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OB-gyne notes Flashcards

1
Q

Birth rate

A

Live births per 1000 females

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2
Q

Fertility Rates

A

Live births per 1000 females aged 15-44 y/o

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3
Q

Perinatal period

A

birth - 28 days

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4
Q

Infant

A

Until 1year of age

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5
Q

Abortion

A
  • <20 weeks AOG or
  • <500 grams
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6
Q

Preterm

A

<37 weeks AOG

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7
Q

Postterm

A

>42 weeks

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8
Q

Term

A

37-42 weeks

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9
Q

Puerperium

A

Time from delivery lasting about 4-6 weeks

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10
Q

Early abortion

A

<12 weeks

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11
Q

Later abortion

A

>12 weeks AOG but <20 weeks AOG

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12
Q

Early UTZ

A

<20 weeks AOG

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13
Q

Late UTZ

A

>20 weeks AOG

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14
Q

Layers of the anterior abdominal wall

A

Skin Camper’s (fatty layer) Scarpa’s fascia (membranous -> colles fascia) Muscles

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15
Q

Blood supply of the anterior abdominal wall

A

Superficial epigastric Deep/inferior epigastric artery

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16
Q

Male Homologues

A
  • Labia Minora - Penile urethra, skin of Penis
  • Labia Majora - Scrotum
  • Clitoris - Penis
  • Skene’s glands - prostate gland
  • Bartholin’s gland - Cowper’s gland
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17
Q

Borders of the Vulva

A
  • Superior: Mons pubis
  • Lateral: Labiocrural fold
  • Inferior: Perineal Body
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18
Q

Management for Bartholin duct cyst

A

Marsupialization

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19
Q

Components of the Pelvic diaphragm

A

Levator ani

  • Pubococcygeus
  • Pubovaginalis
  • Puboperinealis
  • Puboanalis
  • Puborectalis

Ileococcygeus

Coccygeus

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20
Q

Components of the Striated Urogenital Sphincter Complex

A
  • Sphincter urethrae
  • Compressor urethrae
  • Urethrovaginal urethrae
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21
Q

Blood supply of the uterus

A
  • Ovarian artery
  • Uterine artery
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22
Q

Vaginal Blood supply

A

Proximal portion : Vaginal and uterine

Posterior vaginal wall: Middle rectal

Distal: Internal pudendal

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23
Q

Location of the ovaries in relation to the internal iliac

A

Medial

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24
Q

Ligaments (Internal female genitalia)

A
  • Round ligament
  • Broad Ligament
  • Cardinal or transverse cervical (Mackenrodt ligament)
  • Uterosacral ligament
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25
Q

What ligament provides the main support of the Uterus?

A

Cardinal ligament and Uterosacral ligament

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26
Q

Mesosalpinx

A

Around the fallopian tube

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27
Q

Mesoteres

A

Around the round ligament

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28
Q

Mesovarium

A

Over the uterovarian ligament

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29
Q

Parts of the Pelvis

A

False Pelvis

True Pelvis

  • Pelvic inlet
  • Midpelvis
  • Pelvic outlet
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30
Q

Arteries entering the true pelvis

A

“MISO”

  • Median sacral
  • Internal iliac
  • Superior rectal
  • Ovarian
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31
Q

Abnormal levels of hemoglobin

A

1st trimester: <10 g/dl

2nd trimester: <10.5g/dl

3rd trimester: <11 g/dl

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32
Q

Presumptive evidence of Pregnancy

A
  • Morning sickness
  • Fatigue
  • Frequency in urination
  • Quickening
  • Cessation of menses
  • Beading cervical mucus
  • Chadwick’s sign
  • Changes in breast
  • Skin changes
  • Increased temperature
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33
Q

Morning sickness

A

6-18 weeks

peak of HCG is 8-10 weeks plateus at 16 weeks

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34
Q

Quickening

A

16-20 weeks

  • primigravid 18-20 weeks
  • Multigravid 16-18 weeks
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35
Q

