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OB/PEDS 2023 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What should all women be taking regardless of pregnancy status? why?

A

Folic Acid 0.4mg/day—reduce risk of NTD (hx. NTD pregnancy should take 4mg/day)

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2
Q

What should the fundal height be at various prenatal visits?

10

12

16

20-36

term

A

10 weeks
Baseball
FHT via doppler b/t 10-12 weeks

12 weeks
Softball
Fundus rising above symphysis pubis, palpable at this time

16 weeks
Half way b/t symphysis pubis and umbilicus Quickening first noted: earlier with 2nd or subsequent pregnancies: about 18-20 weeks with 1st pregnancy

20-36 weeks
1 cm increase weekly Uterine fundus at umbilicus; fundal height – gestational age (+ or – 1cm)

Term Fundal height drops r/t fetal head engagement into pelvis Vertex position in 95% of pregnancies by 36 weeks

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3
Q

What are the recommended office visits for a low-risk client throughout the pregnancy?

A

o Up to 28 weeks—every 4 weeks
o 28-36 weeks—every 2 weeks
o 36 weeks to delivery—every week
o 40+ weeks—bi-weekly

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4
Q

What vaccines can be given while pregnant?

A

TDapt
influenza

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5
Q

Presumptive signs of pregnancy

A

Amenorrhea
Breast tenderness/enlargement
Chadwick’s sign
Fatigue
Hyperpigmentation
Chloasma
Linea nigra
Fetal movements
Urinary frequency
Nausea/Vomiting

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6
Q

Probable sign of pregnancy

A

Abdominal enlargement
Ballottement
Braxton-Hicks contractions
Goodell’s sign
Hegar’s sign
Palpation of fetal contours
Positive pregnancy test
Uterine enlargement

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7
Q

Positive sign of pregnancy

A

Auscultation of FHTs
Palpation of fetal movements
Radiologic or US verification of gestation

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8
Q

What is the Chadwick’s Sign

A

 Chadwick’s Sign—bluish discoloration of cervix, vagina, & labia

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9
Q

What is the Goodell’s Sign

A

 Goodell’s Sign—softening of the vaginal portion of the cervix—4 weeks gestation

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10
Q

What is the Hegar’s Sign

A

 Hegar’s Sign—softening of lower portion of uterus on palpation—6-12 weeks gestation

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11
Q

What hormone detects pregnancy?

A

hCG (human chorionic gonadotropin)

  • detected at time of implantation
  • Levels double every 1.4 to 2 days; peak at 60-90 days post-fertilization; decrease/plateau at 16 weeks
  • Quant β-hCG used to determine viability of pregnancy
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12
Q

What are you going to do at the prenatal visit

1)

2)

3)

4)

5)

A
  • Confirmation of pregnancy—hCG, FHTs or ulstrasound

o History—menstrual, contraceptive, OB/GYN, sexual, surgical

o Physical exam—VS, head to toe, pelvic

o Lab Testing, Education Materals, Anticipatory guidance

o Expected date of delivery (EDD)—LMP and Naegele’s rule

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13
Q

How to calculate Naegele rule

A

 Naegele’s Rule
* Add 7 days to the date of LMP (1st day), subtract 3 months, and 1 year
* (First day LMP + 7 days) – 3 months + 1 year = EDD

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14
Q

Anticipatory test/guidance at 12-21 weeks gestation

A

quad marker screening

start discussing newborn feeding options

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15
Q

Anticipatory test/guidance at 18-22 weeks gestation

A

Routine anatomy OB ultrasound

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16
Q

Anticipatory test/guidance at 24-28 weeks gestation

A

1 hour glucose test

Rh neg-type and screen (repeat)

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17
Q

Anticipatory test/guidance at 28-34 weeks gestation

A

RhoGam administered

STI testing

review newborn feedings

administer Tdap (if needed)

preterm labor assessment and education each visit

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18
Q

Anticipatory test/guidance at 34-36 weeks gestation

A

GBS swab,

Review s/s of labor and review labor pains

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19
Q

Anticipatory test/guidance at 36-40+ weeks gestation

A

fetal position assessment

cervical exam

review s/s of labor vs false labor

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20
Q

what is
1st
2nd
3rd
trimester

A

1st 1-13
2nd 14-27
3rd 28-40

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21
Q

What are some common 1st trimester complaints

A

Breast Pain/Enlargement & Pigmentation changes

Constipation

Salivation/Bad Taste

Fatigue

Flatulence

Headache

Hemorrhoids

N/V

Urinary Freq/Incontinence

Varicosities

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22
Q

What are some common 2nd trimester complaints

A

Backache

Dyspnea - lay LR side

Epistaxis

Leukorrhea

Ligament Pain

Muscle cramps

PICA (eating non-food items)

Syncope

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23
Q

What are some common 3rd trimester complaints

A

Braxton-Hicks contractions

Discomfort of ↑extremities

Edema in lower extremities

Heartburn

joint/ pelvic gridle pain

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24
Q

Advanced maternal age is considered what age?

