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EBAC - Internal Medicine and Infectious Disease > Obstetrics Pearls > Flashcards

Obstetrics Pearls Flashcards

1
Q

Typical gestational period

A

40 weeks

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2
Q

1st trimester timespan

A

0-12 weeks

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3
Q

2nd trimester timespan

A

13-27 weeks

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4
Q

3rd trimester timespan

A

28-40 weeks

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5
Q

1st trimester common symptoms/hx

A 
Amenorrhea
N/V
Fatigue
Breast tenderness
Urinary frequency
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6
Q

Most common first symptom of pregnancy

A

Breast tenderness

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7
Q

2nd trimester common symptoms/hx

A

Fetal movement
Abdominal discomfort (d/t stretching)
Pigmentation changes (e.g. chloasma)
Syncope

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8
Q

3rd trimester common symptoms/hx

A

Abdominal growth
Braxton-Hicks contractions
Return of urinary frequency with descent of fetus
Increased work of breathing until descent

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9
Q

1st trimester PE findings (by 8 weeks)

A

Cervical softening
Cervical/labial bluish tint
Softening of cervicouterine junction
Breast enlargement

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10
Q

Fetal heart tones first audible

A

10-12 weeks

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11
Q

Goodell’s sign

A

Cervical softening

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12
Q

Chadwick’s sign

A

Cervical bluish tint, sign of increased perfusion

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13
Q

Hegar’s sign

A

Softening of cervicouterine junction

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14
Q

2nd trimester PE findings (by 18-20 weeks)

A

Striae
Fundus at level of umbilicus (i.e. 20 weeks), 1 cm/wk thereafter
Leopold maneuvers possible after 20 weeks

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15
Q

Leopold maneuvers

A

Manual determination of fetal position after 20 weeks

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16
Q

3rd trimester PE findings

A

Loss of mucus plug/blood show prior to labor by 1 week
Increased Braxton-Hicks, rupture of membranes
Lightening 3-4 weeks prior to labor

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17
Q

Pregnancy confirmatory

A

HCG

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18
Q

1st trimester diagnostics

A

UA, urine C and S, CBC, blood group and Rh, Ab screen, rubella (do not admin while pregnant) HbsAg, RPR, HIV, specialty, pap, cervical cultures, STI, U/S (for dating when unsure), chorionic villus sampling

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19
Q

2nd trimester dx wks 16-20

A

Triple/quad screen

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20
Q

Amniocentesis criteria/timeframe

A

h/o chromosomal abnormalities or AMA (wks 15-20)

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21
Q

Fetal survey timeframe

A

wks 18-20

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22
Q

1-hour GTT criteria/timeframe (2nd trimester)

A

h/o DM, wt >200 lbs @ 20 weeks

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23
Q

RhoGAM criteria/timeframe

A

Rh-unsensitized Rh-negative @ 28 weeks

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24
Q

Hgb/Hct timefrime

A

28-36 wks

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25
Q

Nonstress test/biophysical profile timeframe

A

3rd trimester PRN to eval fetus

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26
Q

HBV vaccine and group B strep test timeframe

A

3rd trimester

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27
Q

Earliest fetal viability (week)

A

24 weeks

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28
Q

Prenatal visit interval weeks 0-28

A

Q 4 weeks

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29
Q

Prenatal visit interval weeks 29-36

A

Q 2 weeks

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30
Q

Prenatal visit interval weeks 36+

A

Weekly

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31
Q

First OB visit priorities

A 
Determine estimated date of confinement 
Personal, social, family hx
Complete PE
Routine labs
FHT
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32
Q

Fetal heart tones timeframe to perform

A

10-12 weeks

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33
Q

Follow up OB visit priorities

A

Interval hx
PE, FHT, fundal height, movement, presentation/lie/position
Labs

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34
Q

Routine OB urine labs

A

Protein, glucose, ketones

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35
Q

Ectopic pregnancy defined

A

Conceptus implanted and grows outside uterine cavity (tubal 95%)

