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OB Flashcards

1
Q

Define embryo

A

Fertilization to 8th week of pregnancy

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2
Q

Defie fetus

A

9th week of pregnancy to birth

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3
Q

Define neonate

A

live born from birth to 28 days old

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4
Q

First trimester

A

1-12 weeks

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5
Q

second trimester

A

13-28 weeks

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6
Q

Third trimester

A

28-40 weeks

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7
Q

How do you calculate a mothers expected date of confinement? (EDC)?

A

Nagele’s rule: Add 7 days to LMP and subtract 3 months

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8
Q

Folic acid supplementation in low risk mothers? high risk? What does folic acid help decrease?

A

Low risk=0.4 mg
High risk= 4 mg
Decrease: Neural tube defects, spina bifida
Required for: Skull and SC development

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9
Q

How many weeks does HCG rise exponentially until it plateaus?

A

10 weeks

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10
Q

How long post fertilization does the corpus lute produce progesterone?

A

6 weeks

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11
Q

What is the rate of increase in BHCG in a normal pregnancy?

A

Doubles every 48 hrs

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12
Q

What two hormones are most pregnancy sx’s due to?

A
  1. BHCG

2. Progesterone

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13
Q

Goodell’s Sign

A

Softening of cervix= 4-6 weeks gestation

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14
Q

Hegar’s Sign

A

Softening of uterine isthmus=6-8 weeks gestation

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15
Q

Chadwick’s sign

A

Bluish discoloration of cervix= 8-12 weeks gestation

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16
Q

Down syndrome findings

A
  1. Thickening of nuchal
  2. Absent fetal nasal bone
  3. Increased HCG levels @ 11-13 weeks (should plateau @ 10 weeks)
  4. Decreased Pregnancy-assoc plasma protein A (PAPP-A)
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17
Q

What does increased AFP levels indicate?

A
  1. Neural Tube defects

2. Multiple gestation

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18
Q

At how many weeks do you start to hear fetal heart tones? How many bpm is WNL?

A

Begins 10-12 weeks

120–160 bpm= WNL

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19
Q

When does fundal height begin?

A

20 weeks gestation

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20
Q

When do cervical exams begin?

A

37 weeks gestation

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21
Q

“Count to 10” method

A

Perception of 10 fetal movements (FM) over 2 hr OR 4 FM over 1 hour while mother I at rest

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22
Q

When do we start screening for GDM?

A

24-28 weeks

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23
Q

GDM Diagnosis

A
  1. 50g 1-hour glucose challenge test: Value >130=Failed test

2. 100g 3 hr GTT: > 2 abnormal results= GDM

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24
Q

When do we start screening for Rh (-)?

A

26-28 weeks

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25
Q

If a women is Rh (-), when are you going to administer RhoGAM?

A

28 weeks

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26
Q

When do we screen for Group B Strep?

A

35-37 weeks

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27
Q

Group B strep (+) treatment

A

IV Ampicillin: 2 g, then 1g q. 4hrs until delivery

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28
Q

If a women is in labor, but did not have the Group B screening, what is your treatment/management?

A

Requires empirical abx therapy

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29
Q

What organism does undercooked meat contain?

A
  1. Listeria

2. Toxoplasmosis

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30
Q

What organism does contaminated raw milk/cheese contain?

A

Brucellosis

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31
Q

When should women avoid traveling?

A

> 35 weeks

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32
Q

Define effacement

A

Thinning or shortening of the length of the cervix

Normal length= > 2.5cm

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33
Q

Define Dilation

A

Diameter of the cervical os in centimeters

Complete dilation=10cm

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34
Q

Define Presenting Part of labor

A 
Part of baby coming first through birth canal:
Vertex=Head
Breech=Feet*
Face=Transverse*
Compound=Multiple parts*

*= likely C-section

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35
Q

Define Station part of labor

A

Degree of descent of presenting part in birth canal in relationship to ischial spine:
(-)= Babies head ABOVE ischial spine
(+)= Babies head BELOW ischial spine

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36
Q

Define the First Stage of Labor

A

Interval between onset of labor and full cervical dilation and effacement

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37
Q

Define the Latent Phase in the First Stage of Labor

A

Begins with first regular contractions
Ends @ 3-4 cm dilation
Rate of dilation=<0.5 cm/hr

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38
Q

Define the Active Phase in the First Stage of Labor

A

Dilation rate increases to 1 cm/hr

Ends with complete dilation

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39
Q

Define the Second Stage of labor

A

Begins with complete dilation and ends with delivery of infant

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40
Q

Define the Third Stage of labor

A

Begins with delivery of infant

Ends with Delivery of Placenta (<30 minutes after delivery)

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41
Q

What does Late Deceleration in Fetal HR during labor indicate?

