OBGYN #5 Flashcards
Fundal Height Measurement and time frame
- 12 weeks: above pubic symphysis
- 16 weeks: between pubis and umbilicus
- 20 weeks: at umbilicus
- 38 weeks: 2-3 cm below xiphoid process
What is Ladin’s Sign
Uterus softening after 6 weeks
What is Hegar’s Sign?
uterine isthmus softening after 6-8 weeks gestation
What is Goodell’s Sign?
Cervical softening due to increased vascularization at 4-5 weeks gestation
What is Chadwick’s Sign?
Bluish coloration of the cervix and vulva at 8-12 weeks
Fetal heart tones are heard at about _____ and the normal rate is ______
10-12 weeks
120-160 bpm
Serum B-hCG can detect pregnancy as early as ____ days after conception
Urine B-hCG can detect pregnancy as early as _____ days after conception
5
14
What is Naegele’s Rule?
First day of LMP + 7 days - 3 months
Risk factors for gestational diabetes
- Family HX of gestational diabetes
- Spontaneous abortion
- History of infant > 4,000g at birth (8.8 pounds)
- Multiple gestations
- AA
What is the pathophysiology of gestational diabetes
-Maternal insulin resistance in women with undiagnosed beta cell dysfunction exacerbated by placental release diabetogenic hormones (human placental lactogen), growth hormone, and corticotropin-releasing hormone
Fetal complications of gestational diabetes
- Macrosomia (excessive birth weight)
- Shoulder dystocia
- Preterm labor
- neonatal hypoglycemia
- Congenital malformations
What is the chance that the mother develops type 2 Diabetes mellitus after pregnancy if she has gestational diabetes?
50%
What is the 2 step approach to screening for gestational diabetes?
- Step 1: 50 gram 1 hour glucose challenge test at 24-28 weeks gestation. If positive (>130-140), patients go on to 3h glucose tolerance test
- Step 2: 100 gram 3 hour oral glucose tolerance test (GOLD STANDARD). Threshold for glucose levels are 2 of the 4: fasting > 95, 1 hour > 180, 2 hour > 155, 3 hour > 140.
Lifestyle modifications for gestational diabetes
Diabetic diet and exercise (walking) is the initial treatment of choice
-Pregnant patients are NOT told to lose weight. Daily finger sticks overnight and after each meal.
What is the first-line medical treatment of choice and why? What is the goal of treatment?
Insulin (doesn’t cross the placenta)
-Goal of treatment is fasting glucose < 95
If the patient refuses insulin therapy or won’t comply with insulin, what are safe medication alternatives?
Glyburide or Metformin
What Vitamin should be supplemented to a baby if he/she is breastfeeding?
Vitamin D
What is morning sickness and when does it occur?
Nausea and vomiting up until 16 weeks (most common in first trimester)
What is hyperemesis gravidarum?
Severe, excessive form of morning sickness (nausea, vomiting) associated with weight loss and electrolyte imbalance. Develops during 1st or 2nd trimester and lasts > 16 weeks gestation
What labs are shown with hyperemesis gravidarum?
- Hypokalemia
- Metabolic alkalosis from vomiting
Management of morning sickness and Hyperemesis Gravidarum
- Lifestyle modifications: initial management of choice. Ginger, fluids, avoid spicy foods
- Pyridoxine (B6) + Doxylamine is first line medical management
- If no relief, use antihistamines
- IV rehydration, electrolyte repletion
