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Foundations III > OB > Flashcards

OB Flashcards

1
Q

What do the TPAL of Parity stand for?

A 
Term: deliveries between 37 and 42 weeks
Preterm: between 20-37 weeks
**considered viable after 23 weeks
Abortion: spontaneous or induced prior to 20 weeks
Living: living children
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2
Q

How long does pregnancy last

A

280 days

40 weeks

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3
Q

Technically when does the post partum period end?

A

6 weeks after delivery

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4
Q

Nagele’s Rule

A

Due date: add 7 days to last menstrual period and subtract 3 months

ex. LMP: 2.20.18, EDD: 11.27.19

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5
Q

Gestational age

A

age of fetus calculated from 1st day of LMP (includes 2 weeks when woman is not pregnant

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6
Q

Fetal age

A

age of fetus calculated from time of implantation.

Gestational age - 2 weeks

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7
Q

Which trimester are fetus most sensitive to teratogens?

A

1st trimester

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8
Q

Embryo timeframe

A

fertilization to 8th week of pregnancy

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9
Q

How are the trimesters broken up?

A

First trimester: 1-12 weeks
Second trimester: 13-28 weeks
Third trimester: 28-40 weeks

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10
Q

What is the recommendation for folic acid supplementation for low risk and high risk?

A

low risk: 0.4 mg

high risk: 4 mg

*start these prior to pregnancy

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11
Q

What is the hCG level around the time of missed menses?

A

~25. Then increases exponentially for 10 weeks then plateaus

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12
Q

Progesterone secretion in early pregnancy

A

Corpus luteum makes for ~6 weeks

Placenta makes progesterone after 6 weeks

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13
Q

How much does beta hCG increase in a normal pregnancy

A

doubles every 48 hours

-this is responsible for nausea and vomiting

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14
Q

Goodell’s Sign

A

softening of the cervix

-4-6 weeks gestation

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15
Q

Hegar’s Sign

A

softening of uterine isthmus

-6-8 weeks gestation

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16
Q

Chadwick’s Sign

A

bluish discoloration of cervix

-8-12 week’s gestation

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17
Q

Initial OB Visit

A

Labs: CBC, Blood type and Rh, Rubella, Syphilis, Hep B antigen, HIV, Chlamydia and gonorrhea cultures

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18
Q

When can fetal heart activity be detected?

A

5-6 weeks

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19
Q

When is the Quad screen done?

A

2nd trimester

  1. Blood testing
  2. AFP, hCG, Estriol, Inhibin-A
  • Increased AFP -> neural tube defects, multiple gestations
  • Abnormal tests (all 4) –> trisomy 18 or 21
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20
Q

When is Chorionic Villus Sampling done?

A

1st trimester (extracts placental cells)

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21
Q

When is Amniocentesis done?

A

2nd trimester (extract amniotic fluid)

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22
Q

Frequency of visits

A

initial: 6-8 weeks after LMP
Monthly for 1st and 2nd trimesters

Bimonthly 28-36 weeks
Weekly 36 weeks - delivery

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23
Q

Fetal heart tones

A

120-160 bpm is normal

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24
Q

When do you begin measuring fundal height?

A

20wks

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25
Q

When do you start cervical exams?

A

37 wks

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26
Q

When you measure fundal height at the umbilicus what is the gestational age?

A

20 weeks = umbilicus

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27
Q

When do you need to screen for gestational diabetes?

A

24-28 weeks

28
Q

When do you do repeat antibody screen for Rh negative women

A

26-28 weeks

29
Q

When is hemoglobin and hematocrit screened?

A

3rd trimester

-35 weeks

30
Q

When do you perform group B strep screen?

A

35-37 weeks

31
Q

How many 3 hour Glucose Tolerance tests need to be abnormal to diagnose gestational diabetes?

A

2 or more

32
Q

If a women that is Rh (negative) when do you administer RhoGAM?

A

28 weeks

-attaches to Rh antigen preventing mothers immune system from attacking fetal red blood cells

33
Q

What is the best treatment for a women with group B strep giving vaginal delivery?

A

Ampicillin IV
or
Clindamycin (if PCN allergic)

34
Q

Why do pregnant ladies need to avoid deli meat, hot dogs and soft cheese during pregnancy?

A

Listeria monocytogenes

35
Q

Why do pregnant ladies need to avoid raw milk and cheese?