A
  1. Fetal Hypoxia
  2. Placental Insufficiency
  3. Maternal Hypotension/Hypoxia

*Need to deliver the baby right away

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42
Q

What indicates Hypocontractile uterine activity (Power)?

A
  1. <3 contractions in 10 mins
  2. Contraction <50 secs
  3. <200-250 MVUs
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43
Q

Solution/Tx for Hypocontractile uterine activity (Power)?

A

Pitocin: Augments labor

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44
Q

What is the MC complication in EARLY pregnancy?

A

Abortion (<20 weeks)

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45
Q

What is the MCC for abortion?

A

Chromosomal abnormalities

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46
Q

Define Threatened AB

A

Vaginal Bleeding with CLOSED cervix

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47
Q

Define Inevitable AB

A

Vaginal Bleeding with OPEN cervix

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48
Q

Define Incomplete AB

A

Products of conception partially passed

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49
Q

Define Complete AB

A

Passage of entire conceptus

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50
Q

Define Missed AB

A

Pregnancy retained despite death of fetus

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51
Q

Define Septic AB

A

Recent spontaneous AB complicated by intrauterine infection

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52
Q

AB RF’s

A
  1. Advanced Maternal Age
  2. Prior spontaneous AB
  3. Multigravity
  4. Alcohol
  5. Illicit drug use
  6. Smoking
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53
Q

AB clinical presentation

A
  1. Vaginal bleeding
  2. Pelvic pain
  3. Incidental finding on US
54
Q

Abortion Treatment

A
  1. Surgical: D&C

2. Medical: Misoprostol

55
Q

What test do you need to repeat following an AB?

A
  1. Pregnancy Test: 2 weeks later

2. US: 24 hrs later if took Misoprostol

56
Q

Septic AB si/sx’s

A
  1. Recent spontaneous AB
  2. Systemic sx’s: Fever, chills, malaise
  3. Abd pain
  4. Vaginal bleeding
  5. Malodorous vaginal discharge
57
Q

Septic AB treatment

A
  1. IV abx: Cefoxitin + Doxycycline

2. Afebrile x48 hrs: D/C home with oral abx x2 weeks

58
Q

List the Medical option in an Elective AB. How many days of gestation can you only use this in?

A

Day 1: Mifepristone 200 mcg
24-48 hrs later: Misoprostal 800 mcg buccally

*Only for pregnancies up to 70 days gestation

59
Q

List the Surgical option in an Elective AB during the 1st trimester

A

Suction Curettage

60
Q

Lis the Surgical option in an Elective AB during the 2nd trimester

A

Dilation and Evacuation (D&E): Laminaria (osmotic dilators) placed w/in endocervix 24-48h prior to procedure

61
Q

Postabortal Syndrome sx’s

A
  1. Immediate Abd pain w/in 1 hr of procedure
  2. Large Globular Uterus on bimanual exam
  3. Tacychardia
  4. Nausea, diaphoresis
62
Q

Postabortal Syndrome treatment

A
  1. Methergine 0.2 mg IM

2. D&C

63
Q

Where does the majority of ectopic pregnancies occur?

A

Fallopian tube=98%

64
Q

Ectopic Pregnancy RF’s

A
  1. Prior ectopic pregnancy: 15% recurrence, 2nd ectopic=30% recurrence
  2. Previous tubal surgery
  3. Hx PID
65
Q

Ectopic si/sx’s

A
  1. Pelvic/Abd pain=95%
  2. Vaginal bleeding
  3. Orthostatic sx’s d/t blood loss: dizziness, syncope, weakness
66
Q

What do you medication do you give in an ectopic pregnancy? And what are the 3 criteria’s the women must meet in order to administer this?

A 
Methotrexate IM
Criteria: 
1. HCG <5,000
2. No cardiac activity 
3. Sac < 4 cm
67
Q

How do you check to see if the methotrexate was successful?

A

HCG on days 4 & 7

Successful= >15% HCG decline

68
Q

CI to Methotrexate

A
  1. Renal/liver/pulmonary compromise
  2. @ risk for loss to f/u
  3. Breastfeeding
  4. Heterotopic pregnancy (pregnancy in the uterus AND ectopic)
  5. Immnodeficiency
69
Q

Surgical Indications in an ectopic pregnancy

A
  1. Hemodynamically unstable
  2. Impending or active rupture
  3. Methotrexate failure
  4. Heterotopic pregnancy
70
Q

Gestational Trophoblastic Disease RF’s

A
  1. Previous molar pregnancy
  2. Advanced maternal age
  3. Asian/American
71
Q

Gestational Trophoblastic Disease Clinical Presentation

A
  1. Abnormal bleeding/amenorrhea
  2. Uterine size greater than dates
  3. Pre-eclampsia like sx’s: HTN, proteinuria
  4. Absent fetal heart tones
72
Q

US findings in Gestational Trophoblastic Disease

A

“Snow storm” or “Grape-like clusters” w/in endometrium

73
Q

What is the MC Gestational Trophoblastic Disease?

