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Pediatrics > OBGYN > Flashcards

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
Q

What blood work do you order for preggo

A

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

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26
Q

What is a concerning of Rh status in mother?

A

Rh negative mother and Rh positive father (if father is Rh negative you do not need RhoGAM)

give RhoGAM to protect FUTURE pregnancy

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27
Q

Other than Rh- when do you give Rhogan?

A

vaginal bleeding

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28
Q

What is the MCC infectious cause of fetal growth

A

rubella

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29
Q

When is a rubella infection concerning?

A

1st trimester

check and see if a mother is immune

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30
Q

What is the treatment of a fetal rubella?

A

NO treatment

prevention is key - cannot give during pregnancy though, so you should give it before wanting to be pregnant

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31
Q

treatment of syphilis

A

Pen G

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32
Q

What should prenatal counseling

A

Prenatal vitamins (iron is not in chewables, so these patients can be more)

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33
Q

What is employment for preggo

A

Worried about demanding jobs or exposure

should not lift more than 10 pounds

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34
Q

What is counseling for weight gain in preggo

A

If you start pregnancy at a higher weight, you should not gain as much

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35
Q

Why are we worried about obesity in preggo?

A

Gestational HTN
preeclampsia
gestational DM
Macrosomnia (big babies)

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36
Q

What should you avoid in the diet of preggo?

A

Seafood is avoided if high mercury
No raw food (should do cooked sushi)
No lead

37
Q

How should you where a seatbelt while preggo?

A

UNDER belly and acrossed breast

38
Q

What is concerning about air travel in preggo

A

DVT d/t being in hypercoaguable state

39
Q

What should you avoid drinking while pregnant

A

One cup of coffee a day MAX

40
Q

Should you exercise while preggo?

A

Yes, keep doing everything you did b4.
Moderate intensity for 30 minutes
Avoid aggressive sports though

41
Q

What do you use for screening for smoking?

A

5 As

42
Q

What is fetal alcohol syndrome

A

repetetive daily use causes problems as it is a tetragen

CNS dysfunction and face abnormalities

43
Q

What is a concern about preggo that have illicit drug use?

A

They are less likely to obtain care

Do not routinely screen though

44
Q

Breastfeeding should be done for

A

at least 6 months and up to 2 years

45
Q

How often do term newborns breastfeed?

A

8-12 minutes 15 minutes at a time

46
Q

What patients is breastfeeding difficult

A

Inverted nipples
chemotherapy

47
Q

benefits of breastfeeding

A

decrease infections
increase bonding
decrease childhood obestiy
helps with weight loss
helps with birth spacing (can even be contraception, but not super reliable)

48
Q

CI of breastfeeding

A

alcohol
drugs
HIV
Hep C with cracked nipples
TB
Meds
Breast cancer treatment
Herpes on breast

49
Q

What genetic disorders are high risk so you should screen?

A

AA: sickle cell
NA: CF

most are mixed, so you can’t just screen for one issue, should screen for ALL

50
Q

When is carrier screening done?

A

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
Q

What medication use is now used

A

PLLR pregnancy and lactation and labeling rule

review and based on what is best for the patient (sometimes even CI can be given)

52
Q

What is routine care

A

4 weeks until 28
2 weeks until 3

53
Q

At each prenatal visit, what do yo udo?

A

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
Q

What labs do you order while preggo

A

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
Q

What vaccines are given while preggo

A

Hep A and B
Flu
TDaP after 27 weeks (3rd trimester d/t immunity of baby)
RSV
COVID

56
Q

Common complaints of preggo

A

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
Q

What GI complaint is common in preggo

A

Hemorrhoids
varicosities (should wear compression socks)
Heartburn (d/t relaxation of lower esophageal sphincter, can do antacids, H2 blockers)
Pica - craving weird foods

58
Q

What do you do for sleeping/fatigue

A
59
Q

Leukorrhea

A

increased vaginal discharge

could be pathological

60
Q

MC congential abnormalities

A

heart issues
cleft palate

61
Q

What age does down syndrome increase?

A

35 or older

recommended you do genetic testing

62
Q

What are NTD

A

Neural tube defects

2nd MC after cardiac anomalies

associated with an increase in alpha-fetoprotein

63
Q

why should you not go into hot tubs while pregnant?

A

because hyperthermia with

64
Q

Why do we no long do AFPs?

A

US screening is SOOOOO good, so you can detect neural tube problems

can see a bulge in the spinal cord

65
Q

What is ACOG

A

American college of Obstecrian and gyneocology

says that ALL patients should be offered genetic testing

66
Q

What is frustrating about screening test?

A

not 100% certainty

just looks at risk and identifies low or high risk NOT a diagnosis

67
Q

When can you screen for DS and other aneuloies

A
68
Q

when should you be offered more targeted US?

A

nuchal translucency >3.5mm

Down syndrome hCP is elevated and PAPP-A is decreased with

69
Q

What is 2nd trimester screening

A

triple test

hCP, AFP, anconjugated estriol

70
Q

what do you look at at 18-20 weeks?

A

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
Q

Advantages of cell free DNA

A

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
Q

What is cell free DNA

A

small fetal components (placental trophoblasts) circulate in the blood

73
Q

what is an invasive diagnostic test?

A

Amniocentesis

MC procedure of down syndrome

done 15-20 weeks

74
Q

What does an amniocentesis do?

A

Fetal karyotype because you are in the amniotic

fetal anemia
fetal lung issues
relieve pressure

75
Q

What is chorionic villus sampling?

A

CVS done between 10-13 weeks typically done for termination

76
Q

When do you do fetal blood sampling MC

A

anemia
typically done at placental cord

77
Q

antepartum fetal assessment

A

identify risk factors

allows you to know why the baby is getting stressed

78
Q

When do you see that the baby has something going on

A

not moving
no HR

79
Q

What is fetal movement

A

20-24 weeks
multigravidad = 16-18 weeks (because you know what it feels like)

80
Q

what can affect fetal movement

A

diminused amniotic fluid (less fluid = less movement)
fetus can sleep
fetus size (if big it is hard)

81
Q

What should you do for fetal movements?

A

MEASURE it

should see consistency

82
Q

What is a nonstress test

A

Meausure HR

look for >32 weeks should see 15BPM increase for 15 seconds

want to see 2 accellarations in 20 minutes

83
Q

What should you do before a nonstress test

A

wake up with aucoustic stimulation
should see accelaration
should do BPP if no reaction

84
Q

What is a biophysical profile

A

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
Q

What is BPP

A

combo of AFI and NST

86
Q

What is a dopple r velocimetry

A

look at blood flow of the placenta or brain of the baby

87
Q

what do you look at for umbilical artery

A

S/D >95% if abnormal and you do not want too much resistance

you do if fetal growth restriction

88
Q

what do you do for middle cerebral artery occlusion?

A

fetal anemia

89
Q

AFI

A

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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