Women's Health-OB Flashcards
Chadwick sign
bluish discoloration of the cervix
Hegar sign
softening btwn funds and cervix
When do you get fetal heart tones
10-12 weeks w/ doppler (normal = 120-160)
5-6 weeks w/ Transvag US
Uterus size by weeks
12 = pubic symph 14-16= midway to umbilicus 20 = umbilicus 20-38 = fundal height aka McDonald
What is lightening?
Decrease in fundal height after 38 weeks w/ decent of fetus into the pelvis
How to calculate EDD?
Nagele
add 7 days and subtract 3 mo from LMP
1st visit
@ 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
16-20 wk labs
- quant screenAFP
- amniocentesis
- US
24-28 wk labs
- 1hr GTT
- H&H
34-36 wk labs
-Group B strep screen
10-12 wk labs
PAPP-A, free beta-hCG, nuchal translucency, CVS
Vaccines in Pregnancy
- 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
Spont Abortion
- before 20 wks
- 60% = chromosomal abnormalities
Threatened Abortion
-bleeding w/ or w/o cramps w/ CLOSED cervix
Inevitable Abortion
-bleeding w/ or w/o cramps w/ DILATED cervix
Complete Abortion
-all products have been expelled
Missed Abortion
-embryo or fetus dies but the products are retained
Incomplete Abortion
-some portion of products of conception remain in the uterus
Habitual Abortion
3 or more in succession
think SLE or thyroid
RF for ectopic pregnancy
- previous ectopic
- previous PID
- B/L tubal ligation
- Previous pelvic surgery
- IUD
- Infertility and assisted repro technology
Presentation of ectopic
- 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
Tx of ectopic
- Surgery
- Methotrexate (can’t use if there is a HR or if poor F/U)
- *remember to check Rh and type**
Rh- means what?
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
Presentation of Trophoblastic Dz
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
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*
What is gestational hypertension
BP > or = 140/90
-occurs at or after 20 wks of gestation
When is tx of gestation HTN indicated
When systolic >160 or diastolic >105-110
- NO ACEI***
- Tx: Labetolol, methyldopa, hydralazine
RF for pre-eclampsia
fam hx, primiparity, previous preeclampsia, multiple gestations, advanced maternal age, DM, obesity, SLE, chronic HTN
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
Tx of Pre-eclmpasia
- Frequent monitoring of mom and baby
- Delivery at 37 wks
- Magnesium sulfate to protect the CNS
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
HELLP syndrome
Hemolysis, Elevated Liver Enzymes, Low Platelets
(very severe form of pre-eclampsia)
Tx: delivery
Gestation DM screen
at 24-28 wks
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
Previa
painless vaginal bleed
dx on US
Contraindications = no pelvic/cervical digital exam, no intercourse, no vigorous exercise
PPROM
rupture of membranes before 37 weeks before onset of labor
NST results
Reactive/Normal = 2 or more accelerations in a 20 min period Nonreactive = no sufficient accelerations in 40min
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
Oligohydramnios
BAD
- anomalies
- placental dysfunction
- requries close maternal/fetal surveillance or delivery
Polyhydramnios
sometimes bad
- can be normal
- can cause PROM
- can cause malpresentation of fetus
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)
1st stage of L&D
onset of labor til complete dilation of cervix
- latent = 6h
- active = 3-7h
2nd stage of L&D
complete dilation til delivery of fetus
2h
3rd stage of L&D
Delivery of placenta (5-30 min)
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
Causes of post partum hemorrhage
- uterine atony
- lacerations
- retained placenta
- coagulopathies
management of post partum hemorrhage
-active mgmnt of 3rd stage of labor, oxytocin, early cord clamp and cut, controlled contraction on cord, hysterectomy
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
