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OB Flashcards

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1
Q

Goodell Sign

A

Softening of the cerix

4 weeks

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2
Q

Ladin sign

A

Softening of the midline of the uterus

6 weeks

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3
Q

Chadwick sign

A

Blue discoloration of vagina and cervix

6-8 weeks

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4
Q

Telangiectasias/ palmar erythema

A

First trimester

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5
Q

Chloasma

A

Pregnancy mask

16 weeks

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6
Q

Linea nigra

A

Second trimester

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7
Q

1st trimester prenatal care

A

Visit every 4-6 weeks
US at 11-14 weeks to confirm gestation age and check nuchal lucency
Blood work, pap smear, G/C

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8
Q

2nd trimester prenatal care

A

15 to 20 weeks- triple/quad screen
Auscultation of fetal heart
16-20wk- quickening
18-20wk- US for malformation

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9
Q

3rd trimster prenatal care

A

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

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10
Q

Chorionic villus sampling

A

10-13wk: advanced maternal age or known genetic disease
Catheter into intrauterine cavity and aspirate chorionic villi from placenta
Obtains fetal karyotype

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11
Q

Amniocentesis

A

16-18wk: advanced maternal age or known genetic disease
Transabdominal needle into amniotic sac and withdraw amniotic fluid
Obtains fetal karyotype

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12
Q

Fetal blood sampling

A

Transabdominal need into uterus to get blood from the umbilical cord

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13
Q

Exclusion criteria for methotrexate

A 
Immunodeficiency 
Noncompliant patient- needs to follow up in 4-7 days
Liver disease- MTX is hepatotoxic 
Ectopic >3.5cm 
Fetal heartbeat auscultated
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14
Q

Cramping abdominal pain, vaginal bleeding

No products of conception found on US

A

Complete abortion

Tx: follow up in office

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15
Q

Cramping abdominal pain, vaginal bleeding

Some products of conception found on US

A

Incomplete aborton

Tx: D&C or medical

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16
Q

Cramping abdominal pain, vaginal bleeding

Products of conception intact, but intrauterine bleeding present and dilatation of cervix

A

Inevitable abortion

Tx: D&C or medical

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17
Q

Cramping abdominal pain, vaginal bleeding
Products of conception intact and intrauterine bleeding
No dilatation of cervix

A

Threatened abortion

Tx: bed and pelvic rest

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18
Q

Cramping abdominal pain, vaginal bleeding

Death of fetus, but all products of conception present in uterus

A

Missed abortion

Tx: D&C or medical

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19
Q

Cramping abdominal pain, vaginal bleeding

Infection of uterus and the surrounding area

A

Septic abortion

Tx: D&C and IV abx: levofloxacin and metronidazole

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20
Q

Circumstances when preterm labor should not be stopped with tocolytic and delivery should occur

A 
Maternal severe hypertension 
Maternal cardiac disease 
Maternal cervical dilation >4cm 
Maternal hemorrhage 
Fetal death 
Chorioamnonitis
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21
Q

Placental Previa

A

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

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22
Q

Complete placenta previa

A

Complete covering of internal os

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23
Q

Partial placental previa

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A

Partial covering of internal os

24
Q

Marginal placental previa

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A

Placental is adjacent to internal os

25
Vasa previa
Fetal vessels present over internal os
26
Low-lying placenta
Placenta implanted on lower segment of the uterus, 0-2cm away from os
27
Placenta accreta
Abnormally adheres to superficial uterine wall
28
Placenta increta
Placenta attached to myometrium
29
Placena percreta
placenta invades into the uterine serosa, bladder wall, or rectal wall
30
Risk factors for placental abruption
``` HTN prior placental abruption cocaine use external trauma smoking ```
31
Chronic HTN
BP >140/90 before patients becomes pregnant | Tx: methyldopa, labetalol, nifedipine
32
Gestatoinal HTN
BP > 140/90 starting at 20 weeks gestation No other symptoms Tx: methyldopa, labetalol, nifedipine only during pregnancy
33
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 ```
34
Severe Pre-eclampsia
``` HTN >160/110 Proteinuria: 3+, >5g in 24 hour urine Edema: generalized Mental status changes Vision changes Impaired liver function ```
35
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
36
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
37
Nonstress test
Detect 2 fetal movements Acceleration of HR > 15bpm lasting 20 seconds. Nonreactive stress test, baby may be sleeping- vibroacoustic stimulation
38
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
39
Stage 1 of labor
Onset of labor to full cervical dilation P: 6-18 hours M: 2-10 hours
40
Latent labor
Part of Stage 1 Onset of labor until 4cm dilated P: 6-7 hours M: 4-5 hours
41
Active labor
Part of Stage 1 4cm dilated to fully dilated P: 1cm/hr M: 1.2cm/hr
42
Stage 2 of labor
Full dilation of the cervix to delivery of neonate P: 30min-3hr M: 5-30min
43
Stage 3 of labor
Delivery of neonate to delivery of placenta 30 minutes
44
Steps of Stage 2
``` Engagement Descent Flexion Internal rotation Extension External rotation ```
45
Signs of placental delivery readiness
1. gush of blood 2. umbillical cord lengthening 3. globular uterus
46
Arrest of dilation
No cervical dilation for >2 hours during active labor
47
Arrest of descent
No change in station for >1 hour during active labor
48
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
49
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
50
Linchen planus
30-60 yo women Violet flat papules Tx: topical steroids
51
Vaginal discharge with fishy odor | Grey-white
Bacterial vaginosis- gardnerella Saline wet mount shows clue cells Tx: metronidazole or clindamycin
52
White cheesy vaginal discharge | ph: 4-5
Candidiasis- Candida albicans KOH shows pseudohyphate Tx: with -azole
53
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
54
Paget's disease
Intraepithelial neoplasm Postmenopausal women Vulvar soreness and pruritus Red lesion with superficial white coating Bilateral: radical vulvectomy Unilateral: modified vulvectomy
55
SCC
Pruritus, bloody vaginal discharge, and post menopausal bleeding Dx: with bx Tx: vulvectomy

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