Obstetrics Flashcards
Upper part of the lamellae of labia minora
Prepuce of clitoris
Lower part of the lamellae of labia minora
Frenulum of clitoris
Other term for labia minora
Nymphae
Outermost portion of the ovary
Tunica albuginea
Normal value of obstetric conjugate
> 10cm
Inner cell mass becomes an
embryo
Outer cell mass becomes the
trophoblast
The halo around the blastocyst
zona pelucida
Layer of the trophoblast which is contiguous with maternal decidua and later maternal blood
Syncytiotrophoblast
Innermost layer (embryonic side) of the trophoblas
Cytotrophoblast
Fetal membrane nearest to the fetus
Amnion
The fetal component of the placenta
chorion frondosum (leafy chorion)
Fetoplacental circulation established on day
Day 17
Maternal compartment of placenta
decidua basalis
Provides majority of tensile strength of fetal membranes
Amnion
Extracellular matrix of umbilical cord is a specialized connective tissue called
Wharton’s Jelly
Earliest hormonal signal of pregnancy
HUMAN CHORIONIC GONADOTROPIN (hCG)
Aside from placenta, what fetal organ secretes HCG?
Fetal kidney
HCG is secreted by what part of the placenta?
syncytiotrophoblast
Responsible for vomiting during pregnancy especially at 10wks
HCG
Maximal levels of HCG is detected at what week of gestation?
8-10 weeks;
Can be detected at 5 weeks
HCG is first detected in maternal plasma how many days post-ovulation
8 days
The main function of this hormone is to ensure nutrient supply to fetus especially during times of maternal starvation
Human placental lactogen
After how many weeks will the placenta assume progesterone secretion?
8 weeks
Heart and pericardium are prominent at what week AOG
4th week
Fingers and toes are present at what week AOG
6th week
When does an embyro become a fetus?
8th week after fertilization
10th week by LMP
Uterus palpable just above the symphysis pubis
12th week AOG
Fingers and toes differentiated and provided with nails at what week AOG
12th week
Earliest possible time that the OB-GYNE could detect the sex of the fetus
12th week
Fundus of uterus palpable between symphysis and umbilicus
16th week
Midpoint of pregnancy
20th week
Fundus of uterus palpable at the level of umbilicus
20th week
How many frontal bones are there in a fetal head?
2
Area of lambdoid and temporal sutures
TEMPORAL/CASSERIAN FONTANEL
Greatest circumference in fetal head
Occipitofrontal
Ideal fetal head diameter for vaginal delivery
Biparietal (9.5)
Greatest transverse diameter of fetal head
Biparietal
Primary biological compartment of the maternal transfer
INTERVILLOUS SPACE: Maternal Blood
Extravascular compartment which directly bathes the trophoblast but nomixing occurs
INTERVILLOUS SPACE: Maternal Blood
Inteavillus - fetal blood
An ultrafiltrate of maternal plasma in early pregnancy
Amnionic fluid
At what month in pregnancy does the fetus participates in the regulation of the amount of amniotic fluid by swallowing & respiration?
4 months
After what AOG does amnionic fluid composed largely of fetal urine?
16-20 weeks
Fetal kidneys start producing urine at what AOG
12 weeks
Polyhydramnios
> 2000mL
Atrophied and obliterated
umbilical artery
Umbilical ligament
Intra-abdominal remnant of
umbilical vein
Ligamentum Teres
Constricted ductus venosus
Ligamentum venosum
Erythropoieses in fetal blood circulation occurs in
Fetal liver
At what AOG does the fetus hear sounds in utero
24-26th week
At what week AOG is the fetal eyes sensitive to light and responsive to taste of ingested substance
28th week
Fetal swallowing begins at what AOG
10-12 weeks
Datk-greenish appearance of meconium is caused by
Biliverdin
Mullerian-Inhibiting Substances (MIS) is produced by what cells of the fetal testis?
