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Women's Health > Obstetrics - Exam 1 > Flashcards

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
Q

What does the Kleihauer-Betke test for?

A

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

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26
Q

______ is a common infectious cause of fetal growth restriction and is worse in the _____ trimester

A

rubella

FIRST

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27
Q

What is the tx for rubella? When should pts get vaccined?

A

no specific tx

at least 1 month BEFORE getting pregnant, preg women CANNOT get MMR while pregnant because it is a LIVE vaccine

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28
Q

What causes syphilis? What is the tx?

A

Treponema pallidum

Penicillin G

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29
Q

What is the tx for syphilis is the pt is allergic to PCN?

A

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

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30
Q

What is the recommended dose of folic acid for a preg pt? What is hx of neural tube defects?

A

400 μg of folic acid

at least 4mg per day!!

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31
Q

Maternal _____ is correlated with infant birth weight. What is the recommended additional calorie requirements?

A

weight gain

100-300 calories per day

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32
Q

What is the guideline regarding seafood in pregnancy? Should get a blood ____ test if certain risk factors are identified

A

Most fish and shellfish contain mercury which should be avoided in pregnant and lactating women

blood lead if at high risk

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33
Q

How should a pregnant women wear her seat belt?

A

Recommend wearing three point restraints throughout pregnancy while riding in automobiles

Place lap belt under abdomen and across upper thighs

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34
Q

When is it safe for a preg women to fly? Dental tx?

A

Pregnant women can safely fly up to 35 weeks gestation

normal dental tx is fine for preg women

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35
Q

What is the max caffeine intake for preg pt?

A

less than 200mg

any higher and have increased risk of abortion

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36
Q

T/F: Preg women can safely scuba dive until 32 weeks

A

FALSE preg women should not scuba dive due to decompression sickness

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37
Q

What is the breastfeeding recommendation? How often?

A

Exclusive breast feeding is preferred until 6 months

feed 8-12 times daily for approximately 15mins at a time

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38
Q

What are the 8 CI to breastfeeding?

A

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

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39
Q

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

A

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

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40
Q

______ should be provided to every preg women. If positive, what is the next step? What does it NOT replace?

A

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

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41
Q

What is the FDA pregnancy classification system?

A
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42
Q

**What are the normal prenatal visit schedule for routine care?

A

Every 4 weeks until 28 weeks

Every 2 weeks until 36 weeks

Every week until delivery

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43
Q

What is monitored at every pre-natal visit moving forward?

A

fetal heart rate

fetal growth

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44
Q

What is a normal fetal heart rate? When is it detected?

A

110-160bpm

detectable at 10 weeks via doppler

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45
Q

Describe the normal trend for a healthy pregnancy in terms of fetal growth

A

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
Q

How is the fundal height measured?

A
47
Q

When is the anatomy scan typically done?

A

Anatomy ultrasound (around 18 weeks)-basic scan for all the organ systems to make sure they are healthy

48
Q

What symptoms do you need to ask mom at every prenatal visit?

A

Leakage of fluid
Contractions
Nausea and vomiting
Pelvic pain
Bleeding

49
Q

When do you screen for gestational diabetes? When do you get a repeat CBC?

A

week 24-28

repeat around 28 weeks to monitor for anemia

50
Q

_____ and _____ tests are repeats around 28 weeks and at delivery

A

syphilis and HIV

51
Q

_______ is obtain via vaginal/anal culture obtained between 35-37 weeks. If positive, what do you do?

A

Group B Streptococcal

Intrapartum antibiotic prophylaxis given in labor if culture is positive

52
Q

What vaccines are recommended for preg pts?

A

Hep A and B: if risk of exposure

flu vaccine

Tetanus, Diptheria and Pertussis

RSV

COVID

53
Q

When should a preg pt received the flu and COVID vaccine?

A

at any point in their pregnancy

54
Q

When should Tetanus, Diptheria and Pertussis
be administered?

A

Given in 3rd trimester so mom can pass immunity to the baby

55
Q

When should RSV be administered?

A

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
Q

When is N/V common in pregnancy? How long does it last? What is the tx?

