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Obgyn Clinicals > Normal History > Flashcards

Normal History Flashcards

1
Q

Complications of teenage pregnancy

A

Maternal
. Anemia
. Abortion
. Cpd
.preterm delivery
. Psychological problems,failure of lactation
Fetal
. Iugr
. Low birth weight
Preterm birth

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2
Q

Complications in elderly gravida (35 and above)

A

Maternal
. Abortion
. Cpd
. Diabetes
. Hypertension
. Pre eclampsia
. Abruptio placenta
. Prolonged pregnancy
. Fibroids
. Pph
Fetal
. Iugr
. Low birth weight
. Preterm birth
. Chromosomal abnormalities

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3
Q

Problems in low socioeconomic class

A

Anemia
Prom
Pre eclampsia
Abruptio placenta
Lack of antenatal care and family planning
Iud

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4
Q

Problems in higher socioeconomic class

A

Hypertension
Diabetes
Obesity
Cpd
Pph
Prolonged
Macrosomia

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5
Q

Gravida

A

Number of pregnancies including present pregnancy irrespective of outcome of pregnancy

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6
Q

Para

A

Previous number of deliveries which has crossed the period of viability irrespective of outcome of pregnancy excluding present pregnancy

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7
Q

Abortion

A

Expulsion of products of conception before the period of viability,before 28 weeks

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8
Q

Ectopic gestation

A

Pregnancy outside uterine cavity

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9
Q

Vesicular mole

A

Abnormal pregnancy where there is hydropic degeneration of chorionic villi

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10
Q

Pre term delivery

A

Delivery of fetus after 28 weeks and before 37 completed weeks of pregnancy

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11
Q

Post term delivery

A

Delivery after 42 completed weeks

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12
Q

Nulligravida

A

Woman who is not pregnant now and never had been pregnant

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13
Q

Nullipara

A

Woman who has never had a previous pregnancy which has crossed viability

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14
Q

Primigravida

A

Woman who is pregnant for first time

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15
Q

Primipara

A

Woman who has delivered once beyond period of viability

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16
Q

Parturient

A

Woman in labour

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17
Q

Puerpera

A

Woman who has just given birth

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18
Q

Multigravida

A

Pregnant woman who had pregnancies earlier

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19
Q

Multipara

A

Woman who had two or more deliveries beyond period of viability

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20
Q

Grand multigravida

A

Pregnant woman who had pregnancies earlier >5

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21
Q

Grand multipara

A

Woman who had already five or more deliveries beyond the period of viability

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22
Q

Booking visit

A

The first antenatal visit when you register the patient for antenatal care

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23
Q

Ideal antenatal booking

A

Upto 28 weeks - once in 4 weeks
28-36 weeks- once in 2 weeks
36-40 weeks- weekly

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24
Q

Four visit antenatal care model(FANC)

A

First, 8-12 weeks
Second,24-26 weeks
Third,32 weeks
Fourth,36-38 weeks

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25
Q

When should we give tetanus toxoid

A

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

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26
Q

FOGSI guidelines

A

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

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27
Q

History to be elicited in first trimester

A

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

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28
Q

History to be elicited in second trimester

A

Quickening
Immunisation
Anomaly scan
Iron,folic acid,calcium
Gtt

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29
Q

History to be elicited in third trimester

A

Perception of fetal movements
Growth scan
Bleeding pv or discharge
Any relevant history

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30
Q

Naegeles rule

A

Add 9 months and 7 days
Applicable when menstrual cycles are once in 28 days

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31
Q

Corrected edd (knanes rule)

A

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

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32
Q

Conditions where there is hyperemesis

A

Vesicular mole
Multiple pregnancy
Metabolic causes
Jaundice,gastritis,uti

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33
Q

Conditions where there is bleeding pv

A

Threatened abortion
Missed abortion
Vesicular mole
Inevitable abortion

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34
Q

Vahi Al discharge in first trimester due to

A

Moniliasis

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35
Q

History regarding teratogenic effect

A

Folic acid intake
Fever with rash- measles
Exposure to radiation(upto 5 rads is permissable)