sertoli
Diminished 5a-dihydrotestosterone-binding capacity causing bifid scrotum, infertility, gynecomastia
Familial Male Pseudohermaphroditism, type I/Reifenstein syndrome
Idiopathic Hypogonadotropic Hypogonadism (INH) accompanied by the developmental absence of the olfactory bulbs causing anosmia
Kallman’s syndrome
After what week does the increase in uterine size is predominantly related to pressure exerted by product of conception (mechanical distention)
12 weeks
Most important layer of uterus
Middle layer
Softening of isthmus; lower uterine segment
HEGAR’S SIGN
Softening of cervix
GOODELL’S SIGN
Represents exaggerated luteinization reaction of normal ovary in pregnancy
LUTEOMA OF PREGNANCY
Due to increased vascularity vagina becomes violaceous (bluish to purple)
CHADWICK’S SIGN
Dark discoloration of the face and neck in pregnancy
CHLOASMA/ MELASMA GRAVIDARUM /MASK OF PREGNANCY
Weight gain if BMI before pregnancy is normal
27.5 lbs or 12.5 kg
before 2 lbs 1st trimester, 11 lbs 2nd trimester and 11 lbs 3rd trimester (2-11-11)
Total iron requirement in normal pregnancy
1,000 mg
Caused by reflux of acidic secretion into the lower esophagus due to altered position of stomach
PYROSIS (heartburn)
Focal, highly vascular swelling of gums in pregnancy
EPULIS
PRURITUS GRAVIDARUM is due to
retained bile salt
Brownish-red opacities on posterior surface of cornea
KRUNKENBERG SPINDLES
A woman in labor
Parturient
A woman who had just given birth
Puerpera
At what week AOG is the fundic height reliable to predict or tell the AOG
24-34 weeks
1st leopold maneuver
Fundal grip
2nd leopold maneuver
Umbilical grip
3rd leopold maneuver
Pawlik’s grip
4th leopold maneuver
Pelvic grip
Implantation bleeding, which coincides with expected menses
Hartman’s sign
Positive results in endocrine test for hCG in urine/serum is what sign of pregnancy
Probable sign
Identification of fetal heart action by Stethoscope: –o Doppler principle - 10 weeks
17-19 weeks
Identification of fetal heart action by doppler ultrasound
10 weeks
RADIOGRAPHIC SIGN OF FETAL DEATH wherein there is significant overlap of the skull bone due to liquefaction of the brain
Spalding sign
RADIOGRAPHIC SIGN OF FETAL DEATH wherein there is demonstration of gas in fetal spines
Robert’s sign
Quickening in primigravid
18-20 weeks
Quickening in multigravid
16-18 weeks
Age of viability
28 weeks
Dilated, occluded cervical glands bulging beneath the exocervical mucosa
Nabothian Cysts
Normaln amniotic fluid index
> 10 cm
AFI which requires immediate delivery of the baby
= 5 cm
OGTT is done at what AOG
24-28 week AOG
Pregnant women can safely travel via airplane until what AOG?
36 weeks
Error in 1st trimester UTZ
+/- 3-5 days
Error in 2nd trimester UTZ
+/- 1 week
Error in 3rd trimester UTZ
+/- 2 weeks
McDonald’s Rule
AOG computation
Age (weeks) = FH (cm) x 8/7
Johnson’s Rule
Estimated Fetal Weight
EFW (kg) = FH – 11 x 0.155
Minimum duration of inactive state of fetus
23 minutes (sleep)
Position of the mother as the transducer of a fetal monitor is placed over the abdomen to record FHR
Semi-Fowlers position
Normal FHR
120-160 bpm
Initial response of fetus to hypoxemia
Bradycardia
DECELERATION is decrease in fetal heart rate by at least _____ bpm in _____ secs
15 bpm in 15 secs
NST is a test of
Fetal condition
REACTIVE NST
Defined as ≥ 2 accelerations of FHR that peak at 15 bpm, each lasting ≥ 15 secs within 20 minutes
≥ 32 weeks AOG: acceleration ≥ 15 bpm for ≥ 15 seconds for 20 minutes observation
≤ 32 weeks AOG: acceleration is ≥ 10 bpm for ≥ 10seconds for 20 minutes observation
CST is a test of
uteroplacental function
Positive CST
> /= 2 decelerations
Early deceleration is secondary to
Head compression
Late deceleration is due to
Uteroplacental insufficiency
Variable deceleration is due to
Cord compression
AFI in polyhydramnios
> 24
Amniocentesis is done at what AOG
15-20 weeks AOG
Chorionic villus sampling is done at what AOG?