A

Hydatiform Mole=80%

74
Q

List the two types of Hydatiform Moles

A

Increased paternal genes:

  1. Complete= 2:O, Paternal Chromosome: Maternal Chromosome
  2. Incomplete= 2:1 Paternal Chromosome: Maternal Chromosome
75
Q

Hydatiform Moles treatment

A
  1. D&C
  2. Monitor hCG levels x6-12 months
  3. Avoid pregnancy x12 months
76
Q

Define Choriocarcinoma

A

Highly malignant epithelial tumor: Vascular invasion & widespread METS

77
Q

Causes for Choriocarcinoma

A
  1. Persistent complete hydatiform mole

2. Can follow any type of pregnancy: AB, Ectopic, Normal pregnancy

78
Q

Choriocarcinoma treatment

A

Chemo vs.

Hysterectomy + Chemo

79
Q

Placental Abruption clinical presentation

A
  1. ABRUPT PAINFUL* VAGINAL BLEEDING (after 20 weeks gestation)
  2. Abd/back pain
  3. Contractions
80
Q

Placental Abruption Treatment

A

Stable=Expectant management

Unstable Mother/Fetus= C-section

81
Q

Placenta Previa clinical presentation

A
  1. PAINLESS vaginal bleeding after 20 weeks gestation
82
Q

What should you NEVER do in a women with placenta previa? Why?

A

Never perform cervical exam

Can cause hemorrhage

83
Q

Placenta Previa treatment in symptomatic patients

A
  1. Admit to hospital for monitoring

2. C-Section: Complete placenta previa, consider in Partial if mother/fetus becomes unstable

84
Q

What is the MCC for pre-term delivery?

A

Premature Rupture of Membrane

85
Q

What is the main risk factor for Premature Rupture of Membrane?

A

Genital tract infection: Bacterial Vaginosis

86
Q

Premature Rupture of Membrane clinical presentation

A

“gush” of clear or pale yellow fluid from vagina

87
Q

Diagnostic findings in Premature Rupture of Membrane

A
  1. “Ferning” of fluid under microscope
  2. Vaginal fluid pH= 7.0-7.3
    • AFP
88
Q

Premature Rupture of Membrane treatment

A
  1. Corticosteroids: Promote lung maturity <34 wks

2. If GBS status unknown, administer abx

89
Q

What is the MCC of postpartum hemorrhage?

A

Uterine atony: lack of effective contractions following delivery

90
Q

Postpartum hemorrhage treatment

A
  1. Uterine massage
  2. Meds: Oxytocin, Misoprostol, Methergine
  3. Transfusion
  4. Surgery
91
Q

What does intertwine membrane “lambda sign” on an US indicate?

A

Dichorionic twins

92
Q

What does intertwine membrane “T sign” on an US indicate?

A

Monochorionic twins

93
Q

What is the most serious complication of multiple gestation? What type of twins does this occur in?

A

Twin-Twin Tranfusion Syndrome: Fetuses share one placenta where the blood supply is unevenly distributed

*Monochorionic gestation only=”Identical twins”

94
Q

Define Pregnancy-induced HTN

A

New HTN (>140/90) presenting after 20 weeks gestation with NO proteinuria

95
Q

Define mild pre-eclampisa

A
  1. New HTN (>140/90) presenting after 20 weeks gestation AND
  2. Proteinuria of 0.3g or greater in 24-hr urine
96
Q

Define severe pre-eclampisa

A
  1. > 160/110 BP
  2. Oliguria <500 cc in 24 hrs
  3. 3+ Proteinuria (5+ grams on 24 hr urine)
  4. End organ damage
  5. Fetal compromise
97
Q

Pre-Eclampsia clinical presentation

A
  1. HTN
  2. HA
  3. Visual sx’s: blurred vision, flashing lights (photopsia)
  4. Edema (pulmonary)
  5. Hyperreflexia
  6. Oliguria
98
Q

Pre-Eclampsia with SEVERE features

A

HELLP:
Hemolysis
Elevated Liver enzymes
Low platelet count

99
Q

According to ACOG, when do we treat HTN in pre-eclampsia? Which antihypertensives?

