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OBGYN Flashcards

1
Q

What have happened to pregnancy rates over the years?

A

Downward trend

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2
Q

What is gravity

A

of times someone has been PREGNANT

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3
Q

What is parity?

A

of births at or after 20 weeks

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4
Q

What is T and P

A

Term = born after 37 weeks
P = preterm born after 20 weeks but before 37 weeks

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5
Q

What is A and L

A

A is abortion = all pregnancy losses prior to 20 weeks

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6
Q

What is Nulli, primi,

A

Null = never been pregnant
Prim = currently pregnant and never before

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7
Q

What are the three trimesters?

A

1st = until 14 weeks
2nd 15-28
3rd = 29-42

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8
Q

What is pre-conceptional care?

A

Coming in for history that may make them at risk for pregnancy

Want DM control, med review

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9
Q

When do people typically know they are pregnant?

A

Typically 5-6 weeks after realizing they missed their periods

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10
Q

How many preggos are unplanned?

A

Up to 50%!

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11
Q

How common is prenatal care used?

A

2001 = 50 million prenatal visits

people still do not use adequate care!

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12
Q

What are the s/s of preggo?

A

Amenorrhea (no periods)

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13
Q

Are pregnancy tests accurate?

A

Yes

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14
Q

What can implantation bleeding mean?

A

You thought that you were having a period but it was implantation

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15
Q

What are the lower reproductive changes of preggo and breast changes

A

Softening
blueing
softing of uterus
breast become tender, increase in size, areoli and nipple enlarge
breast will start to produce colostrum (clear yellowish fluid)
Deeply pigmented

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16
Q

How to diagnose pregnancy

A

bHCG

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17
Q

What can alter bHCG?

A

Similar to unit of LH, FSH, and TSH

sometimes can be false positive during LH surge and false hyperthyroidism

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18
Q

What is the function of bHCG

A

Corpus leutum (supports preggo from 9-10 weeks until placenta takes over) and bHCG keeps it alive

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19
Q

What can cause b hCG to be falsely pausitive?

A

serum factors can bind to it

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20
Q

What is B-HCG course of concentration with time

A

increase with time and should double every 1-2 days

Home preggo test = use first urination

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21
Q

When do we do the first US for preggo?

A

Gestiational sac after 4-5 weeks
Yolk sac = bright ring and confirms the location of the ring makes
Fetal pole = looks like a tictac and is where you will see the heart beat and can measure the crown rump length to make sure it correlates with the the last period

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22
Q

What is Naegele’s rule

A

LMP + 7 days - 3 months

US is most accurate

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23
Q

If they have had a pregnancy before, what do you ask?

A

C section
prior complication
infertility components

menstrual history
contraceptive history
psychosocial history (depression, anxiety, violence/abuse, tobacco/alcohol/drugs)

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24
Q

What do you check for PE

A

thyroid
bowel sounds
speculum exam
pap smear if over 21
STD testing to make sure that the baby was not exposed
bimanual exam (small orange = 6 week size, large orange = 8 week size, grapefruit = 12 week size).
Cerivcal dilatoin

