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MI 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
Nonstress test/biophysical profile timeframe
3rd trimester PRN to eval fetus
26
HBV vaccine and group B strep test timeframe
3rd trimester
27
Earliest fetal viability (week)
24 weeks
28
Prenatal visit interval weeks 0-28
Q 4 weeks
29
Prenatal visit interval weeks 29-36
Q 2 weeks
30
Prenatal visit interval weeks 36+
Weekly
31
First OB visit priorities
``` Determine estimated date of confinement Personal, social, family hx Complete PE Routine labs FHT ```
32
Fetal heart tones timeframe to perform
10-12 weeks
33
Follow up OB visit priorities
Interval hx PE, FHT, fundal height, movement, presentation/lie/position Labs
34
Routine OB urine labs
Protein, glucose, ketones
35
Ectopic pregnancy defined
Conceptus implanted and grows outside uterine cavity (tubal 95%)
36
Ectopic pregnancy risk factors
Tubal surgery H/o tubal ectopy PID IUD
37
Ectopic pregnancy sx/hx
Amenorrhea, abnormal dark/tarry spotting, abdominal/pelvic pain, unilateral LQP, LBP, shoulder pain, hemodynamic changes in VS
38
Ectopic pregnancy PE findings
Tender adnexa +/- palpable mass +Chandelier sign (CMT) +Hegar sign +Peritoneal signs, vaginal bleed
39
Ectopic pregnancy work up
Serum hCG, CBC, type, Rh, U/S, preoperative labs
40
Ectopic management level
Emergent
41
Abortion timeframe
Prior to viability 24 weeks
42
Spontaneous abortion rate
15%
43
Spontaneous abortion timeframe
1st trimester
44
1st trimester spontaneous abortion cause
Chromosomal abnormalities
45
2nd trimester spontaneous abortion causes
Cervical incompetence, infection, uterine abnormalities
46
Unplanned pregnancy rate
50% of pregnancies
47
Spontaneous abortion sx/hx
``` Variable vaginal bleeding Cramping/pelvic pressure LBP rupture of membranes Hemodynamic changes in VS ```
48
Spontaneous abortion dx
hCG levels U/S CBC, type, Rh Coag profile PRN
49
Spontaneous abortion management
Refer Bed rest Abstinence Labs
50
Surgical abortion vacuum D and C timeframe
≤12 weeks
51
Surgical abortion D and E timeframe
13 to 14, 20 to 22
52
Medical abortion timeframe
≤49 days
53
Medical abortion agents
mifepristone, misoprostol
54
Pregnancy complications order of occurrence
PIH-preeclampsia-HELLP-eclampsia OR | PIH-preeclampsia-eclampsia-HELLP
55
Pregnancy induced HTN (PIH) defined
>140/90 on 2 occasions
56
PIH incidence
12%
57
PIH risk factors
``` HTN, renal/CV dz DM SLE, autoimmune dz multigravida primagravida h/o of PIH Advanced/early parental age ```
58
PIH work up
BP surveillance CBC/LFT, 24h urine protein, creatinine, CrCl NST 32-34 wks U/S PRN
59
PIH possible fetal effect
Delayed fetal growth (dx x u/s)
60
PIH management
Rest, bed rest LL recumbent | Fetal surveillance: NST u/s, kick counts at home
61
Preeclampsia weight gain
2lbs/wk or 6lbs/mo
62
Preeclampsia edema
Nondependent pretibial >1, +3-4; face, hands, feet (can't get shoes on, rings off, etc)
63
Preeclampsia headache distribution
frontal or occipital HA
64
Preeclampsia advanced finding
Visual disturbance
65
Preeclampsia defined
PIH + proteinuria ≥trace, ≥2 severe
66
Preeclampsia fundal height
Retarded
67
Preeclampsia reflexes
WNL; 3-4+ in severe
68
Preeclampsia management
``` Referral Strict bed rest LL recumbent Fetal surveillance: NST, BPP, u/s Home kick counts Weekly betamethasone injections <34 weeks ```
69
Preeclampsia severe management
Hospitalization, MgSO4 therapy, induced delivery >34 wks or 2 doses betamethasone
70
Preeclampsia B-methasone function
Fetal lung maturity
71
Eclampsia defined
PIH + preeclampsia + tonic-clonic seizure
72
Eclampsia prodrome
Severe, unrelenting HA Acute epigastric, RUQ pain Visual disturbance, spotty vision, blurry, blind
73
Eclampsia findings
BP >160/100 Tonic-clonic seizure Oliguria/anuria Fetal distress in utero
74
Eclampsia dx
CBC, LFT, CMP, coag, 24 h urine for protein, CrCl, uric acid | Hospital fetal surveillance
75
Eclampsia management
MgSO4/valium to break sz | Induced labor stat
76
HELLP syndrome
Hemolysis, elevated liver enzymes, low platelets
77
HELLP syndrome s/s
PIH+preeclampsia+ n +/- vom, jaundice, extreme fatigue, malaise
78
HELLP PE findings
Hepatomegaly, RUQ pain radiating to epigastric, jaundice, ascities, spider nevi, ecchymosis, other liver findings
79
HEELP work up
Preeclampsia + thrombocytopenia, clotting factors, severe hemoconcentration, very elevated LFTs, proteinuria c/w severe preeclampsia
80
HELLP management
Emergent, hospitalization, delivery stat
81
Placenta previa defined
Mal-implantation of placenta in lower uterine segment, partial or complete cervical OS
82
Abruptio placentae defined
Separation of placenta from uterine wall complete/partial
83
Placenta previa bleeding
Often in late 2nd-3rd trimester w/vaginal intercourse
84
Placenta previa risk factor
H/o c-section, multiparous, malpresentation, h/o previa
85
Abruptio placentae acuity level
Emergent
86
Abruptio placentae sequelae
Fetal demise very likely complete>partial
87
Abruptio placentae bleed
Possibly life-threatening hemorrhage in 2nd-3rd trimester
88
Abruptio placentae bleed complication
disseminated intravascular coagulation (DIC)
89
Placental abruption risk factors
Trauma, chronic HTN, PIH, eclampsia, stimulant use, EtOH, cigarettes
90
Placenta previa s/s
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
Placenta previa Dxs
U/S to ID location of placenta implantation EFM to r/o fetal distress CBC if serious bleed
92
Placenta previa management
``` NO bimanual, spec only Hospitalize NST/BPP while in hospital then weekly Total vaginal rest Anticipate delivery if possible ```
93
Placental abruption s/s
``` Severe abdominal pain Heavy BRB by vagina OR minimal if abruption is concealed Rigid uterus if concelead Shock Fetal distress, absent FHTs ```
94
Placental abruption dx
U/S to ID location of placenta implantation EFM to r/o fetal distress CBC, type, Rh for transfusion, coag profile
95
Placental abruption management
Emergent OB admit | Immediate delivery
96
Preterm labor defined
Ctxs >20 weeks <37 weeks resulting in effacement/dilation
97
Preterm labor s/s
Uterine cramping, LBP intermittent/rhythmic, uterine ctx 10-12 mins 5/hr Vaginal spotting/discharge Effacement/shortening/dilation
98
Preterm labor management
``` 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
Postpartum complications
Pulmonary embolism PP hemorrhage PP depression Mastitis (2/2 staph)
100
Mastitis management
Sx treatment (NSAIDs, ice) abx (dicloxacillin, cephalexin, clinda)

MI Internal Medicine and Infectious Disease (35 decks)

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