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
