Obstetrics and Pregnancy Pearls Flashcards
The 40-week process by which an embryo grows and develops into an infant within the uterus of the mother
Pregnancy
The first trimester is to ___ weeks
12 weeks
The first trimester you will see what:
a) __________
b) Nausea
c) __________
d) fatigue
e) breast tenderness
f) urinary frequency
a) Amenorrhea
c) vomiting
The second trimester is ( ___ to ___ weeks)
13 to 27 weeks
Second trimester
a) ____ movement
b) Abdominal discomfort secondary to stretching
c) Change in skin pigmentation
1) ______ (brown or gray-brown patches that appear
on far during pregnancy)
d) Syncopal episodes
a) Fetal movement
c) 1) Chloasma
Third trimester ( ___ to ___ weeks)
28 to 40 weeks
Third Trimester
a) abdominal growth
b) _____ Hicks contractions
c) Return of urinary frequency with the descent of presenting part
d) Increased ______ effort until descent
b) Braxton
d) respiratory
Physical examination
First trimester: by eight weeks of gestation
a) Softening of the cervix (_____ sign)
b) Cervical cyanosis (______ sign)
c) Softening of cervicouterine junction (____ sign)
d) Breast enlargement
e) Fetal heart tone (FHT) by 10 to 12 weeks
a) Goodell’s sign
b) Chadwick’s sign
c) Hegar’s sign
Softening of cervicouterine junction
Hegar’s sign
Cervical cyanosis
Chadwick’s sign
Softening of the cervix
Goodell’s sign
- ______ trimester: Fetal movement by 18 to 20 weeks
a) Striae may appear on breast, hips, or abdomen
b) Fundus palpable at umbilicus at ___ weeks gestation and grows approximately 1 cm per week thereafter
c) Leopold maneuvers possible after 20 weeks
- Second-trimester
b) 20 weeks
c) 20 weeks
- _____ trimester:
a) Lightening may occur up to __ to ___ weeks prior to labor
b) Loss mucus plug/ bloody show prior to labor by approximately 1-week
c) May experience increase in Braxton- Hicks contractions /rupture of membranes
3) Third
a) three to four weeks
b) one week
Diagnostic Test with pregnancy:
1) Urine or serum pregnancy tests to confirm pregnancy
2) Quantitative titers performed on serum hCG only
3) Ultrasound
4) First trimester and/ or new visit
a) U/A
b) Urine C and S
c) \_\_\_\_\_
d) Blood group and Rh
e) Antibody screening
f) Rubella (Rubella vaccine not to be given during
pregnancy)
g) \_\_\_\_\_
h) Syphilis testing screens
i) HIV
j) Specialty screening
k) PAP
l) Cervical cultures
m) STD screening
n) Dating ultrasound for unsure dates and/ or size
unequal to dates
o) Chorionic villus sampling (CVS)4) c) CBC
g) HbAg
Second trimester: Amniocentesis at 15 to 20 weeks if a family history of chromosomal abnormalities or advanced maternal age
a) Triple or ____ screen (“ multiple maker test”) at 16 to 20 weeks
b) Tripel screen: Hcg, ____, and alpha-fetoprotein
c) Quad screens HCG, estriol,____________, and
inhibit-A
d) ______ for the fetal survey at 18 to 20 weeks
e) 1-hour GTT ( or other glucose checks) at 20 weeks if a family history of diabetes or patient weight greater than 200 pounds
a) Quad
b) estriol
c) alpha-fetoprotein
d) Ultrasound
Third Trimester: 1 hour FTT at ___ weeks for routine screening
a) RhoGAM for un-sensitized Rh-negative mothers at __ weeks
b) Hemoglobins/ hematocrit at 28 to 36 weeks dependent upon previous level
c) Nonstress test (NST)/ biophysical profile (BPP) as needed for assessment of fetal well-being
28 weeks
a) 28
Management:
1) Scheduling of prenatal visits
a) 0 to 28 weeks: every ___ weeks
b) 28 to 36 weeks: every ___ weeks
c) 36 weeks to delivery: _____ week
a) four
b) two
c) every
New OB visit: What do you do?
a) Establishment of ___ of _____
date of confinement
Naegele’s rule determine by what?
