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EOR OB/GYN > Prenatal / Normal Pregnancy > Flashcards

Prenatal / Normal Pregnancy Flashcards

1
Q

When is APGAR measured

A

1 and 5 minutes

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2
Q

purpose of APGAR score

A

identify infants who require immediate medical attention

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3
Q

APGAR acronym

A

Appearance
Pulse
Grimace -response to irritable stimuli, reflex irritability
Activity - extremity movement, muscle tone
Respiration

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4
Q

Q 31 Apgar scoring system

A

memorize :)

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5
Q

what apgar score indicates excellent condition

A

7-10

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6
Q

what apgar score indicates moderately depressed

A

4-6

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7
Q

what apgar score indicates severely depression

A

0-3

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8
Q

What are the risk factors for low Apgar scores?

A

Premature birth, cesarean delivery, and perinatal complications

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9
Q

Dizygotic twins

A

refers to fertilization of two separate ova during a single ovulatory period

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10
Q

monozygotic twins

A

refers to a single fertilized ovum that separates into two fetuses

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11
Q

RF for dizygotic twins

A

fertility-enhancing treatments, increasing maternal age, increasing parity, family history of dizygotic twinning, and increased maternal weight and height are associated with an increased prevalence of dizygotic twins

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12
Q

RF for monozygotic twins

A

UNKNOWN :)

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13
Q

Chorionicity

A

Refers to the number of chorionic (outer) membranes surrounding the fetuses

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14
Q

amnionicity

A

refers to the number of amnions (inner) membranes that surround the fetuses

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15
Q

Complications associated with multiple gestation

A

increased risk of preterm birth, intrauterine growth restriction, discordant growth, and increased risk of congenital anomalies

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16
Q

MC complication of multiple gestations

A

premature birth

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17
Q

Discordant growth

A

significant difference in birth weight between the heaviest and lightest infant of a multiple birth pregnancy and is associated with an increased risk of neonatal mortality, particularly when discordance is > 30%

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18
Q

in what type of twins are congenital malformations MC

A

monozygotic twins

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19
Q

what type of multiple gestation pregnancies are at increased risk of discordant growth and twin-twin transfusion syndrome

A

Monochorionic twin pregnancies and dichorionic triplet pregnancies

because the fetuses share a common placenta

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20
Q

Twin-twin transfusion syndrome

A

occurs when vascular arteriovenous anastomoses form, leading to unbalanced blood flow between the donor twin and the recipient twin

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21
Q

Recipient twin in twin-twin transfusion syndrome

A

The recipient twin will have polyhydramnios and an enlarged umbilical cord, abdominal circumference, kidneys, and bladder. The recipient twin will also be at risk for thrombosis or hyperbilirubinemia secondary to polycythemia, cardiomegaly, tricuspid regurgitation, and hydrops fetalis

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22
Q

Donor twin in twin-twin transfusion syndrome

A

The donor twin will have oligohydramnios and is at risk for severe intrauterine growth restriction, anemia, hypovolemia, kidney insufficiency, and pulmonary hypoplasia

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23
Q

True or false: the volume of milk production by mothers of twins is consistently twice that of mothers of singletons

A

True

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24
Q

Twins: If the egg splits 0–3 days after fertilization

A

it will result in dichorionic, diamniotic twins

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25
Q

Twins: Splitting at 4–8 days after fertilization

A

monochorionic, diamniotic twins

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26
Q

MC type of monozygotic twins

A

monochorionic-diamniotic twins

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27
Q

Twins: Splitting at 8–12 days after fertilization

A

Rare

monochorionic, monoamniotic twins

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28
Q

T sign US twins

A

represents the amnion coming off the placenta at a 90° angle between the two distinct amniotic sacs, which is indicative of a monochorionic, diamniotic gestation

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29
Q

Lambda/Twin peak sign twins US

A

represents dichorionic, diamniotic gestation

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30
Q

ACOG recommendations for delivery of uncomplicated dichorionic, diamniotic twins

A

38 weeks

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31
Q

ACOG recommendations for delivery of uncomplicated monochorionic, diamniotic twins

A

between 34 and 37 weeks

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32
Q

ACOG recommendations for delivery of uncomplicated monochorionic, monoamniotic twins

A

between 32-34 weeks

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33
Q

when are corticosteroids administered for lung development

A

administered to all women who may deliver prior to 34 weeks

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34
Q

What type of twins occurs with division of a fertilized egg 13 days or later after fertilization?

