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Obstetrics - Exam 1 Flashcards

1
Q

Define the obstetrical terms: Gravity, parity and the TPAL system

A

Gravity: number of times a woman has been pregnant

Parity: number of pregnancies that led to a birth at or beyond 20 weeks

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2
Q

Define the following terms: nulligravida, primigravida, multigravida

A

Nulligravida – a woman who currently is not pregnant and never has ever been pregnant

Primigravida – a woman who currently is pregnant and has never been pregnant before

Multigravida – a woman who currently is pregnant and who has been pregnant before

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3
Q

Define primipara and multipara

A

Primipara – a woman who has been delivered only once of a fetus or fetuses born alive or dead with an estimate length of gestation of >20weeks

Multipara – a woman who has completed 2 or more pregnancies to 20 weeks gestation or more

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4
Q

What are the trimester breakdowns by week?

A

1st Trimester  until 14 weeks gestation

2nd Trimester  from 15 weeks until 28weeks

3rd Trimester  from 29 weeks until 42 weeks

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5
Q

______ is one a s/s of pregnancy. When does it become a reliable indicator?

A

Amenorrhea

10 days or more after expected menses

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6
Q

some women have _______ from blastocyst implantation and can mistake this as their ______

A

implantation bleeding

menses

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7
Q

What is the Chadwick sign? What does it possibly indicate? What are 2 additional lower reproductive tract changes that occur with pregnancy?

A

Vaginal mucosa appears dark-bluish/red and congested

pregnancy but NOT a conclusive sign

cervical softening and mucus

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8
Q

What is the Hegar sign? What does it possibly indicate?

A

isthmus softening of the uterus

pregnancy

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9
Q

What are some breast changes that occur during pregnancy?

A

breast tenderness, increased size of breast and nipple

areola becomes more deeply pigmented

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10
Q

When can mom start to feel fetal movement? give primigravida and mutligravida timelines

A

Primigravida may not feel till 20 weeks gestation

Multigravida may feel around 16-18 weeks gestation

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11
Q

B-hCG has a similar _____ to what 3 hormones? What is it produced by?

A

similar alpha unit to LH, FSH and TSH

Produced by syncytiotrophoblasts following implantation

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12
Q

How can B-hCG be detected? What is it’s role?

A

in both blood and urine

B-hCG prevent involution of the corpus luteum

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13
Q

What are some causes that could make a pregnancy test be a FALSE positive? Which one is the most common?

A

**heterophilic antibodies: urine test would be negative- MC

Exogenous hCG injection for weight loss

Renal failure with impaired hCG clearance

Physiological pituitary hCG

hCG producing tumors usually in the GI tract, ovary, bladder or lung

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14
Q

If monitoring hCG levels, values should DOUBLE every ________. In order for home pregnancy tests to be the most accurate, when should pt’s take them? Why? What is the minimum level to be detected?

A

1.4 - 2.0 days

Should use with first urination of the day because urine is the most concentrated at that time

Require β-hCG of 12.3 mIU/mL to detect 95% of pregnancies

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15
Q

______ is the FIRST sonographic evidence of pregnancy. What is it made of? When is it first seen?

A

Gestational sac

small anechoic fluid collection within endometrial cavity

4-5 weeks of gestation

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16
Q

_______ confirms with certainty an intrauterine location. What does it look like? When can you see it?

A

Yolk sac

brightly echogenic ring with an anechoic center

Seen around 5-6 weeks gestation

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17
Q

When can a fetal pole/embryo be seen?

A

seen after 6 weeks

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18
Q

______ is the measure from head to butt at ______ is when it shows up best. Can be used up to ___ weeks to predict estimate due date

A

crown rump length

6-12 weeks

12 weeks and accurate within 4 days

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19
Q

What is Naegele’s Rule with estimating date of delivery? **What is the most accurate tool for gestational age assignment?

A

LMP + 7 days - 3 months = EDD

**US in the first trimester crown rump length

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20
Q

What is important to ask a pt regarding their obstetrical hx? menstrual hx?

