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Foundations III-Women's Health > OB lecture (Part 1 to slide 102) > Flashcards

OB lecture (Part 1 to slide 102) Flashcards

1
Q

what is antepartum? intrapartum? postpartum?

A

before birth, prenatal

childbirth, labor and delivery

postnatal period until 6wks following delivery

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2
Q

TPAL stand for?

A

term
preterm
abortion
living children

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3
Q

what is considered a preterm infant?

A

born prior to 37wk gestation

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4
Q

what is considered a fetus?

A

9th wk of pregnancy –> birth

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5
Q

What is Nagele’s rule?

A

add 7 days to LMP and subtract 3 mo’s

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6
Q

what is gestational age?

A

age of fetus calculated from 1st day of LMP including 2wks when women is not pregnant

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7
Q

how long does pregnancy last? (EDC)

A

280 days, 40 wks

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8
Q

what is 1st, 2nd, and 3rd trimester?

A

1-12wks gestation
13-28wks
29-40wks

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9
Q

what skin changes can pregnant women get?

A

Melasma = mask of pregnancy >16wk

linea nigra –> darkening at midline btwn pubis and umbilicus

striae

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10
Q

what respiratory changes can pregnant women get?

A

incr. tidal volume and PO2

decr. expiratory reserve volume and PCO2

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11
Q

what cardiac changes during pregnancy?

A

incr. CO and SV

decr. systemic vascular resistance

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12
Q

effects of pregnancy on kidneys?

A

increased GFR

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13
Q

preconception counseling includes:

A

wt. management, substance use/abuse, folic acid supplementation, manage existing comorbidities

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14
Q

how much folic acid should you recommend?

A

0.4mg low risk
4mg high risk
Most prenatal vitamins contain 1mg

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15
Q

when soon can home pregnancy tests come out positive?

A

by the time of missed menses +/- 1wk

HCG level ~25

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16
Q

how long does HCG rise exponentially?

A

for 10wks then plateus

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17
Q

how often should beta-HCG double?

A

every 48hrs in normal pregnancy

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18
Q

2 hormones responsible for most pregnancy sxs in 1st trimester?

A

beta-HCG and progesterone

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19
Q

PE findings during pregnancy

A

systolic ejection murmur, Chadwick’s sign (bluish cervix), Hegar’s sign (soft uterine isthmus), Goodell’s sign (soft cervix)

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20
Q

routine labs/diagnostic at initial OB visit

A 
CBC
Blood type and Rh
Antibody screen
Rubella immunity
Syphilis testing
Hepatitis B antigen testing
HIV
UA C&S
Chlamydia/gonorrhea cultures
Pap smear
U/S (5-6wk fetal heart activity)
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21
Q

when does genetic screening occur?

A

11-13wk gestation

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22
Q

what are you looking for on U/S in regards to genetic screening during 1st trimester?

A

nuchal translucency (assoc w/ Down Syndrome)

fetal nasal bone

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23
Q

what genetic screening can be done during 2nd trimester?

A

Quad screen: AFP, HCG, estriol, inhibin-A

incr. AFP: neural tube defects, multiple gestation
abn. levels all 4 tests: trisomy 18 or 21

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24
Q

what are some invasive diagnostic tests and when are they performed?

A

amniocentesis (2nd trimester) 15-20wk gestation

chorionic villus sampling (1st tri) 10-12wk

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25
Q

frequency of prenatal visits?

A

Initial visit ~ 6 – 8w after LMP
Monthly until 28w gestation
Bimonthly 28w – 36w gestation
Wkly 36w until delivery

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26
Q

what is included in a routine prenatal care visit for mom?

A

wt. gain 1.5-3lbs 1st trimester, 0.8lb/wk during 2nd trimester and beyond

total wt. gain 25-35lbs

BP, edema, UA (proteinuria and glucosuria)

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27
Q

when can you measure fetal heart tones and what is the bpm?

A

10-12w

120-160bpm

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28
Q

how do you detect fetal movement?

A

begins around 18-20wk for 1st pregnancy using “count to 10” method –> 10 FM’s over 2hrs

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29
Q

at 12wk where do you measure the fundal ht? at 20wks?

A

12w –> pubic symphysis

20w –> umbilicus

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30
Q

when do you perform Group B strep screen?

A

35-37w

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31
Q

how do you dx gestational dm?

