Women's Health- OB Flashcards
What is the Birth Rate?
Live births in a given year for every 1000 PERSONS
What is the Fertility rate?
Number of live births per 1000 WOMEN ages 15-44 per year.
Define a Neonatal
Birth to 28 days of life
What is prenatal?
28 weeks of gestation to first 7 days of life
what is the corrected age?
Chronological age (Weeks) - # of weeks born prematurely
What is GPtpal
G- Gravid- pregnant
Parity: number of births
T-full term between 37-40 weeks
P premature- born alive/deceased 20-37 completed gestational weeks
A- Abortions- pregnancies ending before 20 weeks (induced or spontaneous)
L- Living Children
How many gestational periods are there and how long is each period?
There are 3 gestational periods each is 3 calendar months (1st 2nd 3rd trimesters)
1st trimester can be subdivided into 2 stages, what are they?
Embryonic – two to ten weeks of gestation
Fetal stage- the baby is in the fetal stage from week 10 until birth
What are some common findings in the first trimester?
Morning sickness, fatigue
What are some common findings in the second trimester?
Morning sickness will resolve
Fatigue from the 1st trimester subsides
Aches and pains from the uterine pressure start
Postural changes to accommodate change in weight distribution
Quickening
What is Quickening?
1st feeling of the baby moving, a butterfly feeling
Who is likely to feel quickening later, first time mothers or mothers who have had more children?
First time mothers will feel quickening later
What are some common findings of the 3rd Trimester?
Rapid growth of the fetus
Swelling of the ankles
Mother increased weight gain, regular rest breaks due to loosening of ligaments, back pain, SOB (increased blood volume and C/O) Difficulty sleeping, Urinary frequency, Braxton Hicks Contractions
What are Braxton Hicks Contractions?
Spastic uterine contractions due tin increased stretching of the uterus, these are different from labor contractions in that they don’t increase in intensity and freq.
When do Braxton Hicks contractions usually begin?
Approx 28 weeks
How do you resolve Braxton hicks contractions?
Disappear with walking or exercise- true labor contractions will become more intense
When is the baby “suppose” to be head down?
Around 32-35 weeks
In what stage is an embryo most sensitive to teratogens?
In the embryonic stage
When does Oogenesis occur?
During the Embryonic stage
When does the fetus have the most rapid growth?
Third trimester
Essentials of Diagnosis
Essentials of Diagnosis
What is essential for the diagnosis of pregnancy?
Amenorrhea and a positive pregnancy test
What are some clinical findings of pregnancy- what will the women notice?
Amenorrhea N/V Breast changes Fetal movement Elevated basal body temp Skin changes Pelvic changes
Clinical Findings- Nausea and Vomiting
Clinical Findings- Nausea and Vomiting
What percent of pregnancies will have associated n/v?
50%
When is n/v likely to occur?
At 2 weeks of gestation
When does n/v usually resolve?
13-16 weeks of gestation
What is Hyperemesis gravidarum?
Extreme form of N/V during pregnancy resulting in Dehydration, weight loss, ketonuria, and possible hospitalization
What is the treatment of N/V
Small frequent meals, dry diet and emotional support
Clinical Findings- Breast Changes
Clinical Findings- Breast Changes
Most women will experience mastodynia, what is masyodynia?
Painful breast
Explain the findings of breast engorgement?
Periareolar venous prominence, Montgomery’s tubercles are more pronounced especially in Primiparous (women who is pregnant for the first time.
What are the Montgomery tubercles?
The glands of Montgomery, or Montgomery’s tubercles, are the tiny “bumps” that are scattered around the areola (the darker area which rings the nipple). During pregnancy these glands enlarge and they remain enlarged while breastfeeding.
Clinical Findings: Fetal movement
Clinical Findings: Fetal movement
When should there be an initial perception of fetal movement?
Primiparous: 18-20 weeks gestation
Multiparous: early as 14 weeks gestation
What is Quickening?
Maternal perception of movement
Clinical Findings: Elevated Basal body temperature
Clinical Findings: Elevated Basal body temperature
What causes the increase of basal body temp?