1 year- 3 months + 7 days from last normal menstrual period
Complete PR including height, weight, __ __, pelvic exam, FHT at 10 to 12 weeks
vital signs
New OB visit contains:
a) Established ____ ___ ____
b) History of demographics, social history, family history, occupation, use of substances, nutrition
c) Complete Physical Examination
Estimated date of confinement (EDC)
Return OB visit:
a) History since last visit
b) Exam: BP, weight, ___ ___ in cm, FHT, fetal movement, presentation, fetal lie/position
c) ____: Routine, plus urine for protein, glucose, and ketones at each visit
b) fungal height
c) Labs
High-risk situations requiring consultation/ referral:
1) Recurrent pregnancy losses/ previous fetal death in utero
2) Family history of genetic anomalies
3) Rh sensitization
4) Hemoglobinopathies
5) Thrombocytopenia
6) _____ _____
7) Abnormal triple screen
8) Other abnormal laboratory results
9) HIV
10) _____ ______
11) Abnormal ultrasound findings
12) Previous preterm labor/ preterm delivery
13) Polyhydramnios/ oligohydramnios
14) Intrauterine growth retardation (IUGR)
15) Premature rupture of membranes
16) Preeclampsia/ PIH
17) Gestational diabetes/ insulin-dependent diabetes
18) Fetal presentation other than vertex after ___ to ___ weeks
6) Multiple gestations
10) Uterine bleeding
18) 32 to 34 weeks
Any conceptus that implants and grows outside the uterine cavity
Ectopic pregnancy
- The incidence of ectopic pregnancy within the general population is not more than 2%
- Women with medical history involving the oviducts are at greater risk
a) _____ surgery (to 30%)
b) Previous tubal ectopic pregnancy (to 15%)
c) History of ____ (to 15%)
d) Using/ used IUD ( to 9%) - Women with a history of infertility are at a higher risk than the general population
- 95% occur in the fallopian tubes
- a) tubal surgery
c) PID
Symptoms of ectopic pregnancy:
- _________
- abnormal uterine bleeding usually spotting (maybe dark brown to tarry)
- May present with a variety of abdominal/ pelvic pain complaints
- Unilateral lower ___ ______
- Lower back pain or shoulder pain
- Hemodynamic changes in vital signs (shock-rupture)
- amenorrhea
4. quadrant pain
Physical examination: Ectopic Pregnancy
- Tender ____ with a possible palpable mass
- Positive cervical motion tenderness (CMT)
- Uterine enlargement with ____ _____
- Positive peritoneal signs if a rupture has occurred and, perhaps, vaginal bleeding
- adnexa
3. Hegar’s sign
Diagnostic Test: Ectopic Pregnancy
a) Serum ____(quantitative)
b) CBC, type, and Rh
c) _______
d) Other preoperative labs
a) hCG
c) Ultrasound
Management of ectopic pregnancy:
a) _____
refer
Pregnancy termination at any time prior to viability (24 weeks) either through spontaneous expulsion or medical/ surgical removal
Abortion
Overview: abortion
- Approximately ___% of pregnancy will abort spontaneously; the majority of losses in the first trimester are the result of chromosomal abnormalities that occur randomly and do not repeat in subsequent pregnancies
- Losses in the ____ trimester are duel to cervical incompetence, infection, or uterine abnormalities
- Almost one-half of pregnancies are unplanned; elective abortion accounts for 50 to 60 abortion per ___ live births among unmarried women
1) 15%
2) 2nd trimester
3) 100 live births
Symptoms/ history (spontaneous Ab): abortion
1) vaginal bleeding of varying degrees
2) cramping/ pelvic pressure
3) ___ ____ ____
4) Rupture of membranes
5) hemodynamic changes in vital signs if the ______is involved
3) low back pain
5) hemorrhage
Diagnostics Tests (spontaneous Abortion)
1) ____ levels
2) Ultrasound
3) ___, type, and Rh
4) Coagulation profile as needed
1) hCG levels
3) CBC
Management (spontaneous Ab)
1) Refer
2) ___ ___ if threatened, inevitable
3) Abstinence
4) Labs as above
2) Bed rest
Management (induced or elective Ab)
1. Surgical abortion
a) vacuum ___ and ___: to 12 weeks
b) D and E: 13 to 14 weeks to 20 to 22 weeks
c) Hysterotomy/ hysterectomy
2. Medical: Indicated through ____ days’ pregnancy
a) ______ (Mifeprex): also known as RU 486 =
abortion
b) ________ ( Misoprostol)
1) a) D and C
2) 49 days
a) Mifepristone
b) Prostaglandin
BP >140/90, or rise in systolic > 30 mmHg or diastolic > 15 mmHg above an established baseline on at least two occasions, with readings six hours apart
Pregnancy Induced Hypertension (PID)
PID + proteinuria + generalized edema after 20 weeks gestation
Preeclampsia
Preeclampsia + seizure activity AKA known as?
