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Obstetrics and Pregnancy Pearls > Obstetrics and Pregnancy Pearls > Flashcards

Obstetrics and Pregnancy Pearls Flashcards

1
Q

Define Goodell’s sign.

When?

A

Softening of the cervix.

Seen in 1st trimester, by 8 weeks

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2
Q

Define Chadwick’s sign.

When?

A

Cervical cyanosis.

Seen in 1st trimester, by 8 weeks

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3
Q

Define Hegar’s sign.

When?

A

Softening of cervicouterine junction.

See in 1st trimester, by 8 weeks

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4
Q

When can you hear fetal heart tones?

A

10-12 weeks

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5
Q

When do you tell the mother she can expect to feel her baby move?

A

18-20 weeks

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6
Q

Where do you expect to feel the fundus at 20 weeks?

A

At the umbilicus.

*It grows ~1cm/wk thereafter

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7
Q

When can Leopold maneuvers be done?

A

20 weeks

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8
Q

When should the only required US be done?

A

18-20 weeks for fetal survey, looks at the anatomy

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9
Q

When do you perform the 1hr glucose tolerance test?

A

At 20 weeks if family hx of DM or pt’s weight >200 lbs

At 28 weeks for routine screening

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10
Q

Who is RhoGAM given to and when?

A

Rh NEGATIVE mothers at 28 weeks, 3rd trimester

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11
Q

When can an amniocentesis be performed and on whom?

A

At 15-20 weeks if family history of chromosomal abnormalities or advanced maternal age

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12
Q

How many total prenatal care visits should a woman receive? What is the breakdown?

A

15 total visits.
Every 4 weeks from 0-28 weeks (first 7 months)
Every 2 weeks from 28-36 weeks (7-9 months)
Every week from 36 weeks to delivery

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13
Q

How do you calculate Naegele’s rule?

A

Subtract 3 months and add 7 days from 1st day of last menstrual period

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14
Q

What should be done at every prenatal visit?

A

BP, weight, fundal height in cm, FHT, fetal movement (starting at 10 weeks), presentation (Leopold maneuver at 20 weeks) and fetal lie.

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15
Q

What is the classic presentation of an ectopic pregnancy?

A 
Spotting - dark brown/tarry 
Variety of abdominal/pelvic complaints
Unilateral lower quadrant pain
Low back pain or shoulder pain
Hemodynamic changes in VS - shock - HR
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16
Q

What is the age of viability?

A

24 weeks

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17
Q

Spontaneous Abortion

A

prior to viability - 24 weeks

approx 15% of all pregnancies

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18
Q

What are pregnancy losses in the first trimester often due to?

A

chromosomal abnormalities

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19
Q

What are pregnancy losses in the second trimester often due to?

A

incompetent cervix
infection
uterine abnormalities

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20
Q

What signs/symptoms may indicate a spontaneous abortion?

A 
vaginal bleeding of varying degrees
cramping/pelvic pressure
low back pain
rupture of membranes
hemodynamic changes in VS - hemorrhaging - HR
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21
Q

What tests would you run if you suspected a spontaneous abortion?

A

serum hCG, US, CBC, blood type and Rh

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22
Q

What are the primary risk factors for PIH?

A
  • HTN
  • Renal/Cardiac disease
  • DM
  • Lupus/autoimmune disease
  • Multiple gestation
  • Primigravida
  • Personal or family hx of PIH or preeclampsia
  • Maternal age <14 or >35
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23
Q

What are the diagnostic tests of PIH?

A

BP surveillance
CBC, LFTs, 24hr urine for protein, creatinine clearance
NST

24
Q

What is the primary management of PIH?

A

Rest at home, if worsening, bed rest in L lateral recumbent position and ongoing fetal surveillance with NST, US and kick counts

25
Q

Preeclampsia S/S

A

PIH + Proteinuria + Generalized Edema after 20 weeks gestation

***Sudden weight gain
*Progression from digital and mild facial edema to
generalized edema
*Frontal or occipital headaches
*Visual disturbances with worsening condition

26
Q

What testing is done for pre-eclampsia?

A 
BP surveillance
Urine testing Q visit, repeat 24 hr/urine
Baseline labs/coag studies
NST weekly; biophysical profile
 **Amniotic fluid must be included
Ultrasound
27
Q

What is the management of pre-eclampsia?

A 
Referral.
Strict bedrest, L lateral 
Fetal surveillance
NST
US
Kick counts 
Weekly injections with B-methasone for fetal lung maturity
28
Q

What are the physical findings in eclampsia?

A

PIH + Preeclampsia + Seizure

May have prodromal symptmos of:

  • Severe, unrelenting headache
  • Epigastric or RUQ pain which worsens
  • Visual changes, spotty vision, blurriness, blindness

BP consistently > 160/100
Tonic-clonic seizures
Oliguria progressing to anuria
Fetal distress in utero

29
Q

What is the testing for eclampsia?

A

CBC, LFTs with full chem profile, coag profile
24hr urine for protein
creatinine/creatinine clearance
Uric acid

30
Q

What is the management of eclampsia?

A

Refer.
Most likely will be hospitalized and delivery encouraged as soon as mother is stable enough.
MgS04 to break seizure.

31
Q

What does HELLP stand for?

A

Hemolysis, Elevated Liver enzymes, Low Platelets

32
Q

What are signs/symptos of HELLP?

A 
Pre-eclampsia plus...
Nausea w/wo vomiting
Jaundice
Extreme fatigue
Ill-feeling
33
Q

What would you expect to find on the physical exam of someone with HELLP syndrome?

