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Women's Health-OB Flashcards

1
Q

Chadwick sign

A

bluish discoloration of the cervix

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2
Q

Hegar sign

A

softening btwn funds and cervix

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3
Q

When do you get fetal heart tones

A

10-12 weeks w/ doppler (normal = 120-160)

5-6 weeks w/ Transvag US

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4
Q

Uterus size by weeks

A 
12 = pubic symph
14-16= midway to umbilicus
20 = umbilicus
20-38 = fundal height aka McDonald
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5
Q

What is lightening?

A

Decrease in fundal height after 38 weeks w/ decent of fetus into the pelvis

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6
Q

How to calculate EDD?

A

Nagele

add 7 days and subtract 3 mo from LMP

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7
Q

1st visit

A

@ 6-8 weeks

  • complete hx and screening labs:
  • GC/chlam, Hep B, HIV, rubella, ABO, D(Rh), H&H, RPR/VDRL, CF, urine culture for asymp bacteriuria
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8
Q

16-20 wk labs

A
  • quant screenAFP
  • amniocentesis
  • US
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9
Q

24-28 wk labs

A
  • 1hr GTT

- H&H

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10
Q

34-36 wk labs

A

-Group B strep screen

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11
Q

10-12 wk labs

A

PAPP-A, free beta-hCG, nuchal translucency, CVS

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12
Q

Vaccines in Pregnancy

A
  • influenza: unvaccinated should be immunized at ANY time during influenza season
  • Tdap: all pregos who have not been previously vaccinated should get 1 dose during the late 2nd or 3rd trimester (after 20 wks to protect baby)
  • NO LIVE VACCINES = VARICELLA, MMR, YELLOW FEVER
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13
Q

Spont Abortion

A
  • before 20 wks

- 60% = chromosomal abnormalities

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14
Q

Threatened Abortion

A

-bleeding w/ or w/o cramps w/ CLOSED cervix

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15
Q

Inevitable Abortion

A

-bleeding w/ or w/o cramps w/ DILATED cervix

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16
Q

Complete Abortion

A

-all products have been expelled

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17
Q

Missed Abortion

A

-embryo or fetus dies but the products are retained

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18
Q

Incomplete Abortion

A

-some portion of products of conception remain in the uterus

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19
Q

Habitual Abortion

A

3 or more in succession

think SLE or thyroid

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20
Q

RF for ectopic pregnancy

A
  • previous ectopic
  • previous PID
  • B/L tubal ligation
  • Previous pelvic surgery
  • IUD
  • Infertility and assisted repro technology
21
Q

Presentation of ectopic

A
  • always high index of suspicion*
  • spotting
  • pelvic pain
  • positive hcG might be lower than expected
  • *US** a level of 1500 HCG should allow visualization of intrauterine gestation
22
Q

Tx of ectopic

A
  • Surgery
  • Methotrexate (can’t use if there is a HR or if poor F/U)
  • *remember to check Rh and type**
23
Q

Rh- means what?

A

do not have anti-D
(after first exposure make anti-D and then the next pregnancy w/ Rh + baby = attack baby’s RBCs = hemolysis, CHF, death)
rhogam at 28 wks gestation and w/in 72 hr of delivery

24
Q

Presentation of Trophoblastic Dz

A

aka Molar/Hydatidifrom Pregnancy

  • bleeding
  • hyperemesis
  • large for dates uterus
  • hCG markedly high for LMP
  • *pre-eclampsia in 1st or 2nd trimester is pathognomic for molar pregnancy**
  • snowstorm or cluster of grapes appearance on US
25
Molar Pregnancy complications
- mets to lung - choicarcinoma * **need effective bc = no pregnancy for 1yr b/c you want to follow serial HCG weekly to zero and then monthly for one year***
26
What is gestational hypertension
BP > or = 140/90 | -occurs at or after 20 wks of gestation
27
When is tx of gestation HTN indicated
When systolic >160 or diastolic >105-110 * ***NO ACEI****** - Tx: Labetolol, methyldopa, hydralazine
28
RF for pre-eclampsia
fam hx, primiparity, previous preeclampsia, multiple gestations, advanced maternal age, DM, obesity, SLE, chronic HTN
29
Pre-eclampsia Diagnostic Criteria
Develop HTN after 20 wks - new onset proteinuria or thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, cerebral or vascular disturbance - progressive
30
Tx of Pre-eclmpasia
- Frequent monitoring of mom and baby - Delivery at 37 wks - Magnesium sulfate to protect the CNS
31
Eclampsia =
New onset of grand mal before, during or immediately after postpartum SYMP: severe HA, hyperreflexia, blurred vision, photophobia, RUQ or epigastric pain, altered mental status Tx: Mag Sulfate,**watch for loss of DTRs which signifies toxicity** -Emergent delivery
32
HELLP syndrome
Hemolysis, Elevated Liver Enzymes, Low Platelets (very severe form of pre-eclampsia) Tx: delivery
33
Gestation DM screen
at 24-28 wks
34
Abruption
painful vaginal bleeding - uterine contractions - GI symp * **pt in question probably smokes or does drugs*** tx: may need emergent delivey or may stabilize & monitor in-pt
35
Previa
painless vaginal bleed dx on US Contraindications = no pelvic/cervical digital exam, no intercourse, no vigorous exercise
36
PPROM
rupture of membranes before 37 weeks before onset of labor
37
NST results
``` Reactive/Normal = 2 or more accelerations in a 20 min period Nonreactive = no sufficient accelerations in 40min ```
38
BPP
-NST -Fetal breating mvmnts -Fetal mvmnt -fetal tone -determ of amniotic fluid index **each is cored 2 to 0 Normal = 8 to 10 Equivocal = 6 Abnormal = 4 or less
39
Oligohydramnios
BAD - anomalies - placental dysfunction - requries close maternal/fetal surveillance or delivery
40
Polyhydramnios
sometimes bad - can be normal - can cause PROM - can cause malpresentation of fetus
41
Contraction stress test
looking for presence or absence of late fetal HR decal w/ contractions -if can't tolerate = indication for c-section (variable decel = cord compression = oligohydramnios)
42
1st stage of L&D
onset of labor til complete dilation of cervix - latent = 6h - active = 3-7h
43
2nd stage of L&D
complete dilation til delivery of fetus | 2h
44
3rd stage of L&D
Delivery of placenta (5-30 min)
45
Post-partum hemorrhage def and RF
loss of >500mL after vaginal delivery | RF: prolonged 3rd stage, multiple ddliv, episiotomy, hx of post partum hem, fetal macrosomia
46
Causes of post partum hemorrhage
- uterine atony - lacerations - retained placenta - coagulopathies
47
management of post partum hemorrhage
-active mgmnt of 3rd stage of labor, oxytocin, early cord clamp and cut, controlled contraction on cord, hysterectomy
48
Indications for C-section
- dystocia, protraction disorder, arrest disorder w/ adequate contractions - fetal malposition - multiple intrauterine pregnancies - fetal distress (fetal acidosis) - cord prolapse, placenta previa, placental abruption - previous intra uterine fetal surgery - pervious myomectomy or uterine reconstruction - HIV - active Herpes - medical or obstretical complications precluding vaginal delivery - suspected macrosomia by son graphic estimated fetal weight

PANCE (18 decks)

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