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PANCE review > Women's Health - OB > Flashcards

Women's Health - OB Flashcards

1
Q

Gravida and Parity

A 
G = pregnancies
P = deliveries
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2
Q

What is advanced maternal age?

A

AMA > 35 yo

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3
Q

How to report a women with 3 pregnancies, 1 miscarriage, and two living children one of whom was born premature?

A

G3P2 or G3P1112

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4
Q

What is GTPAL system for reporting female’s obstetric history?

A 
T = term births (after 37 weeks gestation)
P = premature births
A = abortions
L = living children
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5
Q

Nägele’s rule for estimated date of confinement (EDC):

A

EDC = 1st day of LMP + 7 days – 3 months

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6
Q

Early PE signs of pregnancy

A

Chadwick’s sign: blueish coloring of vagina and cervix, secondary to increased estrogen

Hegar’s sign: softening of uterus

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7
Q

Things to check on exam visits during pregnancy

A

baby movement, fundal height, fetal heart rate, U/A and possible vaginal exam

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8
Q

Fundus height at 12 wks, 20 wks, and 36 wks?

A

12 wks = pubic symphisis
20 wks = umbilicus
36 wks = xiphoid process

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9
Q

How frequent are prenatal exams?

A

6-28 wks - every 4 wks
28-36 wks - every 2-3 wks
36 wks to delivery - weekly

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10
Q

When can heart sounds be detected on Doppler U/S?

A

12 wks

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11
Q

Baseline fetal heart rate

A

120-160 bpm

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12
Q

When should gestational diabetes screen be done?

A

28 wks

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13
Q

When should culture for beta hemolytic strep be done prenatally?

A

35 wks

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14
Q

A women whose LMP was on June 6th will have what estimated due date according to Nägele’s rule?

A

March 13th

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15
Q

When can chronic villus sampling be performed?

A

10-12 wks

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16
Q

What is quickening and when does it occur?

A

Quickening is when mother can feel fetal movements for the first time
Typically at 20 weeks though multiparas women may feel a little earlier

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17
Q

What does the biophysical profile done in 3rd trimester test for?

A

Breathing – 1 or more normal breathing episode
Movement – 2 or more movements
Muscle Tone – 1 episode of extension/flexion
Heart Rate – 1 or more episodes of accelerations of at least 15 bpm fetal heart rate
Amniotic Fluid – 1 or more adequate pockets

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18
Q

U/S is performed throughout pregnancy for many reasons, including…

A 
fetal viability
detect presence of more than one fetus
placental localization
checking amniotic fluid levels
position of fetus
gestational age/due date
weights and size of fetus
Detect fetal malformations
Biophysical profile in 3rd trimester
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19
Q

What is a chronic villus sampling?

A

biopsy of placental tissue used to obtain chromosomal info about fetus

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20
Q

Indications of amniocentesis or chronic villus sampling?

A

FHX of genetic d/o, parent with genetic d/o, abnormal U/S, advanced maternal age

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21
Q

Risk of doing chronic villus sampling

A

small infection risk

higher miscarriage risk than amniocentesis

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22
Q

When is quad screen done and what does it measure?

A

15-18 weeks

checks maternal blood for AFP, hCG, estriol, and inhibin-A

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23
Q

Why do quad screen?

A

offered to all women to eval risk of genetic disorders such as Down Syndrome and other trisomies

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24
Q

What is amniocentesis? When can it be done?

A

15-18 wks

needle to withdraw amniotic fluid from uterine cavity to eval for genetic disorders

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25
Q

How is gestational diabetes dx’d?

A

Oral Glucose Challenge at 24-28 weeks

women ingests either 50 or 75 grams of glucose (glucola), an hour later a blood sugar is drawn on the patient and if blood sugar >130 blood is drawn again at 2 hours and if necessary 3 hours

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26
Q

Best method to eval for an abnormal fetal heart

A

U/S

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27
Q

What are 2 early term pregnancy complications?

A 
Spontaneous abortion (w/i 12 wks)
Ectopic pregnancy
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28
Q

Treatment of spontaneous abortion

A

Bed rest and routine physical exam and U/S

If Rh- woman should be given immunoglobulin

If fetus terminated than contents of uterus must be emptied by D&C

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29
Q

Threatened abortion =

A

cramping, bloody discharge (spotting), closed cervical os, a small percentage will go on to spontaneous abortion

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30
Q

Inevitable abortion =

A

Obvious rupture of membranes and leaking of amniotic fluid in the first 12 weeks. If this occurs with cervical dilation this will likely go on to miscarriage.

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31
Q

Complete abortion =

A

Complete detachment of placenta from the uterus and expulsion of the products of conception. The cervical os will be closed once complete

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32
Q

Incomplete abortion =

A

Cervical os is open with some portion of the fetus and/or placenta remaining in the uterus.

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33
Q

Missed abortion =

A

Cervical os is closed and the terminated fetus remains in the uterus. This may go unnoticed for several days or even weeks.

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34
Q

What is the treatment for a missed abortion at 12 weeks?

