OB Flashcards
1
Q
Define embryo
A
Fertilization to 8th week of pregnancy
2
Q
Defie fetus
A
9th week of pregnancy to birth
3
Q
Define neonate
A
live born from birth to 28 days old
4
Q
First trimester
A
1-12 weeks
5
Q
second trimester
A
13-28 weeks
6
Q
Third trimester
A
28-40 weeks
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
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
9
Q
How many weeks does HCG rise exponentially until it plateaus?
A
10 weeks
10
Q
How long post fertilization does the corpus lute produce progesterone?
A
6 weeks
11
Q
What is the rate of increase in BHCG in a normal pregnancy?
A
Doubles every 48 hrs
12
Q
What two hormones are most pregnancy sx’s due to?
A
- BHCG
2. Progesterone
13
Q
Goodell’s Sign
A
Softening of cervix= 4-6 weeks gestation
14
Q
Hegar’s Sign
A
Softening of uterine isthmus=6-8 weeks gestation
15
Q
Chadwick’s sign
A
Bluish discoloration of cervix= 8-12 weeks gestation
16
Q
Down syndrome findings
A
- Thickening of nuchal
- Absent fetal nasal bone
- Increased HCG levels @ 11-13 weeks (should plateau @ 10 weeks)
- Decreased Pregnancy-assoc plasma protein A (PAPP-A)
17
Q
What does increased AFP levels indicate?
A
- Neural Tube defects
2. Multiple gestation
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
19
Q
When does fundal height begin?
A
20 weeks gestation
20
Q
When do cervical exams begin?
A
37 weeks gestation
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
22
Q
When do we start screening for GDM?
A
24-28 weeks
23
Q
GDM Diagnosis
A
- 50g 1-hour glucose challenge test: Value >130=Failed test
2. 100g 3 hr GTT: > 2 abnormal results= GDM
24
Q
When do we start screening for Rh (-)?
A
26-28 weeks
25
If a women is Rh (-), when are you going to administer RhoGAM?
28 weeks
26
When do we screen for Group B Strep?
35-37 weeks
27
Group B strep (+) treatment
IV Ampicillin: 2 g, then 1g q. 4hrs until delivery
28
If a women is in labor, but did not have the Group B screening, what is your treatment/management?
Requires empirical abx therapy
29
What organism does undercooked meat contain?
1. Listeria
| 2. Toxoplasmosis
30
What organism does contaminated raw milk/cheese contain?
Brucellosis
31
When should women avoid traveling?
>35 weeks
32
Define effacement
Thinning or shortening of the length of the cervix
| Normal length= > 2.5cm
33
Define Dilation
Diameter of the cervical os in centimeters
| Complete dilation=10cm
34
Define Presenting Part of labor
```
Part of baby coming first through birth canal:
Vertex=Head
Breech=Feet*
Face=Transverse*
Compound=Multiple parts*
```
*= likely C-section
35
Define Station part of labor
Degree of descent of presenting part in birth canal in relationship to ischial spine:
(-)= Babies head ABOVE ischial spine
(+)= Babies head BELOW ischial spine
36
Define the First Stage of Labor
Interval between onset of labor and full cervical dilation and effacement
37
Define the Latent Phase in the First Stage of Labor
Begins with first regular contractions
Ends @ 3-4 cm dilation
Rate of dilation=<0.5 cm/hr
38
Define the Active Phase in the First Stage of Labor
Dilation rate increases to 1 cm/hr
| Ends with complete dilation
39
Define the Second Stage of labor
Begins with complete dilation and ends with delivery of infant
40
Define the Third Stage of labor
Begins with delivery of infant
| Ends with Delivery of Placenta (<30 minutes after delivery)
41
What does Late Deceleration in Fetal HR during labor indicate?
1. Fetal Hypoxia
2. Placental Insufficiency
3. Maternal Hypotension/Hypoxia
*Need to deliver the baby right away
42
What indicates Hypocontractile uterine activity (Power)?
1. <3 contractions in 10 mins
2. Contraction <50 secs
3. <200-250 MVUs
43
Solution/Tx for Hypocontractile uterine activity (Power)?
Pitocin: Augments labor
44
What is the MC complication in EARLY pregnancy?
Abortion (<20 weeks)
45
What is the MCC for abortion?
Chromosomal abnormalities
46
Define Threatened AB
Vaginal Bleeding with CLOSED cervix
47
Define Inevitable AB
Vaginal Bleeding with OPEN cervix
48
Define Incomplete AB
Products of conception partially passed
49
Define Complete AB
Passage of entire conceptus
50
Define Missed AB
Pregnancy retained despite death of fetus
51
Define Septic AB
Recent spontaneous AB complicated by intrauterine infection
52
AB RF's
1. Advanced Maternal Age
2. Prior spontaneous AB
3. Multigravity
4. Alcohol
5. Illicit drug use
6. Smoking
53
AB clinical presentation
1. Vaginal bleeding
2. Pelvic pain
3. Incidental finding on US
54
Abortion Treatment
1. Surgical: D&C
| 2. Medical: Misoprostol
55
What test do you need to repeat following an AB?