Progesterone will cause an increase of 0.5 C in basal body temp. it will occur during the leteal phase and persist after missed menses
Clinical Findings- Skin Changes
Clinical Findings- Skin Changes
What are some of the skin findings in pregnancy
Chloasma: darkening of the skin- sunlight make it worse
Linea nigra- line will form down the middle of the stomach
Striae
Spider telangiectasia
Clinical Findings Pelvic organ changes
Clinical Findings Pelvic organ changes
What is chadwick’s sign?
Bluish discoloration of the vagina caused by increased vascularity
What is hegar’s sign?
Widening and softening of the isthmus of the uterus while the cervix is still firm
What is Goodell sign?
Softening of the cervix, occurs after Hegars sign
What is Ballottment?
Passive movement of unengaged fetus 16-18 mo, The use of a finger to push sharply against the uterus and detect the presence or position of a fetus by its return impact.
What is Leukorrhea:
White discharge due to estrogen
What is pelvic ligament relaxation?
sacrolillac and pubic symphysis relaxation
What are some tools used for dx?
Fetal Heart tones (FHT), Uterine size/fetal palpation, Sonography, Pregnancy test.
When can you first hear the fetal heart tones?
By using a handheld Doppler after 10 weeks of gestation
What is being looked for on sonography and when is each done?
Cardiac activity- discernible at 5-6 weeks via transvaginal sonogram
End of embryonic stage- 10 weeks after the last normal menstrual period the embryo will have a human appearance
Gestation age- determined by crown rump length which is done between 6-13 weeks gestation.
What margin of error does the gestational age by crown rump have?
About 8% 3-5 days
What are the two types of pregnancy test?
Human chorionic gonadotropin (hCG) can be done by the serum and urine
When is serum HCG positive?
7 days after conception or 21-22 days after last normal menstrual period
When should the home Urine HCG be done, and what is it measuring?
Should be done on the first morning void and it measures antibody assay to Beta-HCG
What is the half-life of HCG?
1.5 days
When do serum and urine levels of HCG return to normal levels?
21- 24 days after delivery/ fetal loss
How can you determine fetal age?
Time elapsed since the fist day of the LNMP expressed in completed weeks
Neagels rule
What is Negels rule?
Estimated delivery date= 1st day of LMP+1 year- 3 months+ 7 days
What can ultrasound tell you about the baby?
Determine the viability
Screen for aneuploidy
Evaluate fetal anatomy and well being
Estimate the gestational age
When is the best period of time that a ultra sound can determine the fetal age?
Between weeks 13-20 is when it is the most accurate parameter ( with 8% margin of error) after 24 weeks the accuracy to estimate age diminishes significantly
What is the fundal Height?
is a measure of the size of the uterus used to assess fetal growth and development during pregnancy. It is measured from the top of the mother’s uterus to the top of the mother’s pubic bone in centimeters.
Ex: the belly button is around 20 weeks
What is the gold standard early pregnancy failure ?
Cardiac activity absence on ultrasound
What lab finding can be used for dx of early pregnancy failure?
Lack of an increase of serial B-HCG levels
What are some signs and symptoms of late pregnancy failure?
Fist sign: absence of fetal movement noted by mother
What is used for diagnosis of late pregnancy failure?
If no appreciable fetal heart tone: US is 100% accureate in determining cardiac activity
What are some complications of pregnancy failure?
DIC- disseminated intravascular coagulopathy
Prenatal care:
Mothers receiving prenantal care=
Mothers receiving prenantal care= loser risk of complications (due to the ability to identify and treat high risk patients)
What risk factors must be determined before conception?
Smoking, alcohol, drug use, and exposure to known teratogens
You must also warn the women about the ABCDEF’s of preg, what are those?
A: Amniotic fluid leakage B: Bleeding vaginally C: Contractions D: Dysuria E: Edema F: Fetal Movement
What effects can smoking have on a women trying to become preg?
Difficulty getting preg
Placenta seperates from the womb too early, casuing bleeding
Placenta covering the cervix causing complications
Water breaks to early
What effects can smoking have on a baby?
Baby born to small Baby born to early sudden infant death syndrome Fetal death Infant death
What is the effect of alcohol of the baby?