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36
Q

Physiological edema

A

Seen in dependant parts
More towards evening
Disappears after 12 hrs of rest

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37
Q

Pathological edema

A

Seen in face,dorsum of hand,abdomen,lower limbs,vulva,presacral area
Due to anemia,pre eclampsia,heart disease,renal disease,liver disease, hypoproteinemia

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38
Q

Bleeding pv after period of viability

A

Abruptio placenta
Placenta previa

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39
Q

When does quickening occur

A

Primi-20 weeks
Multi- 16-18 weeks

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40
Q

Diminished fetal movements due to

A

Oligohydramnios
IUGR
Loss of movements- iud

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41
Q

Symptoms of imminent eclampsia

A

Pathological edema
Blurring of vision
Epigastric pain
Vomiting
Diminished urine output

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42
Q

History indicating anemia in pregnancy

A

Breathlessness
Fatigue
Swelling of legs

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43
Q

History indicating heart disease in pregnancy

A

Breathlessness
Swelling of legs
Palpitations
Recurrent ri
Blood stained sputum

44
Q

When anomaly scan

A

18-20 weeks

45
Q

What are excellent dates

A

Sure of dates
Regular cycles
No ocp within 3 months of conception
16-24 week scan corresponds to gestational age

46
Q

Degrees of consanguinity

A

First degree- siblings
Second- maternal uncle
Third - cousins

47
Q

Indication of lscs

A

Contracted pelvis
Breech
Placenta previa
Malposition
Abruptio placenta
Failure to progress
Eclampsia-
Big baby
Fetal distress

48
Q

Short stature

A

<145 cm

49
Q

BMI grades

A

<18.5- underweight
18.5-25- normal
25-29.9- overweight
>30- obesity

50
Q

Weight gain during pregnancy

A

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

51
Q

Causes of increased wt gain in pregnancy

A

Multiple pregnancy
Pre eclampsia
Polyhydramnios
Gestational diabetes with macrosomia
Obesity

52
Q

Causes of decreased wt gain in pregnancy

A

IUGR
Anemia
Malnutrition
Thin build

53
Q

Site to look for anemia

A

Lower palpebral conjunctiva
Nail beds
Tip of to gue
Soft palate
Palms and soles

54
Q

Sites for cyanosis

A

Central- tongue,lips
Peripheral- hands,feet,fingers,toes,nail beds

55
Q

Sites for jaundice

A

Bulbar conjunctiva
Undersurface of tongue
Soft palate
Palms and sole
Skin

56
Q

Causes of clubbing

A

Congenital cyanotic heart disease
Subacute bacterial endocarditis
Atrial myxoma
Lung disease
Hepatobiliary disease
Graves(thyroid acropachy)

57
Q

Reasons for physiological edema

A

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

58
Q

Causes of pathological edema

A

Anemia
Heart
Renal
Hepatic
Hypoproteinemia
Unilateral- DVT,cellulitis,filariasis
Nonpitting- myxoedema

59
Q

Why varicose veins during pregnancy

A

Obstruction of venous return by gravid uterus

60
Q

Striae gravidarum

A

Linear marks due to rupture of elastic fibres due to stretching which is recent(also seen in obesity,cushings)

61
Q

Linea nigra

A

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

62
Q

Number of weeks at level of umbilicus

A

24 weeks

63
Q

Level of xiphisternum corresponds to how many weeks

A

36 weeks

64
Q

When should dextrorotation be done

A

After 32 weeks,done due to presence of sigmoid colon on the left

65
Q

Leopolds manoevers

A

Fundal grip
Umbilical grip
First pelvic grip(pawliks grip)
Second pelvic grip

66
Q

Shelving sign

A

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

67
Q

Johnson’s formula

A

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

68
Q

McDonald’s rule

A

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

69
Q

Best time to assess cpd

A

During labor

70
Q

Pelvic assessment

A

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

71
Q

Method to assess cpd

A

Munro Kerr Muller
Head goes in- no cpd
Head is flush with public symphysis- minor
Overriding- major

