Normal History Flashcards
Complications of teenage pregnancy
Maternal
. Anemia
. Abortion
. Cpd
.preterm delivery
. Psychological problems,failure of lactation
Fetal
. Iugr
. Low birth weight
Preterm birth
Complications in elderly gravida (35 and above)
Maternal
. Abortion
. Cpd
. Diabetes
. Hypertension
. Pre eclampsia
. Abruptio placenta
. Prolonged pregnancy
. Fibroids
. Pph
Fetal
. Iugr
. Low birth weight
. Preterm birth
. Chromosomal abnormalities
Problems in low socioeconomic class
Anemia
Prom
Pre eclampsia
Abruptio placenta
Lack of antenatal care and family planning
Iud
Problems in higher socioeconomic class
Hypertension
Diabetes
Obesity
Cpd
Pph
Prolonged
Macrosomia
Gravida
Number of pregnancies including present pregnancy irrespective of outcome of pregnancy
Para
Previous number of deliveries which has crossed the period of viability irrespective of outcome of pregnancy excluding present pregnancy
Abortion
Expulsion of products of conception before the period of viability,before 28 weeks
Ectopic gestation
Pregnancy outside uterine cavity
Vesicular mole
Abnormal pregnancy where there is hydropic degeneration of chorionic villi
Pre term delivery
Delivery of fetus after 28 weeks and before 37 completed weeks of pregnancy
Post term delivery
Delivery after 42 completed weeks
Nulligravida
Woman who is not pregnant now and never had been pregnant
Nullipara
Woman who has never had a previous pregnancy which has crossed viability
Primigravida
Woman who is pregnant for first time
Primipara
Woman who has delivered once beyond period of viability
Parturient
Woman in labour
Puerpera
Woman who has just given birth
Multigravida
Pregnant woman who had pregnancies earlier
Multipara
Woman who had two or more deliveries beyond period of viability
Grand multigravida
Pregnant woman who had pregnancies earlier >5
Grand multipara
Woman who had already five or more deliveries beyond the period of viability
Booking visit
The first antenatal visit when you register the patient for antenatal care
Ideal antenatal booking
Upto 28 weeks - once in 4 weeks
28-36 weeks- once in 2 weeks
36-40 weeks- weekly
Four visit antenatal care model(FANC)
First, 8-12 weeks
Second,24-26 weeks
Third,32 weeks
Fourth,36-38 weeks
When should we give tetanus toxoid
First dose from second trimester onwards and second dose is given 4-6 weeks later. If pregnant within 5 yrs,single booster given,if last pregnancy was more than 5 yrs ago, reimmunisation done
FOGSI guidelines
Tdap cmvaccination should be given to all pregnant women with two doses during each pregnancy between 27 and 36 weeks of gestation
Influenza vaccination from 26 weeks onwards
Recommends against tetanus,diphtheria,pertusis,influenza
History to be elicited in first trimester
When was pregnancy confirmed
How was it confirmed
Whether spontaneous
Dating scan
Morning sickness,hyperemesis
Fever with rashes,fever
Folic acid intake or other drug intake
Exposure to radiation
Bleeding pv
Any abnormality
History to be elicited in second trimester
Quickening
Immunisation
Anomaly scan
Iron,folic acid,calcium
Gtt
History to be elicited in third trimester
Perception of fetal movements
Growth scan
Bleeding pv or discharge
Any relevant history
Naegeles rule
Add 9 months and 7 days
Applicable when menstrual cycles are once in 28 days
Corrected edd (knanes rule)
If cycle is 21 days,edd less by 7 days
If cycle is 40 days,add 12 days to edd
If conceived during lactational period,lmp not reliable
Conditions where there is hyperemesis
Vesicular mole
Multiple pregnancy
Metabolic causes
Jaundice,gastritis,uti
Conditions where there is bleeding pv
Threatened abortion
Missed abortion
Vesicular mole
Inevitable abortion
Vahi Al discharge in first trimester due to
Moniliasis
History regarding teratogenic effect
Folic acid intake
Fever with rash- measles
Exposure to radiation(upto 5 rads is permissable)
Physiological edema
Seen in dependant parts
More towards evening
Disappears after 12 hrs of rest
Pathological edema
Seen in face,dorsum of hand,abdomen,lower limbs,vulva,presacral area
Due to anemia,pre eclampsia,heart disease,renal disease,liver disease, hypoproteinemia