Fetus is exposed to alcohol longer than mother (the same amount of alcohol) due to the fact that the has less alcohol dehydrogenase for metabolism of the ETOH)
What is the effect if the mother smokes and drinks?
Concurrent tobacco appears to increase the fetal exposure to alcohol
What amount of alcohol is safe to drink while preg?
No known safe amount to drink while pregnant
When is it safe to drink during preg?
No known safe time to drink during pregnancy
What is the side effects of drinking during preg, esp the 1st trimester?
Growth and CNS issues, in the first trimester will lead to abnormal facial features.
What effect does marijuana during preg have on the baby?
Low birth weight, intercraininal bleeding, jitteriness, hypoglycemia, hypocalcemia. As a neonate poor feeding, irritability, tachypena
What effect do amphetamines during preg have on the baby?
Premature birth, low birth weight, interbranial bleeding
What effect do optiods during pregnancy have on the baby?
Fetal growth restriction, premature birth and low birth weight
What effect does cocaine during pregnancy have on the baby?
Miscarriage, fetal growth restriction, developmental disorders of the urinary system or GI treact, Microcephaly, neurobehavioral problems, placenta abruption, increased startling, jitteriness, excessive sucking in neonate.
Medication Teratogens
Medication Teratogens
Aminopterin:
What is it used for:
What doest it cause:
How does it cause birth defects?
What is it used for: treatment of cancerous tumors
What doest it cause: Wide array of birth defects, including facial abnormalities such as cleft lip and cleft palate
How does it cause birth defects? Blocks folic acid and therefore neural tube defects
Phnytoin, valproic acid, Trimethadione
What are they used for?
What do they cause:
What are they used for? Anti epileptics
What do they cause: a wide array of birth defects including a cleft palate, microcephaly and cardio abnormalities
Warfarin- anticoagulatnts
What is its MOA:
What does it cause:
What is its MOA: inhibits synthesis of vit k dependent clotting factors (2, 7, 9, 10) and anticoagulant protein c and s
What does it cause: CNS defects: mental retardation and optic nerves defects
ACE Inhibitros- anti-hypertensive
what is its MOA
What does it cause?
What it is MOA: Blocks conversion of angiotensin I to II
What does it cause: Fetal growth restriction, baby kidney dysfuction and fetal mortality
Isotretinoin (Acutane)
What is it used for?
What can it cause:
What is it used for? Treates severe acne, derived from vit A, binds to and activatesretinoic acid receptors reulating cell proliferation and differentiation, immunomodulatory and anti-inflammatory responces
What can it cause: cleft palate, heart defects, abnormalities of the outer ears, micronathia, nerural tube defects
Lithium, Phenothiazine, Diazepam
what is it used for?
what do they cause?
What are they used for: Tranqulizer and anti anxiety
What do they cause? Cleft lip/ palate
SSRIs
effects on fetus?
What is the worse SSRI to use?
Most effects are small, irritable, agitation, tremor, increased RR, nasal congestion of diarrhea.
What is the worse SSRI to use?
Paroxetine (Paxil)
What is worse for fetal development the use of an SSRI or Depression?
Depression may be more harmful than SSRIs
Androgens and progestin’s (Birth control)
What affect do androgens and progestins have on the baby?]
Make female fetuses more masculine, baby clitoris may be larger than normal, fused labia, scrotum and penis
Diethylstillbesteol (DES)
What is it and what does it do to the fetus?
It is a form of estrogen, abnormalities of uterus, vagina and cervix
Genetic Screening and Testing:
Genetic Screening and Testing:
What are ACOGs recommendations on genetic testing?
All pregnant women are offered test for
Fetal chromosomal abnormalities
Maternal blood test in first trimester along with ultrasound or
Maternal blood test in second trainmaster with/without ultrasound
When should invasive diagnostic testing be available, what are the options?
It should be avb to all women- Chorionic Villus sampling and Amniocentesis
What is the Quad marker screen?
Alpha fetoprotion (AFP) A protein produced by the babies liver Unconjugated Estriol (UE)- a protein produced by the placenta and babies liver Human Chorionic Gonadotropin: Produced by the placenta Inhibin A: Produced by the liver
When is the Quad marker screen usually done?
15- 20 weeks
On a quad marker screen what defects are seen with to high of AFP at 15-20 weeks?