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25
What blood work do you order for preggo
CBC (white blood cell elevation is common) Blood type and Rh Antibody screening Pap smear Urine protein culture rubella syphilis gonococcal chlamydial hep B and C (drug use) HIV varicella IgG Hgba1c
26
What is a concerning of Rh status in mother?
Rh negative mother and Rh positive father (if father is Rh negative you do not need RhoGAM) give RhoGAM to protect FUTURE pregnancy
27
Other than Rh- when do you give Rhogan?
vaginal bleeding
28
What is the MCC infectious cause of fetal growth
rubella
29
When is a rubella infection concerning?
1st trimester check and see if a mother is immune
30
What is the treatment of a fetal rubella?
NO treatment prevention is key - cannot give during pregnancy though, so you should give it before wanting to be pregnant
31
treatment of syphilis
Pen G
32
What should prenatal counseling
Prenatal vitamins (iron is not in chewables, so these patients can be more)
33
What is employment for preggo
Worried about demanding jobs or exposure should not lift more than 10 pounds
34
What is counseling for weight gain in preggo
If you start pregnancy at a higher weight, you should not gain as much
35
Why are we worried about obesity in preggo?
Gestational HTN preeclampsia gestational DM Macrosomnia (big babies)
36
What should you avoid in the diet of preggo?
Seafood is avoided if high mercury No raw food (should do cooked sushi) No lead
37
How should you where a seatbelt while preggo?
UNDER belly and acrossed breast
38
What is concerning about air travel in preggo
DVT d/t being in hypercoaguable state
39
What should you avoid drinking while pregnant
One cup of coffee a day MAX
40
Should you exercise while preggo?
Yes, keep doing everything you did b4. Moderate intensity for 30 minutes Avoid aggressive sports though
41
What do you use for screening for smoking?
5 As
42
What is fetal alcohol syndrome
repetetive daily use causes problems as it is a tetragen CNS dysfunction and face abnormalities
43
What is a concern about preggo that have illicit drug use?
They are less likely to obtain care Do not routinely screen though
44
Breastfeeding should be done for
at least 6 months and up to 2 years
45
How often do term newborns breastfeed?
8-12 minutes 15 minutes at a time
46
What patients is breastfeeding difficult
Inverted nipples chemotherapy
47
benefits of breastfeeding
decrease infections increase bonding decrease childhood obestiy helps with weight loss helps with birth spacing (can even be contraception, but not super reliable)
48
CI of breastfeeding
alcohol drugs HIV Hep C with cracked nipples TB Meds Breast cancer treatment Herpes on breast
49
What genetic disorders are high risk so you should screen?
AA: sickle cell NA: CF most are mixed, so you can't just screen for one issue, should screen for ALL
50
When is carrier screening done?
EVERYONE does not replace newborn screening. Allows you to see if you are a carrier for CF and if husband is a carrier, then 25% chance.
51
What medication use is now used
PLLR pregnancy and lactation and labeling rule review and based on what is best for the patient (sometimes even CI can be given)
52
What is routine care
4 weeks until 28 2 weeks until 3
53
At each prenatal visit, what do yo udo?
Look for HR at 10 weeks growth of fetus 12 wekks fundus emergening 16 weeks fundus is between pubic symphisis 20 weeks funduns in umblicus the cm at age 20-34 should have a 2 cm +/- therir pregnancy week US dating US Maternal height/weight look at symptoms
54
What labs do you order while preggo
gestational DM screening at 24-28 weeks CBC repeat at 28 weeks monitor for anemia RH- screen Syphilis and HIV for high risk Group B strep (looking for HIGH concentration which might leave)
55
What vaccines are given while preggo
Hep A and B Flu TDaP after 27 weeks (3rd trimester d/t immunity of baby) RSV COVID
56
Common complaints of preggo
N/V (use saltines) Vitamin B6 with doxylamine (OTC sleeping aid) back ache (shifting center of gravity, MC in higher weight women) can do prenatal yoga, maternity belt
57
What GI complaint is common in preggo
Hemorrhoids varicosities (should wear compression socks) Heartburn (d/t relaxation of lower esophageal sphincter, can do antacids, H2 blockers) Pica - craving weird foods
58
What do you do for sleeping/fatigue
59
Leukorrhea
increased vaginal discharge could be pathological
60
MC congential abnormalities
heart issues cleft palate
61
What age does down syndrome increase?
35 or older recommended you do genetic testing
62
What are NTD
Neural tube defects 2nd MC after cardiac anomalies associated with an increase in alpha-fetoprotein
63
why should you not go into hot tubs while pregnant?
because hyperthermia with
64
Why do we no long do AFPs?
US screening is SOOOOO good, so you can detect neural tube problems can see a bulge in the spinal cord
65
What is ACOG
American college of Obstecrian and gyneocology says that ALL patients should be offered genetic testing
66
What is frustrating about screening test?
not 100% certainty just looks at risk and identifies low or high risk NOT a diagnosis
67
When can you screen for DS and other aneuloies
68
when should you be offered more targeted US?
nuchal translucency >3.5mm Down syndrome hCP is elevated and PAPP-A is decreased with
69
What is 2nd trimester screening
triple test hCP, AFP, anconjugated estriol
70
what do you look at at 18-20 weeks?
lots of different genetic conditions or if a bunch of minor abnormalites = concerned even if negative screening (because genetic screenings do not look for zebras)
71
Advantages of cell free DNA
99% diagnostic (still not a diagnositc test) can be done at 9 weeks and can even show the gender of the child one blood draw!!!
72
What is cell free DNA
small fetal components (placental trophoblasts) circulate in the blood
73
what is an invasive diagnostic test?
Amniocentesis MC procedure of down syndrome done 15-20 weeks
74
What does an amniocentesis do?
Fetal karyotype because you are in the amniotic fetal anemia fetal lung issues relieve pressure
75
What is chorionic villus sampling?
CVS done between 10-13 weeks typically done for termination
76
When do you do fetal blood sampling MC
anemia typically done at placental cord
77
antepartum fetal assessment
identify risk factors allows you to know why the baby is getting stressed
78
When do you see that the baby has something going on
not moving no HR
79
What is fetal movement
20-24 weeks multigravidad = 16-18 weeks (because you know what it feels like)
80
what can affect fetal movement
diminused amniotic fluid (less fluid = less movement) fetus can sleep fetus size (if big it is hard)
81
What should you do for fetal movements?
MEASURE it should see consistency
82
What is a nonstress test
Meausure HR look for >32 weeks should see 15BPM increase for 15 seconds want to see 2 accellarations in 20 minutes
83
What should you do before a nonstress test
wake up with aucoustic stimulation should see accelaration should do BPP if no reaction
84
What is a biophysical profile
5 variables NST fetal breathings fetal movements (big movements) fetal tone (flexion/extension) amniotic fluid volume (2x2 pocket) 10/10 best 8/10 is concerning if low AFI 6 = worried, maybe deliver or repeat 4s and 2s = definitely deliver
85
What is BPP
combo of AFI and NST
86
What is a dopple r velocimetry
look at blood flow of the placenta or brain of the baby
87
what do you look at for umbilical artery
S/D >95% if abnormal and you do not want too much resistance you do if fetal growth restriction
88
what do you do for middle cerebral artery occlusion?
fetal anemia
89
AFI
amniotic fluid index looks at the amount of fluid around the baby. Measuring the 4 quadrants of the mom's belly and you get a fluid level in each of the quadrants

Pediatrics (7 decks)

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