OB and Pregnancy Pearls

Question 1

Physical exam of first trimester, second trimester, third trimester

Answer 1

1: Goodell’s sign, Chadwick’s sign, Hegar’s sign, breast enlargement, fetal heart tones by 10-12 weeks)
2: fetal movement by 18-20 weeks, striae, fundus palpable at umbilicus at 20 weeks (1cm per week thereafter), Leopold maneuvers possible after 20 weeks
3: Lightening, loss of mucous plug about 1 week before labor

Question 2

Goodell’s sign

Answer 2

softening of cervix

by 8 weeks

Question 3

Chadwick’s sign

Answer 3

Cervical cyanosis

by 8 weeks

Question 4

Hegar’s sign

Answer 4

Softening of cervicouterine junction

by 8 weeks

Question 5

Leopold’s maneuvers

Answer 5

feel position of baby’s body inside the mom

possible after 20 weeks

Question 6

Diagnostic tests for pregnancy: first trimester

Answer 6

Pregnancy test
Ultrasound
UA, C and S
CBC, blood group, Rh
Antibody screening
Rubella
Syphilis, HIV, Hep B screening
PAP with cervical cultures and STI screening
Chorionic villus sampling (CVS)

Question 7

Diagnostic tests for pregnancy: Second trimester

Answer 7

Amniocentesis at 15 to 20 weeks for AMA or family hx
Triple or Quad screen at 16-20 weeks (estriol, hCG, alpha-fetoprotein), inhibin-A
US for fetal survey at 18-20 weeks
1 hour GTT at 20 weeks if family hx or weight >200 lbs

Question 8

Diagnostic tests in pregnancy: Third trimester

Answer 8

1 hour GTT at 28 weeks
RhoGAM for unsensitized Rh negative mothers at 28 weeks
H and H at 28-36 weeks dependent on previous levels
Nonstress test (NST)/Biophysical profile (BPP) as needed for assessment of fetal well being

Question 9

Scheduling of prenatal visits

Answer 9

0-28 weeks: every 4 weeks
28-36 weeks: every 2 weeks
36 weeks to delivery: every week

Question 10

Naegele’s rule

Answer 10

9 months - 3 months + 7 days from last menstrual cycle to determine due date

Question 11

At all routine OB visits:

Answer 11

BP, weight, fundal height in cm, fetal movement, presentation, fetal lie position
Labs: routine, plus urine for protein, glucose, and ketones

Question 12

Ectopic pregnancy

Answer 12

spotting, dark tarry blood, with pain

check: serum hCG, CBC, type, Rh, US
tx: Refer; will need Rhogam if Rh negative

Question 13

Abortion

Answer 13

Surgical: Vacuum D and C to 12 weeks
D and E: 13-22 weeks
Medical: (through 49 days’ pregnancy)- mifepristone (abortion), misoprostol (evacuation)

Question 14

Hypertensive disorders of pregnancy

Answer 14

PIH (BP >140/90 or >30/15 past baseline on 2 occasions at least 6 hours apart)
Preeclampsia (PIH plus proteinuria and generalized edema after 20 weeks gestation)
Eclampsia (preeclampsia plus seizures)
HELLP (Hemolysis Elevated Liver enzymes and Low Platelet count)

Question 15

Management of PIH

Answer 15

Bed rest at home in left lateral recumbent position

NST, US, and kick counts to monitor fetal activity

Question 16

Placenta Previa

Answer 16

mal-implantation of placenta
late 2nd to early 3rd trimester
often preceded by vaginal intercourse
PAINLESS bleeding
little to no fetal compromise
hospitalize, vaginal rest

Question 17

Abruptio Placentae

Answer 17

Separation of placenta from uterine wall
2nd or 3rd trimester
sudden, acute, life threatening hemorrhage
possible cause: trauma, chronic HTN, cocaine, alcohol, cigarettes
PAINFUL bright red bleeding, signs of shock
Admit

Question 18

Premature Labor

Answer 18

Contractions after 20 weeks, before 37 weeks
Hospitalize if unable to stop contractions prior to cervical change
Tocolytic therapy (terbutaline); if less than 34 weeks, B-methasone (steroid) injections twice a week to enhance fetal lung maturity
Bed rest, vaginal rest, weekly cervical checks

Question 19

Symptoms of first trimester, second trimester, and third trimester

Answer 19

1: (0-12 weeks): amenorrhea, nausea, vomiting, fatigue, breast tenderness, urinary frequency
2: (13-27 weeks): fetal movement, abdominal discomfort secondary to stretching, change in skin pigmentation, syncopal episodes
3: (28-40 weeks): abdominal growth, Braxton-Hicks, urinary frequency (lightening), increased respiratory effort