Open neural tube defects, Twins, Baby over 20 weeks old
On a quad marker screen what defects are seen with to high of HCG at 15-20 weeks?
Down syndrome
When is Chorionic Villus sampling usually done?
In the 1st trimester
What are the two ways the CVS can be performed?
Transabdominally and transvaginally
When is amniocentesis usually done?
After 15th week of pregnancy.
Maturity amniocentesis is most common when?
After 36th week of preg
What are the three most common Trisomys?
13: Patal
21: Downs
18: Edward
First OB visit:
First OB visit:
What needs to be covered in the OB history questions of the first visit?
Current symptoms, Discuss any perceptions regarding childbearing, and outcomes of pervious pregnancies.
What previous surgical procedures may warrant a Caesarean section?
Previous gynecologic, abd, or uterine
What happeneds if there is a family history of DM?
There is a glucose testing at the initial visit if there is a family hx
What is looked at in the PE of the initial Visit?
Bony pelvis (The pelvic inlet, midpelvis and pelvic outlet) the uterus, cervical length and adnexal exam
What test needs to be ran if there is a hx of cat letter boxes, untreated drinking water, contaminate undercooked meat?
Toxoplasmosis
What test needs to be tested if there is a sexually transmitted infection risk factor, under 25 years old, multiple sex partners, hx or prior STI?
A gonorrhea test
What test needs to be done if there is a hx of being around a lot of kids, like a day care worker, NICU nurse, adolescents with multiple sexual partners?
Cytomegalovirus
What immunizations need to be given to preg women?
Preservative free influenza- all preg women
Hep B- >1 sex partner during previous 6 mo, STI
Tdap- if no prev vaccination
What immunizations are contraindicated during preg?
HPV, Infuenza in live attenuated influenza vaccine form, MMR, Varcella
When are follow up appts?
0-32 weeks Q 4 weeks
32-36 weeks Q2 weeks
over 36 weeks Q week
what is determined at the 18-20 week gestational ultrasound?
Fetal Anatomy, Cardiac activity, Crown rump length for gestational age, Nucal region shuld be imaged for abnormality
What is the Leopold maneuver and when is it done?
Done at 26 weeks to determine the size and position of the baby
What lab tests are done in the third trimester?
Gestational DM- Glucose tolerance test
CBC- check for anemia
Group B strep- if + treat with PCN at admission of labor
What are some common complications of pregnancy that do not need to be worried about?
Ptyalism- excessive salivation
Pica- ingestion of substances with no nutritional valve (this can be an issue!)
Vericose veins
Urinary freq and renal function – GFR increased over 50% due to increase in blood volume
Joint and back pain
Leg bramps/ numbness
Breast soreness
Acrodysethesia of the hands- Numbness and tingle
What do you need to tell women about bathing during preg?
Not to use to much soap, not to hot, and not to long (no hot tubs)
What do you need to ell women about exercise during preg?
30 min to moderate intensity physical activity, and avoid activites with risk of maternal injury.
What needs to be told to women about intercourse during preg?
If Cramping, spotting or BRB occur you need to DC intercourse until evaluated
Nutritional Requirements during Preg:
Nutritional Requirements during Preg:
Protein:
1 g/kg/day + 20 grams per day in the 2nd ½ of preg- it is crucial for fetal development
Ca+:
Ca+: 1200 mg/day during preg and lactation
Iron
Iron: Adequate iron intake for increased RBC production
Vitamin
Vitamin: Follic Acid: decreased risk for neural tube defects- inititate 1 mo before conception and cont for first 3 mo post preg
Overall calories
Overall calories: increase 340-450 kcal/day in 2nd and 3rd trimester
What is the recommended weight gain in pregnancy:
Normal pre pregnancy weight 25-35 lbs
What foods need to be avoided during preg?
Soft cheeses, raw eggs (raw cookie dough or cake batter) certain types of fish (shark, sword fish, mackereal), Raw or undercooked fist, Unpasteurized juice or ciders including fresh squeezed (may have ecoli) salads made in a store, such as ham salad, chicken salad, and seafood salad, raw shellfish (oysters) raw or undercooked sprouts and Unpasteurized milk
