OB Flashcards
Goodell Sign
Softening of the cerix
4 weeks
Ladin sign
Softening of the midline of the uterus
6 weeks
Chadwick sign
Blue discoloration of vagina and cervix
6-8 weeks
Telangiectasias/ palmar erythema
First trimester
Chloasma
Pregnancy mask
16 weeks
Linea nigra
Second trimester
1st trimester prenatal care
Visit every 4-6 weeks
US at 11-14 weeks to confirm gestation age and check nuchal lucency
Blood work, pap smear, G/C
2nd trimester prenatal care
15 to 20 weeks- triple/quad screen
Auscultation of fetal heart
16-20wk- quickening
18-20wk- US for malformation
3rd trimster prenatal care
Every 2-3 week visits, until 36wk and then weekly visits
37 week- weekly cervical check
27 week- CBC check, supplement iron if Hb<11
24-26week glucose tolerance test
36 week- cervical culture for G/C and rectovaginal swab for GBS
Chorionic villus sampling
10-13wk: advanced maternal age or known genetic disease
Catheter into intrauterine cavity and aspirate chorionic villi from placenta
Obtains fetal karyotype
Amniocentesis
16-18wk: advanced maternal age or known genetic disease
Transabdominal needle into amniotic sac and withdraw amniotic fluid
Obtains fetal karyotype
Fetal blood sampling
Transabdominal need into uterus to get blood from the umbilical cord
Exclusion criteria for methotrexate
Immunodeficiency Noncompliant patient- needs to follow up in 4-7 days Liver disease- MTX is hepatotoxic Ectopic >3.5cm Fetal heartbeat auscultated
Cramping abdominal pain, vaginal bleeding
No products of conception found on US
Complete abortion
Tx: follow up in office
Cramping abdominal pain, vaginal bleeding
Some products of conception found on US
Incomplete aborton
Tx: D&C or medical
Cramping abdominal pain, vaginal bleeding
Products of conception intact, but intrauterine bleeding present and dilatation of cervix
Inevitable abortion
Tx: D&C or medical
Cramping abdominal pain, vaginal bleeding
Products of conception intact and intrauterine bleeding
No dilatation of cervix
Threatened abortion
Tx: bed and pelvic rest
Cramping abdominal pain, vaginal bleeding
Death of fetus, but all products of conception present in uterus
Missed abortion
Tx: D&C or medical
Cramping abdominal pain, vaginal bleeding
Infection of uterus and the surrounding area
Septic abortion
Tx: D&C and IV abx: levofloxacin and metronidazole
Circumstances when preterm labor should not be stopped with tocolytic and delivery should occur
Maternal severe hypertension Maternal cardiac disease Maternal cervical dilation >4cm Maternal hemorrhage Fetal death Chorioamnonitis
Placental Previa
Presentation:
Painless vaginal bleeding
Dx: transabdominal US showing where placenta lying in uterus
Tx: Placenta may move so…strict pelvic rest!
Immediate C-section if: unstoppable labor, severe hemorrhage, fetal distress
Complete placenta previa
Complete covering of internal os
Partial placental previa
Partial covering of internal os
Marginal placental previa
Placental is adjacent to internal os
Vasa previa
Fetal vessels present over internal os
Low-lying placenta
Placenta implanted on lower segment of the uterus, 0-2cm away from os
Placenta accreta
Abnormally adheres to superficial uterine wall
Placenta increta
Placenta attached to myometrium
Placena percreta
placenta invades into the uterine serosa, bladder wall, or rectal wall
Risk factors for placental abruption
HTN prior placental abruption cocaine use external trauma smoking
Chronic HTN
BP >140/90 before patients becomes pregnant
Tx: methyldopa, labetalol, nifedipine
Gestatoinal HTN
BP > 140/90 starting at 20 weeks gestation
No other symptoms
Tx: methyldopa, labetalol, nifedipine only during pregnancy
Mild Pre-eclampsia
HTN >140/90 Proteinuria: 1-2+, >3g in 24 hour urine Edema: hands, feet, face No mental status change No vision change No liver function impairment
Severe Pre-eclampsia
HTN >160/110 Proteinuria: 3+, >5g in 24 hour urine Edema: generalized Mental status changes Vision changes Impaired liver function
Risk of pre-gestational diabetes
Maternal: Pre-eclampsia Spontaneous abortion Increased infection Post-partum hemorrhage
Fetal
Congenital anomalies- heart and neural tube defects
Macrosomia
Preterm labor
Fetal testing schedule for gestational diabetes
32-26 week- weekly NST and US to assess fetal well being and size
> 36 week- twice weekly: one NST (fetal well being) and one BPP (amniotic fluid and fetal well being)
37 week- L/S ratio (assess fetal lung maturity) >2 is mature, if mature delivery
38-39 weeks: if pt refused L/S deliver now
Nonstress test
Detect 2 fetal movements
Acceleration of HR > 15bpm lasting 20 seconds.
Nonreactive stress test, baby may be sleeping- vibroacoustic stimulation
Biophysical Profile
Fetal HR Fetal chest expansion- 1 breath 30 min Fetal movement: 3 movement in 30 min Fetal muscle tone: flex an extremity Amniotic fluid index
Normal 8-10
Abnormal <4
Stage 1 of labor
Onset of labor to full cervical dilation
P: 6-18 hours
M: 2-10 hours
Latent labor
Part of Stage 1
Onset of labor until 4cm dilated
P: 6-7 hours
M: 4-5 hours
Active labor
Part of Stage 1
4cm dilated to fully dilated
P: 1cm/hr
M: 1.2cm/hr
Stage 2 of labor
Full dilation of the cervix to delivery of neonate
P: 30min-3hr
M: 5-30min
Stage 3 of labor
Delivery of neonate to delivery of placenta
30 minutes
Steps of Stage 2
Engagement Descent Flexion Internal rotation Extension External rotation
Signs of placental delivery readiness
- gush of blood
- umbillical cord lengthening
- globular uterus
Arrest of dilation
No cervical dilation for >2 hours during active labor
Arrest of descent
No change in station for >1 hour during active labor
Lichen Sclerosus
Any age-if post menopausal increased risk of cancer
White thin skin extending from labia to perianal area, clinical diagnosis but do a punch bx if concerned about cancer
Tx: Topical steriods
Squamous cell hyperplasia
Any age- particularly in patients that have chronic vulvar pruritus.
Chronic irritation develop hyperkeratosis- raised white lesions
Tx: Sitz baths or lubricants
Linchen planus
30-60 yo women
Violet flat papules
Tx: topical steroids
Vaginal discharge with fishy odor
Grey-white
Bacterial vaginosis- gardnerella
Saline wet mount shows clue cells
Tx: metronidazole or clindamycin
White cheesy vaginal discharge
ph: 4-5
Candidiasis- Candida albicans
KOH shows pseudohyphate
Tx: with -azole
Profuse green-grey frothy vaginal discharge
Vulvar pruritus, dysuria, pain
ph: 5-6
Trichamonas vaginalis
Saline wet mount shows motile flagellates
Tx: both patient and partner with metronidazole
Paget’s disease
Intraepithelial neoplasm
Postmenopausal women
Vulvar soreness and pruritus
Red lesion with superficial white coating
Bilateral: radical vulvectomy
Unilateral: modified vulvectomy
SCC
Pruritus, bloody vaginal discharge, and post menopausal bleeding
Dx: with bx
Tx: vulvectomy