A

Contents of uterus must be emptied with D&C, otherwise they will become a reservoir for bacteria

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35
Q

Recurrent abortion =

A

Usually defined as 3 or more consecutive spontaneous abortions.

Amazingly the prognosis for these women is good as one spontaneous abortion does not increase risk of another

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36
Q

__________ is defined as the implantation of the fertilized egg outside of the uterus.

A

Ectopic pregnancy

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37
Q

Risk factors for ectopic pregnancy

A 
surgery on fallopian tubes
salpingitis
pelvic inflammatory disease
ectopic pregnancy
endometriosis
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38
Q

Clinical presentation of ectopic pregnancy

A 
Pain!!!
amenorrhea
GI symptoms
light headedness
abnormal vaginal bleeding
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39
Q

Treatment for ectopic pregnancy

A

CANNOT go on to birth

Methotrexate given if mass

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40
Q

What are the two categories of gestational trophoblastic disease?

A 
Hydatidiform mole (molar pregnancy)
Choriocarcinoma
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41
Q

What type tissue does Gestational trophoblastic disease (GTD) develop in?

A

placental tissue

42
Q

Will a patient with GTD be able to deliver a viable fetus?

A

No; there is either no or very little fetal tissue in the uterus. The patient will undergo a D&C to have the contents of the uterus removed.

43
Q

Treatment for Choriocarcinoma typically consists of…?

A

single agent chemo and D&C

44
Q

Which symptoms will immediately cause you to consider hydatidiform mole (molar pregnancy)?

A

Vaginal bleeding and significantly elevated BP in first trimester

45
Q

Preeclampsia

A

protein urea and elevated blood pressure in the late 2nd or 3rd trimester; precursor for eclampsia

46
Q

Eclampsia

A

seizures in a pregnant women with no preexisting disorder

47
Q

Risk factors for Preeclamspia and Eclampsia

A 
First pregnancy
Multiple gestation
Obesity
Advanced maternal age
History of DM, HTN or kidney disease
Teenage pregnancy
African American
48
Q

Signs of eclampsia

A

seizures
oliguria = decreased urine output
muscle aches and pains

49
Q

BP and urine analysis of eclampsia

A

UA: protein urea > 5 g/24hr

BP > 140/90

50
Q

Fetal complications of mother with eclampsia

A

Preterm delivery
Low birth weight
Death

51
Q

Treatment of eclampsia

A

Goal: keep the pregnancy going as long as it is safe and deliver the baby as soon as possible (delivery only treatment)

  • Assess risk of delivery vs risk to mother and child of prolonging pregnancy
  • Magnesium often given as safe anti-seizure med
  • Anti-HTN and steroids may also be given
52
Q

What test is done at every office visit as a screening for preeclampsia?

A

UA and BP

53
Q

What happens if mom is Rh (-) and baby is Rh (+)?

A

Mom may start creating anti Rh (+) antibodies; concern for her next pregnancy not this one

(this baby’s blood will likely not mix with mother unless trauma)

54
Q

Treatment of Rh(-) mothers

A

Prevent production of Rh(+) antibodies:
IM RhoGAM at 28 weeks (99% effective)
Another dose within 72 hrs of trauma, amniocentesis, or delivery

55
Q

What test is used to determine titers of maternal antibodies?

A

Coomb’s test

56
Q

A patient presents to your office in the third trimester of her pregnancy with vaginal bleeding. 3 DDX;s?

A

Placenta previa
Placental abruption
Preterm labor

57
Q

Painless third semester bleeding =

A

placenta previa

58
Q

What is placenta previa?

A

placenta implants over cervical os; partial or complete

59
Q

Treatment of placenta previa

A

Close monitoring is the first step of treatment
Typically delivered by c-section though marginal ones technically can be done vaginally.
Blood transfusion during pregnancy and after delivery if necessary
Nothing per vagina during pregnancy

60
Q

Premature detachment of an otherwise normal placenta from the uterine wall

A

placental abruption

61
Q

painful vaginal bleeding in 3rd trimester =

A

placental abruption

62
Q

Treatment of placental abruption

A

Delivery is definitive treatment, but this must be weighed against the age of fetus, distress of fetus and mother, and degree of separation

63
Q

When does preterm labor occur?

A

20-37 weeks

64
Q

Risk factors for preterm labor

A 
Multiple gestation (10% of  preterm births)
Low socioeconomic status
Mother > 35 yo
Mother with low pre-pregnancy weight
Previous premature birth
Maternal health issues including DM, HTN
Abruptio placentae
65
Q

Clinical presentation of early labor

A

Regular contractions 5-8 minutes apart with any of following: cervical changes, cervical dilation > 2 cm, cervical effacement > 80%

66
Q

Cervical effacement and dilation

A

Effacement - cervix stretching and thinning

Dilatation - cervix opens

67
Q

Leading cause of neonatal mortality in the U.S.