1. Pregnancy Test: 2 weeks later
| 2. US: 24 hrs later if took Misoprostol
56
Septic AB si/sx's
1. Recent spontaneous AB
2. Systemic sx's: Fever, chills, malaise
3. Abd pain
4. Vaginal bleeding
5. Malodorous vaginal discharge
57
Septic AB treatment
1. IV abx: Cefoxitin + Doxycycline
| 2. Afebrile x48 hrs: D/C home with oral abx x2 weeks
58
List the Medical option in an Elective AB. How many days of gestation can you only use this in?
Day 1: Mifepristone 200 mcg
24-48 hrs later: Misoprostal 800 mcg buccally
*Only for pregnancies up to 70 days gestation
59
List the Surgical option in an Elective AB during the 1st trimester
Suction Curettage
60
Lis the Surgical option in an Elective AB during the 2nd trimester
Dilation and Evacuation (D&E): Laminaria (osmotic dilators) placed w/in endocervix 24-48h prior to procedure
61
Postabortal Syndrome sx's
1. Immediate Abd pain w/in 1 hr of procedure
2. Large Globular Uterus on bimanual exam
3. Tacychardia
4. Nausea, diaphoresis
62
Postabortal Syndrome treatment
1. Methergine 0.2 mg IM
| 2. D&C
63
Where does the majority of ectopic pregnancies occur?
Fallopian tube=98%
64
Ectopic Pregnancy RF's
1. Prior ectopic pregnancy: 15% recurrence, 2nd ectopic=30% recurrence
2. Previous tubal surgery
3. Hx PID
65
Ectopic si/sx's
1. Pelvic/Abd pain=95%
2. Vaginal bleeding
3. Orthostatic sx's d/t blood loss: dizziness, syncope, weakness
66
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?
```
Methotrexate IM
Criteria:
1. HCG <5,000
2. No cardiac activity
3. Sac < 4 cm
```
67
How do you check to see if the methotrexate was successful?
HCG on days 4 & 7
| Successful= >15% HCG decline
68
CI to Methotrexate
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
Surgical Indications in an ectopic pregnancy
1. Hemodynamically unstable
2. Impending or active rupture
3. Methotrexate failure
4. Heterotopic pregnancy
70
Gestational Trophoblastic Disease RF's
1. Previous molar pregnancy
2. Advanced maternal age
3. Asian/American
71
Gestational Trophoblastic Disease Clinical Presentation
1. Abnormal bleeding/amenorrhea
2. Uterine size greater than dates
3. Pre-eclampsia like sx's: HTN, proteinuria
4. Absent fetal heart tones
72
US findings in Gestational Trophoblastic Disease
"Snow storm" or "Grape-like clusters" w/in endometrium
73
What is the MC Gestational Trophoblastic Disease?
Hydatiform Mole=80%
74
List the two types of Hydatiform Moles
Increased paternal genes:
1. Complete= 2:O, Paternal Chromosome: Maternal Chromosome
2. Incomplete= 2:1 Paternal Chromosome: Maternal Chromosome
75
Hydatiform Moles treatment
1. D&C
2. Monitor hCG levels x6-12 months
3. Avoid pregnancy x12 months
76
Define Choriocarcinoma
Highly malignant epithelial tumor: Vascular invasion & widespread METS
77
Causes for Choriocarcinoma
1. Persistent complete hydatiform mole
| 2. Can follow any type of pregnancy: AB, Ectopic, Normal pregnancy
78
Choriocarcinoma treatment
Chemo vs.
| Hysterectomy + Chemo
79
Placental Abruption clinical presentation
1. ABRUPT PAINFUL* VAGINAL BLEEDING (after 20 weeks gestation)
2. Abd/back pain
3. Contractions
80
Placental Abruption Treatment
Stable=Expectant management
| Unstable Mother/Fetus= C-section
81
Placenta Previa clinical presentation
1. PAINLESS vaginal bleeding after 20 weeks gestation
82
What should you NEVER do in a women with placenta previa? Why?
Never perform cervical exam
| Can cause hemorrhage
83
Placenta Previa treatment in symptomatic patients
1. Admit to hospital for monitoring
| 2. C-Section: Complete placenta previa, consider in Partial if mother/fetus becomes unstable
84
What is the MCC for pre-term delivery?
Premature Rupture of Membrane
85
What is the main risk factor for Premature Rupture of Membrane?
Genital tract infection: Bacterial Vaginosis
86
Premature Rupture of Membrane clinical presentation
"gush" of clear or pale yellow fluid from vagina
87
Diagnostic findings in Premature Rupture of Membrane
1. "Ferning" of fluid under microscope
2. Vaginal fluid pH= 7.0-7.3
3. + AFP
88
Premature Rupture of Membrane treatment
1. Corticosteroids: Promote lung maturity <34 wks
| 2. If GBS status unknown, administer abx
89
What is the MCC of postpartum hemorrhage?
Uterine atony: lack of effective contractions following delivery
90
Postpartum hemorrhage treatment
1. Uterine massage
2. Meds: Oxytocin, Misoprostol, Methergine
3. Transfusion
4. Surgery
91
What does intertwine membrane "lambda sign" on an US indicate?