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36
Q

Ectopic pregnancy risk factors

A

Tubal surgery
H/o tubal ectopy
PID
IUD

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37
Q

Ectopic pregnancy sx/hx

A

Amenorrhea, abnormal dark/tarry spotting, abdominal/pelvic pain, unilateral LQP, LBP, shoulder pain, hemodynamic changes in VS

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38
Q

Ectopic pregnancy PE findings

A

Tender adnexa +/- palpable mass
+Chandelier sign (CMT)
+Hegar sign
+Peritoneal signs, vaginal bleed

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39
Q

Ectopic pregnancy work up

A

Serum hCG, CBC, type, Rh, U/S, preoperative labs

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40
Q

Ectopic management level

A

Emergent

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41
Q

Abortion timeframe

A

Prior to viability 24 weeks

42
Q

Spontaneous abortion rate

43
Q

Spontaneous abortion timeframe

A

1st trimester

44
Q

1st trimester spontaneous abortion cause

A

Chromosomal abnormalities

45
Q

2nd trimester spontaneous abortion causes

A

Cervical incompetence, infection, uterine abnormalities

46
Q

Unplanned pregnancy rate

A

50% of pregnancies

47
Q

Spontaneous abortion sx/hx

A 
Variable vaginal bleeding
Cramping/pelvic pressure
LBP
rupture of membranes
Hemodynamic changes in VS
48
Q

Spontaneous abortion dx

A

hCG levels
U/S
CBC, type, Rh
Coag profile PRN

49
Q

Spontaneous abortion management

A

Refer
Bed rest
Abstinence
Labs

50
Q

Surgical abortion vacuum D and C timeframe

A

≤12 weeks

51
Q

Surgical abortion D and E timeframe

A

13 to 14, 20 to 22

52
Q

Medical abortion timeframe

A

≤49 days

53
Q

Medical abortion agents

A

mifepristone, misoprostol

54
Q

Pregnancy complications order of occurrence

A

PIH-preeclampsia-HELLP-eclampsia OR

PIH-preeclampsia-eclampsia-HELLP

55
Q

Pregnancy induced HTN (PIH) defined

A

> 140/90 on 2 occasions

56
Q

PIH incidence

57
Q

PIH risk factors

A 
HTN, renal/CV dz
DM
SLE, autoimmune dz
multigravida
primagravida 
h/o of PIH
Advanced/early parental age
58
Q

PIH work up

A

BP surveillance
CBC/LFT, 24h urine protein, creatinine, CrCl
NST 32-34 wks
U/S PRN

59
Q

PIH possible fetal effect

A

Delayed fetal growth (dx x u/s)

60
Q

PIH management

A

Rest, bed rest LL recumbent

Fetal surveillance: NST u/s, kick counts at home

61
Q

Preeclampsia weight gain

A

2lbs/wk or 6lbs/mo

62
Q

Preeclampsia edema

A

Nondependent pretibial >1, +3-4; face, hands, feet (can’t get shoes on, rings off, etc)

63
Q

Preeclampsia headache distribution

A

frontal or occipital HA

64
Q

Preeclampsia advanced finding

A

Visual disturbance

65
Q

Preeclampsia defined

A

PIH + proteinuria ≥trace, ≥2 severe

66
Q

Preeclampsia fundal height

67
Q

Preeclampsia reflexes

A

WNL; 3-4+ in severe

68
Q

Preeclampsia management

A 
Referral
Strict bed rest LL recumbent
Fetal surveillance: NST, BPP, u/s
Home kick counts
Weekly betamethasone injections <34 weeks
69
Q

Preeclampsia severe management

A

Hospitalization, MgSO4 therapy, induced delivery >34 wks or 2 doses betamethasone

70
Q

Preeclampsia B-methasone function

A

Fetal lung maturity

71
Q

Eclampsia defined

A

PIH + preeclampsia + tonic-clonic seizure

72
Q

Eclampsia prodrome

A

Severe, unrelenting HA
Acute epigastric, RUQ pain
Visual disturbance, spotty vision, blurry, blind