A

preterm labor

68
Q

Clinical presentation of labor

A

Pressure
Watery or bloody vaginal discharge
Low back pain

69
Q

Preterm delivery management

A

Bed rest
Tocolytics (anti labor/contraction med); Mg most popular
Steroids for fetal lung development
Surgically a cervical cerclage (cervix sewn closed) may benefit an incompetent cervix

70
Q

Pooling of fluid in the vagina and visualization of fluid leaking from the cervix without any contractions

A

Premature rupture of membranes

71
Q

If mother’s cultures are positive or unknown for group B strep, then she and baby must receive what tx?

A

Penicillin G

72
Q

Treatment of UTI in pregnant woman

A

ampicillin, cephalexin, or nitrofurantoin

73
Q

Treatment course for an infant whose mother is HIV positive?

A

Anti-retroviral therapy x 6 weeks

74
Q

What should be done if mother has active herpes infection at delivery?

A

C-section indicated

75
Q

Effects of pregnant woman with syphilis

A

still birth, late term abortions, transplacental infection, congenital syphilis

76
Q

What should be ruled out with any right-sided abdominal pain in pregnant patient?

A

appendicitis

  • atypical presentation in pregnant women and often overlooked
77
Q

Infectious complications of pregnancy

A 
Group B strep
UTI
HIV
Genital Herpes
Syphilis
Cholecystitis
Appendicitis
78
Q

Should a pregnant women who comes in with a unilateral swollen, red, tender breast continue to breast feed. Should the infant receive antibiotics and if so which antibiotic?

A

Yes, breast feeding is encouraged as breast milk needs to be emptied in order to help clear infection. Little to no risk to infants and they don’t need antibiotics

79
Q

What is “water breaking?”

A

amniotic fluid from vagina

80
Q

What is normal vaginal bleeding of labor?

A

bloody show; small amount of blood that is passage of mucus plug which was covering cervix

81
Q

Braxton Hick’s contractions

A

Begin in 1st trimester; not considered “true” contractions
Irregular
Relieved with change in position
Felt more in pelvis

82
Q

Describe true contractions

A 
regular intervals
last about 60 sec (initially shorter and progress)
progress in strength
they get closer together
felt more in the lower back
83
Q

4 stages of labor

A

First stage: true contractions to full dilation of cervix (10cm); longest phase

Second stage: full dilation to delivery; 20min - 2 hours

Third stage: delivery of infant to delivery of placenta; 5-30 minutes

Fourth stage (technically not a stage): assessment and treatment of lacerations, tears or hemorrhage; oxytocin given to help uterus contract

84
Q

Pathophysiological causes of postpartum hemorrhage

A

Retained portions of placenta
Cervical or vaginal laceration
Poor involution of uterus

85
Q

Postpartum hemorrhage treatment

A

Uterine massage and compression!!
Uterotonic meds including oxytocine, ergonovine, methylgonovine
Fluids/blood transfusion
Consider surgical intervention if bleeding is uncontrollable

86
Q

Station refers to the relation between the presenting portion of the fetus and the _______.

A

ischial spine

87
Q

fetus >4000 grams and associated with maternal diabetes

A

Macrosomia

88
Q

Normal positioning of fetus in uterus

A

vertex; head down

89
Q

Breech position of fetus in uterus

A

butt down

90
Q

Different types of breeches?

A

Frank breech = hips flexed, knees extended
Complete breech = hips flexed, knees flexed
Footling breech = leg extended with foot down either single or double

91
Q

What is cord prolapse during labor? What fetal presentation is it most likely?

A

cord stretched during delivery or compressed between birth canal and fetus; hypoxia is biggest concern

transverse presentation highest risk

92
Q

Shoulder dystocia

A

baby’s anterior shoulder gets stuck behind the mother’s pubic bone during delivery

93
Q

How should macrosomia, shoulder dystocia, breeching, and other problems with delivery be managed?

A

C-section

94
Q

How should breeched fetus be managed?

A

Manually turned with careful monitoring; may need c-section

95
Q

Indications of C-section

A 
Fetal distress
Transverse for breech position
Baby’s head too big for mother's hips (Cephalopelvic Disproportion)
Repeat C-section
Placenta Previa
Active genital herpes
96
Q

What should be done if cervix not dilating during labor?

A

Cervidil may be used; prostoglandin applied directly to cervix to aid with induction

97
Q

Complications of C-section

A

Bleeding
Thromboembolic event
Metritis (uterine wall infection) most common complication

98
Q

Why are IV antibiotics given before C-section surgery?

A

to prevent metritis

99
Q

VBAC =

A

vaginal birth after cesarean

100
Q

First visit after labor should be when?

A

4-6 weeks postpartum

101
Q

List four things that should be included in a the first postpartum office visit.

A

Bleeding and/or vaginal discharge
Pelvic pain
Sex and contraception requirements (wait 6-12 wks)
Bowl and bladder function
Breast vs bottle feed
Emotional well being
Fasting glucose if patient had gestational diabetes

102
Q

How to determine station of fetus?

A

Station of fetus is the relation between the presenting body part and the ischial spines.

Felt by digital exam and recorded using number line where zero is directly at ischial spines and negative numbers are above and positive numbers are below

Recorded in cm (+2, +1, 0, -1, -2 cm)

PANCE review (18 decks)

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