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WH 3 > OB review session > Flashcards

OB review session Flashcards

1
Q

hx of chlaymdia, smoking, hx of PID, prior ectopic pregnancy, assisted reproduction, age, surgery,inflammation

A

these are associated with increased risk for ectopics

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2
Q
  • cramping bleeding
  • closed cervix (no tissue coming out)
  • hcG could be normal; recheck in 48hrs to see if pregnancy will be normal or not
A

threatened SAB

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3
Q
  • cramping, bleeding
  • open cervix but nothing coming out of it
  • after rechecking hCG, it either doesnt increase like its supposed to or it decreases
A

inevitable SAB

it wont be full term;matter of WHEN

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4
Q
  • sx
  • open cervix and things starting to come out
  • US might still show some tissue in uterus
A

incomplete SAB

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5
Q
  • had sx
  • passed tissue so os might be closed now
  • US shows empty uterus
A

complete SAB

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6
Q

immunizations that are contraindicated in pregnancy

A

MMR
varicella

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7
Q

what is the most common reason for an abnormal fetal screen

A

incorrect gestational age

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8
Q

bHCG pattern

A

doubles every 48 hrs until 12 wks when it starts to fall

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9
Q

1st trimester fetal screen (2)

A

NT/PAPP-A
b-hCG

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10
Q

2nd trimester mom(3) and fetal(4) screening

A
  • Mom: 1-hr glucola, CBC, antibody screen
  • Fetus: triple/quad screen (AFP, b-HCG, estriol/inhibin-A)
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11
Q

recommended folic acid dose

A

400

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12
Q

which trimester is AFP checked

A

if the 1st trimester screenings were done, then only do it in 2nd trimester

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13
Q

intrauterine pregnancy should be seen on transvaginal vs transabdominal US with this level of hCG (discriminatory value)

A

transvaginal: 1500-2000
transabdominal: 2500

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14
Q

3rd trimester prenatal screenings (mom, PRN, fetal- 2 each)

A
  • Mom: CBC, GBS
  • Fetal: NST, BPP
  • PRN: depression, STI
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15
Q

“Advanced” screening test (NIPT, cell-free fetal DNA)

A

maternal serum test
10-20 wks (optimal 11-13)
T21,18,13 and some sex chromosome aneuploidies
“Near-diagnostic” DNA test

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16
Q

3 ways to manage miscarriage

A
  • expectant management
  • meds– misopristol
  • surgery– evacuation or actual surgery
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17
Q

what is naegeles rule & when is it used

A

used in dating pregnancies when pt is either irregular or cant remember LMP
9 months + 1 wk

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18
Q

date the pregnancy if fundal height is just above pelvis

A

12 wks

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19
Q

if you can hear FHT, how far along is pregnancy most likely?

A

at least 10-12 wks

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20
Q

how far does a pregnancy need to be to be detected on US?

A

6-7 wks

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21
Q

when can you do **fetal **diagnostic testing for chorionic villi sampling vs amniocentesis

A
  • chorionic villi: 10-15 wks (1st trimester)
  • amniocentesis: 15-20 wks (2nd trimester); used to evaluate high AFP
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22
Q

2 **maternal **diagnostic testing

A

GTT
3hr GTT

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23
Q

recommended weight gain for entire pregnancy (normal vs low vs high BMI)

A

Normal: 25-30 lbs
if underweight: 30+ lbs
if overweight: lower end of range but not recommending weight loss

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24
Q

if fundal height is at level of umbilicus, how many wks gestational age in typical singleton pregnancy?

A

20 wks

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25
Q

at ____ weeks, hCG levels starts to taper down

A

10-12 wks

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26
Q

3 things related to fetus to monitor prenatally

A

fundal height
fundal HR
fetal movement (quickening)

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27
Q

in general, the first tremester fetal screenings are looking for ____

A

trisomies!!!

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28
Q

the quad screen in second trimester is looking for

A

genetic things like trisomies + neural tube defects

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29
Q

test that looks at fetal HR in response fetal activity

A

non-stress test (NST)

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30
Q

test that looks at fetal HR in response to uterine contraction

A

contraction stress test (CST)

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31
Q

biophysical profile in 3rd trim. fetal monitoring involves using both NST & US to look at ____ (4 things)

A

fetal breathing
movement
tone
AFI

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32
Q

5 HTN disorders in pregnancy

A

chronic HTN
gestational HTN
pre-eclampsia (toxemia)
Eclampsia
HELLP syndrome

33
Q

HTN after 20 wks in 5-10%; no proteinuria

A

gestational HTN

34
Q

chorinic villi sampling vs amniocentesis prcocedure

A

chorionic takes placenta DNA
amniocentesis takes amniotic fluid

both don’t directly take DNA out of fetus

35
Q
  • HTN w/ proteinuria
  • multi-system involvement possible
A

pre-eclampsia (toxemia)

36
Q

when does preeclampsia become eclampsia?

A

when there are seizures

37
Q

4-12% of pts with pre/eclampsia have this

A

HELLP syndrome

38
Q

CBC, BUN/Cr, LFTs, UA, 224 hr urine, coags are labs you can get to analyze ____

A

HTN disorders in pregnancy

39
Q

4 tx of HTN d/o in pregnancy

A
  • Methyldopa
  • a/b-blocker (labetolol)
  • hydralazine
  • CCB (nifedipine)
40
Q

3 meds that must NOT be used to tx HTN in pregnancy

A

ACE
ARBs
Diuretics

41
Q

normal range of fetal HR

A

110-160bpm

42
Q

when does fetal quickening happen?