Beading cervical mucus

A

6 weeks

poor crystallization or beading is due to PROGESTERONE

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36
Q

Ferning

A

sign of increased estrogen, makes pregnancy unlikely

also observed as a result of amniotic fluid leakage

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37
Q

Chadwick’s sign

A

6 weeks

Vaginal mucosa becomes dark-bluis red and congested

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38
Q

Chloasma/Melasma

A

Mask of pregnancy due to MSH

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39
Q

Spider telangiectasia

A

increased estrogen

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40
Q

Increased temperature

A

6 weeks due to increased PROGESTERONE

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41
Q

PROBABLE evidence of Pregnancy

A
  • Enlargement of abomen
  • Hegar’s sign
  • Goodell’s sign
  • Braxton Hick’s contractions
  • Physical outlining of fetus
  • ballottement
  • Detection of B-HCG
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42
Q

Hegar’s sign

A

6-8 weeks

softening of the uterine isthmus

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43
Q

Goodell’s sign

A

softening of the cervix

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44
Q

POSITIVE SIGNS of pregnancy

A
  • FHT
  • perception of fetal movement by examiner
  • Sonographic recognition
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45
Q

Fetal heart tone

A

Normal: 120-160

Auscultaion: 16 weeks

Doppler: 10 weeks

TV-UTZ: 5 weeks

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46
Q

75 g OGTT

A

24-28 weeks

Human placental lactogen is produced during this time

has growth hormone like action and causes insulin resitance, lipolysis, and increased fatty acids

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47
Q

Biophysical profile

A

24-28 week

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48
Q

10 danger signs of Pregnancy

A
  • Headache
  • BOV
  • Prlonged Vomiting
  • Fever
  • Nondependent edema
  • Epigastric/RUQ pain
  • Dec. fetal movement
  • Dysuria
  • Bloody vaginal d/c
  • Watery vaginal d/c
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49
Q

Signs of Preeclampsia

A
  • headache
  • BOV
  • Prolonged Vomiting
  • Epigastric/RUQ pain
  • Nondependendent edema
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50
Q

Estimated date of Confinement

A

Naegele’s rule

EDC= LNMP + 7 days - 3 months

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51
Q

fundal height

A

cm

top of the pubis syphysis to the top of the fundus

b/w 20-34 weeks, fundus correlates closely with AOG

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52
Q

Fundal height

A

12 weeks - uterus becomes an abdominal organ

16 weeks - fundus is midway b/w the pubis symphisys and the umbilicus

20 weeks- level of the umbilicus

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53
Q

Frequency of Prenatal check-up

A

<28 weeks (monthly)

28-36 weeks ( every 2 weeks)

>36 weeks (every week)

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54
Q

Recommended weight gain

A

BMI:

  • <18.5 = 28-40 lbs
  • 18.5-24.9 = 25-35 lbs (37-54 lbs if twins)
  • 25-29.9 = 15-25 lbs (31-50 lbs if twins)
  • >30 = 11-20 lbs (25-42 lbs if twins)
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55
Q

Recommended dietary allowances

A
  • Calories ( increase 100-300 kcal/day)
  • Protein (5-6 g/day)
  • Iron (27 mg elemental FE/day) - if large/twins (60-100) - start giving 2nd trimester
  • Folic acid (400 mcg) (4 mg if with history of NTD)
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56
Q

Caffeine intake (OB)

A

Max; 3 cups of 4 oz

57
Q

Travel (OB)

A

safe up to 36 weeks

58
Q

Fetal lie

A

Relation of the fetal long axis to that of the mother

59
Q

Fetal presentation

A

Portion of the body that is foremost within the birth canal

60
Q

Fetal attitude

A

Posture or Habitus

61
Q

Fetal Position

A

Relationship of fetal presenting part to the right or left of birth canal

62
Q

Predispositon factors for transverse lie

A
  • Multiparity
  • Placenta previa
  • Hydramnios
  • Uterine anomalies
63
Q

caput succedaneum

A

local edema

molding refers to bony changes in the fetal head, which results in shortened suboccipitobregmatic diameter

