OB/Pregnancy Flashcards
1
Q
First Trimester
A
First 12 weeks
2
Q
1st trimester symptoms
A
Amenorrhea N/V Fatigue Breast tenderness Urinary Frequemcy
3
Q
Second trimester
A
13-27 weeks
4
Q
2ns trimester symptoms
A
Fetal movement
Abdominal discomfort secondary to stretching
Change in skin pigmentation
Syncopal episodes
5
Q
Chloasma
A
Brown or gray-brown patched that appear on face during pregnancy
6
Q
Third trimester
A
28-40 weeks
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
8
Q
1st trimester PE
A
by 8 weeks of gestation: Goodell’s sign, Chadwick’s sign, Hegar’s sign
Breast enlargement
9
Q
When do you start to hear fetal heart tones?
A
10-12 weeks
10
Q
Goodell’s sign
A
Softening of cervix
11
Q
Chadwick’s sign
A
Cervical cyanosis
12
Q
Hegar’s sign
A
Softening of cervicouterine junction
13
Q
2nd trimester PE
A
Fetal movement by 18-20 weeks
Striae
14
Q
Where is fundus palpable at 20 weeks gestation?
A
Umbilicus
15
Q
How many cm’s does fundus grow per week after 20 weeks?
A
1cm per week
16
Q
When are Leopold’s maneuvers possible?
A
20 weeks
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
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
19
Q
What is a triple screen?
A
hCG, estriol, and alpha-fetoprotein
Done at 16-20 weeks
20
Q
What is a quad screen?
A
hCG, estriol, AFP and ihibin-A
Done at 16-20 weeks
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
22
Q
0-28 weeks prenatal visits
A
every 4 weeks
23
Q
28-36 weeks prenatal visits
A
every 2 weeks
24
Q
36 weeks to delivery
A
every week
25
Naegele's Rule
1 year - 3 months + 7days from last normal menstrual cycle.
26
Ectopic pregnancy
any conceptus that implants and grows outside the uterine cavity
95% are in fallopian tubes
27
High risk for ectopic pregnancy
Tubal surgery
Previous tubal ectopic pregnancy
Hx of PIC
IUD
28
Symptoms of ectopic pregnancy
```
Amenorrhea
AUB--usually spotting, dark brown to tarry
Unilateral lower quadrant pain
lower back/shoulder pain
Hemodynamic changes in VS
```
29
PE of ectopic pregnancy
Tender adnexa w/ possible palpable mass
+ cervical motion tenderness (CMT)
Uterine enlargement w/ hegar's sign
+ peritoneal signs if rupture has occurred
30
Diagnostics of ectopic pregnancy
Serum hCG
CBC, type and Rh
US
31
Abortion
Termination at anytime prior to viability (24 weeks) either spontaneous or medical/surgical
32
Main reason for SAB in 1st trimester
chromosomal abnormalities
33
Main reason for SAB in 2nd trimester
Cervical incompetence
Infection
Uterine abnormalities
34
Symptoms of SAB
```
Vaginal bleeding
Cramping/pelvic pressure
Low back pain
ROM
Hemodynamic changes in VS
```
35
Diagnostics for SAB
hCG level
US
CBC, type and Rh
Coag profile
36
Management of SAB
Refer
Bed rest if threatened or inevitable
Abstinence
Labs
37
Surgical elective abortion
Vacuum D&C up to 12 weeks
| D&E 13-14 weeks to 20-22 weeks
38
Medical elective abortion
Through 49 days of pregnancy
Mifepristone also known as RU 486
Prostaglandin
39
Pregnancy induced HTN
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
Preeclampsia
PIH+proteinuria+generalized edema after 20 weeks
41
Eclampsia
Preeclampsia + seizure activity
42
HELLP Syndrome
Hemolysis Elevated Liver enzymes and Low Platelet count
43
Contribution factors for PIH
```
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
Testing for PIH
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
Management of PIH
Rest at home--if worsens, bed rest in left lateral recumbent position
Fetal surveillance-- NST, US and kick counts
46
Preeclampsia s/s
Sudden weight gain
Progression from digital and mild facial edema to generalized edema
Frontal or occipital HA's
Visual disturbances with worsening condition
47
PE of preeclampsia
>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
Testing w/ preeclampsia
```
Same as PIH
Plus
Urine testing every visit
NST weekly biophysical profile
US
```
49
Management of preeclampsia
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
Eclampsia
```
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
Management of eclampsia
Mg sulfate to break seizure (valium if ineffective) then IV gtt to stabilize
Anticipate delivery ASAP
52
HELLP syndrome s/s
```
Hemolysis, elevated liver enzymes and low platelets
All of preeclampsia plus..
Nausea/vomiting
Jaundice
Extreme fatigue/ill feeling
```
53
PE of HELLP syndrome
Hepatomegaly
Tenderness or pain in the RUQ extending to epigastric area
Jaundice
Possible ascites
54
Diagnostics of HELLP syndrome
```
All same for preeclampsia
Thrombocytopenia <50,000
Clotting factors reduced
Severe hemoconcentration
Very elevated LFT's
Proteinuria consistent w/ severe preeclampsia
```
55
Placenta Previa
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
S/S of placenta previa
```
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
Tests for PP
US for localization of placental implantation
EFM to exclude fetal distress
CBC if bleeding is severe/consistent
58
Management of PP
```
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
Abruptio Placentae
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
Etiology of AP
```
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
S/S of AP
```
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
Tests for AP
US
EFM to monitor for fetal distress
CBC, type, Rh, coags,
63
Management of AP
Immediate transport and referral
| If hemorrhage or fetal distress are present--immediate delivery when mother becomes stable
64
Premature labor
The occurrence of contractions after 20 weeks but before 37 weeks which result in the dilatation and/or effacement of the cervical os
65
Risk factors for premature labor
```
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
S/S of preterm labor
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
Prevention of preterm labor
Id and elimination of risk factors
Reassessment of risk factors at each trimester
Education regarding warning signs of premature labor
68
Management of preterm labor
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
Postpartum complications
PE
PP hemorrhage
PP depression
Mastitis
70
Mastitis
Painful inflammation of the breast usually d/t Staph
| Symptomatic tx= NSAIDS, ice packs, Abx (Dicloxacillin, cephalexin, clinda)