A

around 20 wks

43
Q

you give RhoGAM when mom is ____ with ____ fetus; when? (gestational age & 2 other situations)

A
  • Rh - mom with Rh + fetus
  • at 28 wks or threatened abortion or trauma

basically anytime fetal blood would be in contact with maternal blood

44
Q

normal kick-counts is ____ every hour

A

10x an hr is reassuring

45
Q

when would you turn to the BPP in 3rd trimester?

A

if non reactive NST

46
Q

positive NST is…

A

2 acceleration in 20 mins
this is good

47
Q

reassuring vs NOT reassuring BPP score

A

8-10 is reassuring
0-4 is not reassuring and means to move to delivery

48
Q

what does HELLP mean?

A

Hemolysis
Elevated LFT
Low Platelets

would see anemia, RUQ pain, low plts, abnormal blood counts, DIC

49
Q

6 complications associated with GDM

A

congenital anomalies
SAB & stillbirth
macrosomia
polyhydramnios
placental abruption
neonatal hypoglycemia (rebound)!

50
Q

oligohydramnios is associated with GDM or HTN d/o? which one?

A

HTN d/o

51
Q

7 things associated with postpartum hemorrhage

A
  • **prolonged labor
  • precipitous labor
  • pre-eclampsia
  • multiple gestation**
  • retained placenta
  • operative delivery
    * uterine atony is underlying!
52
Q

is maternal obesity associated with preterm labor?

A

No! its actually more associated with underweight

53
Q

underlying cause of preterm labor and 4 examples

A
  • inflammation
  • smoking, short interpregnancy interval (<12-18 months), UTI/genital tract infxn, periodontal dz
54
Q

placental abruption is associated with (5)

A
  • Gestational HTN
  • prior placental abruption
  • multiparity
  • smoking, cocaine
  • trauma
55
Q

pregnant pt close to term shows up with bleeding, after fall; notice hard cord like belly & tenderness

A

placentall abruption

56
Q

2 primary factors in evaluating labor progression

A

cervial effacement & dilation

57
Q

effacement vs dilation

A

effacement: cervix length; 0% is thick and long & 100% is thin
dilation is opening; can go up to 10cm

58
Q

early (latent) < 4cm
transition 4-6 cm
late (active) 6-10cm

A

1st stage of labor

59
Q

dilation you need in 1st stage of labor to declare arrest and move to c section

A

4-6cm

60
Q

stage where pushing starts & baby starts to pass; avg time of 1-2 hrs for first birth and 30mins for multiple

A

2nd stage

61
Q

after delivery youre waiting for the placenta and can give pitocin or tug on umbilicus to help

A

3rd stage

62
Q

first 6 hrs post partum where there is a lot of CV changes

A

4th stage

63
Q

what is labor dystocia

A

failure to progress

64
Q

4 Ps of labor dystocia

A
  • Power of contraction
  • Passenger size
  • Pelvis size
  • Presentation/Position
65
Q

most favorable presentation for vaginal delivery

A

occiput-anterior (back of head facing moms belly)

66
Q

2 worse positions that require c section

A

transverse lie
placenta premia (placenta blocking opening)

67
Q

** look at postpartum care lecture!!*

A

focus on support, education and management considerations

68
Q

early decelarations indicates

A

head compression (vagal response)

69
Q

late decelerations indicate

A

uteroplacental insufficiency causing fetal MI

Causes: epidural, pitocin, HTN d/o of pregnancy, tobacco, drug,SLE, IUGR

70
Q

variable decelerations indicate

A

cord compression;

71
Q

IV sedation vs epidural

A
  • sedation takes edge off and helps get through to pushing stage; dont give too close to delivery
  • epidural takes away pain & slows labor; has higher rate of vaccuum, forceps, fever but no diff in c-section rates
72
Q

mediolateral vs midline epistiotomy

A
  • mediolateral has less 3rd & 4th degree lacerations but more blood loss, pain, difficulty repair
  • midline has more 3rd & 4th degree extensions but less bleeding, pain & easier repair
73
Q

2 things to check for in the placenta post partum

A
  1. is it intact? no cotyledons missing
  2. the 3 vessel cords (2 arteries, 1 vein)
74
Q

placenta previa vs placental abruption

A
  • previa– usually painless bleeding; needs cesearean if at term
  • abruption is usually painful bleeding; non-reassuring fetal heart tracing; may need emergent delivery
75
Q

6 causes of intrapartum maternal bleeding

A
  • placenta previa
  • placental abruption
  • cervical dilation
  • cervicitis
  • trauma
  • UTI
76
Q

temperature considered intrapartum fever

A

100.4 TWICE of 101.5 ONCE

77
Q

if there is intrapartum fever what should you assume & how to tx?

A

chorioamnionitis– often with fetal tachy
tx– start abx

78
Q

4 indications for assisted vaginal delivery

A
  • Maternal exhaustion
  • Non-reassuring fetal heart tracing
  • Prolonged 2nd stage of labor
  • Maternal cardiac or other contraindications to pushing
79
Q

vaccum vs forceps

A
  • vacuum– more comon, less trauma risk; MUST be pushing; not for preterm delivery
  • Forceps– ok i fnot pushing & ok with preterm delivery

WH 3 (3 decks)

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