72
Q

Role of dating scan

A

Intra or extra uterine
Viable or not
Number of sacs
Gestational age
Any mass,fibroid,moles

73
Q

Dating scan done when

A

7-12 weeks, to measure crown rump length

74
Q

Nt scan done when

A

11-13.6 weeks
More than 3 mm is strong marker for chromosomal abnormality like downs syndrome

75
Q

Anomaly scan when and why

A

18-20 weeks
Gestational age
Placenta location
Fetal biometry
Multiple gestation
Amount of liquor amnii

76
Q

Tests done at time of booking

A

Urine routine
HB ,pcv
Blood grp and rh typing
HIV screening
Thyroid profile
Blood sugar

77
Q

When is gtt done

A

Low risk-24-28 weeks
High risk-24-28 weeks,if neg repeat at 32-34 weeks

78
Q

What is presentation

A

The part of fetus which lies in lower pole of uterus

79
Q

Presenting part

A

Fetal part which occupies lower uterine segment overlies the internal is and when cervix dilates,is felt by examining finger

80
Q

Attitude

A

Relation of fetal parts to one another

81
Q

Lie

A

Relationship of long axis of fetus to long axis of uterus

82
Q

Position

A

Relation of denominator to different quadrants of pelvis

83
Q

Denominator

A

Fixed bonypoint,which comes in contact with various quadrants of pelvis

84
Q

Largest transverse diameter

A

Biparietal diameter-9.5 cm

85
Q

Shortest transverse diameter

A

Bitemporal diameter-8 cm

86
Q

Engaging diameter in vertex presentation

A

Suboccipito bregmatic diameter-9.5 cm

87
Q

Engaging diameter in face presentation

A

Submentobregmatic- 9.5 cm

88
Q

Engaging diamter in brow presentation

A

Verticomental-13.5

89
Q

Engaging diameter in deflexed head as in occpitoposterior position

A

Occipitofrontal-11 cm

90
Q

Vertex

A

Diamond shaped area bounded anteriorly by bregma, posteriorly by posterior fontanelle and parietal eminence on either side

91
Q

Engagement

A

When the widest transverse diameter of the presenting part has gone through the pelvic brim

92
Q

Labour

A

Process by which products of conception are expelled by mother after period of viability either spontaneously or with external aid

93
Q

Preterm labor

A

Before 37 weeks
Late preterm-32-37 weeks
Early preterm-28-32
Extreme preterm -<28 weeks

94
Q

Term pregnancy when

A

37-42 weeks
Early-37-39
Full-39-40
Late->40-42
Post term->42

95
Q

Show

A

Release of mucus plug with blood from cervical canal due to dilatation and effacement of cervix

96
Q

Cardinal movements of fetal head during labour

A

Engagement
Descent
Flexion
Internal rotation
Extension
Restitution
External rotation
Delivery of shoulder

97
Q

Stages of labour

A

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

98
Q

AMTSL

A

Oxytocin 10 units IM,within one minute of birth
Delayed cord clamping
Controlled cord traction
Placenta delivered
Uterine tonus assessment

99
Q

Indications for early cord clamping

A

Rh isoimmunisation
Get distress
HIV positive mother
Immediate rescusitation of baby

100
Q

Episiotomy

A

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

101
Q

Indications for episiotomy

A

Rigid perineum
Big baby
Breech
Face to pubis delivery
Shoulder dystocia
Instrumental delivery

102
Q

Advantages of mediolateral episiotomy

A

Reduces trauma to perineum
Reduces maternal pushing effort
Rectum and anal sphincter not affected

103
Q

Degrees of lacerated perineum

A

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

104
Q

Diff between tru and false labor pains

A

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

105
Q

Partograph

A

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

106
Q

Tests for diagnosis of pregnancy

A

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

Obgyn Clinicals (3 decks)

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