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EOR - OB/GYN > Prenatal care + Normal Pregnancy > Flashcards

Prenatal care + Normal Pregnancy Flashcards

1
Q

APGAR score

A

Activity (2=active movement)

Pulse (2= >100 BPM)

Grimace (2= pulls away, sneeze)

Appearance (2=pink)

Respiration (2=crying)

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2
Q

What is a good APGAR score vs a score that indicates resucitation?

A
  • Score > 6 is good
  • Score of 4 necessitates resuscitation
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3
Q

What is fetal attitude?

A

Fetal attitude: relationship of fetal parts to one another

  • Full flexion (chin on chest; rounded back with flexed arms, legs); smallest diameter of head (suboccipitobregmatic diameter) presents at pelvic inlet
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4
Q

What is fetal lie?

A

Fetal lie: relationship of fetal cephalocaudal axis (spinal column) to maternal cephalocaudal axis

  • Longitudinal (ideal): fetal spine lies along maternal
  • Transverse: fetal spine perpendicular to maternal
  • Oblique: fetus at slight angle
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5
Q

What is fetal presentation?

A

Fetal presentation: fetal/presenting part enters pelvic inlet first

Cephalic is ideal → Head first down pelvis

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6
Q

What are the various types of breech position?

A

Breech: head up; bottom, feet, knees present first

  • Frank breech: hips flexed; knees extended; bottom presents
  • Complete breech: hips, knees flexed; bottom presents
  • Incomplete breech: one/both hips not completely flexed; feet present
  • Shoulder: transverse lie; shoulders present first
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7
Q

Tx of breech baby?

A

TX: External cephalic version at or near term, followed by a trial of a vaginal delivery if the version is successful and planned cesarean delivery if breech presentation persists

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8
Q

a 24-year-old G2P1 comes for her 13-week office visit she has a fundal height and an alpha-fetoprotein which are greater than expected for her due date.

A

Multiple gestations, twins!

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9
Q

3 types of twins

A
  • Monozygotic (Identical) – multiple (typically two) fetuses produced by the splitting of a single zygote
  • Dizygotic (Fraternal) – multiple (typically two) fetuses produced by two zygotes
  • Polyzygotic – multiple fetuses produced by two or more zygotes
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10
Q

How are twins diagnosed?

A

Often diagnosed at first screening ultrasound other clues include

  • Fundal height is usually greater than dates
  • Extra fetal heart tones
  • Elevated maternal alpha-fetoprotein (AFP)
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11
Q

What are cervical changes seen prior to delivery

A
  • Remodeling of cervix by enzymatic collagen dissolution, ↑ water content →softening, ↑ distensibility
  • Cervical softening → expulsion of mucus plug → “bloody show” (pink-tinged mucus)
  • Spontaneous rupture of amniotic membranes (ROM)
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12
Q

What is false labor?

A
  • AKA Braxton-Hicks contractions
  • True labor: regular, increase in frequency, duration, intensity; produce cervical changes (e.g. dilation/opening, effacement/getting thinner); pain begins in lower back, radiates to abdomen, not relieved by ambulation
  • False labor: irregular, intermittent contractions; no cervical changes; pain in abdomen; walking may decrease pain
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13
Q

What is the first stage of labor?

A

FIRST STAGE OF LABOR ⇒ onset of labor to fully dilated (10 cm)

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14
Q

What happens in early latent stage of labor?

A
  • 8–12 hours
  • Mild contractions every 5–30 minutes
  • Duration 30 seconds each
  • Gradually increase in frequency, intensity, duration
  • Cervical dilation 0–3 cm
  • Effacement 0–30%
  • Spontaneous ROM
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15
Q

What happens in active phase of labor?

A
  • 3–5 hours
  • Contractions every 3–5 minutes
  • Duration ≥ 1 minute
  • Cervical dilation 3–7 cm
  • Effacement 80%
  • Progressive fetal descent
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16
Q

What happens in transition phase of labor?

A
  • 30 minutes–2 hours
  • Intense contractions every 1.5–2 minutes
  • Duration 60–90 seconds
  • Cervical dilation 7–10cm
  • Effacement 100%
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17
Q

The second stage of labor is considered when:

A

SECOND STAGE ⇒ fully dilated to the birth of the infant

  • AKA pushing stage
  • Begins with full dilation
  • Navigation through maternal pelvis dictated by 3 Ps:

Power, passenger, passage

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18
Q

What happens in the “power stage” of the 2nd stage of labor?

