OB and Pregnancy Pearls Flashcards
Physical exam of first trimester, second trimester, third trimester
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
Goodell’s sign
softening of cervix
by 8 weeks
Chadwick’s sign
Cervical cyanosis
by 8 weeks
Hegar’s sign
Softening of cervicouterine junction
by 8 weeks
Leopold’s maneuvers
feel position of baby’s body inside the mom
possible after 20 weeks
Diagnostic tests for pregnancy: first trimester
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)
Diagnostic tests for pregnancy: Second trimester
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
Diagnostic tests in pregnancy: Third trimester
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
Scheduling of prenatal visits
0-28 weeks: every 4 weeks
28-36 weeks: every 2 weeks
36 weeks to delivery: every week
Naegele’s rule
9 months - 3 months + 7 days from last menstrual cycle to determine due date
At all routine OB visits:
BP, weight, fundal height in cm, fetal movement, presentation, fetal lie position
Labs: routine, plus urine for protein, glucose, and ketones
Ectopic pregnancy
spotting, dark tarry blood, with pain
check: serum hCG, CBC, type, Rh, US
tx: Refer; will need Rhogam if Rh negative
Abortion
Surgical: Vacuum D and C to 12 weeks
D and E: 13-22 weeks
Medical: (through 49 days’ pregnancy)- mifepristone (abortion), misoprostol (evacuation)
Hypertensive disorders of pregnancy
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)
Management of PIH
Bed rest at home in left lateral recumbent position
NST, US, and kick counts to monitor fetal activity
Placenta Previa
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
Abruptio Placentae
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
Premature Labor
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
Symptoms of first trimester, second trimester, and third trimester
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