A

Prior pregnancies – vaginal or C-section

Prior complications

Infertility components

Interval between menses
Contraceptive use

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21
Q

During the first bimanual exam, what size will the uterus be in the mom is 6 weeks, 8 weeks, 12 weeks? Also need to screen for _____ and ______

A

Small orange  6 week size
Large orange  8 week size
Grapefruit  12 week size

Chlamydia and Gonorrhea testing

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22
Q

Why is it important to test blood type during the first visit? What do you do if it comes back negative?

A

need to screen for Rh factor

is mom is negative she needs RhoGam

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23
Q

What is the recommended RhoGam schedule for Rh negative moms?

A

RhoGAM at 28 weeks

RhoGAM should be given if vaginal bleeding or trauma prior to this time

RhoGAM should be given postpartum if infant is Rh positive

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24
Q

What is the dosing recommendations for RhoGam? What is the test called?

A

0.3mg of Rh IgG will eradicate 15mL of fetal red blood cells. Equivalent to 30mL of fetal blood

Kleihauer-Betke

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25
What does the Kleihauer-Betke test for?
Tests the amount of fetal red blood cells in the maternal circulation In cases of trauma or abruption, can perform test and administer additional RhoGAM if necessary
26
______ is a common infectious cause of fetal growth restriction and is worse in the _____ trimester
rubella FIRST
27
What is the tx for rubella? When should pts get vaccined?
no specific tx at least 1 month BEFORE getting pregnant, preg women CANNOT get MMR while pregnant because it is a LIVE vaccine
28
What causes syphilis? What is the tx?
Treponema pallidum Penicillin G
29
What is the tx for syphilis is the pt is allergic to PCN?
Women with Penicillin G allergy should have either a oral stepwise penicillin dose challenge or skin testing performed If allergy confirmed, penicillin desensitization is recommended
30
What is the recommended dose of folic acid for a preg pt? What is hx of neural tube defects?
400 μg of folic acid at least 4mg per day!!
31
Maternal _____ is correlated with infant birth weight. What is the recommended additional calorie requirements?
weight gain 100-300 calories per day
32
What is the guideline regarding seafood in pregnancy? Should get a blood ____ test if certain risk factors are identified
Most fish and shellfish contain mercury which should be avoided in pregnant and lactating women blood lead if at high risk
33
How should a pregnant women wear her seat belt?
Recommend wearing three point restraints throughout pregnancy while riding in automobiles Place lap belt under abdomen and across upper thighs
34
When is it safe for a preg women to fly? Dental tx?
Pregnant women can safely fly up to 35 weeks gestation normal dental tx is fine for preg women
35
What is the max caffeine intake for preg pt?
less than 200mg any higher and have increased risk of abortion
36
T/F: Preg women can safely scuba dive until 32 weeks
FALSE preg women should not scuba dive due to decompression sickness
37
What is the breastfeeding recommendation? How often?
Exclusive breast feeding is preferred until 6 months feed 8-12 times daily for approximately 15mins at a time
38
What are the 8 CI to breastfeeding?
Use of street drugs or uncontrolled alcohol intake Infant with galactosemia HIV Hepatitis C with cracked nipples or broken skin Active tuberculosis Certain medications Women undergoing breast cancer treatment Active herpes lesions on the breast
39
What are the genetic disorders that the following ethnic groups are at the highest risk for? African Americans Mediterranean Asian Jewish North European Caucasians Native Americans
African Americans  Sickle Cell Mediterranean  Beta thalassemia Asian  Alpha Thalassemia Jewish  Tay Sachs, Canavan Disease, Cystic Fibrosis North European Caucasians  Cystic Fibrosis Native Americans  Cystic Fibrosis
40
______ should be provided to every preg women. If positive, what is the next step? What does it NOT replace?
carrier screening pt's partner should be offered testing Prenatal carrier screening does not replace newborn screening, nor does newborn screening replace the potential value of prenatal carrier screening