Dichorionic twins
92
What does intertwine membrane "T sign" on an US indicate?
Monochorionic twins
93
What is the most serious complication of multiple gestation? What type of twins does this occur in?
Twin-Twin Tranfusion Syndrome: Fetuses share one placenta where the blood supply is unevenly distributed
*Monochorionic gestation only="Identical twins"
94
Define Pregnancy-induced HTN
New HTN (>140/90) presenting after 20 weeks gestation with NO proteinuria
95
Define mild pre-eclampisa
1. New HTN (>140/90) presenting after 20 weeks gestation AND
2. Proteinuria of 0.3g or greater in 24-hr urine
96
Define severe pre-eclampisa
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
Pre-Eclampsia clinical presentation
1. HTN
2. HA
3. Visual sx's: blurred vision, flashing lights (photopsia)
4. Edema (pulmonary)
5. Hyperreflexia
6. Oliguria
98
Pre-Eclampsia with SEVERE features
HELLP:
Hemolysis
Elevated Liver enzymes
Low platelet count
99
According to ACOG, when do we treat HTN in pre-eclampsia? Which antihypertensives?
SBP >160 or DBP > 105
| 1st line: Labetalol, Nifedipine, Methyldopa
100
Treatment for failed management of severe pre-eclampsia or eclampsia
1. IV Labetalol or Hydralazine
2. Bethamethasone <34 wks gestation: Enhance fetal lung maturity
3. MgSO4
*Prompt deliver if the above treatments fail
101
What is the MC medical complication in pregnancy?
GDM
102
What complication are you at a 2 fold increased risk for in GDM?
Pregnancy-induced HTN
103
1st line tx in GDM?
Insulin
104
Goal fasting blood glucose? 2-hr postprandial?
FBG= <95-105
| 2-hr PP= <120
105
List the RhoGAM dosing schedule in Rh (-) women. And indication for administering in Rh (-) women
Mothers who are NOT alloimmunized=AB (-)
1st dose=28w gestation
2nd dose=w/in 72 hrs. of delivery of Rh (+) infant
106
List the other indications for administering RhoGAM
1. Amniocentesis
2. Ectopic Pregnancy
3. Spontaneous or Induced AB
4. Bleeding during pregnancy
*Only give half the dose if <28w
107
Treatment of hemolytic disease of fetus or newborn (HDFN)
1. Intrauterine transfusion
| 2. Early delivery
108
Define Frank Breech
MC*
| Both hips flexed with knees extended so feet adjacent to head
109
Define Complete Breech
Both hips and knees are flexed
110
Define Incomplete Breech
One or both hips are NOT completely flexed
111
Breech treatment
1. External cephalic versionperformed @ 34-35w
| 2. C-section
112
Cord Prolapse Tx
EMERGENT C-Section
113
Define Dystocia
Abnormal labor: Cervix fails to dilate progressively over time and fetus fails to descend
114
What causes Dystocia?
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
Dystocia treatment
1. Oxytocin
2. Forceps
3. Vacuum
4. C-Section
116
Toxoplasmosis etiology
Contact with cat feces or poorly cooked meat
117
Toxoplasmosis clinical presentation
Classic Triad:
1. Chorioretinitis
2. Hydrocephalus
3. Intracranial Calcifications
118
Toxoplasmosis Treatment
Pyrimethamine x 1yr
Sulfadiazine x 1 yr
Folinic Acid x 1 yr
119
What is the transmission rate of syphilis?
100%
120
Early syphilis dz?
1. Blood tinged nasal secretions
2. Saddle nose: 2ry to syphilitic rhinitis
3. Diffuse osteochondritis
121
Late syphilis dz?
1. Hutchinson teeth: notching of permanent incisiors
| 2. Saber shin: anterior bowing of tibia
122
What is the rubella transmission rate in the 1st trimester? 2nd trimester?
1st trimester=80%
| 2nd trimester=50%
123
What are the two main clinical presentations in Rubella?
1. Hearing loss
| 2. Blueberry muffin rash: purpuric skin lesions
124
What is the #1 congenital infection and #1 cause for sensorineural hearing loss?
CMV
125
CMV clinical presentation
1. Microcephaly
2. IUGR
3. Severe mental retardation
4. Intracranial calcifications, chorioretinitis (also see in toxoplasmosis)
126
What is the rate of HSV transmission during a vaginal delivery? How can you prevent this? Tx?
50% transmission
Prevention: C-section
Tx: Acyclovir
127
What are the major complications of HSV in infants?
1. Meningitis
| 2. Encephalitis
128
What are "reassuring" acceleration in a fetal HR?
>32 wks: 15 bpm lasting 15 seconds or longer
| <32 wks: 10 bpm lasting 15 seconds or longer
129
Define Postpartum Blues
Sx's begin 2-3 days after delivery and resolve WITHIN 2 weeks of onset
Self-limiting
130
Define Postpartum Depression
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
When do you screen for postpartum depression? What do you use?
Edinburgh Postnatal Depression Scale
ALL postpartum women (4-8wks) regardless of sx's
NOT used to dx
