OB Flashcards
Define embryo, fetus, and infant
Fertilization to 8 weeks
8 weeks to birth
Birth to 1 year
Naegle rule of estimating date of delivery
LMP - 3 months + 7 days
Developmental age vs gestational age
Number of days since fertilization
Days or weeks since LMP (usually DA + 2 weeks)
What screens occur in each trimester?
1- fetal heart sounds
2- quad screen, movement @20 weeks, an atomic U/S @20
3- frequent visits to check for labor
What is a term pregnancy?
37 weeks -
Interpret a GP number
G(# of pregnancies) P(full term births/pre term/abortions/living kids)
What are the first signs of pregnancy and when?
Goodell sign - 4 weeks - softening of cervix
Ladin sign - 6 weeks - softening of midline of uterus
Chadwick sign - 7 weeks - vagina/cervix turn blue
Telangectasias/palmar erythema - 1st trimester
Chloasma - 16 weeks - mask of pregnancy
Linea Nigra - 2nd trimester - hyper pigmented line on abdomen
When does the bhcg peak?
10 weeks (can visualize gestation at 5 weeks)
What are cardiology changes of pregnancy?
Increased cardiac output (increases HR)
Slightly lower blood pressure (trough 26 weeks)
What are renal changes of pregnancy
Increase in size of kidney and ureters
Increase in GFR
What are the hematologic changes of pregnancy
Anemia (plasma volume increases by 50%)
Hypercoagulable
What tests are completed in the 1st trimester
11-14 weeks: u/s to confirm gestational age, check for NT Blood tests Pap GC Down syndrome screen
What is the best way to establish gestational age
U/S
What screenings occur in the 2nd T
15-20 weeks: triple/quad screen (AFP/Bhcg/estriol + inhibin)
-AFP: dating error/NTD/abdominal wall defect
-other 3 tests: increase sensitivity of AFP
Fetal heart rate
16-20: quickening (feel for fetal movement)
18-20: U/S to look for malformation
What should you do if you have continued Braxton hicks contractions
Check the cervix (cervix should not be open)
What are 3T tests?
26: glucose load (if >140 then do oral tolerance test)
27: CBC (iron if hb
Name 2 tests for obtaining fetal karyotype and how they are done
CVS: 10-13 weeks into intrauterine cavity
Amniocentesis: 11-14 weeks transabdominally into amniotic sac
Most common site of ectopic pregnancy
Ampulla
Risk factors for ectopic
Previous ectopic»_space; PID = IUD
When do you avoid MTX in patients with ectopics?
Immunodeficiency Non compliant Liver disease Larger than 3.5cm Heartbeat present
How do you define an abortion
Before 20 weeks or less than 500 grams
What is required to differentiate abortion types
Ultrasound
What are the 5 main types of abortion and their tx?
Complete: follow up
Incomplete: D&C or medical
Inevitable (cervix dilated): D&C or medical
Threatened (no cervical dilation): bed/pelvic rest
Missed (fetus dead but products present): D&C or medical
What is the first clue of multiple gestations?
Elevated AFP and BHCG
What are the 2 twin types?
Mono: 1 egg/1sperm –> identical
Di: 2 eggs/2sperm –> fraternal
What is morning sickness due to and when does it occur
Increase in placental release of BhCG
12-14 weeks
Define preterm labor
Contractions with cervical dilation
When do you wish to delay delivery and what do you administer?
24-33 EGA, 600-2500 grams
Administer betamethasone and tocolytics (MgSulfate>Ca2+ blockers=Terbutaline)
Do you deliver if in PROM?
Chorio? Then yes
Term with no chorio? Wait 6-12 hours and then induce if no SVD
What should you never do in 3rd T bleeding?
Digital vaginal (abdominal U/S instead)
How do you define a low lying placenta?
Not covering the os (0
Differences between placenta Accreta/Increta/Percreta?
Superficial uterine wall
myometrium
serosa/bladder/rectum invasion
When is prenatal Ab screening completed
28 and 35 weeks –> unsensitized at 28 weeks get rhoGAM
How do you handle a patient sensitized to Rh (>1:4)?
no treatment necessary
>1/16 –> serial amniocentesis to evaluate fetal bili
What 3 drugs are safe for chronic HTN in pregnancy?
Methyl dopa
Labetalol
Nifedipine
What is different in mild and severe preE
> 140/90 Vs >160/110
300mg protein vs >5g
hand/feet/face vs generalized edema
No AMS/vision changes/liver issues vs Yes to all
Treat eclampsia
Mag Sulfate
Hydralazine
Delivery
What tests do you get weeks 32-37?
32-36: weekly NST and U/S for fetal size
>36: 2 tests per week of NST and BPP (amniotic fluid)
37: L/S ratio
How do you evaluate for gestational DM?
1) glucose load test (nonfasting ingestion of 50mg and measure 1 hour later
2) >140 = oral glucose tolerance test (100mg fasting and measure at 1 2 and 3 hours)
Gestational DM treatment vs Type 2 DM
Diet and walking +/- metformin and glyburide
Insulin
What is the definition of a reactive NST and what is 1 reason for a bad test?
2 fetal movements + acceleration of >15bpm for 15-20 seconds
Baby may be sleeping
BPP consists of:
NST Fetal chest expansions (1+ over 30 min) Fetal movement (>3 in 30 min) Fetal muscle tone (flex an extremity) AFI
What are the 5 stages of labor?
1: onset to full dilation Latent: onset to 4cm Active: 4cm to full 2: full to delivery 3: delivery to placenta
Steps of stage 2
Engage - descend - flex - internal rotation - extend - external rotation - delivery of anterior shoulder - delivery of posterior shoulder
What patients should not get PGE2?
Asthmatics (may cause bronchospasm)
Define: Prolonged latent stage Protracted cervical dilation Arrest of descent Arrest of cervical dilation
Takes >20 hours to reach 4cm
Cervix does not dilate more than 1.2cm in an hour
Fetal head does not move down the canal
No dilation of the cervix for >2 hours
What are the 3 breeches?
Frank: hips flexed with extended knees
Complete: hips and knees flexed
Footling: feet are first (one or both)
Define postpartum hemorrhage and the most common cause
> 500mL blood after delivery
Atony: no contractions of the uterus after delivery
How do you treat atony?
1) Examine to ensure there is no rupture
2) Bimanual compression and massage
3*) oxytocin to induce contraction