A

screen at 24-8w

50g 1hr glucose challenge test
value >130 = 3h GTT

need 2 or more abn. results

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32
Q

when do you perform Rh antibody screening? and what is the tx?

A

26-28w gestation

if negative –> RhoGAM at 28w

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33
Q

If women are Group B strep (+) what is the tx?

A

intrapartm IV abx if vaginal delivery: Ampicillin or Clinda w/ PCN allergy

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34
Q

T or F: most women in labor prior to GBS screen require empirical abx therapy?

A

FALSE. all women!

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35
Q

what are some dietary recommendations?

A

calories –> 350 additional per day

protein –> 1g/kg/day

iron –> 30mg/day

Calcium–> 250mg/day

carbs–> 175g/day

Folic acid –> 0.4mg/day

Vit D –> 600IU/day

fish w/ low mercury content

caffeine –> <200mg/day

36
Q

what foods should women avoid in pregnancy?

A

unpasteurized dairy products or undercooked meats

37
Q

what exercise should women avoid during pregnancy >20w gestation?

A

any exercise on the back bc it can decr. blood flow to etus by compressing IVC

38
Q

vaccines in pregnancy?

A

update Tdap and inactive influenza

avoid ALL live vaccines

39
Q

what is effacement?

A

Thinning or shortening of the length of the cervix

Normal length is > 2.5cm

40
Q

what is complete dilation?

A

10cm dilation and 100% effacement

diameter of cervical os in cm

41
Q

Process of labor: what is station?

A

Degree of descent of the presenting part in the birth canal in relationship to the ischial spines
(+ or -)

42
Q

what are the 3P’s of labor?

A

power: uterine contractions
passenger: size, position attitude of presentation

pelvis/passage: bony and soft tissue of maternal pelvis

43
Q

Characteristics of first stage of labor:

A

latent phase: 1st regular contractions to 3-4cm dilation

active phase: ends w/complete dilation

44
Q

how is hypocontractile uterine activity (power) measured? what is the solution?

A

external tocometry or internal pressure catheter (IUPC)

solution –> augment labor w/pitocin

45
Q

what is cephalopelvic disporportion? solution?

A

non-gynecoid pelvis, previous injury or illness causing contracted pelvis

solution = abd. delivery

46
Q

what is an abortion?

A

loss of pregnancy prior to 20w gestation d/t chromosomal abnormalities or teratogens

47
Q

what is the MC complication in early pregnancy?

A

abortion (80% in 1st trimester)

48
Q

what is a threatened abortion? inevitable abortion?

A

threatened–> vaginal bleeding w/a closed cervix

inevitable –> vaginal bleeding w/open cervix

49
Q

what is a missed abortion?

A

pregnancy is retained despite death of the fetus

50
Q

what are some RF’s for complicated pregnancy abortion?

A

Advanced maternal age, prior spontaneous abortion, multigravity, alcohol, illicit drug use, smoking

51
Q

physical exam/labs for a complicated pregnancy abortion?

A

Blood w/in vagina, open vs. closed cervix
CBC
βHCG quant
Transvaginal u/s (heart tone, fetal pole, yolk sac)
blood type and RH

52
Q

Tx for complicated pregnancy abortion?

A

expectant management –> pregnancy test 2wks later

surg = dilation and curettage

medical = misoprostol
80mcg per vagina, repeat U/s 24h later, preg test 2w later

53
Q

Tx for septic abortion

A

hospitalization for IV abx = cefoxitin (+) doxycycline

54
Q

medical options for elective abortion?

A

day 1 - Mifepristone 200mg

24-48hr later = Misoprostol 800mcg buccaly

ONLY up to 70 days gestation

55
Q

surgical elective abortion options?

A

suction curettage: 1st trimester pregnancy

dilation and evacuation: 2nd trimester, laminaria placed w/in endocervix 24-48h prior to procedure

56
Q

surgical abortion complications:

A

hemorrhage, uterine perforation, infx/retained products, death, postabortal pregnancy

tx–> methergine and D&C

57
Q

RF’s for ectopic pregnancy

A

prior ectopic, previous tubal surgery, hx of PID

58
Q

clinical presentation of ectopic pregnancy

A

pelvic/abd pain, vag bleeding, orthostatic s/s

59
Q

Diagnostic/labs for ectopic pregnancy?

A

CBC, βhCG, CMP, LFT’s, Rh factor, blood type, BUN, Cr

Transvaginal u/s

60
Q

medical tx for ectopic pregnancy?

