm discrepancy is significant.
What are the general recommendations at the initial visit?
Active lifestyle Sexual activity permissible 25-35# weight gain for normal BMI Nutritious diet No ETOH/smoking/drugs Avoid cat litter box Wear lap/safety belt Discussion of first trimester screening
How does respirations change during pregnancy?
Chest diameter ↑ by 2 cms Chest circumference ↑ by 5 cms Diaphragmatic excursion ↑ by 4 cms RR-no change 30-40% ↑ in tidal volume Expiratory reserve volume- decreases
Is respiratory alkalosis normal in pregnancy?
yes
What cardiac changes are normal in pregnancy?
Hypervolemia (increases by about 50%)
Heart rate- 12-18 bpm increase
Stroke volume- 10-30% increase
Cardiac Output - therefore 33-45% increase
Increased split S1-S2, systolic ejection murmur heard 90% of the time.
