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Obstetrics and pregnancy > OB/Pregnancy > Flashcards

OB/Pregnancy Flashcards

1
Q

First Trimester

A

First 12 weeks

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2
Q

1st trimester symptoms

A 
Amenorrhea
N/V
Fatigue
Breast tenderness
Urinary Frequemcy
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3
Q

Second trimester

A

13-27 weeks

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4
Q

2ns trimester symptoms

A

Fetal movement
Abdominal discomfort secondary to stretching
Change in skin pigmentation
Syncopal episodes

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5
Q

Chloasma

A

Brown or gray-brown patched that appear on face during pregnancy

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6
Q

Third trimester

A

28-40 weeks

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7
Q

3rd trimester symptoms

A

Abdominal growth
Braxton-hicks contractions
return of urinary frequency with descent of presenting part
Increased respiratory effort until descent

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8
Q

1st trimester PE

A

by 8 weeks of gestation: Goodell’s sign, Chadwick’s sign, Hegar’s sign
Breast enlargement

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9
Q

When do you start to hear fetal heart tones?

A

10-12 weeks

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10
Q

Goodell’s sign

A

Softening of cervix

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11
Q

Chadwick’s sign

A

Cervical cyanosis

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12
Q

Hegar’s sign

A

Softening of cervicouterine junction

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13
Q

2nd trimester PE

A

Fetal movement by 18-20 weeks

Striae

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14
Q

Where is fundus palpable at 20 weeks gestation?

A

Umbilicus

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15
Q

How many cm’s does fundus grow per week after 20 weeks?

A

1cm per week

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16
Q

When are Leopold’s maneuvers possible?

A

20 weeks

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17
Q

3rd trimester PE

A

Lightening by 3-4 weeks prior to labor
Loss of mucus plug/bloody show approx. 1 week prior to labor
May experience increase in Braxton hicks contractions
Rupture of membranes

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18
Q

2nd trimester diagnostics

A

Amniocentesis 15-20 weeks if familial hx of chromosomal abnormalities or advanced maternal age
Triple/quad screen at 16-20 weeks
1hr GTT @ 20 weeks (if fam hx of diabetes, or >200lbs)
US for fetal survey @ 18-20 weeks

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19
Q

What is a triple screen?

A

hCG, estriol, and alpha-fetoprotein

Done at 16-20 weeks

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20
Q

What is a quad screen?

A

hCG, estriol, AFP and ihibin-A

Done at 16-20 weeks

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21
Q

3rd trimester diagnostics

A

1hr GTT @ 28 weeks
RhoGAM for in-sensitized Rh-neg mothers done @ 28 weeks
H&H @ 28 weeks
NST/biophysical profile (BPP) as needed for assessment for FWB

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22
Q

0-28 weeks prenatal visits

A

every 4 weeks

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23
Q

28-36 weeks prenatal visits

A

every 2 weeks

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24
Q

36 weeks to delivery

A

every week

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25
Q

Naegele’s Rule

A

1 year - 3 months + 7days from last normal menstrual cycle.

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26
Q

Ectopic pregnancy

A

any conceptus that implants and grows outside the uterine cavity
95% are in fallopian tubes

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27
Q

High risk for ectopic pregnancy

A

Tubal surgery
Previous tubal ectopic pregnancy
Hx of PIC
IUD

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28
Q

Symptoms of ectopic pregnancy

A 
Amenorrhea
AUB--usually spotting, dark brown to tarry
Unilateral lower quadrant pain
lower back/shoulder pain
Hemodynamic changes in VS
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29
Q

PE of ectopic pregnancy

A

Tender adnexa w/ possible palpable mass
+ cervical motion tenderness (CMT)
Uterine enlargement w/ hegar’s sign
+ peritoneal signs if rupture has occurred

30
Q

Diagnostics of ectopic pregnancy

A

Serum hCG
CBC, type and Rh
US

31
Q

Abortion

A

Termination at anytime prior to viability (24 weeks) either spontaneous or medical/surgical

32
Q

Main reason for SAB in 1st trimester

A

chromosomal abnormalities

33
Q

Main reason for SAB in 2nd trimester

A

Cervical incompetence
Infection
Uterine abnormalities

34
Q

Symptoms of SAB

A 
Vaginal bleeding
Cramping/pelvic pressure
Low back pain
ROM
Hemodynamic changes in VS
35
Q

Diagnostics for SAB

A

hCG level
US
CBC, type and Rh
Coag profile

36
Q

Management of SAB

A

Refer
Bed rest if threatened or inevitable
Abstinence
Labs

37
Q

Surgical elective abortion

A

Vacuum D&C up to 12 weeks

D&E 13-14 weeks to 20-22 weeks

38
Q

Medical elective abortion

A

Through 49 days of pregnancy
Mifepristone also known as RU 486
Prostaglandin

39
Q

Pregnancy induced HTN

A

PIH–approx. 12% of pregnancies
BP >140/90 or a rise in SBP >30mmHg or DBP >15 mmHg
At least 2 occasions, with readings 6 hours apart

40
Q

Preeclampsia

A

PIH+proteinuria+generalized edema after 20 weeks

41
Q

Eclampsia

A

Preeclampsia + seizure activity

42
Q

HELLP Syndrome

A

Hemolysis Elevated Liver enzymes and Low Platelet count

43
Q

Contribution factors for PIH

A 
Preexisting HTN, renal or CV disease
Diabetes
Lupus/autoimmune disorders
Multiple gestation
Primigravida
Personal or fam hx
Maternal age at either end of time line (young or old)
44
Q

Testing for PIH

A

BP Surveillance
CBC, LFT’s 24 hour urine progein, Cr, Cr Cl
NST after 32-34 weeks or PRN
US PRN, usually for IUGR

