CM: Intro to Obstetrics Flashcards Preview

Block 8 - Endo & Repro > CM: Intro to Obstetrics > Flashcards

Flashcards in CM: Intro to Obstetrics Deck (16):
1

What is definitive evidence of pregnancy?

detecting fetal heart rate
fetal movement
visualizing fetus

2

What is probable evidence of pregnancy?

ab enlargement, uterine and cervical changes, endocrine tests (serum hCG, urine test)

3

How can gestational age be estimated from LMP, quickening, or fundal height?

LMP - Nagele's rule - add 7 days to first day of LMP and subtract 3 months = due date
quickening - b/w 16-20 weeks
fundal height- b/w 20-32 wks, cm = wks

4

What are the recommended routine lab tests at an initial prenatal visit?

hemoglobin and hematocrit
urinalysis and urine culture
blood typing and antibody screen
rubella, syphilis, hep B, gonorrhea and chlamydia screens, pap smear
HIV and CF carrier testing

5

What additional tests can be used to assess a pregnancy?

1st tri screening - nuchal translucency
2nd tri screening - MSAFP
CVS or amnio if indicated
glucose tt at 24-28 weeks
repeat Hgb/Hct, RPR and HIV, Ab screen at 32 wks

6

What are the 5 indications for antepartum surveillance?

HTN
diabetes
clinical intrauterine growth restriction
hx of previous stillbirth
post date (after 42 weeks gestation) pregnancy

7

What results of a non-stress test indicate certain states of fetal well-being?

HR of non-acidotic fetus will temporarily accelerate
well if fetal HR accelerates >15 BPM for 15 sec twice w/i 20 min period

8

What results of a contraction stress test indicate certain states of fetal well being?

uterine contractions may cause increase in pressure great enough to briefly impair O2 exchange b/w mom and baby
early decelerations (or none or even w fetal movement) indicates well
late decelerations means hypoxic or acidotic
persistent late decelerations = uteroplacental insufficiency

9

How can the amniotic fluid lecithin/sphingomyelin ratio be used to assess fetal maturation?

>2 means low likelihood of respiratory distress syndrome

10

What findings on an ultrasound are associated with <1% risk of RDS?

BPD (biparietal diameter) >9.3 cm
FL (femur length) >7.4 cm

11

What is the recommended weight gain for different mothers w regards to BMI before pregnancy?

underweight - 28-40 lbs
normal weight - 25-35 lbs
overweight - 15-25 lbs
obese - 11-20 lbs

12

What are the caloric requirements for pregnancy?

300 Kcal/day increase
500 Kcal/day increase postpartum if breastfeeding
also need folate! before pregnancy if trying

13

What are the different categories of drugs in pregnancy?

A - no risk shown (prenatal vitamins)
B - no risk, or only shown in animals (antibiotics)
C - uncertain safety, animal danger but no adequate human studies (2/3 of meds)
D - unsafe, only if benefits outweigh risks (systemic steroids, seizure meds)
X - NO NO NO
tylenol OK, NSAIDs maybe not

14

What are 6 more commonly known teratogens?

alcohol
thalidomide (phocomelia)
organic mercury (Minamata Bay syndrome)
aminopterin/methotrexate (craniofacial defects)
isotretinoin (accutane)
diethylstilbestrol (DES)

15

How can fetal alcohol syndrome be recognized?

intrauterine growth restriction, craniofacial abnormalities (absent philtrum, flat nasal bridge, maxillary hypoplasia, short palpebral fissures), brain cardiac and spinal defects, behavioral disturbances
cannot be diagnosed prenatally

16

What is the pathophysiology of the 8 major causes of discomfort in pregnancy?

syncope - postural hypotension, get up slowly
ankle edema - increased venous pressure from uterus impinging in IVC
breathlessness - increased progesterone
morning sickness - unknown
ptyalism - profuse salivation, maybe from ingestion of starch
heartburn - reflux from upper displacement of stomach
constipation - hemorrhoids, iron supplements, smooth muscle relaxation, decreased activity
urinary urgency/frequency