A

conjoined twins

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35
Q

what is part of the exam in the first stage of labor

A

evaluation for membrane rupture; presence of uterine bleeding; cervical dilation and effacement; fetal lie, presentation, and position; fetal size and pelvic capacity; fetal and maternal well being; fetal station

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36
Q

what is fetal station

A

measured by the location of the leading bony edge of the presenting part relative to the maternal ischial spines

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37
Q

is fetal station measured in cm, inches, mm, what???

A

CM

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38
Q

negative numbers for fetal station

A

a position above the ischial spines

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39
Q

positive numbers fetal station

A

position below the ischial spines

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40
Q

what is the highest fetal station score

A

-5

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41
Q

what is the lowest fetal station score and what does it represent

A

+5 station

when the baby’s head is in the vaginal opening just before birth

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42
Q

when can Neuraxial techniques for treatment of pain be initiated during labor

A

can be initiated at any stage of labor to provide pain relief

43
Q

relative contraindications to neuraxial techniques

A

coagulopathy, infection at the site of neuraxial analgesia puncture, and increased intracranial pressure

44
Q

what does Neuraxial analgesia usually consist of

A

dilute local anesthetic, such as bupivacaine or ropivacaine, and an opioid, such as fentanyl or sufentanil

45
Q

common ADE neuraxial analgesia

A

pruritus

46
Q

Postdural puncture headaches

A

occur 6–72 hours after dural puncture and present with headaches that are worse with sitting or standing

47
Q

tx postdural puncture headaches

A

epidural blood patch

48
Q

At which vertebral level is an epidural most commonly placed in obstetrics patients?

A

L3-L4

49
Q

MC indications for C section

A

failure to progress during labor, nonreassuring fetal status, and fetal malpresentation

50
Q

Two common transverse incisions for C section

A

Pfannenstiel incision and the Joel-Cohen incision

51
Q

Pfannenstiel incision

A

performed 2–3 cm above the symphysis pubis in a curved shape

52
Q

what is the preferred incision for C section

A

Pfannenstiel incision

53
Q

why are transverse incisions preferred in c section

A

reduced blood loss, shorter operating duration, shorter hospital stay, and lower rates of fever, postoperative pain, and use of analgesia

54
Q

MC used technique to enter the uterus in a C section

A

low transverse uterine incision (Munro Kerr)

55
Q

Women who desire to trial vaginal birth after cesarean section should receive

A

two-layer closure of the uterus

single-layer closure is effective with all other patients

56
Q

Women who trial labor after cesarean section have an increased risk of

A

uterine rupture and abnormal placentation, such as placenta previa or accreta

57
Q

how many stages is labor divided into

A

3

58
Q

first stage of labor

A

characterized by the onset of uterine contraction (every 3–5 minutes for more than 1 hour) until complete cervical dilation at 10 cm

consists of the latent and active phases

59
Q

latent phase of first stage of labor

A

characterized by gradual cervical dilation until approximately 5 cm

60
Q

active phase of first stage of labor

A

occurs when the cervix is dilated to 5–6 cm and is characterized by rapid cervical dilation (1.2 cm/hour for nulliparous women and 1.5 cm/hour for multiparous women)

61
Q

second stage of labor

A

occurs from cervical dilation until delivery of the fetus

62
Q

third stage of labor

A

occurs after the delivery of the fetus and ends with the delivery of the placenta

63
Q

prolonged labor

A

An abnormally long latent phase or second stage of labor

64
Q

protraction

A

abnormally long active phase

65
Q

labor arrest

A

complete cessation of progress in labor

66
Q

RF for labor arrest

A

hypocontractile uterine activity (< 3–4 contractions/10 minutes, contraction duration < 50 seconds, or contractions < 200 Montevideo units) and cephalopelvic disproportion caused by fetal malposition or malpresentation

67
Q

in what type of pelvis is transverse arrest most likely to occur

A

android pelvis or platypelloid pelvis

68
Q

android pelvis

A

narrow forepelvis, convergent side walls of the pelvic midcavity, forward inclination of the sacrum, and a narrow subpubic arch of the pelvic outlet

69
Q

anthropoid pelvis

A

characterized by a narrow transverse diameter, wide anteroposterior diameter, divergent forepelvis, narrow side walls of the pelvic midcavity, and wide inclination of the sacrum

70
Q

gynecoid pelvis

A

characterized by a wide forepelvis, straight side walls of the pelvic midcavity, and a wide subpubic arch of the pelvic outlet

71
Q

what types of pelvis are least likely to be associated with labor arrest

A

Anthropoid and gynecoid pelvis

72
Q

MC type of pelvis in females and considered normal

A

gynecoid

73
Q

platypelloid pelvis

A

characterized by a narrow anteroposterior diameter, straight forepelvis, wide side walls of the pelvic midcavity, narrow inclination of the sacrum, and a wide subpubic arch of the pelvic outlet