A
  • Advanced maternal age (AMA)—greater than 35yoa
  • More likely to experience complications with pregnancy, especially after 40
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25
Q

Anticipatory Guidance During Pregnancy

Accidents / blows to abdomen

bathing

chemical use

alcohol

A

Accidents & blows to the abdomen
o Danger signs—vaginal bleeding, leaking fluid, new/persistent/severe abdominal pain, uterine contractions, decreased/no fetal movement

Bathing
o May take warm (not hot) tub baths if ROM is not suspected; watch for syncope, overheating, dehydration

Chemical Use & Safety
o Tobacco—increased risk infertility, spontaneous abortion, preterm labor, delivery, IUGR, PROM, placenta previa, placental abruption, LBW, prenatal death, SIDS

Alcohol—complete abstinence—FAS, IUGR, microcephaly, congenital anomalies, fetal demise & birth defects of internal organs

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26
Q

Danger Signs and Symptoms in the 1st trimester

A

Spotting/bleeding (bright red blood)
Cramping
Painful Urination
Severe vomiting/diarrhea
Fever >100.4F
Vaginal infection or STI
Persistent/severe low abdominal pain
Lightheadedness/Dizziness

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27
Q

Danger Signs and Symptoms in the 2nd trimester

A

1st trimester concerns plus:
Regular uterine contractions
Unilateral leg/calf pain
Sudden gush or consistent leaking of fluid
Absence of fetal mvt >24 hours
Sudden weight gain
Sif edema of face and/or hands
Severe upper abdominal pain
Headache w/ visual changes and/or photophobia

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28
Q

Danger Signs and Symptoms in the 3rd trimester

A

1st & 2nd trimester concerns plus:
Decrease in daily fetal mvt
Menstrual-like bleeding
Constant, severe contractions
Abdominal pain w/o relief
PROM

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29
Q

signs and symptoms of preterm labor

A
  • Lightening, dropping or engagement when presenting part descends into the pelvis
  • Easier breathing but increased pelvic pressure, cramping, low back pain, more frequent urination
  • 2-4 weeks before labor or as late as during labor
  • Vaginal discharge increases or thickens; loss of mucous plug
  • Braxton-Hicks increase or become more intense
  • Softening of cervix, effacement, and some dilation up to 4cm
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30
Q

Signs and symptoms of active labor

when is it a medical emergency

A
  • True labor contractions in the back, legs, or lower abdomen
  • Menstrual-like or GI cramping sensations

Doppler FHT, tocometer (to monitor baby)

  • 4-6cm dilation or greater with regular, painful contractions causing progressive cervical change
  • Palpation of umbilical cord during pelvic exam is life-threatening emergency
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31
Q

routine exams include

A
  • Bimanual exam or Fundal height measurement
  • FHR depending on gestational age
  • Advise mother on availability of prenatal tests
32
Q

What test can they do first trimester to test for downs

A
  • Traditional Aneuploidy Screening
    o Between 9 & 13 weeks gestational age
    o Trisomy 18 (Edwards Synd.) & Trisomy 21 (Downs Synd.)
33
Q

What does the Quadruple Screening & MSAFP for NTDs
test
looking for
greatest accuracy
___ levels are associated with downs

A
  • Quadruple Screening & MSAFP for NTDs

o MSAFP, hCG, diametric inhibin A, estriol
o NTDs, Trisomies 13, 18, 21
o Greatest accuracy if performed during 16-18 weeks GA
o If elevated MSAFP—ultrasound to identify possible causes
o Low levels MSAFP—associated with Down syndr.