Preeclampsia
Hemolysis Elevated Liver enzymes and a low platelet count
HELLP
Incidence of Pregnancy Induced Hypertension involves approximately ___% of all pregnancies
12%
Pregnancy Induced Hypertension contributes to / predisposing factors like:
a) Pre-existing _______, renal, cardiovascular disease
b) diabetes
c) Lupus, autoimmune disorders
d) Multiple gestations
e) ________
f) Personal or family history of PIH, preeclampsia
g) Maternal age at either end of the reproductive timeline
a) hypertension
e) Primigravida
Testing for Pregnancy Induced Hypertension:
a) ___- surveillance
b) CBC, LFTs, 24 hours urine for protein,creatinine/ creatinine clearance, etc.
c) NST after ___ to ___ weeks or PRN
d) Ultrasound PRN, usually for a lag in fetal growth as a result of PIH
a) BP
c) 32 to 34 weeks
Management of Pregnancy Induced hypertension:
a) ____ at home: If condition worsens, bed rest in left lateral recumbent position
b) ____ surveillance: NST, ultrasound, and kick counts for fetal activity at home
a) Rest
b) Fetal
___________
Signs and symptoms
a) Sudden weight gain
b) Progression from digital and mild facial edema to generalized edema
c) Frontal or occipital headaches
d) Visual disturbances with worsening conditions
Preeclampsia
Physical Findings: Preeclampsia
1) Hypertension
a) > ____/____ mmHg or > 30/15 mm Hg aboce established baseline
a) 140/90
Physical Findings: Preeclampsia
2) Proteinuria
a) Trace to ____on a voided sample; progressing to +2 with a worsening condition
+1
Physical Findings: Preeclampsia
3) _______
a) Nondependent edema >1 + progressing to pretibial
_____ >3 to 4+
b) Wordsening facial and generalized ______
Edema
Physical Findings: Preeclampsia
4) Weight gain
a) Greater than \_\_\_ pounds per week or 6 pounds in
one month
b) Lagging \_\_\_\_\_\_ height4) a) 2
b) fundal
Physical Findings: Preeclampsia
5) ________
a) WNL progressing to 3 - 4+ with a worsening condition
5) Reflexes
Preeclampsia testing
1) _____ surveillance
2) Urine testing every visit; repeat ___-hour urine testing PRN
3) Baseline labs if not established; coagulation studies with a worsening condition
3) Baseline labs if not established; coagulation studies with a worsening condition
4) ____ weekly; biophysical profile (amnionic fluid index must be included)
5) Ultrasound to monitor fetal growth and evaluate placental conditions PRN
1) BP
2) 24
4) NST
Preeclampsia testing/ Management:
a) referral
b) strict bed rest with worsening condition in a ____ lateral recumbent position
c) Fetal surveillance: NST, BPP, ultrasound
d) ____ counts at home
e) Weekly steroid injection (B- methasone) for fetal lung maturity if < ___ weeks gestation
f) Hospitalization and MgSO4 therapy to stabilize if severe condition, then delivery if fetal maturity assured (> 34 weeks or 2 doses of B- ______)
b) left
d) kick
e) 34 weeks
f) B- methasone
\_\_\_\_\_\_\_\_\_\_
Signs and symptoms: Physical findings
1) PIH + Pre-eclampsia + seizure
2) May have prodromal symptoms of
a) Severe, unrelenting headache
b) Epigastric or RUQ pain which progressively or
suddenly worsens
c) Visual changes, including spotty vision, blurriness,
blindness
3) BP consistently elevated above 160/100
4) Tonic-clonic seizure
5) Oliguria may progress to anuria
6) Fetal distress in utero (FDIU)Eclampsia
Testing for eclampsia include:
a) CBC, ____ with full chemistry profile, coagulation profile 24-hour urine for protein, creatinine/ creatinine clearance, uric acid
b) ____surveillance continuous in hospital
a) LFTs
b) Fetal
Management of eclampsia:
a) refer physical management
b) _____ to break seizure (valium if ineffective); then IV drip to stabilize
c) Anticipate delivery as soon as stable
b) MgSO4
Signs and symptoms of HELLP
a) Those of preeclampsia, plus
b) Nausea, with or without vomiting
c) _________
d) Extreme fatigue, ill feeling
c) Janudince
Physical findings of HELLP:
a) _______
b) Tenderness or pain in RUQ, extending to epigastric area
c) ________
d) Possible ascites
a) Hepatomegaly
c) Jaundice
Tests of HELLP:
a) Test of preeclampsia
b) Clotting factors ______
c) sever hemoconcentration
d) very _____ LFTs
e) proteinuria consistency with severe preeclampsia
b) reduced
d) elevated
Management of HELLP:
a) Refer _____ management
b) Hospitalization
c) Delivery as soon as stable
a) Physician
Mal-implantation of the placenta in the lower uterine segment
Placentia Previa
Placentia Previa:
- The cervical os may be completely, partially, or marginally covered
- Bleeding usually occurs in the last ____ to the early third trimester and often is precipitated by vaginal intercourse
- Etiology is unknown
- Increased incidence in:
