OBGYN Flashcards
What have happened to pregnancy rates over the years?
Downward trend
What is gravity
of times someone has been PREGNANT
What is parity?
of births at or after 20 weeks
What is T and P
Term = born after 37 weeks
P = preterm born after 20 weeks but before 37 weeks
What is A and L
A is abortion = all pregnancy losses prior to 20 weeks
What is Nulli, primi,
Null = never been pregnant
Prim = currently pregnant and never before
What are the three trimesters?
1st = until 14 weeks
2nd 15-28
3rd = 29-42
What is pre-conceptional care?
Coming in for history that may make them at risk for pregnancy
Want DM control, med review
When do people typically know they are pregnant?
Typically 5-6 weeks after realizing they missed their periods
How many preggos are unplanned?
Up to 50%!
How common is prenatal care used?
2001 = 50 million prenatal visits
people still do not use adequate care!
What are the s/s of preggo?
Amenorrhea (no periods)
Are pregnancy tests accurate?
Yes
What can implantation bleeding mean?
You thought that you were having a period but it was implantation
What are the lower reproductive changes of preggo and breast changes
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
How to diagnose pregnancy
bHCG
What can alter bHCG?
Similar to unit of LH, FSH, and TSH
sometimes can be false positive during LH surge and false hyperthyroidism
What is the function of bHCG
Corpus leutum (supports preggo from 9-10 weeks until placenta takes over) and bHCG keeps it alive
What can cause b hCG to be falsely pausitive?
serum factors can bind to it
What is B-HCG course of concentration with time
increase with time and should double every 1-2 days
Home preggo test = use first urination
When do we do the first US for preggo?
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
What is Naegele’s rule
LMP + 7 days - 3 months
US is most accurate
If they have had a pregnancy before, what do you ask?
C section
prior complication
infertility components
menstrual history
contraceptive history
psychosocial history (depression, anxiety, violence/abuse, tobacco/alcohol/drugs)
What do you check for PE
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
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
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
Other than Rh- when do you give Rhogan?
vaginal bleeding
What is the MCC infectious cause of fetal growth
rubella
When is a rubella infection concerning?
1st trimester
check and see if a mother is immune
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
treatment of syphilis
Pen G
What should prenatal counseling
Prenatal vitamins (iron is not in chewables, so these patients can be more)
What is employment for preggo
Worried about demanding jobs or exposure
should not lift more than 10 pounds
What is counseling for weight gain in preggo
If you start pregnancy at a higher weight, you should not gain as much
Why are we worried about obesity in preggo?
Gestational HTN
preeclampsia
gestational DM
Macrosomnia (big babies)
What should you avoid in the diet of preggo?
Seafood is avoided if high mercury
No raw food (should do cooked sushi)
No lead
How should you where a seatbelt while preggo?
UNDER belly and acrossed breast
What is concerning about air travel in preggo
DVT d/t being in hypercoaguable state
What should you avoid drinking while pregnant
One cup of coffee a day MAX
Should you exercise while preggo?
Yes, keep doing everything you did b4.
Moderate intensity for 30 minutes
Avoid aggressive sports though
What do you use for screening for smoking?
5 As
What is fetal alcohol syndrome
repetetive daily use causes problems as it is a tetragen
CNS dysfunction and face abnormalities
What is a concern about preggo that have illicit drug use?
They are less likely to obtain care
Do not routinely screen though
Breastfeeding should be done for
at least 6 months and up to 2 years
How often do term newborns breastfeed?
8-12 minutes 15 minutes at a time
What patients is breastfeeding difficult
Inverted nipples
chemotherapy
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)
CI of breastfeeding
alcohol
drugs
HIV
Hep C with cracked nipples
TB
Meds
Breast cancer treatment
Herpes on breast
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
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.
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)
What is routine care
4 weeks until 28
2 weeks until 3
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
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)
What vaccines are given while preggo
Hep A and B
Flu
TDaP after 27 weeks (3rd trimester d/t immunity of baby)
RSV
COVID
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
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
What do you do for sleeping/fatigue
Leukorrhea
increased vaginal discharge
could be pathological
MC congential abnormalities
heart issues
cleft palate
What age does down syndrome increase?
35 or older
recommended you do genetic testing
What are NTD
Neural tube defects
2nd MC after cardiac anomalies
associated with an increase in alpha-fetoprotein
why should you not go into hot tubs while pregnant?
because hyperthermia with
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
What is ACOG
American college of Obstecrian and gyneocology
says that ALL patients should be offered genetic testing
What is frustrating about screening test?
not 100% certainty
just looks at risk and identifies low or high risk NOT a diagnosis
When can you screen for DS and other aneuloies
when should you be offered more targeted US?
nuchal translucency >3.5mm
Down syndrome hCP is elevated and PAPP-A is decreased with
What is 2nd trimester screening
triple test
hCP, AFP, anconjugated estriol
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)
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!!!
What is cell free DNA
small fetal components (placental trophoblasts) circulate in the blood
what is an invasive diagnostic test?
Amniocentesis
MC procedure of down syndrome
done 15-20 weeks
What does an amniocentesis do?
Fetal karyotype because you are in the amniotic
fetal anemia
fetal lung issues
relieve pressure
What is chorionic villus sampling?
CVS done between 10-13 weeks typically done for termination
When do you do fetal blood sampling MC
anemia
typically done at placental cord
antepartum fetal assessment
identify risk factors
allows you to know why the baby is getting stressed
When do you see that the baby has something going on
not moving
no HR
What is fetal movement
20-24 weeks
multigravidad = 16-18 weeks (because you know what it feels like)
what can affect fetal movement
diminused amniotic fluid (less fluid = less movement)
fetus can sleep
fetus size (if big it is hard)
What should you do for fetal movements?
MEASURE it
should see consistency
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
What should you do before a nonstress test
wake up with aucoustic stimulation
should see accelaration
should do BPP if no reaction
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
What is BPP
combo of AFI and NST
What is a dopple r velocimetry
look at blood flow of the placenta or brain of the baby
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
what do you do for middle cerebral artery occlusion?
fetal anemia
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