64
Q

Phases of partutiton

A
  • Phase 1 (Quiescence) - prelude to parturition
  • Phase 2 (Activation) - Preparation for labor
  • Phase 3 (stimulation) - Processes of Labor
  • Phase 4 (Involution) - Parturient recovery
65
Q

QUIESCENT phase

A
  • Prelude to parturition
  • Begins even before implantation
  • Contractile unresponsiveness
  • Cervical softening
  • Braxton Hicks contractions may be felt
66
Q

ACTIVATION phase

A
  • preparation of labor
  • during the last 6-8 weeks of pregnancy
  • Myometerial unresponsiveness suspeded: OXYTOCIN receptors increase
  • Formation of the LUS
  • Cervical ripening, effacement, and loss of structural integrity
67
Q

Treatment to promote cervical ripening

A
  • PGE2
  • PGF2
  • progesterone antagonist
68
Q

STIMULATION phase

A
  • processes of labor
  • Uterine contraction
  • cervical dilatation,
  • fetal and placental expulsion
69
Q

INVOLUTION phase

A
  • parturient recovery
  • Uterine involution
  • Cervical repair
  • Breastfeeding
70
Q

LABOR

A

uterine contractions that bring about demonstrable effacement and dilatation of the cervix

71
Q

FIRST stage of Labor

A

Starts with painful regular contractions ends with cervical dilatation

Bloody show - spontaneous release of blood-tinged mucus plug from the cervical canal

72
Q

Ferguson reflex

A

mechanical stretching of the cervix enhances uterine activity

73
Q

Ring of Bandl

A

Pathological retraction ring

  • thinning of the LUS is extreme
74
Q

SECOND stage of Labor

A

Begins with complete cervical dilatation (10 cm)

Ends with fetal delivery

75
Q

the most important force in fetal expulsion

A

Intraabdominal pressure

76
Q

Station

A

describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines

77
Q

THIRD stage of labor

A

Delivery of the placenta

78
Q

7 cardinal movements of labor

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
79
Q

Engagement

A

BPD passes thru the pelvic inlet

80
Q

Descent

A

Due to 4 forces:

  • Pressure of the amniotic fluid
  • Pressure of the fundal contractions
  • Maternal effort
  • Straightening of fetal body
81
Q

Flexion

A

OFD shifts to SOBD

82
Q

Internal rotation

A

Occiput moves toward pubis symphysis

83
Q

Extension

A

Due to 2 opposing forces:

  • Pressure of fundal contraction
  • resistance of pelvic floor
84
Q

External rotation

A

BSD to APD

85
Q

Functional division of Labor

A

Preparatory Division

Dlatational Division

Pelvic Division

86
Q

Abnormal labor progression in the active phase

A

cervical dilatation<1.2 cm/hour in nulliparas

cervical dilataion <1.5cm/hour in multiparas

87
Q

Labor arrest

A

Absence of appreciable change in 2 hours in the presence of adequate uterine contractions

88
Q

Signs of Placental separation

A

“up-down-up-down”

  • Uterus becomes globular and firmer (CALKIN’s sign)
  • Sudden gush of blood
  • Uterus rises in the abdomen
  • Lengthening of the umbilican cord
89
Q

Mechanisms of placental expulsion

A

Schultze

Duncan

90
Q

Schultze Mechanism

A

Blood from the placental site pours into the membrane sac and does not escape externally until after extrusion of the placenta

Retroplacental hematoma follows the placenta or is found within the inverted space

91
Q

Duncan Mechanism

A

Placenta separates first at the periphery and the blood collects between the membranes and the uterine wall and escapes from the vagina maternal surface appears first

92
Q

Prolonged latent phase

A

>20 hours (nullipara)

>14 hours (multipara)

93
Q

Protracted active phase

A

<1.2 cm/hour (nullipara)

<1.5 cm/hour (Multipara)

94
Q

Protracted descent

A

<1 cm/hour (nullipara)

<2 cm/hour (multipara)

95
Q

Prolonged deceleration phase

A

>3 hours (NP)

>1 hour (MP)

96
Q

Secondary arrest of dilatation

A

>2 hours (NP)

>1 hour (MP)