A
  • Frequency, duration, intensity of uterine contractions
  • Physiology of contractions
    • Stimulation of uterine myometrium
    • Alpha-receptors stimulate uterine contractions
    • Numerous oxytocin receptors, mostly on uterine fundus
  • Contraction steps
    • Wave begins in fundus, proceeds downward to rest of uterus → muscle shortens in response to stimulus →increment (build up) → acme (peak) → decrement (gradual letting up) →relaxation → fetal descent, cervical effacement, dilation → amount of pressure exerted by uterine contractions (intrauterine pressure) measured in millimeters of mercury (mm Hg)
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19
Q

What happens in the “passenger stage” of the 2nd stage of labor?

A

Describes the fetal size, attitude, lie, presentation

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20
Q

What happens in the “passage stage” of the 2nd stage of labor?

A

Route through bony pelvis

  • Size, type of pelvis
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21
Q

What are the size/types of pelvis’s?

A
  • Gynecoid: rounded pelvic inlet, midpelvis, outlet capacity adequate; optimal for vaginal delivery
  • Android: heart-shaped pelvic inlet; ↓midpelvis diameters, outlet capacity; associated with labor dystocia
  • Anthropoid: oval-shaped pelvic inlet; midpelvis diameters, outlet capacity adequate; favorable for vaginal delivery
  • Platypelloid: oval-shaped pelvic inlet, ↓ midpelvis diameters, outlet capacity adequate; not favorable for vaginal delivery
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22
Q

What are the cardinal movements of labor? (mechanisms of labor)

A
  • Descent:: presenting part reaches pelvic inlet (engagement ) before onset of labor → degree of descent (fetal station), relationship of presenting part to maternal ischial spines → fetus moves from pelvic inlet (-5 station) down to ischial spines (0 station) to pelvic outlet (+4 station) to crowning at vaginal opening (+5 station)
  • Flexion: fetal chin presses against chest, head meets resistance from pelvic floor
  • Internal rotation: fetal shoulders internally rotate 45º; widest part of shoulders in line with widest part of pelvic inlet
  • Extension: fetal head passes under symphysis pubis (+4 station), moves (+5 station), emerges from vagina
  • Restitution (external rotation): head externally rotates as shoulders pass through pelvic outlet, under symphysis pubis, turns to align with back
  • Expulsion: anterior shoulder slips under symphysis pubis, followed by posterior shoulder, rest of the body; marks end of second stage
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23
Q

What is the 3rd stage of labor?

A

Delivery of infant to delivery of placenta

Delivery of placenta, umbilical cord, fetal membranes; uterus contracts firmly, placenta begins to separate from uterine wall

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24
Q

What happens in the 4th stage of labor?

A
  • Physiological adaptation to blood loss, initiation of uterine involution
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25
Q

What monitoring is done during labor?

A
  • Heart rate and the pattern is an indicator of infant well-being
  • Normal heart rate in newborn 120-160 beats per minute
  • Consistent decelerations after a contraction can indicate fetal distress
  • External fetal monitor – on the maternal abdomen
  • Internal fetal monitor – electrode attached to the infants head
26
Q

What are fetal HR accelerations?

A
  • Accelerations: Increase of baseline 15 bpm for 15 seconds ⇒ Response to fetal movement ⇒ Reassuring
27
Q

What are fetal HR early decelerations?

A
  • Early decelerations: Mirror images of contractions ⇒ Fetal head compression ⇒ benign
28
Q

What are fetal HR variable decelerations?

A
  • Variable Decelerations: Rapid FHR drop with a return to baseline with variable shape ⇒ Cord compression ⇒ Benign if mild or moderate ⇒ worrisome if severe
29
Q

What are fetal HR late decelerations?

A
  • Late Decelerations:FHR drop at the end of the contraction ⇒ Uteroplacental insufficiency ⇒Always worrisome
30
Q

What happens to the uterus during pregnancy?

A
  • ↑ size, capacity due to hypertrophy, hyperplasia, mechanical stretching
  • 20 times larger
  • ↑ strength, distensibility, contractile proteins, number of mitochondria
  • ↑ volume capacity (10 mL–5 L)
  • Softening of uterine isthmus (Hegar’s sign)
31
Q

What happens to the cervix during pregnancy?