45
Q

Management of PIH

A

Rest at home–if worsens, bed rest in left lateral recumbent position
Fetal surveillance– NST, US and kick counts

46
Q

Preeclampsia s/s

A

Sudden weight gain
Progression from digital and mild facial edema to generalized edema
Frontal or occipital HA’s
Visual disturbances with worsening condition

47
Q

PE of preeclampsia

A

> 140/90 or >30/15 above baseline
Proteinuria- trace to +1, +2 with worsening condition
Nondependent edema >+1 progressing to pretibial edema >3-4+
Worsening facial edema
Weight gain- >2lbs/week or 6lbs/month
Lagging fundal height
Reflexes- WNL, 3-4+ w/ worsening condition

48
Q

Testing w/ preeclampsia

A 
Same as PIH 
Plus
Urine testing every visit
NST weekly biophysical profile
US
49
Q

Management of preeclampsia

A

Strict bed rest w/ worsening condition, LL recumbent position
Kick counts at home
Weekly steroid injections for fetal lung maturity if <34 weeks
Hospitalization and mag sulfate therapy to stabilize severe condition then delivery if fetal maturity assured >34 weeks or 2 doses of B-methasone

50
Q

Eclampsia

A 
PIH + preeclampsia + seizures
May have severe, unrelenting HA, epigastric or RUQ pain, visual changes
BP consistently elevated above 160/100
Tonic-clonic seizures
Oliguria--may progress to anuria
Fetal distress in utero
51
Q

Management of eclampsia

A

Mg sulfate to break seizure (valium if ineffective) then IV gtt to stabilize
Anticipate delivery ASAP

52
Q

HELLP syndrome s/s

A 
Hemolysis, elevated liver enzymes and low platelets
All of preeclampsia plus..
Nausea/vomiting
Jaundice
Extreme fatigue/ill feeling
53
Q

PE of HELLP syndrome

A

Hepatomegaly
Tenderness or pain in the RUQ extending to epigastric area
Jaundice
Possible ascites

54
Q

Diagnostics of HELLP syndrome

A 
All same for preeclampsia
Thrombocytopenia <50,000
Clotting factors reduced
Severe hemoconcentration
Very elevated LFT's
Proteinuria consistent w/ severe preeclampsia
55
Q

Placenta Previa

A

Mal-implantation of the placenta in the lower uterine segment
Cervical os may be completely, partially, or marginally covered
Bleeding usually occurs in the late second to early 3rd trimester and often is precipitated by vaginal intercourse

56
Q

S/S of placenta previa

A 
Painless bleeding
Immediately following intercourse
May have no precipitating factor
No evidence of contractions
No uterine tenderness
Often little to no fetal compromise unless bleeding is severe
57
Q

Tests for PP

A

US for localization of placental implantation
EFM to exclude fetal distress
CBC if bleeding is severe/consistent

58
Q

Management of PP

A 
NO bimanual exam--only speculum to determine extent of bleeding
Hospitalization usually required
NST/BPP while in hospital then weekly
Vaginal rest--NOTHING in the vagina
If fetus is mature--delivery
59
Q

Abruptio Placentae

A

Separation of placenta from uterine wall–completely or partially
Complete abruption is an EMERGENCY and unless already hospitalized at the time of the event–fetal death is likely
Usually occurs in 2nd to 3rd trimester
Hemorrhage may be sudden and life threatening to the mother
Uncontrolled hemorrhage can result in DIC

60
Q

Etiology of AP

A 
Unknown
Recurrence rate is 5%-17% after one occurrence, 25% after 2 occurences
Trauma
chronic HTN
Cocaine use
Alcohol, smoking
Uterine tumor or structural abnormality
61
Q

S/S of AP

A 
Severe abdominal pain
BRIGHT red bleeding is heavy if unconcealed
Bleeding may be minimal if concealed
Rigid uterus in concealed
Shock
Fetal distress/absent FHT's
62
Q

Tests for AP

A

US
EFM to monitor for fetal distress
CBC, type, Rh, coags,

63
Q

Management of AP

A

Immediate transport and referral

If hemorrhage or fetal distress are present–immediate delivery when mother becomes stable

64
Q

Premature labor

A

The occurrence of contractions after 20 weeks but before 37 weeks which result in the dilatation and/or effacement of the cervical os

65
Q

Risk factors for premature labor

A 
Hx of preterm delivery
Genital/urinary infetions
Multiple gestation
Low-income
Poor weight gain/nutrition
Drug use (esp cocaine, smoking)
Uterine structural abnormalities
Cervical trauma
Adolescent or advanced maternal age
66
Q

S/S of preterm labor

A

Uterine cramping that is intermittent or constant
Lower back pain
Uterine contractions with frequency of 10-12 min 5/hr
May experience vaginal spotting or change in d/c
Cervical effacement/shortening and/or dilatation

67
Q

Prevention of preterm labor

A

Id and elimination of risk factors
Reassessment of risk factors at each trimester
Education regarding warning signs of premature labor

68
Q

Management of preterm labor

A

Hospitalization if unable to stop contractions prior to cervical change
Tocolytic therapy IF cervical change occurs
If <34 weeks and successfully tocolyzed, give B-methasone injections 2x/week, to enhance fetal lung maturity up to 34 weeks
Bed rest
Vaginal rest
Weekly cervical checks

69
Q

Postpartum complications

A

PE
PP hemorrhage
PP depression
Mastitis

70
Q

Mastitis

A

Painful inflammation of the breast usually d/t Staph

Symptomatic tx= NSAIDS, ice packs, Abx (Dicloxacillin, cephalexin, clinda)

Obstetrics and pregnancy (1 decks)

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