OB/GYN Flashcards
What does Gravidity and Parity mean?
Gravidity: the number of times a women has ben pregnant
Parity: the number of pregnancies that led to a birth beyond 20 wks gestational age or an infant weighing >500g
(Term, preterm, aborted, living)
What is gestational age and what are the method to determine it? (5)
GA= # of wks and day measured from the first day of the LMP
Fundal height= umbilicus-20 weeks +2-3 cm/wks thereafter
Fetal heart tones (Doppler): typically 10-12 weeks
Quickening, or appreciation of fetal movement: occurs at 17-18 wk at the earliest
U/S: fetal crown-rump length at 6-12wk
—biparietal diameteer, femur length, and abdominal circumference (AC) 13 wks
What are the 2 methods of diagnosing a pregnancies?
B-HCG: standard
—produced by the placenta, peaks 100,000 mIU/mL by 10wks GA
—decrease throughout the second trimester;levels off in the third
—hCG levels doulbe appr every 48 every hours during early pregnancy
U/S: confirm an intrauterine pregnancy
—gestational sac is visible on TVUS by 5th wk GA
—b-HCG in range 1000-1500 mIU/mL
Weight gain recommendation based on prepreganancy weight?
Underweight (BMI <19.8): 25-40 lbs (12-18kgs)
Acceptable (BMI 19.8-26.0): 25-35 lbs (11-16kgs)
Overweight (BMI 26.1-29.0): 15-25 lbs (7-11kgs)
Severely overweight ( BMI >29.0) 10-20 lbs (5-9kgs)
Excessive gain >1.5 kg/month
Inadequate gain <1.0 kg/month
what are the guidelines for nutritional supplementation:
An addition 100-300 kcal/day; 500 kcal/day during breastfeeding
Folic acid supplements: 0.4 mg/day, or 4 mg/day for women w/ hx
Iron: starting at he first visit, 30 mg/day of elemental iron (150 mg iron su)
Calcium: 1300 mg/day <19 yo; 1000mg/day >19 yo
Vit D: 10micrograms or 400 IU/day
Vit B12: 2 micrograms/day
What happens for the following parameters in the cardiovascular system during pregnancy: HR, BP, SV, CO, PVD, PVR
HR: Gradually increase 20%
BP: gradually decrease 10% by 34 wks, then increases to prepregnancy values
SV: increases to max. At 19 wks, then plateaus
CO: Rises rapidly by 20%, then gradually increases an additional 10% by 28 wks
Peripheral venous distention: progressive increase to term
PVR: progresisive decrease to term
What happens for the following parameters in the pulmonary system during pregnancy: RR, TV, Expiratory reserve, Vital capacity, respiratory minute volume?
RR: unchanged Tidal Volume: Increases by 30-40% Expiratory reserve: Gradual decrease Vital capacity: Unchanged Respiratory minute volume: increases by 40%
What happens for the following parameters in the bloodsystem during pregnancy: volume, hematocrit, fibrinogen, electrolytes?
Volume: increase by 50% in second trimster
Hematocrit: decreases slightly
Fibrinogen: increases
Electrolytes: unchanged
What happens for the following parameters in the gastrointestinal system during pregnancy: sphincter tone, gastric emptying tome?
Sphincter tone: decreases
Gastric emptying time: increases
What organisms can cross the placenta?(9)
Toxoplasma Gondi Rubella HIV Varicella-zoster virus CMV Enteroviruses Treponema pallidum Listeria monocytogenes parvovirus B19
How often to pregnancy women go to the doctors during each trimester?
Weeks 0-28: every 4 weeks
Weeks 29-35: every 2 weeks
Weeks 36-birth: every wk
What testing is performed at the initial prenatal visit?
Heme: CBC, RH factor, type and screen
Infectious disease: UA and culture, rubella antibody titer, HBsAg, RPR/VDRL, cervical gonorrhea and chlamydia, PPD, HIV, Pap smear (to check for Dysplasia, consider HCV and varicella based on history
If indicated: HbA1c and sickle cell
Genetic screen: tag-Sachs Dx, cystic fibrosis
What tests are preformed during the prenatal visits from 9-14wks?
Offer PAPP-A + unchallenged transparency + free b-HCG +/- CVS
What tests are preformed during the prenatal visits from 15-22wks?
Offer maternal serum AFP or quad screen (AFP, estriol, bHCG, inhibin A) +/- amniocentesis
What tests are preformed during the prenatal visits from 18-20wks?
U/S for full anatomic screen
What tests are preformed during the prenatal visits from 24-28wks?
One-hour glucose challenge test for gestational diabetes screen
What tests are preformed during the prenatal visits from 28-30wks?
RhoGAM for RH- women
What tests are preformed during the prenatal visits from 35-37wks?
GBS culture, repeat CBC
What tests are preformed during the prenatal visits from 34-40wks?
In high-risk pt, cervical chlamydia and gonorrhea cultures, HIV,RPR
What are the five components of the Apgar system?
Heart rate Respiratory effort Muscle tone Reflex irritability Color
What is the next step in managing a patient that has a blood fluid breast mass determined by FNA?
Excisional biopsy