** of no cervical dilatation

97
Q

Arrest of descent

A

> 1 hour (NP)

> 1 hour (MP)

** must be in deceleration phase

98
Q

Failure of descent

A

No descent on deceleration phase or 2nd stage of labor

99
Q

Precipitous Labor

A

Expulsion of fetus in <3 hours

Associated with:

  • Abrutio placenta
  • Meconium passage
  • Postpartum hemorrhage
  • Low APGAR

TX:

  • B-mimetic
  • MgSO4
  • Lateral decubitus
100
Q

Cepalopelvic disproportion

A

DC <11.5 cm

BSD <8cm

BTD <8 cm

101
Q

Asynclitism

A

lateral deflection of the sagittal suture, posteriorly toward the sacral promontory or anteriorly toward the symphysis pubis

102
Q

Anterior Asynclitism

A

sagittal suture approaches the sacral promontory and the anterior parietal bone presents itself on the examiner’s finger

103
Q

Shoulder Dystocia Drill

A

A- Ask for help

L - lift legs (Mcrobert’s position)

A - Anterior shoulder disempaction

R - Rotation of the posterior shoulder

M - Manual Extraction of the posterior arm

E - Episiotomy

R - Roll on all fours

104
Q

McRobert’s position

A

causes straightening of the sacrum, rotation of the pubis symphysis toward the maternal head, and a decrease in the angle of pelvic inclination

105
Q

Mazzanti Maneuver

A

(Abdominal) - anterior shoulder disempaction with the heel of clasped hands, suprapubic pressure is applied by another member of the team to the posterior aspect of the anterior shoulder pressure may be sufficient to abduct the shoulder

106
Q

Rubin’s maneuver

A

(Vaginal) Physician’s hand reaches the ost anterior fetal shoulder, which is then pushed toward the anterior surface of the fetal chest this abducts the shoulder, which reduces the shoulder to shoulder diameter

107
Q

Woods corkscrew maneuver

A

delivery of the posterior shoulder then progressively rotating the posterior shoulder 180 degrees in a corksrcrew fashion

108
Q

Gaskin maneuver

A

Moving the mother to an all fours position with the back arched, widening the pelvic outlet

109
Q

Cleidotomy

A

Fracturing the clavicle with scissors

110
Q

Symphysiotomy

A

Symphyseal cartilage is cut

111
Q

Zavanelli

A

Return the head to the occiput anterior or posterior position

Give acute tolysis

Flex the head slowly push it back to the vagina

CS delivery is then performed

112
Q

Guideline for intrapartal FHR monitoring (LOW RISK)

A

Auscultation:

  • 1st Stage: every 15 minutes
  • 2nd Stage: every 5 minutes
113
Q

Guideline for intrapartal FHR monitoring (HIGH RISK)

A

Continuous EFM

Documented systematic assessment every hour

114
Q

Baseline Heart Rate

A

Mean FHR rounded to increments of 5 beats over minute during a 10 minute segment excluding segments that differ by 25 bpm

Normal: 110-160

115
Q

Baseline Variability

A

Fluctuations with irregular amplitude and inconstant frequency

  • Absent: Amplitude range undetectable
  • Minimal: Amplitude range detectable, but <5 beats/min
  • Moderate: 6-25 beats/min
  • Marked: >25 beats/min
116
Q

Acceleration

A

Visually apparent abrupt increase in FHR above baseline, with the time from the onset of the acceleration to its acme <30 seconds)

if >32 weeks : Peak is >15 beats/min lasts >15 seconds but < 2 inutes.

if <32 weeks: Peak >10 beats/min above the baseline; lasts >10 seconds but < 2 minutes from onset to return to baseline

Prolonged acceleration: lasts > 2 minutes but < 10 minutes in duration

Change in baseline: if the acceleration lasts >10 minutes

117
Q

Decelerations

A

Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction;

Gradual FHR is defined as from onset to the FHR nadir is >30 seconds

118
Q

Early deceleration

A

The nadir deceleration occurs at the same time as the peak of the contraction

Head compression -> vagal nerve activation

119
Q

Late deceleration

A

Deceleration is delayed in timing, with the deceleration occuring after the contraction.