A

Brucellosis

36
Q

Which vaccines should pregnant ladies get?avoid?

A

Do: Tdap and Flu

Don’t: Live vaccines; MMR, varicella

37
Q

Presenting parts

A

Vertex: head
Breech: feet
Transverse, Compound –> c-section

38
Q

Acceleration: abrupt increase in heart rate from baseline

A

reassuring sign of fetal well being

39
Q

Variable deceleration: abrupt decrease in heart rate from baseline

A

extremely common

40
Q

Late deceleration: gradual symmetrical decrease in heart rate

A

may indicate fetal distress (ex. fetal hypoxia, maternal hypotension)

41
Q

What can be given if there is hypocontractile uterine activity

A

give pitocin

42
Q

What is the most common complication of early pregnancy?

A

Abortion (chromosomal abnormalities ~50%)

43
Q

Abortion Types

A

Threatened: vaginal bleeding + closed cervix

Inevitable: vaginal bleeding + open cervix

Missed: pregnancy retained despite death of fetus

44
Q

What drug induces uterine contractions and is used to expel conceptus with abortion?

A

Misoprostol (prostaglandin analogue)

45
Q

Septic Abortion: Tx

A
  • Hospitalize

- IV antibiotics (cefoxitin and Doxycycline)

46
Q

What is the medical regimen for an elective abortion?

A
  1. Mifepristone (day 1)
  2. Misoprostal (day 2 or 3)

**Used only for <70 days gestation

47
Q

Elective abortion: surgery 1st versus 2nd trimester

A

1st trimester: suction curettage

2nd trimester: Dilation and evacuation

48
Q

Where do most ectopic pregnancies occur?

A

fallopian tube (mostly the ampullary portion)

49
Q

Ectopic pregnancy: Tx

A
  1. Give RhoGAM in Rh (-) women
  2. Methothrexate IM

(hCG needs to be below 5000, no cardiac activity for this to work)

50
Q

What is the diagnosis if the patient has a large uterus, no fetal heart tones, hyperemesis and pre-eclampsia like symptoms prior to 20 weeks with “snow storm” within endometrium

A

Gestational trophoblastic disease

51
Q

What is the most common type of gestational trophoblastic disease and which ethnic groups are susceptible?

A
  • Hydatiform mole

- Asians and American Indians

52
Q

If your patient has a hydatiform mole, what patient education do they need to get?

A

Avoid pregnancy for 12 months

53
Q

With a placenta previa (covering the cervical os) what must you NEVER do?

A

Never perform cervical exam —>hemorrhage!

-avoid intercourse

54
Q

Painful bleeding versus Painless bleeding after 20 weeks?

A

Painful –> placental abruption

Painless –> placenta previa

55
Q

What are some risk factors for premature rupture of membranes?

A
  • Genital tract infection (bacterial vaginosis)

- smoking

56
Q

What is the treatment for premature rupture of membranes?

A

corticosteroids to promote lung maturation <34 weeks

57
Q

What is a classic diagnostic finding in sample fluid from premature rupture of membranes?

A

“ferning” under microscope

58
Q

What is the most common cause of post-partum hemorrhage?

A

uterine atony (lack of contractons so blood vessels are constricted)

59
Q

What is the treatment for post-partum hemorrhage?

A
  • uterine massage
  • IV fluids
  • Oxytocin/misoprotol/methergine
60
Q

Most twins are monozygotic (identical) or dizygotic (fraternal)?

A

dizygotic “fraternal twins”

-2 amniotic sacs

61
Q

In the 1st trimester you see a “lamda sign” on US, what does this indicate?

A

Dichorionic twins (fraternal)

62
Q

What does a “T sign indicate?

A

Monochorionic twins (identical)

63
Q

When does pregnancy-induced HTN technically occur?

A

> 20 weeks (no proteinuria)

64
Q

Pre-eclampsia

A
  • New onset HTN and proteinuria after 20 weeks
    mild: BP >140/90, AND 0.3 or more protein in 24 hr urine specimen

Severe: BP >160/110

(need 2 separate readings)

65
Q

Eclampsia

A

seizures in a women with pre-eclampsia

66
Q

In a pre-eclampsia patient when is medication indicated and which HTN meds do you use?

A

Use if >160/110

IV labetalol or hydralazine

Foundations III (34 decks)

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