A
  • Formation of mucus plug; seals endocervical canal
  • ↑ vascularity → purplish-blue color
  • Mild softening due to edema, hyperplasia (Goodell’s sign); ↑ softening in third trimester
32
Q

What is the function of the placenta?

A
  • Develops where embryo attaches to uterine wall
  • Expands to cover 50% internal uterine surface
  • Functions as maternal-fetal organ for metabolic, nutrient exchange
  • Secretes estrogen, progesterone, relaxin, hCG
33
Q

What happens to the vagina during pregnancy?

A
  • ↑ vascularity → bluish-purple color
  • Loosening of connective tissue → ↑ distensibility
  • Leukorrhea
    • pH of 3.5–6.0 → protects against bacterial infections
34
Q

What happens to the heart in pregnancy?

A
  • Mild hypertrophy
  • S2, S3 more easily auscultated, split exaggerated
  • Heart displaced upward, forward, slightly to left
  • ↑ heart rate by 15–20 beats/minute
  • Stroke volume ↑ 30%, cardiac output (CO) ↑ 30-50% (by term); ↓ blood pressure (BP) despite ↑ CO due to progesterone-induced vasodilation; BP = CO × systemic vascular resistance (SVR)
  • Supine hypotensive syndrome caused by gravid uterus pressing on inferior vena cava (left lateral recumbent position optimal for CO, uterine perfusion)
  • Gravid uterus elevates pressure veins draining legs, pelvic organs → slowed venous return, dependent edema, varicose veins, hemorrhoid
35
Q

What happens to blood in pregnancy?

A
  • ↑ blood volume (approx. 1500 mL)
    • Related to sodium, water retention due to changes in osmoregulation, secretion of vasopressin by anterior pituitary, renin-angiotensin-aldosterone system (RAAS)
  • ↑ total red blood cell (RBC) volume (approx. 30%), with iron supplementation
    • ↑ volume, oxygen-carrying capacity needed for ↑ basal metabolic rate (BMR), needs of uterine-placental unit (offsets blood loss at delivery)
    • Plasma > RBC volume → hemodilution, ↓ hematocrit (physiologic anemia)
  • ↑ white blood cell (WBC) count (approx. 5,000–12,000/mm3)
  • ↑ clotting factors (fibrin, fibrinogen): hypercoagulable state of pregnancy
36
Q

What happens to respiratory system in pregnancy?

A
  • ↑ oxygen consumption, subcostal angle, anteroposterior diameter, tidal volume (30–50%), minute ventilatory volume, minute oxygen uptake
  • Gravid uterus places upward pressure on diaphragm → elevates approx. 4 cm
  • Hyperventilation → mild respiratory alkalosis (renal compensation → maternal blood pH 7.40–7.45)
  • Nasal congestion, epistaxis due to estrogen-induced edema
37
Q

What happens to GI system during pregnancy?

A
  • Gums bleed easily due to estrogen-induced hyperemia, friability
  • Progesterone-induced smooth muscle relaxation, delayed gastric emptying, ↓ peristalsis → nausea, vomiting (AKA “morning sickness” ); constipation; heartburn (pyrosis), esophageal reflux; intrahepatic cholestasis of pregnancy due to ↓ gallbladder emptying time → ↑ risk of cholelithiasis
  • ↑ saliva production (ptyalism)
38
Q

What happens to the kidneys during pregnancy?

A
  • ↑ glomerular filtration rate (GFR)
    • 40–50% by second trimester; ↑ urinary output (25%)
  • ↑ size of kidneys (1–1.5 cm)
  • Dilation of urinary collecting system →physiologic hydronephrosis
  • Urinalysis
    • Glycosuria (due to ↑ glucose load), ↑ protein excretion (due to altered proximal tubule function + ↑ GFR)
39
Q

What are the recommended nutritional needs of pregnancy?

A
  • Recommendation of additional 300 kcal/day, weight gain of 25–35 pounds (11.5–16 kg)
    • 11 lb. (5 kg): placenta, amniotic fluid, fetus
    • 2 lb. (0.9 kg): uterus
    • 4 lb. (1.8 kg): ↑ blood volume
    • 3 lb. (1.4 kg): breast tissue
    • 5–10 lb. (2.3–4.5 kg): maternal reserves
  • 600 mcg folic acid/day → RBC synthesis, placental/fetal growth, ↓ risk of neural tube defects
  • 1,000–1,300 mg calcium/day supports pregnancy, lactation
  • 60g protein daily supports tissue growth
  • 27 mg iron/day supports ↑ RBCs
40
Q

What is the appointment intervals for pregnant patients?