34
Q

Ultrasound
4-5 weeks
6 weeks
7-8 weeks
9-12 weeks
11-14 weeks
18-22 weeks

A
  • Identification of gestational sac at 4-5 weeks
    heart beat can be detected 6 weeks
  • Fetal limbs at 7-8 weeks
  • Fetal movement, stomach, bladder, umbilical cord, spin at 9-12 weeks
  • Anatomic assessment at 11-14 weeks
  • Universal recommendation for standard US at 18-22 weeks
35
Q

During the 2nd and 3rd trimesters ultrasound is used for

A

US for Fetal Age/Growth/Well-being
* Gestational Age
* Growth Assessment
* Amniotic Fluid Volume
* Post-term Pregnancy monitoring
* Maternal/Fetal Exposures monitoring
* Documentation of Fetal Viability

36
Q

fetal mvmt starts at

noticeable to mom at

A

Fetal Movement
* Passive mvt starts as early as 7 weeks; noticeable by the mother at 16-20 weeks

37
Q

When to start kick counts

what is normal?

A
  • Kick counts—28 weeks till end of pregnancy—10 movements in 2 hours is normal
38
Q

Fetal heart rate
is doppler by

normal HR is

Bradycardia

Tachycardia

A

Fetal Heart Rate
* Doppler by 10-12 weeks
* Normal 110-160
* Bradycardia—less than 110 for 10 minutes; 80-100 is non-reassuring; persistent <80 ominous
* Tachycardia—greater than 160 for 10 minutes

39
Q

FHR variability

Undetectable—

o Minimal—

o Moderate—

o Marked—

o Accelerations—

o Deceleration—

A
  • FHR Variability

o Undetectable—FHR changes are absent or undetectable

o Minimal—FHR changes are undetectable up to or <5 bpm

o Moderate—6-25 bpm

o Marked—changes >25 bpm

o Accelerations—increased in FHR over baseline

o Deceleration—decreases in FHR below baseline

40
Q

Nonstress test
FHR monitored by

assess
with

A

o FHR monitor transducer and Tocometer over fundus
o Assess over 20 minutes with mother marking events for each fetal movement

41
Q
  • Contraction Stress Test
    purpose

similar to ____ but adds:

o Positive—

o Negative—

A
  • Contraction Stress Test
    o Induced stress to assess placental insufficiency
    o Similar procedure to NST, add maternal BP every 10-15, nipple stimulation to induce contractions
    o Positive—abnormal—late decelerations present
    o Negative—normal—no late decelerations
42
Q

Biophysical Profile

A
  • Real-time ultrasound assessing fetal tone, breathing, motion, & AFV while doing a NST at the same time
  • Score 0-10 (fetal asphyxia more certain closer to 0 and cesarean deliver required)
43
Q

Intrauterine Growth Restriction

definition

based on

attempt to

A

Intrauterine Growth Restriction—fetal weight below 10th percentile for age with evidence of abnormal or dysfunctional growth

o Based on 2 ultrasounds, 3 weeks apart

o Attempt to determine cause from maternal history and physical exam; schedule delivery at 38-39 or 34-37 weeks if additional risk factors are present

44
Q

Small for Gestational Age

definition

A

Small for Gestational Age—

birth weight less than 10th percentile for GA without reference to etiology

45
Q

Macrosomia

definition

A
  • Macrosomia—

estimated fetal weight >4000g (greater than 90th percentile)—high risk for birth trauma
o Plan cesarean delivery

46
Q

What can be given to mom to promote fetal lung maturity?

A
  • Maternal steroids to promote fetal lung maturity
47
Q

Signs of Effective Breastfeeding:

A

Signs of Effective Breastfeeding:
Feeds well at least 8 times a day
Appropriate weight gain
5-10 wet diapers daily w/ 2-3 BMs
Sleeps or content between feedings

48
Q

What contraceptives can you use when breastfeeding?

A

 Progestin only OCP
 Nexplanon implant
 Depo-Provera injection
 IUD (Mirena)

49
Q

What will you see with Hep B

how is it treated?

