Pregancy, Labor, and Delivery: Young Flashcards
What are the 2 things to do in medicine?
- maintain your composure
2. ease the babies head out
What not to do?
NEVER FORCE BABY OUT… easy it along
When is a fetus viable?
~24 weeks
When is preterm defined as?
viable 24 wks to 37 weeks
What is early term?
37-38
What is term?
39-40
What is late term?
41
What is post term?
42
What is total term pregnancy?
40 weeks from date of last menstrual period
What is the goal of the first visit of a pregnant mother?
identify problems or potential problems
What do you assess in initial visit?
Risks Discuss chromosome assessment: age based Monitor: wt gain bp Rh diabetes anemia stds Group B strep plan for delivery
What is the medical definition of abortion?
Pregnancy doesn’t make it 20 weeks=aborted
What are the risks of chromosome abnormality at 18? 45?
18: 1/1500
45: 1/50
What is defined as advanced maternal age?
age 35… really more like 37, 38
What is the risk of fetal loss in amniocentesis?
1/250
What % of US population has group B strep?
20%… pretty much from diet and life
What does GBS screening decrease the risk of fetal loss by?
2 orders of magnitude
What nutrition is necessary?
Wight gain
Obesity is a form of malnutrition
Essential amino acids: eat meat/soy
What are the BP things we look at?
Pre-exisiting
Hypertension of pregnancy:
gestational hypertension
pre-ecclampsia
EXAM/TEST: What HTN drug is ABSOLUTELY CONTRAINDICATED IN pregnancy?
ACE inhibitors: take them off of it even if they are thinking or at the age to possibly get pregnant
EXAM: When is organogenesis complete?
12 weeks… so first trimester ACEinh. will do damge
What is gestational hypertension?
Benign hypertension
What is pre ecclampsia?
HTN
Proteinuria (edema): 500 mg protein per day
What is the natural history of pre ecclampsia?
Death
What is strange about pre ecclampsia?
Only seen in humans, no animal models
What is eclampsia?
Convulsions
How do you know someone is pre-ecclampsia?
Clinical judgememt
When does pre eclampsia not show up before?
20 weeks
TEST: what is THE major complication of pregnancy?
Pre eclampsia
What is Rh factor?
Rhesus monkey D antigen
Prior pregnancy event
Mom Rh neg., baby positive, possibly sensitize mom develops antigens and rejects next pregnancy
Is Rh A or B type?
No… just Rh factor on either type gets attacked in baby
What do you do to prevent Rh attack?
RhoGam: Coat fetal red cells which contain Rh antigens using IgG so mom doesn’t see antigen (72 hours)
If mom is Rh negative, what happens?
RhoGam either way. Baby has 50/50 chance of being Rh positive.
What is high risk for diabetes?
Prior DM in pregancy
Multiple gestation
AMA
Obese
What percent with gestational DM develop overt DM later in life?
40-50%
BOARDS/not this test: hCG is elevated in pregnany. What is it similar to?
TSH
Insulin
So: thyroid, insulin, hCG
When do you do a ultrasound to check organ size?
18-20 weeks
If a patient has a cyst in the brain, or calcification of heart, how do you consul?
It will go away!
What does ultrasound tell us?
Structure (where and how many)
Blood flow
What does ultrasound not tell us?
if the baby is okay…
What is the strict criteria of fetal heart rate?
110-160 bpm
with accelerations
with decelerations
When someone comes into the exam, what do you do with them?
Talk with them! OB is medicine and sociology
What are social considerations of pregnancy?
Finances
Work
Other Children=a job
Delivery planning
Fibroid is what?
Leiomyomyoma
A subtotal hysterectomy?
Cervix is left behind
What is viability?
Ability to live outside the uterus
NOT a “viable baby at 6 weeks”, this is just a healthy fetus
What is premature?
After 24 weeks… death before 20 weeks is an abortion
Premature and Preterm are two different words. What do they mean?
Premature=baby
Preterm= timeline
Membranes break. What does not break?
Water!
What % of pregnancy are normal?
75%
25% have a major complication
What are the main complications?
infection preterm labor per eclampsia prior CS not vertex
What are the phases of labor?
Latent phase “pre labor” <4 cm
Active phase 1st 4-10 cm
Pushing 2nd
Delivery of placenta 3rd
What are the dilation of first stage?
4-10 cm (1st stage0
How do we measure contractions?
Intrauterine pressure catheter
What are the duration of labor definitions?
Latent: no limits
Active: friendman curve, actually 1-2 cm/hr
2nd stage: 3 hr. primip, or 2 hour multi
3rd stage: 1 hour
BOARDS, not this test: What are the 7 cardinal movements of delivery?
- engagement: head into pelvis
- descent: chin to chest
- flexion : chin back up
- internal rotaion: turn
- extension: head up
- external rotation/restitution: back to straight
- expulsion-delivery of anterior shoulder, delivery of posterior shoulder under symphysis
What are the notable characteristics of the cord?
Is it intact?
3 vessels?
Bleeding?
How do you pull the cord out?
Gentle traction: do not avulse cord… put your hand in there and scoop out, antibiotics and sepsis risk.
Twist the rope
What do you do to mom after birth?
Assess for damage
What are the definitions of perineum lacerations?
1st degree: skin only
2nd: defect in underlying, but not anal sph.
3rd: into or through anal sphincter
4th: defect of rectum
What percent of babies are delivered CS?
30-33%
What percent of babies in puerto rico are delivered CS?
70%
What is VBAC?
Vaginal birth after C section: risk of ruptured uterus/bleeding/scarring
TEST: If you have a prior CS, and placenta is low anterior, what is the risk?
Placenta accreta
