Uncomplicated Pregnancy - PANCE Pearls Flashcards
How early can serum B-hCG detect pregnancy?
early as 5 days after conception
How early can urine B-hCG detect pregnancy?
14 days after conception
Sign of uterus softening after 6 weeks
Ladin’s sign
sign of uterin isthmus softening after 6-8 weeks of gestation
Hegar’s sign
palpable lateral bulge or softening of uterine cronus 7-8 weeks gestation
Piskacek’s sign
cervical softening due to increased vascularization around 4-5 weeks gestation
Goodell’s sign
bluish coloration of the cervix and vulva around 8-12 weeks
Chadwick’s sign
When do you normally hear fetal heart tones and what is the normal ranges?
10-12 weeks
120-160 bpm
When can you detect fetus on pelvic ultrasound?
5-6 weeks
When is quickening (fetal movement) first experienced?
16-20 weeks
Gravida is ….
of times pregnant (regardless if carried to term)
Para is …
of births (>20 weeks) - includes viable and nonviable births
If a patient had one set of twins, what would be the para value?
1
3 pregnancies and 3 births
G3P3
4 pregnancies, 3 births, 1 miscarriage
G4P3A1
Gestational age if you feel the fundal height above the public symphysis
12 weeks
Gestational age if you feel the fundal height midway between the pubis and umbilicus
16 weeks
Gestational age if you feel the fundal height at the umbilicus
20 weeks
Gestational age if you feel the fundal height 2-3 cm below the xiphoid process
38 weeks
What is Naegele’s Rule?
estimated date of delivery
1st day of LMP + 7 days - 3 months
What is EDD for a LMP on 8/7/2016?
5/14/17
What routine tests are ordered at the first prenatal visit?
BP, blood type & Rh CBC UA random glucose HBsAg HIV & syphilis rubella titer screen for sickle cell and CF pap smear
Three markers that can be tested in Down syndrome screening
free B-hCG, PAPP-A, Nuchal translucency
What free B-hCG level may indicate abnormalities?
abnormally high or low
Low PAPP-A (serum pregnancy associated plasma protein A) could indicate
fetal Down syndrome
Nuchal translucency checked by ultrasound at 10-13 weeks, what would indicate abnormality?
increased thickness
If uterine size and gestation is abnormal, what two tests could you perform on your patient around 10-13 weeks?
chorionic villus sampling (CVS) or amniocentesis
When can you find fetal heartbeat on ultrasound?
5-6 weeks
What instances would you offer a woman chorionic villus sampling at 10-13 weeks?
prior child with chromosomal abnormalities
maternal age > 35
abnormal 1st or 2nd trimester maternal screening test
abnormal ultrasound
prior pregnancy losses
What is the advantage of chorionic villus sampling?
allows option of early termination of pregnancy if find abnormalities
What is the disadvantage of chorionic villus sampling?
performing it increases the risk of spontaneous abortion
What weeks are first trimester?
weeks 1 - 12
What weeks are second trimester?
weeks 13-27
What weeks are third trimester?
week 28 - birth
What is triple screening measured at 15-20 weeks?
a-fetoprotein, B-hCG, estradiol
Diagnosis?
Low a-FP, High B-hCG, Low estradiol
Down syndrome
Diagnosis?
High a-FP, No B-hCG, No estradiol
Open neural tube defects (ex. spina bifida)
or multiple gestation
Diagnosis?
Low a-FP, Low B-hCG, Low estradiol
trisomy 18
High levels of Inhibin A indicate?
chromosomal abnormalities
Test to check amniotic fluid levels, fetal viability, and growth for gestational age
ultrasound
If you are going to perform amniocentesis, when is the best time?
15-18 weeks gestation
When do you screen for gestational diabetes?
24-28 weeks
When should unsensitized Rh negative mohters receive RhoGAM?
at 28 weeks and within 72 hours after childbirth
What screening/tests do you perform in the third trimester?
gestational diabetes repeat antibody titers group B streptococcus screening Hemoglobin and Hematocrit Biophysical profile Non Stress Testing
What 5 variables are looked at in biophysical profile?
How many points is each and what is the max score?
fetal breathing, fetal tones, amniotic fluid levels, NST and gross fetal movements
2 points each = 10 points total
What is baseline fetal heart rate in non stress testing?
120-160 bpm
In Reactive Non Stress Test, what would indicate fetal well being?
> 2 accelerations are seen in 20 minutes
increase in fetal HR > 15 bpm from baseline lasting > 15 seconds
In Nonreactive Non Stress Test, what would indicate the fetus is sleeping, immature, or compromised?
no fetal heart rate accelerations
increase in fetal HR < 15 bpm lasting < 15 seconds
Way to measure fetal response to stress at times of uterus contraction
contraction stress test
No late decelerations in the presence of 3 contractions in 10 minutes would indicate
negative contraction stress test - fetal well being
Repetitive late decelerations in the presence of 3 contractions in 10
positive contraction stress test - worrisome (esp if nonreactive NST)
What defines infertility?
failure to conceive after 1 year
what percentages of instances are males the cause of infertility?
40%
What is the test to diagnose infertility?
hysterosalpingography
What does hysterosalpingography evaluate?
tubal patency or abnormalities
Medical management that can induce ovulation
clomiphene
Three management options for infertility
clomiphene
intrauterine insemination
IVF