73
Q

Eclampsia findings

A

BP >160/100
Tonic-clonic seizure
Oliguria/anuria
Fetal distress in utero

74
Q

Eclampsia dx

A

CBC, LFT, CMP, coag, 24 h urine for protein, CrCl, uric acid

Hospital fetal surveillance

75
Q

Eclampsia management

A

MgSO4/valium to break sz

Induced labor stat

76
Q

HELLP syndrome

A

Hemolysis, elevated liver enzymes, low platelets

77
Q

HELLP syndrome s/s

A

PIH+preeclampsia+ n +/- vom, jaundice, extreme fatigue, malaise

78
Q

HELLP PE findings

A

Hepatomegaly, RUQ pain radiating to epigastric, jaundice, ascities, spider nevi, ecchymosis, other liver findings

79
Q

HEELP work up

A

Preeclampsia + thrombocytopenia, clotting factors, severe hemoconcentration, very elevated LFTs, proteinuria c/w severe preeclampsia

80
Q

HELLP management

A

Emergent, hospitalization, delivery stat

81
Q

Placenta previa defined

A

Mal-implantation of placenta in lower uterine segment, partial or complete cervical OS

82
Q

Abruptio placentae defined

A

Separation of placenta from uterine wall complete/partial

83
Q

Placenta previa bleeding

A

Often in late 2nd-3rd trimester w/vaginal intercourse

84
Q

Placenta previa risk factor

A

H/o c-section, multiparous, malpresentation, h/o previa

85
Q

Abruptio placentae acuity level

86
Q

Abruptio placentae sequelae

A

Fetal demise very likely complete>partial

87
Q

Abruptio placentae bleed

A

Possibly life-threatening hemorrhage in 2nd-3rd trimester

88
Q

Abruptio placentae bleed complication

A

disseminated intravascular coagulation (DIC)

89
Q

Placental abruption risk factors

A

Trauma, chronic HTN, PIH, eclampsia, stimulant use, EtOH, cigarettes

90
Q

Placenta previa s/s

A

Painless bleed, immediately after coitus OR no precipitating factor
No e/o ctx
No uterine tenderness
Little to no fetal compromise unless severe bleed

91
Q

Placenta previa Dxs

A

U/S to ID location of placenta implantation
EFM to r/o fetal distress
CBC if serious bleed

92
Q

Placenta previa management

A 
NO bimanual, spec only
Hospitalize
NST/BPP while in hospital then weekly
Total vaginal rest
Anticipate delivery if possible
93
Q

Placental abruption s/s

A 
Severe abdominal pain
Heavy BRB by vagina OR minimal if abruption is concealed
Rigid uterus if concelead
Shock
Fetal distress, absent FHTs
94
Q

Placental abruption dx

A

U/S to ID location of placenta implantation
EFM to r/o fetal distress
CBC, type, Rh for transfusion, coag profile

95
Q

Placental abruption management

A

Emergent OB admit

Immediate delivery

96
Q

Preterm labor defined

A

Ctxs >20 weeks <37 weeks resulting in effacement/dilation

97
Q

Preterm labor s/s

A

Uterine cramping, LBP intermittent/rhythmic, uterine ctx 10-12 mins 5/hr
Vaginal spotting/discharge
Effacement/shortening/dilation

98
Q

Preterm labor management

A 
Tocolytic therapy if +cervical changes
Hospitalization if unable to stop ctxs
<34 weeks + successful tocolytics give b-methasome BIW until 34 wks
Bed rest
Vaginal and bed rest
Weekly cervical checks
99
Q

Postpartum complications

A

Pulmonary embolism
PP hemorrhage
PP depression
Mastitis (2/2 staph)

100
Q

Mastitis management

A

Sx treatment (NSAIDs, ice) abx (dicloxacillin, cephalexin, clinda)

EBAC - Internal Medicine and Infectious Disease (35 decks)

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