A
  • Monthly visits to a healthcare professional for weeks 4–28 of pregnancy
  • Visits twice monthly from 28 to 36 weeks
  • Weekly after week 36 (delivery at week 38–40)
41
Q

What are the vitamin recommendations for pregnant patients?

A
  • All pregnant women should receive a prenatal vitamin.
  • Folic acid supplementation (0.4–0.8 mg) prior to conception; 4 mg for secondary prevention
  • Calcium: 1,000–1,300 mg/day; supplement may be beneficial for women with high risk for gestational hypertension or communities with low dietary calcium intake.
  • Iron: Screen for anemia (Hgb/Hct) and treat if necessary. Recommend 30 mg/day of iron in pregnant women.
  • Vitamin A: Pregnant women in industrialized countries should limit to <5,000 IU/day.
  • Vitamin D: Consider supplementation in women with limited exposure to sunlight.
42
Q

What is the ACOG definition of hypertension

A

ACOG defines hypertension as BP >140 mm Hg systolic or >90 mm Hg diastolic

43
Q

When is fetal HR audible?

A
  • Fetal heart rate: usually audible by 12 weeks’ GA with a Doppler instrument
44
Q

When is fetal position palpable?

A
  • Fetal position by abdominal palpation at 36 weeks
45
Q

How do you calculate Nageles rule?

A
  • What was the first day of bleeding? = 1’st day of the last menstrual period
    • 1’st day of last menstrual period + 7 days – 3 months + 1 year
46
Q

When should the first initial OB appt be?

A

6 weeks after LMP

47
Q

What is the triple screen and quad screening that can be performed?

A
  • Triple screen: AFP, HCG, Estriol
  • Quad Screen: AFP, HCG, Estriol, Inhibin A
48
Q

When would you perform an amnio?

A
  • Amniocentesis: between 15-18 weeks (beginning of the second trimester) – especially for women over age 35 in the high-risk group
49
Q

When is the 2-hour oral glucose test performed?

A

75 g 2-hour oral glucose tolerance test at 26-28 weeks

50
Q

When is Group B strep test be performed?

A
  • Group B strep test between 35-37
51
Q

What would you estimate gestational age if baby is at pubic symphysis?

A

12 weeks

52
Q

What would you estimate gestational age if baby is Midway from symphysis to umbilicus?

A

16 weeks

53
Q

What would you estimate gestational age if baby is at umbilicus

A

20 weeks

54
Q

What would you estimate gestational age if baby is above pubic symphysis?

A

20-36 weeks

Height (in cm) above pubic symphysis correlates with weeks of gestation

55
Q

What happens in the first trimester screening at 11-14 weeks?

A
  • Ultrasound for nuchal translucency
  • PAPP-A and hCG
    • ↑ levels are seen in chromosomal abnormalities
    • Low levels of PAPP-A can be associated with Down’s Syndrome
56
Q

Cell free fetal DNA occurs at 10 weeks and includes what?

A
  • Analyze fetal DNA in maternal blood
  • Screens for trisomies of 13, 18, and 21
  • Positive test results should be followed by CVS or amniocentesis
57
Q

Quadruple screen occurs at 16-18 weeks and includes

A
  • AFP, hCG, estriol, inhibin
    • ↑ AFP = neural tube or abdominal wall defects
    • ↑ hCG and inhibin and ↓ AFP and estriol = Down syndrome
      • ↓ AFP, hCG, and estriol = Edwards syndrome
58
Q

Second trimester appts are every 4 weeks and include what screenings?

A
  • 15-18 weeks
    • offer triple marker screen (hCG, estriol, AFP)
      • used to detect neural tube defects or trisomies
  • 16-20 weeks
    • amniocentesis if > 35 years old or history indicates
  • 17 weeks
    • document movement
  • 24 weeks
    • glucose screening
  • 25 -28 weeks
  • repeat Hct
59
Q

When would a pregnant patient start coming in every 2 weeks?

A

week 28, then every two weeks, then every week after 36

60
Q

When would RhoGAM be given if indicated?

A

28-30 weeks

61
Q

Mothers with pre-gestational diabetes should undergo twice weekly non stress testing until delivery

A

Weeks 28-32

62
Q

When would cervical chlamydia and gonorrhea cultures if indicated

A

36-40 weeks

EOR - OB/GYN (6 decks)

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