A

Jaundice, Hepatomegaly

tx -
A—IgG
B—HBIG

50
Q

How do you get Rubella

symptoms

tx

A
  • Direct contact with urine, stool, or nasopharyngeal secretion; incubation 2-3 weeks

Postauricular & occipital lymphadenopathy
Fever, conjunctival erythema
Maculopapular rash on face spreads to trunk and disappears by the 3rd day

If none, vaccination 3 months prior to conception during preconception period or during immediate postpartum

If 1st trimester counsel on risks to fetus (Teratogenic effects in early pregnancy)

51
Q

Chicken pox

symptoms

tx

A

Characteristic rash; fluid filled vesicles

Medications for symptomatic relief
Acetaminophen
Acyclovir
Vaccination
Prevent spread of infection

52
Q

Most common intrauterine infection & leading infectious cause of mental retardation & hearing loss

A

cytomegalovirus

53
Q

cytomegalovirus

how is it spread

symptoms

tx

A

Acquired mostly from sexual contact, blood transfusions, contact with daycare children

Lymphadenopathy, hepatosplenomegaly
Leukocytosis, Lymphocytosis
Elevated LFTs

No treatment
Good hygiene & handwashing
Protected sex

54
Q
  • Primary infection during pregnancy associated with stillbirth or congenital infection, permanent neurological damage
A

Toxoplasmosis

55
Q

how is Toxoplasmosis contracted?

A
  • Ingestion of contaminated meat, feces of infected cats/farm animals, unwashed fruit/veg

Ultrasound to r/o defects
Wear gloves when handling cat litter or gardening; good handwashing
No undercooked or raw meats
Sulfadiazine, Pyrimethamine, Folinic acid

56
Q

HIV interventions for mom and baby

A

Prenatal screening
Newborn screening
HIV can be spread through breast milk
Postpartum contraception

57
Q

Pyelonephritis

what antibiotics are okay

not okay

A

okay
3rd gen cephalosporin drug of choice
Typically hospitalized for IV Abx and hydration

caution
Nitrofurantoin is a good drug to suppress infection—do not use in last few weeks of pregnancy
Sulfa drugs should be avoided in late pregnancy (neonatal hyperbilirubinemia)

avoid
Fluoroquinolones should be completely avoided in pregnancy

58
Q

Intra-Amniotic Infection is typically caused by

tx

A

Group B Strep Disease—leading cause of neonatal infection in US; maternal illness, UTI, GI infection, endometritis, bacteremia
Colonizes in vagina when present during pregnancy

IV penicillin or ampicillin for intrapartum

59
Q
  • Spontaneous Abortion—

o Threatened Abortion—

o Inevitable Abortion—

o Incomplete Abortion—

o Complete Abortion—

o Missed Abortion—

o Habitual Abortion—

A
  • Spontaneous Abortion—termination of pregnancy before the point of fetal viability
    o Threatened Abortion—possible pregnancy loss—slight bleeding, some contractions, prognosis unpredictable
    o Inevitable Abortion—pregnancy that cannot be salvages—moderate bleeding, moderate to severe cramping, dilated cervix, prognosis poor
    o Incomplete Abortion—some products of conception are passed, moderate to severe cramping, heavy bleeding, prognosis poor
    o Complete Abortion—all products of conception are expelled, bleeding minimal, contractions subsided
    o Missed Abortion—embryo is not viable but retained in utero for at least 6 weeks, spotting that later becomes heavier
    o Habitual Abortion—3 or more consecutive spontaneous abortions—recurrent pregnancy loss
60
Q

What can help prevent an abortion?

A

progesterone supplementation (vaginal supp.)

61
Q

What is an Ectopic Pregnancy

how to tx

A

Ectopic Pregnancy - Implantation of fertilized ovum outside the uterine cavity. OB emergency!

Stable, non-ruptured—IM methotrexate or laparoscopic surgery

Unstable—immediate surgical intervention

62
Q

What is placenta previa

subjective

objective

plan

A
  • Placenta Previa—placenta becomes implanted in the lower segment of uterus and obstructs presenting part prior to or during labor; placenta is pulled away from endometrial wall

Subjective
Painless bright red bleeding

Objective
Dx by ultrasound; avoid pelvic exams

Plan
Early detection and appropriate referral
<36 weeks—bed rest
May require early delivery—cesarean is best

63
Q

What is Abruptio Placentae

Subjective

plan

A

Abruptio Placentae—partial or complete detachment of a normally implanted placenta at any time prior to delivery

Subjective
Acute, severe abdominal pain, dark red bleeding

Immediate detection and appropriate referral
ABCs, IV fluids, expedient transport to hospital, blood transfusion
Emergent delivery

64
Q

Iron-Deficiency Anemia occurs because

normal H&H levels each trimester

what is the highest sensitivity

A

Iron-Deficiency Anemia—decreased RBC production due to inadequate iron supply, usually secondary to poor dietary intake

