OB Flashcards
how long to wait after rubella vaccination to get pregnant
wait 1-3 months after vaccination
reactive nonstress test
HR: 110-160
moderate variability (6-25/min)
> 2 accels in 20 mins (15 by 15)
contraction stress test
evaluates fetal capability to handle stress
goal: 3 contractions (40-60secs) in 10 mins with no late or variable decels (negative)
late decels w/ 50% contractions is positive –> bad
pregnant nurses can not care for which patients
TORCH
- toxoplasmosis
- other viruses (parvovirus, varicella-zoster virus, zika virus)
- rubella
- cytomegalovirus
- herpes simplex virus
prenatal visits scheduling
qmonth until 28 weeks
every other week from 28-36 weeks
qweek after 36 weeks until 42 weeks
quickening introduction
16-20 weeks GA
GDM screenings
24-28 weeks GA
1h glucose challenge test
fetal heart rate heard
8-12 weeks GA
infertility
inability to conceive after 12 months of frequent, unprotected sex w/out medical complications
subjective signs/ presumptive
- amenorrhea
- n/v
- urinary frequency
- breast tenderness
- quickening
- excess fatigue
objective signs/ probable
- goodells sign
- chadwick sign
- hegar sign
- uterine enlargement
- braxton hicks contractions
- ballottement
- fetal outline palpation
- uterine and funic souffle
- chloasma
- linea nigra
- areola darkening
- pregnancy test
- striae gravidarum
positive signs/diagnostic
- FHR heard on doppler
- fetal movement palpated by HCP
- visualization of fetus via US
- fetal skeleton on xray
term pregnancy
> or = to 37 weeks 0 days
rhogam administration
within 72h of birth
indirect coombs test
determines antibody presence in Rh neg mom (if + –> can not give rhogam)
cervical cerclage
placed anywhere from 12-23 weeks GA, removed around 36-37weeks GA
activity restriction required
s/s of preterm labor
low back ache, contractions, pelvic pressure, ROM
fundal height at 16 weeks GA
halfway between symphysis pubis and U
fundal height at 20-22 wks
at U
fundal height at 36 wks
approaching xyphoid process
fundal height beyond 20 weeks
cm matches weeks of GA
ex: 24cm at 24 wks
syphilis Tx and screening
screening: first prenatal visit, 3rd trimester, at delivery
Tx: penicillin
prenatal folic acid intake
400-800mcg/day
fortified cereals, green leafy veggies, enriched breads
anemia in pregnancy
Hgb < 10.5 in 2nd trimester
Hgb < 11 in 3rd trimester
increase intake of iron rich foods in the second trimester
1h oral glucose challenge test
tests for GDM
> or = to 130-140 is abnormal
optimal BMI for fertility
18.5-24.9
Naegele’s rule
first day of LMP - 3 months + 7 days = EDD
weight gain for BMI < 18.5
28-40lbs total
1lb/week for 2nd/3rd trimesters
weight gain for BMI 18.5-24.9
25-35lbs total
1lb/week for 2nd/3rd trimesters
weight gain for BMI 25-29.9
15-25lbs total
0.5lb/week for 2nd/3rd trimesters
weight gain for BMI >30
11-20lbs total
0.5lb/week weight gain for 2nd/3rd trimesters
weight gain during first trimester of pregnancy
1.1-4.4lbs
nitrazine pH strip
determines presence of amniotic fluid (alkaline)
may be contaminated by sperm or blood
Leopold maneuver
- Fundus
- sides
- fetal part closest to vagina (presenting part)
- fetal flexion
gestational HTN
new onset elevated BP at >20wks w/ no proteinuria
chronic HTN in pregnancy
SBP >140 or DBP >90 at < 20wks
preeclampsia
new onset elevated BP at >20wks
+
proteinuria and signs of end organ damage
P/C ratio indicative of preeclampsia
0.3
DTR assessment in eclampsia
2+ is normal
0-1 is hypo –> mag tox
3-4 is hyper –> seizure risk
HELLP syndrome and s/s
hemolysis
elevated liver enzymes
low plt
s/s: RUQ pain, N/V, malaise
Tx: deliver fetus
GTPAL
G: # of pregnancies T: # of babies delivered at 37.0 wks P: # of babies delivered at 20.0-36.6wks A: number of pregnancies ending before 20.0 wks L: # of living children
category III tracing
absent variability fetal bradycardia (<100/min) prolonged or recurrent variable or late decelerations or sinusoidal FHR pattern
Tx: deliver baby
variable decels cause
cord compression or prolapse
oligohydramnios
early decels cause
head compression
late decels cause
placental insufficiency
PPROM
rupture before 37wks
oxytocin –> contraction goal
q 2-3 mins
lasting 80-90secs
uterine tachysystole
> 5 contractions in 10mins
contractions lasting >90 secs
stage 1
latent phase
0-5cm dilation
best time for education
stage 1
active phase
6-7cm dilation
contraction s q3-5mins (30-60secs)
stage 1
transition phase
7-10cm dilation
contractions q2-3mins (60-80secs)
stage 2
10cm dilation until birth
monitor & document FHR q5mins
stage 3
birth of baby until expulsion of placenta
stage 4
1-4hs after birth
Tx for shoulder dystocia
McRoberts maneuver
suprapubic pressure
bishop score indicative of cervical favorability (successful induction)
>6-8 consistency position dilation effacement station
onset of postpartum depression
4-6 wks postpartum (up to 12 months)
taking in period
24-48h PP
mother dependent of healthcare team
taking hold period
2-10 days PP
mother learns to care for baby
letting go period
10 days PP
mother becomes comfortable in new role
PP uterine involution
should reduce 2cm qday PP
macrosomia infant size
> 8lbs 13oz
timing of occurrence of secondary PPH
> 24h-6wks PP
LBW newborn
<2500g
normal percentile weight for newborns
between 10-90th
APGAR
indicates how well a newborn is transitioning into life
performed at 1 and 5mins of life
scores <7 may require extra efforts
Appearance Pulse grimace Activity Resp effort
newborn hypoglycemia
BG <35 (maybe <40)
pathological jaundice
occurs in first 24h of life
first void and meconium passage
void: 24h
meconium 24-48h
normal newborn head circumference
13-14inches
newborn temp
36.5-37
newborn HR
110-160
newborn RR
30-60
apnea pauses <20secs normal
weight loss expected of newborns during first 3-4 days of life in %
5-6%