41
What is the FDA pregnancy classification system?
42
**What are the normal prenatal visit schedule for routine care?
Every 4 weeks until 28 weeks Every 2 weeks until 36 weeks Every week until delivery
43
What is monitored at every pre-natal visit moving forward?
fetal heart rate fetal growth
44
What is a normal fetal heart rate? When is it detected?
110-160bpm detectable at 10 weeks via doppler
45
Describe the normal trend for a healthy pregnancy in terms of fetal growth
Fundal height  used to monitor fetal growth and amniotic fluid volume At 12 weeks, the fundus is emerging from the bony pelvis At 16 weeks, fundus is between the pubic symphysis and the umbilicus At 20 weeks, fundus is at the umbilicus Between 20-34 weeks, the height of the uterine fundus measured in centimeters correlates closely with gestational age --> Ex: At 25 weeks, the fundal height will be 25 centimeters
46
How is the fundal height measured?
47
When is the anatomy scan typically done?
Anatomy ultrasound (around 18 weeks)-basic scan for all the organ systems to make sure they are healthy
48
What symptoms do you need to ask mom at every prenatal visit?
Leakage of fluid Contractions Nausea and vomiting Pelvic pain Bleeding
49
When do you screen for gestational diabetes? When do you get a repeat CBC?
week 24-28 repeat around 28 weeks to monitor for anemia
50
_____ and _____ tests are repeats around 28 weeks and at delivery
syphilis and HIV
51
_______ is obtain via vaginal/anal culture obtained between 35-37 weeks. If positive, what do you do?
Group B Streptococcal Intrapartum antibiotic prophylaxis given in labor if culture is positive
52
What vaccines are recommended for preg pts?
Hep A and B: if risk of exposure flu vaccine Tetanus, Diptheria and Pertussis RSV COVID
53
When should a preg pt received the flu and COVID vaccine?
at any point in their pregnancy
54
When should Tetanus, Diptheria and Pertussis be administered?
Given in 3rd trimester so mom can pass immunity to the baby
55
When should RSV be administered?
preg pt between 32 0/7 and 36 6/7 weeks of gestation this respiratory season who have a planned delivery within 2 weeks and did NOT receive maternal RSV vaccine the previous year
56
When is N/V common in pregnancy? How long does it last? What is the tx?
first trimester until about 16 weeks lasts about 35 days Vitamin B6 with or without Doxylamine Prochlorperazine, Metoclopramide, Ondansetron
57
What is Hyperemesis gravidarum? Why is it dangerous?
Vomiting so severe that dehydration, electrolyte and acid-base disturbances and starvation ketosis occur Severe enough to cause weight loss
58
What is the tx for hemorrhoids in a preg pt?
Topical applied anesthetics Warm soaks Stool softeners
59
What is pica? What does it indicate?
craving of pregnant women for strange food  ice, starch, dirt severe iron deficiency
60
Why does a preg pt always want to sleep? What is Leukorrhea?
Likely due to progesterone and associated discomforts increase vaginal discharge due to increased mucus secretion by cervical glands in response to increase in estrogen
61
Major congenital abnormalities are identified in_____ of pregnancies. All women before _____ should be offered screening
2-3% 20 weeks gestation
62
What is the MC class of birth defects? 2nd MC?
cardiac anomalies neural tube defects
63
elevated _____ is associated with neural tube defects. Where is it synthesized?
alpha-fetoprotein (AFP) in maternal and fetal serum and amniotic fluid AFP synthesized by fetal yolk sac and later by fetal GI tract and liver
64
What are the 6 risk factors for having a fetus with neural tube defects?
Family history MTHFR mutation Aneuploidy Diabetes Hyperthermia Medications  specifically seizure medications
65
When do you screen for neural tube defects? What level indicates a NTD?
Screen by measuring maternal serum AFP between 15-18 weeks gestation >2.0 - 2.5 MoM is indicative of a neural tube defect with a false positive rate of 5%
66
AFP can be elevated for 7 other reasons besides NTD, what are they?
Multifetal gestation Pilonidal cyst Chorioangioma of the placenta Placental abruption Oligohydramnios Preeclampsia Fetal growth restriction
67
_______ is more important for detecting NTDs than AFP
 Second-trimester fetal US has a higher rate of detection for NTDs than using AFP
