OB Flashcards
Jewish
MD and Taysachs
Canavan gowshers
Jewish/french canadian
taysachs
AA
sickle
White
CF
Presumptive pregnancy
amenorrhea, tenderness, frequency, n/v, fatigue, chadwicks, linea nigra, chloasma, quickening (fetal movements)
Probable pregnancy
ballotment (boyency of baby), Braxton hicks, goodells (softening of cervix) and hegars (softening of lower uterine segment), uterine and abdominal enlargement, positive test (miscarriage, tubal, molar), palpation of fetal contour
Positive pregnancy signs
- auscultation of fetal heart
- palpation of fetal movements
- ultrasound verification of gestation
nagels rule
-3 months + 7 days from first day of last period
Serum hcg doubles every
48 hours
1st trimester
2nd
3rd
1st- 1-3 months
2nd 3-6 months
3rd 6+
PE measurements/description Diagonal conj Transverse diameter Anterior posterior diameter Ischial tuberosity Cervical length
Diagonal conj- 12.5 cm Transverse diameter- sharp or blunt Anterior posterior diameter - curved or flat Ischial tuberosity- >8 cm Cervical length >4 cm (
Lab tests
Blood type/Rh CBC HGB electro syphillis, hep b and c, HIV, G/C varicella, rubella BS HCG PAP UA TSHR other: CMV, parvo (day care), toxo (cats), gtt, hsv, toxic screen Genetic
Nutrition pregnancy Folic acid calories Foods to avoid Protein Dairy Whole grain Vitamin C Green leafy Other fruits/veg
- 400 mcg a day
- Increase 300 calories a day 1800-2400
- avoid: soft cheese, shellfish, lobster, shrimp, clams, tuna swordfish such as LOWSWIMMING FISH NOT OKAY
- protein: 75-100 g 4 serv
- dairy: 4
- whole grain: 6
- vit C f/g: 2
- green: 2
- other f/v: 3
Routine schedule visits
^28 weeks: once a month
^36 weeks: twice a month
36+ every week until term
40+ twice a week, usually induced by 41
Postpartum visit schedule
Vaginal
C/S
Vaginal- 6 weeks
C/S- 2 weeks for incision, then 6 weeks later
if AMA or young- then more frequently
Prenatal visits and what we do/see at these visits
up to 20 weeks
each: BP wt urine
1st visit ASAP
12 weeks: FHR, fundus at symphisis pubis, FIRST SEQUENTIAL 10-12
16 weeks: Fundus between belly button and SP, recheck H+ H, second sequential (alpha fetal protein)
20 weeks: fundus at umbilicus, quickening, U/S** fetal survey
Prenatal visits and what we do/see at these visits (20+ weeks)
24-28 weeks: fundus 1 cm a week, diabetic screen, RHOGAM, H+H, s/s PTL (cervix if at risk)
28 weeks: pediatrician, PCB, feeding, fetal kick count*
36: beta strep, cervix, s/s labor, lightening*
>36: cervix, fetal position, birth control, circumcision
hegars
softening lower uterine segment
goodell
softening of cervix
chadwicks
bluish cervix
1st trimester changes and tx
n/v/constipation/hemorrhoids/flatulence: emetrol, zofran, compazine, phenergan, metamucil
fatigue urinary frequency/incontinence varicosities headache Breast pain/menstrual cramps
General physiologic changes of pregnancy
Smooth muscle relaxation (decreased peristalsis)
Increased blood volume
Increased CO - peaks 24 weeks
Increased GFR
2nd trimester changes
Backache
Syncope (pooling of blood, pressure vena cava, increase BV)
Leukorrhea (increased E2, thin white yellow)
Epitaxis/epulsis (E2, r.o sinusitis, HTN, anemia)
Muscle cramps (pressure on nerves- adequate calcium)
Round ligament pain (avoid long standing or sitting- ectopic, cyst, appendix, hernia)
Increased saliva/bad taste (avoid starch)
PICA (assess constipation, intestinal obstruction, lead intoxification, anemia, hypercalcemia)
3rd trimester changes
Braxton hicks- after 6 months- painless tightening, no dilation (left lateral position)
Dyspnea
Edema (increased capillary permeability, decreased return)
Dyspepsia(progesterone decreased peristalsis- tums mylanta maalox r/o gall bladder hernia ulcer)
