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Obstetrics & Gynecology > Normal Pregnancy & Labour > Flashcards

Normal Pregnancy & Labour Flashcards

1
Q

Naegele’s Rule

A

Date of confinement= LMP-3months + 7 days

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2
Q

GTPAL

A
  1. Pregnancies
  2. Term births
  3. Preterm
  4. Abortions
  5. Live births
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3
Q

Four important history questions?

A
  1. Bleeding
  2. Leaking
  3. Contractions
  4. Fetal movements
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4
Q

Trisomy 21 screening findings

A
  1. Increased nuchal translucency
  2. Increased B-HCG
  3. Decreased PAPP-A
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5
Q

If a low PAPP-A on 1st trimester screen, do?

A

Uterine artery doppler @ 22 weeks

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6
Q 
Fundal height at:
12 weeks? 
16 weeks?
20 weeks?
Beyond 21 weeks?
A

12 weeks= symphysis
16 weeks=halfway to umbilicus
20 weeks=at umbilicus
Beyond 21 weeks=# of weeks +/- 2cm

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7
Q

Treatment if mom is GBS positive?

A

IV abx during labour

  1. Pen G (5 million U then 2.5 million q 4 h)
  2. 2nd line= ancef/clindamycin
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8
Q

Normal length of stages of labour?

A
  1. Latent: 14 h multi, 20h primi
  2. Active: 1.2 cm/h primi, 1.5 cm/h multi
  3. Second stage: 1 h multi, 2 h primi ( add 1 h for epidural)
  4. Third stage: 30 min.
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9
Q

3 P’s of labour progress?

A
  1. Power: contractions and pushing
  2. Passenger: size and position of baby
  3. Pelvis

Can correct power but not passenger or pelvis

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10
Q

What are the cardinal movements of the fetal vertex?

A
  1. Engagement: Head should lower to level of ischial spines
  2. Descent
  3. Flexion
  4. Internal rotation to occiput anterior position
  5. Extension
  6. External Rotation
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11
Q

What are the three signs of placental separation?

A
  1. Gush of blood
  2. Lengthening of cord
  3. Rise of fundus (support so it does not invert)
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12
Q

What are the types of malpresentation?

A
  1. Breech (complete, frank, footing)
  2. Face
  3. Brow
  4. Shoulder
  5. Compound
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13
Q

What are the parts of a fetal NST?

A
  1. Baseline (110-160)
  2. Variability: 5-25 bpm
  3. Accelerations 15x15
  4. Decelerations
  5. Overal impression (atypical, abnormal, normal)
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14
Q

Variable Decelerations

A

Cord compression, hypoxia

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15
Q

Early Decelerations

A

Normal, due to head compression

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16
Q

Late Decelerations

A

Placental insufficiency/ fetal hypoxia

17
Q

Increased variability ddx

A

Mild hypoxia, fetal gasping

18
Q

Decreased variability ddx

A

Fetal hypoxia, fetal sleep

19
Q

Fetal Bradycardia ddx

A

Need to deliver STAT

Ddx: rapid descent, late hypoxia, cord prolapse, hypercontractibility

20
Q

Scalp pH

A

Do if atypical FHS
<7.20: deliver
7.2-7.24: Repeat in 30 min
<7.25: repeat if FHR remains abnormal

21
Q

What should be done if you are unsure of babies oxygenation status?

A
  1. Reposition into LL decubitus
  2. Give o2
  3. Give IV fluids
  4. Stop oxytocin
22
Q

10 B’s of post-partum rounds

A
  1. Blues
  2. Breasts
  3. Belly
  4. Bleeding (1 pad/h normal)
  5. Blood type (Rh)
  6. Bladder
  7. Bowels (avoid constipation)
  8. Bum (tears, hemarrhoids)
  9. Baby (social)
  10. Before- deal with pre-existing conditions
23
Q

4 T’s of primary post-partum hemorrhage

A
  1. Tone
  2. Tissue
  3. Trauma
  4. Thrombin
24
Q

Puerpural fever

A 
Fever in 6 weeks after birth
DDx: 
1. Wind- resp infections, atelectasis, PE
2. Woobies- mastitis
3. Water- UTI/ pyelonephritis
4. Womb- endometritis, retained products of conception
5. Wound
6. Walking- DVT,
25
Q

Diagnostic Criteria post-partum depression

A
  1. Depressed mood
  2. Sleep disturbance
  3. Lake of interest in usually pleasurable thing
  4. Diminished self-esteem or guilt
  5. Fatigue or loss of energy
  6. Change in appetite
  7. Psychomotor agitation
  8. Suicidal ideation
26
Q

First trimester investigations

A

Blood: serology for HIV, syphilis, HepBSAG, varicella, rubella, CBC, type and screen
Urine: glucose, protein
Date: 9-12 week dating ultrasound
Screen: U/S for nuchal translucency, PAPP-A, B-HCG
Diagnostics: maternal free cell DNA, amniocentesis, chorionic villi sampling

27
Q

Second trimester investigations

A 
Check: ultrasound for parts
Syphilis
Repeat type and screen
Check fetal heart rate, symphysis fundus height
Screen, quadruple
28
Q

Components of a biophysical profile

A
  1. FHR- >2 accells in 20 min
  2. Breathing- >1 episode lasting >30s
  3. Movements- >3 body or limb movements
  4. Tone- >1 episode of flex/extension limb or open/close hand
  5. Amniotic fluid- >1 cord and >1 limb free fluid pocket 2x2 cm

If 6- repeat in 24 h
If <6- delivery may be indicated

29
Q

Abnormal NST

A
  1. Baseline: <100bpm or >160 for >30 min or erratic
  2. Variability: <5 for 80 min, sinusoidal, 25 bpm>10 min
  3. Decelerations: variable > 60s, late decels
  4. Accelerations: <2 with >15 bpm, 15 s in 80 min

This means urgent action is required

Obstetrics & Gynecology (7 decks)

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