68
Risk of fetal trisomy increases with maternal age, particularly after ____. Who should get screened for genetic syndromes?
35yo EVERYONE should be offered a screening regardless of maternal age or risk of chromosomal abnormalities
69
What is the goal of prenatal screenings?
to provide a RISK assessment they are NOT diagnostic
70
When do you perform the first trimester screening? What are you looking for?
11-14 weeks -> Combined First screen Evaluates nuchal translucency and serum analytes (PAPP-A, hCG) to detect Down syndrome
71
What is nuchal translucency?
maximum thickness of the subcutaneous translucent area between the skin and soft tissue overlying the fetal spine at the back of the neck
72
On first trimester screening, if If nuchal translucency is _____ patient should be offered targeted sonography with or without fetal echocardiography and fetal karyotyping. How is the risk assessed?
>3.0mm Risk of fetal aneuploidy and structural malformations is proportional to degree of NT enlargement
73
**When looking at a first trimester screening, if the hCG is elevated and the PAPP-A is decreased, what does it indicate?
Down Syndrome
74
**When looking at a first trimester screening, if the hCG is decreased and the PAPP-A is decreased, what does it indicate?
trisomy 18 and 13
75
What does the triple test test for? When is it used?
triple test: hCG, AFP and unconjugated estriol when pt presents for prenatal care later in the pregnancy
76
Using the triple test, what will a down syndrome result look like? trisomy 18?
lower AFP, lower estriol, higher hCG all 3 markers decreased
77
What does the quad screen test for? When is it used?
hCG, AFP, unconjugated estriol and inhibin 2nd trimester screening
78
What will a pt with down syndrome's quad test result look like?
lower AFP, lower estriol, higher hCG, higher inhibin
79
What should you do if a pt's fetus tests positive for down syndrome on the first trimester screen?
offer invasive testing and screen again in the second trimester offer genetic counseling and definitive fetal chromosome analysis: CVS vs amniocentesis
80
What does an US of a fetus that indicates a high risk of fetal aneuploidy show?
A structural abnormality involving a major organ or the presence of two or more minor structural abnormalities or dysmorphisms in the same fetus can indicate high risk of fetal aneuploidy
81
If any major anomalies are found on US, what should you do? What is considered a minor abnormalities? What is a minor one is found?
major: invasive testing minor includes: Nuchal fold >6mm Pylectasis (dilation of kidney) Hyperechogenic bowel Choroid plexus cyst minor: genetic testing
82
**______ is the best screening approach to detect fetal abnormalities. When can it be done? What if the test is inconclusive?
Cell-free DNA 9-10 weeks to term inconclusive result: associated with increased risk of having chromosomal abnormalities
83
Fetal component of cell-free DNA is derived from ______ that are released into the maternal circulation from cells undergoing programmed _____
placental trophoblasts cell death
84
______ is the most SENSITIVE and SPECIFIC screening test for the common fetal aneuploidies. Is it equivalent to diagnostic testing?
Cell free DNA NOT equivalent **and can be wrong**
85
What if you have a Positive Screen?
Offer patient confirmatory testing/diagnostic testing= Invasive Testing CVS Amniocentesis
86
What is amniocentesis? When is it performed? What is the purpose?
Transabdominal withdrawal of amnionic fluid Performed typically between 15-20 weeks gestation **Most common procedure for DIAGNOSIS of fetal aneuploidy
87
What are the indications for amniocentesis?
assess fetal karyotype polyhydramnios assess fetal anemia assess fetal lung maturity
88
What is polyhydramnios? What does it cause? What is the tx?
more than 25 ml of fluid in the mom can cause contractions amniocentesis
89
_____ is done to assess fetal anemia and ______ is measured in the fluid which has an indirect measure of ______
amniocentesis ΔOD 450 measurement fetal hemolysis (to assess fetal anemia)
90
amniocentesis can assess fetal lung maturity by elevating _______. _____ begins to elevate after 32 weeks while ______ does not. When ratio is _____ risk of respiratory distress is low