A

first trimester until about 16 weeks

lasts about 35 days

Vitamin B6 with or without Doxylamine
Prochlorperazine, Metoclopramide, Ondansetron

57
Q

What is Hyperemesis gravidarum? Why is it dangerous?

A

Vomiting so severe that dehydration, electrolyte and acid-base disturbances and starvation ketosis occur

Severe enough to cause weight loss

58
Q

What is the tx for hemorrhoids in a preg pt?

A

Topical applied anesthetics
Warm soaks
Stool softeners

59
Q

What is pica? What does it indicate?

A

craving of pregnant women for strange food  ice, starch, dirt

severe iron deficiency

60
Q

Why does a preg pt always want to sleep? What is Leukorrhea?

A

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
Q

Major congenital abnormalities are identified in_____ of pregnancies. All women before _____ should be offered screening

A

2-3%

20 weeks gestation

62
Q

What is the MC class of birth defects? 2nd MC?

A

cardiac anomalies

neural tube defects

63
Q

elevated _____ is associated with neural tube defects. Where is it synthesized?

A

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
Q

What are the 6 risk factors for having a fetus with neural tube defects?

A

Family history
MTHFR mutation
Aneuploidy
Diabetes
Hyperthermia
Medications  specifically seizure medications

65
Q

When do you screen for neural tube defects? What level indicates a NTD?

A

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
Q

AFP can be elevated for 7 other reasons besides NTD, what are they?

A

Multifetal gestation

Pilonidal cyst

Chorioangioma of the placenta

Placental abruption

Oligohydramnios

Preeclampsia

Fetal growth restriction

67
Q

_______ is more important for detecting NTDs than AFP

A

Second-trimester fetal US has a higher rate of detection for NTDs than using AFP

68
Q

Risk of fetal trisomy increases with maternal age, particularly after ____. Who should get screened for genetic syndromes?

A

35yo

EVERYONE should be offered a screening regardless of maternal age or risk of chromosomal abnormalities

69
Q

What is the goal of prenatal screenings?

A

to provide a RISK assessment they are NOT diagnostic

70
Q

When do you perform the first trimester screening? What are you looking for?

A

11-14 weeks -> Combined First screen

Evaluates nuchal translucency and serum analytes (PAPP-A, hCG) to detect Down syndrome

71
Q

What is nuchal translucency?

A

maximum thickness of the subcutaneous translucent area between the skin and soft tissue overlying the fetal spine at the back of the neck

72
Q

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?

A

> 3.0mm

Risk of fetal aneuploidy and structural malformations is proportional to degree of NT enlargement

73
Q

**When looking at a first trimester screening, if the hCG is elevated and the PAPP-A is decreased, what does it indicate?

A

Down Syndrome

74
Q

**When looking at a first trimester screening, if the hCG is decreased and the PAPP-A is decreased, what does it indicate?

A

trisomy 18 and 13

75
Q

What does the triple test test for? When is it used?

A

triple test: hCG, AFP and unconjugated estriol

when pt presents for prenatal care later in the pregnancy

76
Q

Using the triple test, what will a down syndrome result look like? trisomy 18?

A

lower AFP, lower estriol, higher hCG

all 3 markers decreased

77
Q

What does the quad screen test for? When is it used?

A

hCG, AFP, unconjugated estriol and inhibin

2nd trimester screening

78
Q

What will a pt with down syndrome’s quad test result look like?

A

lower AFP, lower estriol, higher hCG, higher inhibin

79
Q

What should you do if a pt’s fetus tests positive for down syndrome on the first trimester screen?

A

offer invasive testing and screen again in the second trimester

offer genetic counseling and definitive fetal chromosome analysis: CVS vs amniocentesis

80
Q

What does an US of a fetus that indicates a high risk of fetal aneuploidy show?

A

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
Q

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?

A

major: invasive testing

minor includes:
Nuchal fold >6mm
Pylectasis (dilation of kidney)
Hyperechogenic bowel
Choroid plexus cyst

minor: genetic testing

82
Q

**______ is the best screening approach to detect fetal abnormalities. When can it be done? What if the test is inconclusive?

