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Step 2 > OB > Flashcards

OB Flashcards

1
Q

Define embryo, fetus, and infant

A

Fertilization to 8 weeks
8 weeks to birth
Birth to 1 year

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2
Q

Naegle rule of estimating date of delivery

A

LMP - 3 months + 7 days

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3
Q

Developmental age vs gestational age

A

Number of days since fertilization

Days or weeks since LMP (usually DA + 2 weeks)

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4
Q

What screens occur in each trimester?

A

1- fetal heart sounds
2- quad screen, movement @20 weeks, an atomic U/S @20
3- frequent visits to check for labor

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5
Q

What is a term pregnancy?

A

37 weeks -

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6
Q

Interpret a GP number

A

G(# of pregnancies) P(full term births/pre term/abortions/living kids)

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7
Q

What are the first signs of pregnancy and when?

A

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

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8
Q

When does the bhcg peak?

A

10 weeks (can visualize gestation at 5 weeks)

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9
Q

What are cardiology changes of pregnancy?

A

Increased cardiac output (increases HR)

Slightly lower blood pressure (trough 26 weeks)

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10
Q

What are renal changes of pregnancy

A

Increase in size of kidney and ureters

Increase in GFR

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11
Q

What are the hematologic changes of pregnancy

A

Anemia (plasma volume increases by 50%)

Hypercoagulable

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12
Q

What tests are completed in the 1st trimester

A 
11-14 weeks: u/s to confirm gestational age, check for NT
Blood tests
Pap
GC
Down syndrome screen
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13
Q

What is the best way to establish gestational age

A

U/S

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14
Q

What screenings occur in the 2nd T

A

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

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15
Q

What should you do if you have continued Braxton hicks contractions

A

Check the cervix (cervix should not be open)

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16
Q

What are 3T tests?

A

26: glucose load (if >140 then do oral tolerance test)
27: CBC (iron if hb

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17
Q

Name 2 tests for obtaining fetal karyotype and how they are done

A

CVS: 10-13 weeks into intrauterine cavity
Amniocentesis: 11-14 weeks transabdominally into amniotic sac

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18
Q

Most common site of ectopic pregnancy

A

Ampulla

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19
Q

Risk factors for ectopic

A

Previous ectopic&raquo_space; PID = IUD

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20
Q

When do you avoid MTX in patients with ectopics?

A 
Immunodeficiency
Non compliant
Liver disease
Larger than 3.5cm
Heartbeat present
21
Q

How do you define an abortion

A

Before 20 weeks or less than 500 grams

22
Q

What is required to differentiate abortion types

A

Ultrasound

23
Q

What are the 5 main types of abortion and their tx?

A

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

24
Q

What is the first clue of multiple gestations?

A

Elevated AFP and BHCG

25
Q

What are the 2 twin types?

A

Mono: 1 egg/1sperm –> identical
Di: 2 eggs/2sperm –> fraternal

26
Q

What is morning sickness due to and when does it occur

A

Increase in placental release of BhCG

12-14 weeks

27
Q

Define preterm labor

A

Contractions with cervical dilation

28
Q

When do you wish to delay delivery and what do you administer?

A

24-33 EGA, 600-2500 grams

Administer betamethasone and tocolytics (MgSulfate>Ca2+ blockers=Terbutaline)

29
Q

Do you deliver if in PROM?

A

Chorio? Then yes

Term with no chorio? Wait 6-12 hours and then induce if no SVD

30
Q

What should you never do in 3rd T bleeding?

A

Digital vaginal (abdominal U/S instead)

31
Q

How do you define a low lying placenta?

A

Not covering the os (0

32
Q

Differences between placenta Accreta/Increta/Percreta?

A

Superficial uterine wall
myometrium
serosa/bladder/rectum invasion

33
Q

When is prenatal Ab screening completed

A

28 and 35 weeks –> unsensitized at 28 weeks get rhoGAM

34
Q

How do you handle a patient sensitized to Rh (>1:4)?

A

no treatment necessary

>1/16 –> serial amniocentesis to evaluate fetal bili

35
Q

What 3 drugs are safe for chronic HTN in pregnancy?

A

Methyl dopa
Labetalol
Nifedipine

36
Q

What is different in mild and severe preE

A

> 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

37
Q

Treat eclampsia

A

Mag Sulfate
Hydralazine
Delivery

38
Q

What tests do you get weeks 32-37?

A

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

39
Q

How do you evaluate for gestational DM?

A

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)

40
Q

Gestational DM treatment vs Type 2 DM

A

Diet and walking +/- metformin and glyburide

Insulin

41
Q

What is the definition of a reactive NST and what is 1 reason for a bad test?

A

2 fetal movements + acceleration of >15bpm for 15-20 seconds

Baby may be sleeping

42
Q

BPP consists of:

A 
NST
Fetal chest expansions (1+ over 30 min)
Fetal movement (>3 in 30 min)
Fetal muscle tone (flex an extremity)
AFI
43
Q

What are the 5 stages of labor?

A 
1: onset to full dilation
Latent: onset to 4cm
Active: 4cm to full
2: full to delivery
3: delivery to placenta
44
Q

Steps of stage 2

A

Engage - descend - flex - internal rotation - extend - external rotation - delivery of anterior shoulder - delivery of posterior shoulder

45
Q

What patients should not get PGE2?

A

Asthmatics (may cause bronchospasm)

46
Q 
Define:
Prolonged latent stage
Protracted cervical dilation
Arrest of descent
Arrest of cervical dilation
A

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

47
Q

What are the 3 breeches?

A

Frank: hips flexed with extended knees
Complete: hips and knees flexed
Footling: feet are first (one or both)

48
Q

Define postpartum hemorrhage and the most common cause

A

> 500mL blood after delivery

Atony: no contractions of the uterus after delivery

49
Q

How do you treat atony?

A

1) Examine to ensure there is no rupture
2) Bimanual compression and massage
3*) oxytocin to induce contraction

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