A

administer RhoGAM in Rh (-) women

Methotrexate IM

61
Q

parameters for dosing methotrexate IM in ectopic pregnancy?

A

inhibits DNA synthesis and fetal cells

HCG < 5,000, no cardiac activity, sac <4cm

repeat HCG on days 4 and 7 ( >15% HCG decline)

62
Q

contraindications to methotrexate?

A

Renal / liver / pulmonary compromise, at risk for loss to follow up, breastfeeding, heterotopic pregnancy, immunodeficiency

63
Q

surgical tx options for ectopic pregnancy?

A

administer RhoGAM if (-)

laparoscopy vs. laparotomy

indicated: hemodynamically unstable, impending or active rupture, methotrexate failure, heterotopic pregnancy

64
Q

what is Gestational Trophoblastic Disease?

A

Abn. proliferation of trophoblastic tissue (epithelium) of the placenta 2/2 abn. fertilization

maternal tumor arises from gestational tissue

65
Q

what are the 4 types of gestational trophoblastic dz?

A

Hydatiform Mole = MC (80%)
Invasive Mole
Placental site nodule
Choriocarcinoma

66
Q

what is complete and partial hydatiform mole (molar pregnancy)

A

complete: no chromosomes or 2 copies of paternal
partial: 2:1 paternal vs. maternal DNA

67
Q

clinical presentation of gestational trophoblastic dz?

A 
Abn. uterine bleeding/Amenorrhea
Uterine size greater than dates
Absent fetal heart tones
Hyperemesis 
Pre-eclampsia “like” sx prior to 20w
68
Q

what will you see on U/S for gestational trophoblastic dz?

A

“snow storm” or “grape-like clusters” w/in endometrium

uterine is enlarged

69
Q

Tx for hydatiform mole?

A

D&C to evacuate contents of uterus, pelvic rest for 4-6 wk, close monitoring of hCG levels for 6-12 mo’s, avoid pregnancy 12mo’s

70
Q

what is placental abruption?

A

Premature separation of a normally implanted placenta after 20th wk gestation d/t rupture of maternal vessels

71
Q

clinical presentation of placental vaginal bleeding:

A

Abrupt PAINFUL vaginal bleeding
Abd/back pain
Contractions

72
Q

tx for placental abruption?

A

closely monitor hemodynamic status, continuous fetal monitoring, expectant management in stable mom’s only

unstable –> C-section

73
Q

what is placenta previa?

A

An abnormal location of the placenta over, or in close proximity to, the internal cervical os

(unknown etiology)

74
Q

RF’s for placenta previa?

A

Prior c- section
Multiple gestation
Prior Hx of previa
Advanced maternal age

75
Q

clinical presentation for placenta previa?

A

PAINLESS vaginal bleeding after 20wk gestation

76
Q

what is a low-lying placenta previa?

A

located near but not directly adjacent to internal os?

77
Q

dx for placenta previa?

A

U/S

Never perform cervical exam bc hemorrhage can occur

78
Q

Tx fo placenta previa?

A

asx. –> avoid intercourse, decr. physical activity, may resolve w/advanced gestational age
sx. –> admit to hospital, C-section

79
Q

what is the MC cause for pre-term delivery?

A

premature rupture of membranes (before onset of uterine contractions

80
Q

what is pre-PROM?

A

Rupture of membranes before 37w gestation without the presence of uterine contractions

81
Q

RF’s for premature rupture of membranes?

A

genital tract infx (BV), smoking, previous pre-term delivery

82
Q

Dx for premature rupture of membranes:

A

Speculum exam reveals amniotic fluid coming out of the cervical os or pooling of fluid in the vaginal fornix

Sample vaginal fluid and look for “ferning” under microscope

high concentration (+) alpha-fetoprotein

vaginal fluid pH is 7.0-7.3

83
Q

Tx for premature rupture of membranes?

A

corticosteroids to promote lung maturity < 34w

If GBS status unknown administer abx prophylaxis

Expectant management until delivery

84
Q

what is the etiology of post-partum hemorrhage?

A

uterine atony (#1): lack of effect contractions following delivery

trauma, coagulopathy

85
Q

PE for post-partum hemorrhage?

A

Tachycardia
Oliguria
↓O2 saturation
Hypotension

86
Q

tx for post-partum hemorrhage

A 
Uterine massage
IV hydration
Oxytocin/misoprostol/methergine
Blood transfusion
Surgery

Foundations III-Women's Health (13 decks)

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