Lecithin/Sphingomyelin ratio (L/S ratio) Lecitihin Sphingomyelin >2.0, risk is LOW
91
What are the complications of amniocentesis?
Pregnancy loss rate 1 per 300-500 Amniotic fluid leakage Chorioamnionitis Needle injuries to fetus
92
What is Chorionic Villus Sampling (CVS)? When can it be performed? What is the indication? What is the advantage of amniocentesis?
Biopsy of the chorionic villi in the placental tissue Performed between 10-13 weeks gestation Assess fetal karyotype Primary advantage over amniocentesis is that it can be done earlier allowing for earlier pregnancy termination if desired
93
What are the relative CI for CVS?
Vaginal bleeding Active genital tract infection Extreme uterine ante- or retroflexion Body habitus precluding visualization
94
What are the complications associated with CVS?
pregnancy loss limb reduction defects: especially if done at 7 weeks gestation, LESS risk if done at greater than 10 weeks vaginal spotting infection
95
What is Cordocentesis? When is it used? What are the indications?
fetal blood sampling or percutaneous umbilical blood sampling Initially used for fetal transfusion of red blood cells -Fetal anemia – Most common -Assessment and treatment of platelet alloimmunization -Fetal karyotype assessment
96
What are the complications of fetal blood sampling?
Fetal loss rate is about 1.4% Cord vessel bleeding Fetal-maternal bleeding Fetal bradycardia
97
What are 3 invasive testings options?
amniocentesis CVS fetal blood sampling
98
What is antepartum fetal assessment used for? What is it based on?
To identify fetuses at risk of intrauterine death or other complications of intrauterine asphyxia and intervene to prevent adverse outcomes if possible Based on idea that fetus responds to hypoxemia in a predictable manner
99
When is it recommended to start Antepartum Fetal Surveillance? What about those at high risk?
Begin testing around 32-34 weeks with repeat testing every 7 days high risk: start at 26-28 weeks
100
What are 3 factors that can affect fetal movement?
Amniotic fluid: Less fluid = less fetal activity fetal sleep-wake cycles gestational age: advanced gestational age they have LESS space and activity may diminish
101
When should you start counting fetal movements? On average, what should you feel? How often should mom count fetal movement?
around 28 weeks Patient should perceive 10 movements in up to 2 hours count fetal movement for 1 hour a day
102
Non-stress tests evaluate the ______. What are the normal accelerations seen for a fetus less than 32 weeks? Older than 32 weeks?
fetal HR for 20 minutes: 2 or more accelerations is normal In fetuses < 32 weeks, an acceleration is a 10bpm change in baseline that lasts 10 seconds or longer In fetuses > 32 weeks, an acceleration is a 15bpm change in baseline that lasts 15 seconds or longer
103
What should you do if you think the fetus is sleeping during a non-stress test?
acoustic stimulator on mom's belly for 1-2 seconds and it can be repeated up to 3 times should wake baby up and should start to see HR accelerations in a normal baby
104
If non-stress test is abnormal, what should you do next? What are the 5 components?
Biophysical Profile (BPP) aka you get an ultrasound 1. Non-stress test (NST) 2. Fetal breathing 3. fetal movement 4. fetal tone 5. amniotic fluid volume
105
What is the scoring system for BPP? What is the intrepration?
0-10 at 2 intervals (10,8,6,4,2,0)
106
In the BPP, how does the fetus get 2 points per category?
points are good! score of 10 is perfect, normal, healthy baby 8/10 is also a normal score
107
What are the 2 components of the modified BPP?
AFI (amniotic fluid index) and non-stress test
108
What 3 fetal vascular circuits are evaluated during a doppler velocimetry?
Umbilical artery Middle cerebral artery Ductus venosus
109
When is an umbilical artery velocimetry considered abnormal? What does it indicate?
aka measures the velocity of the blood flow through the umbilical artery if the systolic/diastolic ratio is >95th percentile for gestational age something is impeding the umbilical artery blood flow, leads to fetal growth restriction
110
When would you want to assess a fetus's middle cerebral artery velocity via doppler US?
is considered about: -Intrauterine growth restriction -Isoimmunization -Fetal anemia
111

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