A

SBP >160 or DBP > 105

1st line: Labetalol, Nifedipine, Methyldopa

100
Q

Treatment for failed management of severe pre-eclampsia or eclampsia

A
  1. IV Labetalol or Hydralazine
  2. Bethamethasone <34 wks gestation: Enhance fetal lung maturity
  3. MgSO4

*Prompt deliver if the above treatments fail

101
Q

What is the MC medical complication in pregnancy?

102
Q

What complication are you at a 2 fold increased risk for in GDM?

A

Pregnancy-induced HTN

103
Q

1st line tx in GDM?

104
Q

Goal fasting blood glucose? 2-hr postprandial?

A

FBG= <95-105

2-hr PP= <120

105
Q

List the RhoGAM dosing schedule in Rh (-) women. And indication for administering in Rh (-) women

A

Mothers who are NOT alloimmunized=AB (-)
1st dose=28w gestation
2nd dose=w/in 72 hrs. of delivery of Rh (+) infant

106
Q

List the other indications for administering RhoGAM

A
  1. Amniocentesis
  2. Ectopic Pregnancy
  3. Spontaneous or Induced AB
  4. Bleeding during pregnancy

*Only give half the dose if <28w

107
Q

Treatment of hemolytic disease of fetus or newborn (HDFN)

A
  1. Intrauterine transfusion

2. Early delivery

108
Q

Define Frank Breech

A

MC*

Both hips flexed with knees extended so feet adjacent to head

109
Q

Define Complete Breech

A

Both hips and knees are flexed

110
Q

Define Incomplete Breech

A

One or both hips are NOT completely flexed

111
Q

Breech treatment

A
  1. External cephalic versionperformed @ 34-35w

2. C-section

112
Q

Cord Prolapse Tx

A

EMERGENT C-Section

113
Q

Define Dystocia

A

Abnormal labor: Cervix fails to dilate progressively over time and fetus fails to descend

114
Q

What causes Dystocia?

A

3 P’s:

  1. Power: Inadequate uterine contractions
  2. Passenger: Abnormal fetal lie, presentation, or large head
  3. Pelvis: Cephalopelvic disproportion-pelvis now large enough to allow infant to pass
115
Q

Dystocia treatment

A
  1. Oxytocin
  2. Forceps
  3. Vacuum
  4. C-Section
116
Q

Toxoplasmosis etiology

A

Contact with cat feces or poorly cooked meat

117
Q

Toxoplasmosis clinical presentation

A

Classic Triad:

  1. Chorioretinitis
  2. Hydrocephalus
  3. Intracranial Calcifications
118
Q

Toxoplasmosis Treatment

A

Pyrimethamine x 1yr
Sulfadiazine x 1 yr
Folinic Acid x 1 yr

119
Q

What is the transmission rate of syphilis?

120
Q

Early syphilis dz?

A
  1. Blood tinged nasal secretions
  2. Saddle nose: 2ry to syphilitic rhinitis
  3. Diffuse osteochondritis
121
Q

Late syphilis dz?

A
  1. Hutchinson teeth: notching of permanent incisiors

2. Saber shin: anterior bowing of tibia

122
Q

What is the rubella transmission rate in the 1st trimester? 2nd trimester?

A

1st trimester=80%

2nd trimester=50%

123
Q

What are the two main clinical presentations in Rubella?

A
  1. Hearing loss

2. Blueberry muffin rash: purpuric skin lesions

124
Q

What is the #1 congenital infection and #1 cause for sensorineural hearing loss?

125
Q

CMV clinical presentation

A
  1. Microcephaly
  2. IUGR
  3. Severe mental retardation
  4. Intracranial calcifications, chorioretinitis (also see in toxoplasmosis)
126
Q

What is the rate of HSV transmission during a vaginal delivery? How can you prevent this? Tx?

A

50% transmission
Prevention: C-section
Tx: Acyclovir

127
Q

What are the major complications of HSV in infants?

A
  1. Meningitis

2. Encephalitis

128
Q

What are “reassuring” acceleration in a fetal HR?

A

> 32 wks: 15 bpm lasting 15 seconds or longer

<32 wks: 10 bpm lasting 15 seconds or longer

129
Q

Define Postpartum Blues

A

Sx’s begin 2-3 days after delivery and resolve WITHIN 2 weeks of onset
Self-limiting

130
Q

Define Postpartum Depression

A
  1. Sx’s begin DURING pregnancy OR
    w/in 4 weeks post-delivery
  2. Requires @ least 5 mood & cognitive sx’s for @ least 2 consecutive weeks
  3. 1 sx must either be: Depressed mood or loss of interest in pleasure
131
Q

When do you screen for postpartum depression? What do you use?

A

Edinburgh Postnatal Depression Scale
ALL postpartum women (4-8wks) regardless of sx’s
NOT used to dx

Foundations-Women's Health (8 decks)

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