Bleeding pv after period of viability
Abruptio placenta
Placenta previa
When does quickening occur
Primi-20 weeks
Multi- 16-18 weeks
Diminished fetal movements due to
Oligohydramnios
IUGR
Loss of movements- iud
Symptoms of imminent eclampsia
Pathological edema
Blurring of vision
Epigastric pain
Vomiting
Diminished urine output
History indicating anemia in pregnancy
Breathlessness
Fatigue
Swelling of legs
History indicating heart disease in pregnancy
Breathlessness
Swelling of legs
Palpitations
Recurrent ri
Blood stained sputum
When anomaly scan
18-20 weeks
What are excellent dates
Sure of dates
Regular cycles
No ocp within 3 months of conception
16-24 week scan corresponds to gestational age
Degrees of consanguinity
First degree- siblings
Second- maternal uncle
Third - cousins
Indication of lscs
Contracted pelvis
Breech
Placenta previa
Malposition
Abruptio placenta
Failure to progress
Eclampsia-
Big baby
Fetal distress
Short stature
<145 cm
BMI grades
<18.5- underweight
18.5-25- normal
25-29.9- overweight
>30- obesity
Weight gain during pregnancy
Total-9-12 kg
First trimester- 1 kg
Second- 3-4 kg
Third-4-6 kg
When gain is more than half kg a week,may be early manifestation of pre eclampsia,due to occult edema
Underweight should gain 12-14 kg
Average-10-12 kg
Overweight-8-10
Obese-<8 kg
Causes of increased wt gain in pregnancy
Multiple pregnancy
Pre eclampsia
Polyhydramnios
Gestational diabetes with macrosomia
Obesity
Causes of decreased wt gain in pregnancy
IUGR
Anemia
Malnutrition
Thin build
Site to look for anemia
Lower palpebral conjunctiva
Nail beds
Tip of to gue
Soft palate
Palms and soles
Sites for cyanosis
Central- tongue,lips
Peripheral- hands,feet,fingers,toes,nail beds
Sites for jaundice
Bulbar conjunctiva
Undersurface of tongue
Soft palate
Palms and sole
Skin
Causes of clubbing
Congenital cyanotic heart disease
Subacute bacterial endocarditis
Atrial myxoma
Lung disease
Hepatobiliary disease
Graves(thyroid acropachy)
Reasons for physiological edema
Pressure on ivc by gravid uterus
Vasodilation due to progestrone
Change in colloid and hydrostatic pressure
Sodium and water retention due to estrogen and progestrone
Increase in aldosterone
Causes of pathological edema
Anemia
Heart
Renal
Hepatic
Hypoproteinemia
Unilateral- DVT,cellulitis,filariasis
Nonpitting- myxoedema
Why varicose veins during pregnancy
Obstruction of venous return by gravid uterus
Striae gravidarum
Linear marks due to rupture of elastic fibres due to stretching which is recent(also seen in obesity,cushings)
Linea nigra
Cutaneous manifestation of pregnancy which is a dark line normally from umbilicus to public symphysis or from xiphisternum to symphysis,due to melanocyte stimulating hormone of anterior pituitary
Number of weeks at level of umbilicus
24 weeks
Level of xiphisternum corresponds to how many weeks
36 weeks
When should dextrorotation be done
After 32 weeks,done due to presence of sigmoid colon on the left
Leopolds manoevers
Fundal grip
Umbilical grip
First pelvic grip(pawliks grip)
Second pelvic grip
Shelving sign
At term,as the head gets engaged,there is falling forward of uterus and when mother sits,examiner can rest the hand over the fundus
Johnson’s formula
Fetal wt estimation
Applicable only in cephalic
In unengaged head,wt= fundal ht in cm -12× 155 g
In engaged head, fetal wt= fundal ht-11×155 g
Also by usg
McDonald’s rule
To assess gestational age
Ht of fundus in cm×2/7 is age in lunar months
Ht of fundus in cm×8/7 is age in weeks
Best time to assess cpd
During labor
Pelvic assessment
Sacral promontory reached
Bay of sacrum well curved
Sacrosciatic notch admits two fingers
Pelvic side walls are parallel or convergent
Ischial spines are not prominent
Interischial diameter admits two fingers
Public symphysis admits two fingers(acute or obtuse)
Clenched fist between ischial tuberosities
Coccyx mobile
Method to assess cpd
Munro Kerr Muller
Head goes in- no cpd
Head is flush with public symphysis- minor
Overriding- major
Role of dating scan
Intra or extra uterine
Viable or not
Number of sacs
Gestational age
Any mass,fibroid,moles
