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women's health exam 2 > prenatal care, labor > Flashcards

prenatal care, labor Flashcards

1
Q

What should be checked if a female is planning to get pregnant

A
  • BMI
  • dental caries
  • HIV status
  • immunizations
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2
Q

which immunizations are contraindicated in pregnancy

A
  • MMR
  • varicella
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3
Q

what supplement is recommended for preconception care

A
  • folic acid 0.4-0.8 mg daily
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4
Q

when is 1st prenatal care visit recommended

A

by 10 weeks gestation

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5
Q

what is the way to take note of obstetrical history

A
  • gravida x , Para (TPAL)
    • x: # of pregnancies
    • T: # full term births
    • P: # of preterm births (<37 weeks)
    • A: # of abortions (spontaneous, induced, ectopic)
    • L: # of living children
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6
Q

2 living children born as full term births, 1 spontaneous abortion, 1 ectopic, currently pregnant

A
  • G 5, P 2-0-2-2
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7
Q

EDD and EDC

A
  • EDC = estimated date of confinement
  • EDD: estimated date of delivery
    • both: due date
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8
Q

Naegele’s rule

A
  • calculated EDC
    • add 7 days to LMP and subtract 3 months
      • ex: LMP 2/20/14
      • EDD: 11/27/2014
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9
Q

early term

A

37-38 weeks

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10
Q

full term

A

39-40 weeks

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11
Q

late term

A

41 weeks

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12
Q

post-term

A

42 weeks and beyond

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13
Q

chadwick’s sign

A
  • bluish/pruple coloration of vagina/cervix associated with pregnancy
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14
Q

what specimen collection is done during 1st visit of prenatal care

A
  • pap smear
  • chlamydia smear
  • +/- gonorrhea swab
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15
Q

what routine labs are taken during first visit of prenatal care

A
  • urine hCG
  • CBC
  • type and Rh
  • rubella and varicella immunity
  • syphilis testing
  • hep B antigen testing
  • HIV
  • UA C&S
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16
Q

tranvaginal US can visualize fetal cardiac motion as early as

A
  • 5.5-6 weeks
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17
Q

length of 1st trimester

A
  • week 1- end of week 12
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18
Q

length of 2nd trimester

A
  • week 13 - end of week 26
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19
Q

length of 3rd trimester

A
  • week 27 - end of pregnancy
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20
Q

what is quickening and when does it occur

A
  • first fetal movements
  • first pregnancy: 18-20 weeks
  • not first pregnancy: 16-18 weeks
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21
Q

what fetal heart rate is within normal limits

A
  • 120-160 bpm
    • > 180 severe
    • < 100 severe
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22
Q

fundal height at 12 weeks? at 20 weeks?

A
  • 12 weeks: pubic symphysis
  • 20 weeks: umbilicus
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23
Q

what are Leopold maneuvers

A
  • common way to determine the position of a fetus inside the woman’s uterus
  • done during 3rd trimester
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24
Q

what is effacement and dilation of cervix

A
  • effacement: thinning or shortening of the cervix
    • nml length > 2.5 cm
  • dilation: opening of cervical os
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25
Q

what is the station part of the physical exam in 3rd trimester

A
  • degree of descent of the presenting part (part of baby coming 1st through the birth canal) in the birth canal in relationship to the pelvic inlet
26
Q

what are routine screening labs during every prenatal visit

A
  • urine for protein +/- sugar
27
Q

when is gestational diabetes screened for? how?

A
  • 24-28 weeks
  1. 50 g 1 hour oral glucose challange test
  2. if value >130-140, then f/u with 100 g 3 hours oral glucose tolerance test for diagnosis
28
Q

when is Rh antibody screen done

A
  • 1st visit
    • if women is Rh negative, test repeated in 3rd trimester
      • if negative screen, Rh immune globulin given
29
Q

when is group B testing done during prenatal care? why?

A
  • 35-37 weeks gestation
  • swab lower vagina and rectum
  • if +, need intrapartum abx prophylaxis to reduce incidence of neonatal GBS-> meningitis
30
Q

what does the down syndrome screening done?