A
  • *Hepatosplenomegaly
  • *RUQ pain/tenderness extending to epigastric area
  • *Jaundice
  • *Possible ascites
34
Q

What is the management of someone with HELLP syndrome?

A

Refer for physician management… hospital, delivery ASAP

35
Q

What would you expect to find on laboratory data with HELLP syndrome?

A

Thrombocytopenia - <50,000
Reduced clotting factors
Severe hemoconcentration
Very elevated LFTs - AST and ALT in 100’s
Proteinuria consistent w/severe preeclampsia

36
Q

What tests should be done if placenta previa?

A

Ultrasound, CBC, external fetal monitoring

37
Q

How is placenta previa managed?

A

Hospitalization is often required and vaginal rest.

38
Q

What is premature labor?

A

Contractions after 20 weeks and before 37 weeks gestation

Risk factors: Hx of preterm labor, STI/UTI, multiple gestation, low income, poor weight gain, poor nutrition, drug use/cocaine, smoking, cervical trauma, maternal age <14 or >35

39
Q

What is the management of pre-term labor?

A

Hospitalization for tocolytic therapy

40
Q

What are signs/symptoms of premature labor?

A

Etiology Unknown

Uterine cramping/intermittent or constant; lower back pain; uterine contractions 10-12 minutes (5/hr), vaginal spotting, change in vaginal discharge, cervical effacement or shortening or dilation

41
Q

First Trimester Symptoms

A 
0-12 weeks
Amenorrhea
N/V
Fatigue
Breast tenderness
Urinary Frequency
42
Q

Second Trimester

A

13-27 weeks
Fetal Movement - 18-20 weeks
Abdominal discomfort secondary to stretching
Change in skin pigmentation
*Cholasma - brownish/tan mask-like appearance
Syncopal episodes
Striae

*Fundus palpable at umbilicus @20 weeks, increases by
1 cm per week

43
Q

Third Trimester

A

28-40 weeks
Fetal movement
Braxton-Hicks contractions
Increased respiratory effort

  • Lightening may occur 3-4 weeks prior to labor
  • Loss of mucus plug/bloody show 1 week prior to labor
  • Braxton-Hicks contractions
  • Rupture of membrane
44
Q

Fundus

A

Palpable at umbilicus at 20 weeks, up or down 1 cm/week

IE: at 17 weeks, palpable at 3 cm below umbilicus

45
Q

Triple Screen

When and what’s included?

A

16-20 weeks\

hCG, estriol, alpha-fetoprotein

46
Q

Quad Screen

When and what’s included

A

16-20 weeks

hCG, estriol, alpha-fetoprotein, and inhibin A

47
Q

PIH

A

*Pregnancy Induced HTN
*BP >140/90 or rise in systolic >30 or diastolic >15 on at
least 2 occasions w/readings 6 hrs apart
*Approx 12% of all pregnancies

48
Q

Preeclampsia Physical Exam Findings

A

*HTN - >140/90 or increase in systolic of 30 or increase of
diastolic of 15 from baseline
*Proteinuria - Trace to +1 progressing to +2 with
worsening condition
*Edema - Nondependent edema >1+ progressing to >3-4+
pretibial edema and worsening facial edema
*WG - >2 lbs/week or >6 lbs/month, lagging fundal height
*Reflexes - WNL progressing to 3-4+ with worsening
condition

49
Q

Placenta Previa

A
  • Mal-implantation of placenta in lower uterine segment
  • Bleeding occurs in late 2nd trimester and often
    precipitated by vaginal intercoursePAINLESS

Risk Factors Include:

  • Previous C-section or uterine surgery
  • Multiparity
  • Malpresentation
  • Hx of previous placenta previa
50
Q

Abruptio Placentae

A
  • Separation of placenta from uterine wall
  • Contributing factors: Trauma, chronic HTN,
    preeclampsia/eclampsia, cocaine use, EtoH, smoking,
    uterine tumorSEVERE Abdominal PAIN

Immediate transport to ER

51
Q

Ectopic Pregnancy

A

Any conceptus that implants and grows outside the uterine cavity

Greater risk with:

  • Previous tubal surgery
  • Previous ectopic pregnancy
  • Hx of PID
  • Using/used an IUD

Women with history of infertility are at increased risk

95% occur in fallopian tubes

52
Q

Ectopic Pregnancy

Physical Exam Findings

A
  • Tender adnexa w/possible palpable mass
  • Positive CMT (cervical motion tenderness)
  • Uterine enlargement w/Hegar’s sign
  • +Peritoneal signs if rupture occurred and perhaps
    vaginal bleeding
53
Q

Ectopic Pregnancy

Diagnostic Testing

A

serum hCG
CBC, type, and Rh
Ultrasound
Other pre-op labs

Refer

54
Q

Induced/Elective Abortion

A
  • Surgical abortion
    • vacuum D&C to 12 weeks
    • D&E 13-22 weeks
    • hysterotomy/hysterectomy

Medical - indicated through 49 days of pregnancy
*mifepristone - RU486
*prostaglandin (Misoprostol) - used for NSAID induced
ulcers

55
Q

Postpartum Complications

A

Pulmonary Embolism - SOB

Postpartum hemorrhage

Postpartum depression

Mastitis - usually staph - NSAIDs and ice packs
Abx if needed - dicloxacillin, cephalexin, clindamycin

Obstetrics and Pregnancy Pearls (2 decks)

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