74
Q

key facts about induction of labor

A

Induction of labor is thought to slow down the latent part of the first stage of labor but has no impact on the duration of the active part of the first stage of labor or the second stage

75
Q

indications for induction of labor

A

prelabor rupture of membranes, post-term pregnancy, hypertensive disorders of pregnancy when delivery is appropriate, fetal demise, oligohydramnios, chorioamnionitis, and fetal growth restriction

76
Q

C/I for induction of labor

A

prior uterine rupture, active genital herpes, placenta previa, vasa previa, umbilical cord prolapse, transverse fetal lie, and category III fetal tracings

77
Q

when can induction of labor be done electively

A

39 weeks if dated well and without contraindications to labor

78
Q

what med is used MC for induction of labor

A

oxytocin

79
Q

what is frequently assessed prior to induction of labor

A

cervix

bc it can help predict the duration of an induced labor and the chance of vaginal delivery

80
Q

what measurements help to form the bishop score

A

Assessment of the cervix includes considering cervical dilation, fetal station, cervical effacement, cervical softness, and cervical position

81
Q

what is a bishop score

A

provides a quantitative measurement of how favorable a cervix is for induction

82
Q

what bishop score is considered favorable

A

≥ 6

83
Q

what bishop score is considered unfavorable

A

3 or less

84
Q

what do you do In cases where induction is desired but the cervix is unfavorable

A

prostaglandins or a transcervical balloon catheter can be used to increase cervical favorability (ripening)

85
Q

MC ADE of oxytocin

A

Tachysystole - an average of more than five contractions per 10 minutes for ≥ 30 minutes

86
Q

tx tachysystole

A

reduction or discontinuation in the dose of oxytocin

87
Q

The cardinal movements of labor

A

describe the position of the fetus as it enters, occupies, and exits the birth canal

88
Q

how many fetal positions that make up the cardinal movements of labor

A

7

89
Q

what are the seven fetal positions that make up the cardinal movements of labor

A

engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion

in this order^^^

90
Q

fetal positions: engagement

A

This is when the largest part of the fetal head (called the biparietal diameter and measured ear to ear) is introduced into the birth canal at the level of the ischial spine

91
Q

fetal positions: descent

A

The fetal head progresses deeper into the birth canal. This is where a large majority of the molding of the fetal head takes place

92
Q

fetal positions: flexion

A

Once the head reaches the pelvic inlet, it flexes at the neck, pressing the fetal chin to the chest. This presents the smallest aspect of the fetal head at the birth canal

93
Q

fetal positions: internal rotation

A

Internal rotation then occurs to allow the fetal head to follow the path of least resistance in the birth canal. At the pelvic inlet (the pelvic floor), the birth canal is widest laterally. At the pelvic outlet, the birth canal is widest from the anterior to the posterior surfaces. Internal rotation allows the fetal head to deliver without causing maternal back pain

94
Q

fetal positions: extension

A

the fetal head passes through the pelvic arch and undergoes extension. The face and chin are born face-down as extension occurs

95
Q

fetal positions: external rotation

A

(also called restitution) occurs spontaneously once the fetal head is delivered. The infant’s head moves from a face-down position to facing one of the maternal thighs. This rotation helps the shoulder through the pelvic arch

96
Q

when is the MC time to identify shoulder dystocia

A

during external rotation

97
Q

fetal positions: expulsion

A

the final cardinal movement of labor, is often completed spontaneously or with one more gentle push. It is at this stage where the shoulders are delivered, first the anterior shoulder using downward traction and then the posterior shoulder using upward traction. Gentle pressure should be used to avoid a brachial plexus injury

98
Q

monitoring of mom and fetus during labor

A

fetal heart rate, uterine contractions, and the maternal cervix

99
Q

FHR monitoring during labor

A

performed every 30 minutes in the first stage of labor and every 15 minutes in the second stage of labor for mothers without risk factors

100
Q

how are contractions monitored during labor

A

external tocodynamometer

101
Q

when are vaginal exams performed during labor

A

Vaginal exams are kept to a minimum but are typically performed on admission, prior to administering analgesia when the mother feels the urge to start pushing, at 4-hour intervals in the first stage of labor, and at 2-hour intervals in the second stage of labor

102
Q

what is the technical fourth stage of labor

A

It consists of the uterus regaining its tone and starting to involute.

103
Q
A

EOR OB/GYN (18 decks)

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