A
  • all women offered screening < 20 weeks gestation
31
Q

what is the maternal serum screen (quad screen) for down syndrome screening? what is it screening for

A
  • AFP, uE3, hCG, and inhibin A are measured in maternal serum
  • neural tube defects, down syndrome, trisomy 18
32
Q

what is the first trimester combined test for down syndrome screening

A
  • sonographic determination of nuchal translucency with serum markers (PAPP-A & beta-hCG)
33
Q

accuracy of obstetric US during first trimester in determining due date

A
  • +/- 5-7 days
34
Q

accuracy of obstetric US during 2nd trimester (18-20 weeks) in determining due date

A
  • +/- 10-14 days
35
Q

what is the Nitrazine test

A
  • vaginal pH 6.5-8.0 (paper turns blue)
    • normal pH: 5-6
  • indicated ruptured amniotic sac
36
Q

What is the Fern test

A
  • air dried sample on a slide of fluid examined under microscopae for characteristic “fern” pattern
  • indicates ruptured amniotic sac
37
Q

What is the first stage of labor and what are its two parts

A
  • interval between onset of labor and full cervical dilation and effacement
  • latent and active phase
38
Q

what is the latent phase of the first stage of labor ? rate of dilation?

A
  • begins with first regular contractions and ends at 3-4 cm dilation
  • rate of dilation is slow <0.5 cm/hr
39
Q

what is the active phase of the first stage of labor ? rate of dilation?

A
  • rate of dilation 1 cm/hr
  • follows latent phase - ends with complete dilation
40
Q

what is the second stage of labor

A
  • begins with complete dilation and ends with delivery of infant
  • “pushing” phase
41
Q

what is the third stage of labor

A
  • begins with delivery of infant and ends with delivery of placenta
42
Q

what are the 3 P’s of the progress of labor

A
  • power
  • passenger
  • passage
43
Q

What is the “Power” of progress of labor

A
  • uterine contractions
    • due to inc in prostaglandin E2 and F2a
      • leads to increased sensitivity of uterine muscle fibers to circulating oxytocin
44
Q

define adequate labor

A
  • 3-5 contractions in 10 min
45
Q

function of internal tocodynamometry

A
  • measures frequency, duration, and intensity of labor via a IUPC: intrauterine pressure catheter
46
Q

List the various presentations that the baby can

A
  • vertex: head first
  • face, brow
  • breech: frank, complete, footling
  • transverse lie: head on one side, butt on other
  • compound: 2 fetal parts
47
Q

borders of pelvic inlet

A
  • symphysis (top)
  • sacral promontory (posterior)
  • pectinate lines (lateral)
48
Q

borders of midpelvis

A
  • midpoint of symphysis: top
  • midpoint of sacral curve: posterior
  • ischial spines: lateral
49
Q

borders of outlet pelvis

A
  • inferior border of symphysis (anterior)
  • tip of sacrum (posterior)
  • ischial tuberosities (lateral)
50
Q

most common structure of pelvis that is also the best suited for childbirth

A
  • Gynecoid
51
Q

what structure of pelvis is most unfavorable for delivery

A
  • android
52
Q

List the cardinal movements of labor: changes of position of fetus as it passes through birth canal

A
  1. engagement
  2. flexion
  3. descent
  4. internal rotation
  5. extension
  6. external rotation
53
Q

when is it normal for placental seperation

A
  • < 30 minutes
54
Q

what are signs of seperation of placenta that occurs during third stage of labor

A
  • uterus rises in abdomen
  • globular configuration
  • gush of blood and/or “lenthening” of umbilical cord
55
Q

what periodic changes for acceleration in fetal monitoring are considered normal

A
  • increases 15 bpm above baseline and lasts 15 seconds
56
Q

what periodic changes for deceleration in fetal monitoring are considered normal

A
  • early
    • ​mirrors shape of contraction
    • due to head compression
57
Q

what periodic changes for deceleration in fetal monitoring are considered abnormal

A
  • variable: with respect to timing of contraction. due to cord compression
  • Late: caused by fetal hypoxia: worst case
58
Q

what is the Bishop score used for

A
  • assesses likelihood of successful induction of labor by artifical means
    • 9-13 points: highest likelihood of success
    • 0-4 points: highest likelihood of failed
59
Q

complications of giving oxytocin to induce labor

A
  • uterine hyperstimulation (> 5 conctraction q 10 min)
  • water intoxication
60
Q

define Puerperium

A
  • period following delivery of baby and palcenta to about 6 weeks postpartum
61
Q

what type of milk is produced after 1st day of birth? when is mature milk formed

A
  • colostrum
  • mature milk after 3rd-5th day

women's health exam 2 (3 decks)

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