Dating scan done when
7-12 weeks, to measure crown rump length
Nt scan done when
11-13.6 weeks
More than 3 mm is strong marker for chromosomal abnormality like downs syndrome
Anomaly scan when and why
18-20 weeks
Gestational age
Placenta location
Fetal biometry
Multiple gestation
Amount of liquor amnii
Tests done at time of booking
Urine routine
HB ,pcv
Blood grp and rh typing
HIV screening
Thyroid profile
Blood sugar
When is gtt done
Low risk-24-28 weeks
High risk-24-28 weeks,if neg repeat at 32-34 weeks
What is presentation
The part of fetus which lies in lower pole of uterus
Presenting part
Fetal part which occupies lower uterine segment overlies the internal is and when cervix dilates,is felt by examining finger
Attitude
Relation of fetal parts to one another
Lie
Relationship of long axis of fetus to long axis of uterus
Position
Relation of denominator to different quadrants of pelvis
Denominator
Fixed bonypoint,which comes in contact with various quadrants of pelvis
Largest transverse diameter
Biparietal diameter-9.5 cm
Shortest transverse diameter
Bitemporal diameter-8 cm
Engaging diameter in vertex presentation
Suboccipito bregmatic diameter-9.5 cm
Engaging diameter in face presentation
Submentobregmatic- 9.5 cm
Engaging diamter in brow presentation
Verticomental-13.5
Engaging diameter in deflexed head as in occpitoposterior position
Occipitofrontal-11 cm
Vertex
Diamond shaped area bounded anteriorly by bregma, posteriorly by posterior fontanelle and parietal eminence on either side
Engagement
When the widest transverse diameter of the presenting part has gone through the pelvic brim
Labour
Process by which products of conception are expelled by mother after period of viability either spontaneously or with external aid
Preterm labor
Before 37 weeks
Late preterm-32-37 weeks
Early preterm-28-32
Extreme preterm -<28 weeks
Term pregnancy when
37-42 weeks
Early-37-39
Full-39-40
Late->40-42
Post term->42
Show
Release of mucus plug with blood from cervical canal due to dilatation and effacement of cervix
Cardinal movements of fetal head during labour
Engagement
Descent
Flexion
Internal rotation
Extension
Restitution
External rotation
Delivery of shoulder
Stages of labour
First- onset of true labor pains to full cervical dilatation
Second- full cervical dilatation to delivery of fetus
Third- delivery of placenta
Fourth-2 hours following placental delivery
AMTSL
Oxytocin 10 units IM,within one minute of birth
Delayed cord clamping
Controlled cord traction
Placenta delivered
Uterine tonus assessment
Indications for early cord clamping
Rh isoimmunisation
Get distress
HIV positive mother
Immediate rescusitation of baby
Episiotomy
Surgical incision of perineum and posterior vagin wall performed during second stage of labour to quickly enlarge the passage to expedite delivery
Mediolateral incision
During crowning,when the head does not recede into vagina in between contractions
Indications for episiotomy
Rigid perineum
Big baby
Breech
Face to pubis delivery
Shoulder dystocia
Instrumental delivery
Advantages of mediolateral episiotomy
Reduces trauma to perineum
Reduces maternal pushing effort
Rectum and anal sphincter not affected
Degrees of lacerated perineum
First degree- laceration of vaginal mucosa and perineal skin
Second- perineal muscles and perineal body
Third- perineum including anal sphincter
Fourth- involvement of anal sphincter,anal and rectal mucosa
Diff between tru and false labor pains
Tru. False
Regar intervals. Irregular
Inc frequency. No Inc
Radiates to back and thigh. No radiat
Show. No show
Dilation of cervix. No
Not relieved by enema. Releived
Partograph
Composite graphical record of maternal and fetal key data and events during labor like cervical dilation,descent of fetal head,heart rate,duration of labor and vital signs and drugs used. With help of alert line and action line,any deviation from normal may be detected quickly and treated
Tests for diagnosis of pregnancy
Urine pregnancy test- positive when beta HCG >50 iu/l
Serum beta hcg- positive when value 2-20 iu/l
Usg- gestational sac and fetal pole with cardiac activity