A

Cell-free DNA

9-10 weeks to term

inconclusive result: associated with increased risk of having chromosomal abnormalities

83
Q

Fetal component of cell-free DNA is derived from ______ that are released into the maternal circulation from cells undergoing programmed _____

A

placental trophoblasts

cell death

84
Q

______ is the most SENSITIVE and SPECIFIC screening test for the common fetal aneuploidies. Is it equivalent to diagnostic testing?

A

Cell free DNA

NOT equivalent and can be wrong

85
Q

What if you have a Positive Screen?

A

Offer patient confirmatory testing/diagnostic testing= Invasive Testing

CVS
Amniocentesis

86
Q

What is amniocentesis? When is it performed? What is the purpose?

A

Transabdominal withdrawal of amnionic fluid

Performed typically between 15-20 weeks gestation

**Most common procedure for DIAGNOSIS of fetal aneuploidy

87
Q

What are the indications for amniocentesis?

A

assess fetal karyotype

polyhydramnios

assess fetal anemia

assess fetal lung maturity

88
Q

What is polyhydramnios? What does it cause? What is the tx?

A

more than 25 ml of fluid in the mom can cause contractions

amniocentesis

89
Q

_____ is done to assess fetal anemia and ______ is measured in the fluid which has an indirect measure of ______

A

amniocentesis

ΔOD 450 measurement

fetal hemolysis (to assess fetal anemia)

90
Q

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

A

Lecithin/Sphingomyelin ratio (L/S ratio)

Lecitihin

Sphingomyelin

> 2.0, risk is LOW

91
Q

What are the complications of amniocentesis?

A

Pregnancy loss rate 1 per 300-500

Amniotic fluid leakage

Chorioamnionitis

Needle injuries to fetus

92
Q

What is Chorionic Villus Sampling (CVS)? When can it be performed? What is the indication? What is the advantage of amniocentesis?

A

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
Q

What are the relative CI for CVS?

A

Vaginal bleeding

Active genital tract infection

Extreme uterine ante- or retroflexion

Body habitus precluding visualization

94
Q

What are the complications associated with CVS?

A

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
Q

What is Cordocentesis? When is it used? What are the indications?

A

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
Q

What are the complications of fetal blood sampling?

A

Fetal loss rate is about 1.4%

Cord vessel bleeding

Fetal-maternal bleeding

Fetal bradycardia

97
Q

What are 3 invasive testings options?

A

amniocentesis

CVS

fetal blood sampling

98
Q

What is antepartum fetal assessment used for? What is it based on?

A

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
Q

When is it recommended to start Antepartum Fetal Surveillance? What about those at high risk?

A

Begin testing around 32-34 weeks with repeat testing every 7 days

high risk: start at 26-28 weeks

100
Q

What are 3 factors that can affect fetal movement?

A

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
Q

When should you start counting fetal movements? On average, what should you feel? How often should mom count fetal movement?

A

around 28 weeks

Patient should perceive 10 movements in up to 2 hours

count fetal movement for 1 hour a day

102
Q

Non-stress tests evaluate the ______. What are the normal accelerations seen for a fetus less than 32 weeks? Older than 32 weeks?

A

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
Q

What should you do if you think the fetus is sleeping during a non-stress test?

A

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
Q

If non-stress test is abnormal, what should you do next? What are the 5 components?

A

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
Q

What is the scoring system for BPP? What is the intrepration?

A

0-10 at 2 intervals (10,8,6,4,2,0)

106
Q

In the BPP, how does the fetus get 2 points per category?

A

points are good! score of 10 is perfect, normal, healthy baby
8/10 is also a normal score

107
Q

What are the 2 components of the modified BPP?

A

AFI (amniotic fluid index) and non-stress test

108
Q

What 3 fetal vascular circuits are evaluated during a doppler velocimetry?

A

Umbilical artery
Middle cerebral artery
Ductus venosus

109
Q

When is an umbilical artery velocimetry considered abnormal? What does it indicate?

A

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
Q

When would you want to assess a fetus’s middle cerebral artery velocity via doppler US?

A

is considered about:

-Intrauterine growth restriction
-Isoimmunization
-Fetal anemia

111
Q
A

Women's Health (6 decks)

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