Exam #5: History & Exam of the Pregnant Female Flashcards Preview

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Flashcards in Exam #5: History & Exam of the Pregnant Female Deck (31)
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1

Why should you ask the pregnant patient about her past menstrual cycles?

Regularity or irregularity can effect due date

2

When should a woman start taking folic acid if she has a history of a prior infant with a NTD?

Prior to attempting subsequent pregnancy

3

What immunizations can be given during pregnancy?

tDAP
Influenza

4

What is Naegele's Rule?

Method of estimating date of delivery (EDD)

"Day 1 of the LMP - 3 months + 7 days"

5

When is US most accurate?

Early--it is INVERSELY related to the length of gestation
- Accurate within 5 days if within the first 7 weeks

6

What are the two questions you need to ask when a woman presents with an early pregnancy?

1) Where is it i.e. is it an ectopic pregnancy?
2) Is the fetus viable?

7

How do you determine viability & location of a pregnancy?

- Dates
- Doppler for fetal heart tones
- bHCG
- Ultrasound

8

What is a molar pregnancy?

This is a "fetus" that does NOT have a viable number of chromosomes

9

When can you first hear fetal heart tones?

9-10 weeks

10

Why aren't Pap smears done in 17 year olds?

- Lesions found

11

What can pyelonephritis cause in the pregnant female?

Pre-term labor

12

What is the most important thing to know when a women presents in labor?

Need to know when fluid leak started--> has implications for when labor needs to happen for prevention of infection

13

What are leopold manuvers used to determine?

Fetal lie or fetal presentation i.e. relation of the fetus to the maternal spine
- Transverse
- Oblique
- Longitudinal

14

How does the fetal position differ from the fetal lie?

Fetal position describes the presenting part in relation to the pelvis
- Determined with the occiput--"Occiput Posterior vs. Occiput Anterior" & variations of that

15

What is the difference between effacement & dilation?

Effacement= thinning
Dilation= open

16

What are the different stages of labor and how long do they last?

1= Onset of labor to complete dilation of cervix
8-20 hours

2= Complete dilation of cervix to delivery of the baby
3-4 min

3= Delivery of the baby to delivery of the placenta
30 min

17

How does the time of labor differ for women that have and have not had a prior pregnancy?

Longer labor time (curve) is normal for 1st pregnancy

18

What are labor curves used to determine?

Need for:
1) Oxytocin
2) C-section

19

When dating a history on a pregnant woman, what do you need to know?

1) Risk factors that may affect pregnancy
2) Due date & fetal growth

20

What are special things that you will focus on in terms of history on a pregnant woman?

1) Diet
2) Prior surgery
3) OB/GYN history
- Menses, STD, Pap smear, Infertility
- G/P, C-section, Complications
4) Family history
- Inherited disorders, birth defects
5) Social history--drugs & alcohol/ abuse

21

What do G, P, T, P, A, & L mean in an OB/GYN history?

G= # pregnancies
P= # w/ birth beyond 20 weeks
T= # term pregnancies
P= # preterm pregnancies
A= # abortions/ miscarriages/ ectopic pregnancies
L= # of living children

22

During your first physical of a gravid female, what are special things that you will need to take into account?

1) Height/ weight
2) Uterine size & shape
3) Pelvis size & shape
4) Blood pressure baseline

23

What labs should you get on your gravid patient?

- Prenatal screen for genetic abnormalities
- STD
- Cervical cytology (after age 21)
- Blood group
- Urine culture

24

How often should you be seeing your gravid patient in the office?

36 weeks= weekly

25

What is done at each gravid patient visit?

- Fetal heart determination
- Weight
- BP
- Urine for glucose/ protein/ nitrites

26

When is fetal activity perceived by the mother?

18-20 weeks

27

When do you need to start measuring the fundal height?

20 weeks

28

What is the rule of thumb regarding fundal height?

Weeks of gestation= cm from symphysis pubis to top of fundal +/- 2cm

29

What are the common physical changes that happen in pregnancy?

- N/V & dehydration
- Constipation
- GERD
- Hemorrhoids
- Pica
- Varicose veins
- Hemorrhoids
- Urinary frequency
- Larger breasts
- Dyspnea

30

What are the later physical changes of pregnancy?

- Contractions
- Edema
- Excessive weight gain
- Skin pigmentation changes--"cholasma" & "spider hemangiomas"
- MSK changes
- Carpal Tunnel Syndrome