9-11 weeks
Fetus is said to be engaged if the biparietal diameter of the fetal head has passed through the
pelvic inlet
Shortest diameter of the pelvic cavity
PELVIC MIDPLANE DIAMETER
Used as a landmark in assessing the level to which the presenting part of the fetus has descended
PELVIC MIDPLANE DIAMETER
Ischial spine
Heart-shaped pelvic inlet
Android pelvis
The relation of the fetal long axis of the fetus to that of the mother
FETAL LIE
Military attitude fetal presentation? Presenting part?
Sinciput; anterior fontanel or bregma
Thighs are flexed on the abdomen and the legs are extended over the anterior surfaces of the body
Frank breech
Thighs are flexed on abdomen and legs are flexed over the thighs; the feet present at the level of the buttocks (Indian sit)
Complete breech
One or both feet, one or both knees are lowermost; one or both hips are not flexed and one or both feet or knees lie below the breech such that a foot or a knee is lower most inthe birth canal
Incomplete/Footling breech
The portion of the fetus arbitrarily chosen to orient it with the maternal pelvis in shoulder presentation
acromion/ scapula
The relation of the fetal parts to one another
FETAL ATTITUDE
The relation of an arbitrarily chosen portion of the fetal PP to the RIGHT (R) or LEFT (L) side of the maternal pelvis/ birth canal
FETAL POSITION
The “obliteration” or “taking up” of the cervix
Degree of Effacement
Shortening of the cervical canal from the length of about 2cm to mere circular orifice with almost paper thin edges
From regular uterine contractions to full cervical dilatation(10 cm)
FIRST STAGE OF LABOR
Duration is variable
Nulliparous: 7h
Multiparous: 4h
Full cervical dilatation to delivery of baby
SECOND STAGE OF LABOR
Duration varies:
Nulliparous: 50 mins
Multiparous: 20 mins
Maneuver that allows control of the delivery of the head wherein the hand exerts forward pressure on the chin of the fetus through the perineum to the coccyx of the mother
Ritgen maneuver
From delivery of the infant to the delivery of placenta
THIRD STAGE OF LABOR
The earliest sign of placental separation
Uterus becomes globular and firmer (Calkin’s sign)
MECHANISM OF PLACENTAL SEPARATION wherein blood from the implantation site escapes immediatelyl
DUNCAN (Dirty)
MECHANISM OF PLACENTAL SEPARATION wherein bleeding may be concentrated behind the placenta and membranes until the placenta is delivered
SCHULTZE (Shiny or smooth)
Maneuver of placental delivery wherein you apply suprapubic pressure
Brandt Andrews Maneuver
Fourth stage of labor
An hour after delivery of placenta
Degree of laceration including fourchette, perineal skin, vaginal mucosa but not underlying fasciaor muscle
1st DEGREE
Degree of laceration up to fascia and muscle of perineal body but not the anal sphincter
2nd DEGREE
Degree of laceration up to anal sphincter (extends from the vaginal mucosa, perineal skin and fascia up to anal sphincter, but not rectal mucosa
3rd DEGREE
Degree of laceration up to rectal mucosa but not rectal muscle
4th degree