Uteroplacental insufficiency-> hypoxia Maternal hypotension

  • Excessive uterine activity
  • Placental dysfunction
  • Maternal disease
120
Q

variable Deceleration

A

Visually aparent abrupt decrease in FHR;

an Abrupt decrease is defined as from onset to the FHR nadir <30 seconds

Cord compression patterns occlusion of vein -> reduced fetal blood return -> acceleration occlusion of artery -> fetal systemic hypertension -> deceleration

121
Q

Prolonged deceleration

A

Decrease in FHR from the baseline is >15 beats/min lasting > 2 minutes but < 10minute in duration

122
Q

Sinusoidal pattern

A

Visually apparent, smooth, sine wave like undulating patern in FHR baseline with a cycle frequency of 3-5 minutes that persists for 20 minutes or more

Severe fetal anemia

123
Q

Uterine contractions

A

quantified as the number of contractions present in a 10 minute window, averaged over a 30 minute period

  • Normal: <5 contractions in 10 minutes
  • tachysystole > 5 contractions in 10 minutes (averaged over 30 minutes)
124
Q

Category I FHR:

A
  • Normal tracings
  • Baseline: 110-160
  • Moderate variability
  • (-) late decelerations
  • (+/-) accelerations
125
Q

Category II FHR:

A
  • Indeterminate tracings
  • Requires continued surveillance
  • Baseline: Tachycardia
  • Bradycardia not accomapanied by no variability
  • Variability: minimal
  • Decelerations: Periodic or episodic
  • Accelerations (-)
126
Q

Category III FHR

A

Abnormal tracings

Predictive of abnormal fetal acid base status

Requires prompt evaluation and initiation of attempts to resolve

127
Q

Nonstress test

A

tracing is labeled as nonstress when there is no contraction within the 20 minute trace.

  • Reactive: >2 accelerations within 20-40
  • NR: <2 accelerations
128
Q

Resuscitative Measures for abnormal tracing

A
  • Left lateral decubitus
  • oxygen support
  • Discontinue oxytocin
  • IV fluid bolus (200cc)
129
Q

How to give oxytocin

A

10-20 units in 1L = 10-20 mU/mL

start at 6mU/mL increase in 40 minute interval to 42 mU/mL

in PGH: 10 units in 1L start at 8 drops/min titrate by 2 cc/hr every 15-20 minutes

GOAL: q3-4 min contractions, moderate to strong, 60-90s but < 7 contractions in 15 minutes

130
Q

When to stop giving oxytocin

A

contractions are 5x in 10 minutes

contractions are 7x in 15 minutes

contractions are longer than 60-90 secs.

If fetal heart rate is non reassuring

131
Q

Induction of labor

A

Stimulation of contraction before spontaneous onset of labor

132
Q

Augmentation of Labor

A

Stimulation of sponteneous contraction that is inadequate

133
Q

Indications of induction of Labor

A
  • Rutpture BOW
  • Maternal HPN
  • Nonreassuring fetal status
  • Postterm gestation
134
Q

Contraindications for induction of labor

A
  1. Uterine factors:
  • Uterine scar,
  • Classical CS
  • Placenta previa
  1. Fetal Factors
  • Macrosomia
  • Fetal congenital anomaly
  1. Maternal factors
  • Maternal size
  • Pelvic anatomy
  • Active genital herpes
135
Q

Failed induction of labor

A

12 hours of Oxytocin after ruptured BOW without progress

136
Q

Bishop scoring system

A

Predicts labor induction Dilatation

  • Effacement
  • Consistency
  • Position
  • Station

score of 9 : high likelihood

<4: unfavorable

137
Q

Agents for cervical ripening

A
  • Dinoprostone (PGE2)
  • Misoprostol (PGE1)
138
Q

Mechanical Dilatation of the cervix

A
  • Hygroscopic osmotic dilatation
  • membrane stripping
  • Transcervical catheter attached to dangling urine bag with 300mL water

high yield concepts (21 decks)

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