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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
at ____ weeks, hCG levels starts to taper down
10-12 wks
26
3 things related to fetus to monitor prenatally
fundal height fundal HR fetal movement (quickening)
27
in general, the first tremester fetal screenings are looking for ____
trisomies!!!
28
the quad screen in second trimester is looking for
genetic things like trisomies + neural tube defects
29
test that looks at fetal HR in response **fetal activity**
non-stress test (NST)
30
test that looks at fetal HR in response to **uterine contraction**
contraction stress test (CST)
31
biophysical profile in 3rd trim. fetal monitoring involves using both NST & US to look at ____ (4 things)
fetal breathing movement tone AFI
32
5 HTN disorders in pregnancy
chronic HTN gestational HTN pre-eclampsia (toxemia) Eclampsia HELLP syndrome
33
HTN after 20 wks in 5-10%; no proteinuria
gestational HTN
34
chorinic villi sampling vs amniocentesis prcocedure
chorionic takes placenta DNA amniocentesis takes amniotic fluid | both don't directly take DNA out of fetus
35
* HTN w/ proteinuria * multi-system involvement possible
pre-eclampsia (toxemia)
36
when does preeclampsia become eclampsia?
when there are seizures
37
4-12% of pts with pre/eclampsia have this
HELLP syndrome
38
CBC, BUN/Cr, LFTs, UA, 224 hr urine, coags are labs you can get to analyze ____
HTN disorders in pregnancy
39
4 tx of HTN d/o in pregnancy
* Methyldopa * a/b-blocker (labetolol) * hydralazine * CCB (nifedipine)
40
3 meds that must NOT be used to tx HTN in pregnancy
ACE ARBs Diuretics
41
normal range of fetal HR
110-160bpm
42
when does fetal quickening happen?
around 20 wks
43
you give RhoGAM when mom is ____ with ____ fetus; when? (gestational age & 2 other situations)
* 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
normal kick-counts is ____ every hour
10x an hr is reassuring
45
when would you turn to the BPP in 3rd trimester?
if non reactive NST
46
positive NST is...
2 acceleration in 20 mins this is good
47
reassuring vs NOT reassuring BPP score
8-10 is reassuring 0-4 is not reassuring and means to move to delivery
48
what does HELLP mean?
Hemolysis Elevated LFT Low Platelets | would see anemia, RUQ pain, low plts, abnormal blood counts, DIC
49
6 complications associated with GDM
congenital anomalies SAB & stillbirth macrosomia polyhydramnios placental abruption neonatal hypoglycemia (rebound)!
50
oligohydramnios is associated with GDM or HTN d/o? which one?
HTN d/o
51
7 things associated with postpartum hemorrhage
* **prolonged labor * precipitous labor * pre-eclampsia * multiple gestation** * retained placenta * operative delivery *** uterine atony is underlying!**
52
is maternal obesity associated with preterm labor?
No! its actually more associated with underweight
53
underlying cause of preterm labor and 4 examples
* inflammation * smoking, short interpregnancy interval (<12-18 months), UTI/genital tract infxn, periodontal dz
54
placental abruption is associated with (5)
* Gestational HTN * prior placental abruption * multiparity * smoking, cocaine * trauma
55
pregnant pt close to term shows up with bleeding, after fall; notice hard cord like belly & tenderness
placentall abruption
56
2 primary factors in evaluating labor progression
cervial effacement & dilation
57
effacement vs dilation
effacement: cervix length; 0% is thick and long & 100% is thin dilation is opening; can go up to 10cm
58
early (latent) < 4cm transition 4-6 cm late (active) 6-10cm
1st stage of labor
59
dilation you need in 1st stage of labor to declare arrest and move to c section
4-6cm
60
stage where pushing starts & baby starts to pass; avg time of 1-2 hrs for first birth and 30mins for multiple
2nd stage
61
after delivery youre waiting for the placenta and can give pitocin or tug on umbilicus to help
3rd stage
62
first 6 hrs post partum where there is a lot of CV changes
4th stage
63
what is labor dystocia
failure to progress
64
4 Ps of labor dystocia
* Power of contraction * Passenger size * Pelvis size * Presentation/Position
65
most favorable presentation for vaginal delivery
occiput-anterior (back of head facing moms belly)
66
2 worse positions that require c section
transverse lie placenta premia (placenta blocking opening)
67
**** look at postpartum care lecture!!*
focus on support, education and management considerations
68
early decelarations indicates
head compression (vagal response)
69
late decelerations indicate
uteroplacental insufficiency causing fetal MI | Causes: epidural, pitocin, HTN d/o of pregnancy, tobacco, drug,SLE, IUGR
70
variable decelerations indicate
cord compression;
71
IV sedation vs epidural
* 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
mediolateral vs midline epistiotomy
* 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
2 things to check for in the placenta post partum
1. is it intact? no cotyledons missing 2. the 3 vessel cords (2 arteries, 1 vein)
74
placenta previa vs placental abruption
* previa-- usually painless bleeding; needs cesearean if at term * abruption is usually painful bleeding; non-reassuring fetal heart tracing; may need emergent delivery
75
6 causes of intrapartum maternal bleeding
* placenta previa * placental abruption * cervical dilation * cervicitis * trauma * UTI
76
temperature considered intrapartum fever
100.4 TWICE of 101.5 ONCE
77
if there is intrapartum fever what should you assume & how to tx?
chorioamnionitis-- often with fetal tachy tx-- start abx
78
4 indications for assisted vaginal delivery
* Maternal exhaustion * Non-reassuring fetal heart tracing * Prolonged 2nd stage of labor * Maternal cardiac or other contraindications to pushing
79
vaccum vs forceps
* 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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