  • 1st trim: <11/33%
  • 2nd trim: <10.5/32%
  • 3rd trim: <11/33%

o Ferritin level highest sensitivity

plan -
Well-balanced diet, iron rich foods & foods the enhance iron absorption
Avoid taking iron supplements with milk, tea or antacids
Repeat Hgb in 2 weeks; monitor for infection and s/sx intrauterine growth retardation; following delivery should remain on iron therapy for at least 3 months

65
Q

most common cause of macrocytic anemia

requirement during pregnancy

A

folic acid deficiency
Folic acid requirement during pregnancy 400mcg/day
Most common cause of macrocytic anemia (pernicious anemia); usually diet related
Leads to neural tube defects

plan -
Daily intake 1mg; if previous hx neural tube defect should take 4mg/day 2-3 months prior to and during pregnancy

Repeat labs in 2 weeks; same follow up as IDA

66
Q

Plan for mothers with sickle cell anemia

A

Preconception counseling, Genetic referral

Reinforce avoiding triggers (cold environments, heavy physical exertion, dehydration, stress) and recognize symptoms of crisis

Folic Acid 4mg daily (d/t continued turnover of RBCs)

Crisis—hospitalization, transfusions, oxygen, IV hydration, sedation and analgesia

67
Q

what is HYPEREMESIS GRAVIDARUM

s/sx

tx

A

Severe nausea and vomiting; most common causes of early hospitalization in pregnancy

S/Sx of dehydration—high urine specific gravity, ketones in urine, weight loss of 5% or more; 1st trimester with typical resolution by 20 weeks

Begin with prevention—1 mo before pregnancy start MVI; dietary mods (avoid spicy, fatty; small frequent meals, bland, high protein)

Antihistamines—diphenhydramine; Antiemetics—chlorpromazine; Benzamides—metoclopramide; SRA—ondansetron

68
Q

Chronic hypertension in pregnancy def

A

Chronic hypertension in pregnancy
Hx of HTN prior to conception or HTN diagnosed prior to 20 weeks

69
Q

what is preeclampsia

A

gestational HTN with/without proteinuria

Proteinuria—24 hour urine collection—300mg or more of proteinuria

If absent proteinuria
HTN with: 1—thrombocytopenia; 2—renal insufficiency; 3—pulmonary edema; 4—visual disturbances; 5—elevated liver enzymes

70
Q

normal BP

preeclampsia BP

sever preeclampsia BP

A

normal BP <140/90

preeclampsia BP 140-159/ 90-109

sever preeclampsia BP >160/ 110

71
Q

Eclampsia symptoms

treatment

A

Eclampsia
Facial twitching
Tonic-clonic seizures
Pulmonary edema
Circulatory/renal failure

Bedrest, MgSO4, Valium, Phenobarb
Hydralazine
Steroids
Delivery

72
Q

Preeclampsia tx

A

Delivery of fetus is only cure for preeclampsia.

If less that 34 weeks—corticosteroids for lung development, OB management rather than primary care

Hospitalization if severe—apresoline; Mag Sulfate

ACEIs & ARBs are contraindicated in pregnancy

73
Q

Obesity during pregnancy

A

Lifestyle interventions—diet & exercise, labs, sonogram

Avoid weight loss during pregnancy; attempt weight gain only 11-20 lbs

74
Q

How to screen for diabetes when pregnant?

Screening vs diagnostic

A

o 1—50 gm 1 hour glucose tolerance test (<130-140 mg/dL)

o 2—100 gm 3 hour glucose tolerance test (2 elevated levels during 3 hour test indicate Gestational Diabetes)
Fasting blood sugar levels should be lower than 95 mg/dL.
After one hour, blood sugar levels should be lower than 180 mg/dL.
After two hours, blood sugar levels should be lower than 155 mg/dL.
After three hours, blood sugar levels should be lower than 140 mg/dL.

75
Q

Plan for gestational diabetes

A

o Control glucose levels; home self-monitoring; exercise; insulin if diet & exercise fail

Those with GDM are at higher risk of DM2 later in life & with future pregnancies

76
Q

What are sign of preterm labor/birth

what to do?

A

Cervical changes

20-37 weeks: 4 contractions 20 minutes apart or 8 contractions per hour with progressive cervical changes, dilation greater than 1 cm and effacement >80%

premature rupture of membrane (PROM) before 37 weeks

Plan
Immediate referral to OBGYN

OB/PEDS 2023 (2 decks)

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