OB Block 2 Cram Flashcards
When is the first pregnancy visit needed and when are f/us needed?
How is the obstetric conjugate estimated?
Fist: 10-12wks EGA
Until 27wks: q4wks
28-36wks: q2wks
+36wks: q2wk
Inferior pubic symphisis to sacral promontory:
Diagonal conjugate - 2.5cm= +10cm
Preferred pelvis types for vaginal delivery?
Midpelvis is measured at ? and during labor are called ?
Gynecoid*
Anthropoid
Ischial spine
Stations
Mid pelvis and ischial spine make up ? labor start point?
Why is the interspinous diameter important?
Station 0
Above= neg numbers
Below= pos numbers
Obstructed/arrested labor point
When would GA be adjusted to an US date?
What are the two layers of the Double Decidua Sign and the importance?
<9wks old w/ >5d difference
9-14wk old w/ >1wk difference
D Parietalis
D Capsularis
First/earliest sign of intrauterine pregnancy
What is TORCH
What are the Others?
Toxoplasmosis Other Rubella
CMV HSV
Coxsackie Chicken C/G
HIV HTV HBV
GBS TB Bacteriuria Zika Syphilis
What are the RNA viruses in this block?
What are the DNA viruses?
Rubella HIV (retrovirus)
CMV HSV Varicella HBV
Toxoplasmosis infection can lead to ? in the baby
How is this type of infection Tx
Microcephaly
Spiramycin- PT only
Pyrimethamin Sulfa w/ FA- PT and baby
When does a CMV infection become a possibility?
How is a Dx made but w/ ? cautious info?
Mono-like
Hydrops IUGR CNS abnormality on US
Serology- IgM x 2yrs
When are pregnant PTs not screened for GBS?
What are the risk-factor strategies?
GBS bacteriuria this pregnancy
Previously infected infant
FBIRD Fever Bacteriuria Infected infant Ruptured +18hrs Delivered <37wks
When is intrapartum prophylaxis indicated for GBS
BUIC Bacturemia Unknown (DRNF) Infected infant Culture pos
DRNF Delivered <37wks Ruptured >18hrs NAAT Pos Fever >100.4
When is intrapartum GBS prophylaxis not needed?
Previous pregnancy w/ +culture
Planned c-section
Neg vag/rectal cultures during this pregnancy
When are pregnant PTs screened for bacteriuria?
What ABX are used for empiric Tx?
What can this progress into and how is it Tx?
All PTs at new OB appt w/ UA and culture
Nitro Amox Amp w/ Test of Cure after completion of ABX
Leading cause of septic shock during pregnancy:
Pyelonephritis Tx InPt w/ IV ABX
Pregnant PTs need to be cautious and not exceed daily limits of ? vitamins?
Why is it recommended to be on folic acid prior to conception?
How much is recommended?
Iron Zinc Selenium
A B6 C D
NT closes on day 28
400-800mcg/day ideally 12wks prior
When would PTs be recommended to increase daily folate to 4mg?
What meds are c/i during pregnancy?
Valproate/Carbamazepine
Hx of NTD
T1DM
BMI >35
100 IS CAT
>100mg/day ASA Isotretinoin Sulfonamides Coumadin ACEIs Tetracyclines
What is the leading cause of preventable developmental disabilities?
What are the discriminating features of FAS?
FAS
Flat midface
Indistinct philtrum
Thin upper lip
Short fissures/nose
When/why would sex need to be avoided during pregnancy?
What dental issue is linked to increased risk of preterm labor?
Miscarriage risk/hx
Placenta previa
Premature labor
Peridontal dz
When are domestic violence screenings conducted?
When to screen for depression or behavioral health w/ ? questionnaire?
First prenatal visit
One/trimester
Post-partum visits
Once during perinatal period
Edinburgh post-natal depression
When is breast feeding c/i?
What are the emergent return criteria for PTs >20wks EGA?
HIV Lithium Dependence Active TB
Contractions q3-5min
Membrane rupture
Vaginal bleeding
What criteria need to be met for an elective delivery to be considered?
What may be the first test ordered at the first prenatal appointment?
FHTs in past 30wks
US dating supports
HCG at 36wks prior
Not before 39wks
hCG confirmation test
What is the quick time frame milestones for prenatal care by week?
FQAFGRO 10: Doppler FHT 18: quickening 18-20: anatomy scan 20: fundal height at umbilicus 24-28: GTT 28: Rhogam if M-/F+ 36: GBS
How quickly does hCG increase during pregnancy
What is seen on TVUS to correlate to hCGs for viability
What would be seen and indicative of demise?
Doubles every 2.2 days
Sac- 5wks, 1500
Pol- 5wks, 5200
Cardiac- 7wks, 17,500
Gestational sac w/out yolk
No FCM
CRL >5mm
What are the 6 types of abortions and the criteria of each
Threat: <20wks w/ bleeding and closed os
Inevitable: bleeding w/ dilated os, non-viable
InComp: Bleeding, dilated and passage of tissue
Comp: Os closed after passage of tissue
Missed: demise yet retained
Recurrent: +3 SpAbs in succession
Fetus feels mother’s stress until ? age
How are EPL’s managed?
22wks
Threat: reassure
InComp: Type/Cross, evacuate
Missed: US, manage w/ Misoprostol
What are 5 things conducted at routine prenatal visits?
How far should the fundus advance above umbilicus after 20wks and what indicates need for US?
BP/Weight
Fundal height
Fetal cardiac activity
Fetal movements
1cm per week
>3cm discrepancy