a) Previous cesarean birth/ uterine surgery
b) ______
c) representation (breech or transverse lie)
d) History of previous Previa
- second
4. b. Multiparity
____ _____: Signs and symptoms
- Bleeding is painless
- May occur immediately following vaginal intercourse
- May have precipitating factors
- No evidence of contractions
- No uterine tenderness
- Often little to no fetal compromise unless the bleeding is severed or other cause of distress exists
Placentia Previa
Test for Placentia Previa:
- ________ for localization of placental implantation
- EFM to exclude fetal distress
- If bleeding is continuous or severe, obtain ___
- Ultrasound
3. CBC
Management of Placentia Previa:
- ___ _____ exam: Speculum examination only to determine the extent of bleeding
- ________ usually required
- NST/BPP while in hospital and then weekly
- Vaginal rest: Nothing in the vagina
- If the fetus is mature, anticipate delivery
- No bimanual
2. Hospitalization
Separation of the placenta from the uterine wall, completely or partially
Abruptio Placentae
Abruptio Placentae:
- Complete abruption is an obstetrician emergency and unless hospitalized at the time of the event, fetal death is very likely
- Abruption usually occurs in the ___ or ____ trimester and may be initiated by a number of factors
- Hemorrhage may be sudden and life-threatening to the mother
- Uncontrolled ______ will result in disseminated intravascular coagulation (DIC)
- second or third
4. hemorrhage
Abruptio Placentae:
Etiology:
1. Unknown
2. Recurrent rat is ___ to ___% after one occurrence, 25% after 2 occurrences
3. Contributing factors
a) Trauma
b) Chronic hypertension/preeclampsia/ eclampsia
c) ________
d) Alcohol, cigarette use
e) Uterine tumor or structural abnoralitiy
- 5 to 17%
3) c) Cocaine use
______ ____: Signs and symptoms
a) Severe abdominal pain
b) Bright red bleeding is heavy if unconcealed
c) May be minimal to moderate bleeding if the abruption is concealed
d) The uterus is rigid in concealed abruption
e) Shock
f) Fetal distress/ absent FHTs
Abruptio Placentae
Tests for abruptio Plantae:
- ______ to locate placental implantation (Note: the US is not alone in diagnostic or abruption)
- EFM to monitor for fetal distress
- ____, type, and Rh for transition, coagulation profiles to monitor hemodynamic changes
- Ultrasound
3. CBC
Management of Abruptio Placentae
- Immediate transport and referral: Physician management
- If ________ and/ or fetal distress are present, immediate delivery when the mother becomes stable
- hemorrhage
Or “ preterm labor”; the occurrence of attractions after 20 weeks but before 37 weeks gestation which results in dilation and/or defacement of the cervical os; contractions may or may not be perceived by the mother as painful or even present
Premature Labor
Etiology of Premature Labor:
a) _______
a) Unknown
Risk factors for premature labor:
a) history of _____ delivery
b) genial and or urinary tract infections
c) multiple gestation
d) ___ income
e) poor weight gain, poor nutrition
f) Drug use, especially cocaine; smoking
g) Uterine structure ________
h) Cervical trauma
i) adolescent or advanced maternal age
a) preterm
d) low
g) abnormalities
Symptoms/ Findings of Premature Labor:
1) ______ cramping that is intermittent or constant
2) Lower back pain which may be constant or intermittent and rhythmic
3) Uterine contractions with a frequency of ___ to ___ minutes (5/ hr)
4) May experience vaginal spitting or change in vaginal discharge
5) Cervical effacement/ shortening and/ or dilatation
1) Uterine
3) 10 to 12
Prevention of Premature Labor include:
1) Identification and _____ of risk factors
2) Reassessment of risk factors each trimester
3) _____regarding warning sign of premature labor
1) elimination
3) Education
Management of Premature labor include:
1) Hospitalization if unable to stop _____ prior to cervical change
2) ______ therapy if cervical change occurs
3) If less than 34 weeks and successfully tocolysis, give B-methasone (steroid) injections twice a week to enhance fetal lung maturity, until ___ weeks
4) Bed rest
5) If no further contractions during hospitalization may discharge with oral tocolytics
6) Vaginal rest and bed rest at home
7) Weekly cervical checks
1) contractions
2) Tocolytic
3) 34 weeks
________ complications:
1) Pulmonary embolism (shortness of breath)
2) Postpartum hemorrhage
3) Postpartum depression
4) Mastitis (painful inflammation of the breast, usually due to Staphylococcal species)
a) Symptomatic treatment (e.g. NSAIDs, ice packs);
antibiotics therapy (e.g. dicloxacillin, cephalexin,
clindamycin)
Postpartum complications
