Green PANCE book- OB Flashcards by Cassidy Ruocco

start at the first day of last menstrual period, go back 3 months and add 7 days

how to determine due date

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The initial prenatal visit should occur how many weeks after LMP (last menstrual period)

6-8 weeks

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pregnant women should be examined every ___ weeks until the 32nd week

4 weeks

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pregnant women should be examined every ___ weeks up to 36 weeks of gestation

2 weeks

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A woman should be examined every ___ week from 36 weeks till the end of gestation

1! every week!

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fetal heart tones should be examined at…

10 weeks (9-12 weeks)

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check fundal height starting at….

20 weeks

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normal fetal HR

120-160 bpm

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Quickening or the first awareness of fetal movement usually occurs at…

18-20 weeks (first pregnancy)

14-18 weeks (multiple pregnancies)

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Backache
Increasing varicosities
Heartburn
Hemorrhoids
Bleeding gums
Profuse salivation
Fatigue

associated with healthy pregnancy

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abnormally low PAPP-A and abnormally high B-hCG indicated increased risk of…

Trisomy 21 and other genetic disorders

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Ultrasound can detect fetal HR as early as _____ weeks after LMP

5-6 weeks

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Bluish discoloration of vagina and cervix seen in pregnancy

Chadwick’s sign

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Softening between funds and cervix in pregnancy

Hegar sign

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Amenorrhea
N/V
Breast tenderness
Quickening (fetal movement)
-nullipara: 18-20 weeks
-multipara: 14-16 weeks
Easy fatigue
Urinary frequency

Symptoms of pregnancy

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Chadwick sign
Increased basal body temp
Skin changes (melanoma, linea nigra)
Hegar sign
Uterine growth

Signs of pregnancy

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At 12 weeks pregnant, uterus is palpable above…

pubic symphysis

and fetal heart sounds heard

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At 14-16 weeks pregnant, uterus is midway between…

pubic symphysis and umbilicus

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At 20 weeks, uterus is at level of…

umbilicus

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20-38 weeks, height of uterine funds corresponds roughly (+/-2 cm) to weeks of…

gestational age

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38-40 weeks, gravid uterus is about 2-3 cm below the

xiphoid process

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A catheter or needle is used to biopsy placental cells

*avail 10-14 weeks gestation

Chorionic villus sampling (CVS)

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Withdrawal of amniotic fluid via needle under ultrasound guidance

*avail 15-18 weeks gestation

Amniocentesis

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External doppler monitor, along with an external stress gauge for uterine contractions (together called the non stress test) is used….

near term to monitor fetal well being!

*third trimester screening

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Implantation of a pregnancy anywhere but the endometrium *more than 95% occur in fallopian tube

Ectopic pregnancy

Most common cause of ectopic pregnancy is occlusion of the tube secondary to....

adhesions

``` Hx of previous ectopic implantation Previous salpingitis (caused by PID) Previous abdominal or tubal surgery Use of IUD Assisted repro ```

risk for ectopic pregnancy

Unilateral adnexal pain Amenorrhea or spotting Tenderness or mass on pelvic exam also....dizziness or syncope as well as GI distress

Ectopic pregnancy

Severe abdominal or shoulder pain associated with peritonitis, tachycardia, syncope or orthostatic hypotension

Rupture ectopic pregnancy

if serial increases of hCG are less than expected, what should be suspected?

Ectopic pregnancy

_______ _______ is diagnostic in 90% of ectopic gestation

transvaginal ultrasonography

methotrexate can be used in the tx of

ectopic pregnancies

the termination of pregnancy, by any means, before 20 weeks gestation

abortion

Spontaneous, premature expulsion of the products of conception

Spontaneous abortion

80% of spontaneous abortions occur during the...

first trimester | 50% of these associated with genetic abnormalities

Smoking, infection, maternal systemic dz, immunologic parameters, drug use

Risk factors for spontaneous abortion

Spectrum of diseases arising from the placenta and include complete and partial hydatidiform moles, placental site invasive moles, trophoblastic tumors and choriocarcinomas *divided into benign and malignant forms

Gestational trophoblastic disease (GTD) | complete molar pregnancies are most common form of GTD

A hydatidiform mole (also called a molar pregnancy) benign or malignant?

Benign | complete molar pregnancies are the most common form of GTD

Characterized by an empty egg and the appearance of "grape like vesicles" or a "snow storm pattern" on ultrasound

Complete hydatidiform moles

What is present in partial hydatidiform moles?

a fetus! ..but the fetus is nonviable

Abnormal vaginal bleeding Uterine size greater than dates Hyperemesis gravidarum (excessive vomiting) Preeclampsia like symptoms before 20 wks

presentation of complete or partial molar pregnancy

Tx of benign or low risk tumors vs malignant GTD tumors

Benign....chemo Malignant..chemo with or without radiation or surgery

what can happen 1/80 births

twins *prenatal visits should occur more frequently!

2/3 of twins are...

dizygotic (or fraternal) ..formed by the fertilization of 2 ova

Fam hx Those taking fertility drugs Mothers above average weight and height African american women

more likely to have dizygotic (fraternal) twins

These types of twins occur randomly and are associated with fetal transfusion syndrome and discordant fetal growth

Monozygotic twins (fertilization of 1 ovum)

Most common complications of multiple gestation...

spontaneous abortion or preterm birth | preeclampsia and anemia more likely also

Carbohydrate intolerance of variable severity that is only present during pregnancy

Gestational diabetes | lifetime risk increased by 50% to developing diabetes later

Preeclampsia Hyper acceleration of general diabetic complications Traumatic births (including shoulder dystocia)

Maternal complications with gestational diabetes

Macrosomia Prematurity Feal demie Delayed fetal lung maturity

Fetal complications with gestational diabetes

Obtain a random glucose on all pregnant women during the....

first prenatal visit!! ..repeat at 24-48 weeks

Managed with diet and exercise *must check blood glucose levels daily

Management of gestational diabetes

Delivery of a viable infant before 37 weeks gestation *most common cause of neonatal deaths not resulting from congenital abnormalities

Preterm labor

1. Developmental delays 2. Cerebral palsy 3. Lung disease

More likely in low birth weight infants

Smoking, cocaine use, uterine malformations, cervical impotence, infections, low pre pregnancy weight

Increase risk of pre term labor

Defined as regular uterine contractions (greater than 4-6 per hour) between 20-36 weeks gestation and the presence of 1 or more.. 1. dilation greater of 2cm or greater on presentation 2. dilation of 1cm or greater on serial exams 3. cervical effacement of greater than 80%

Preterm labor

A length of 2 cm at 24 weeks gestation increases risk to deliver _________

prematurely

Rupture of the amniotic membranes before the onset of labor at or beyond 37 weeks of gestation

premature rupture of membranes (PROM) *90% of women will go into spontaneous labor after PROM

Chorioamnionitis and endometritis increased risk of....

premature rupture of membranes (PROM)

Abnormal labor, which occurs when the cervix fails to dilate progressively over time and the fetus fails to descend

Dystocia

3 P's that can cause abnormalities in labor/delivery

1. Pelvis..sometimes pelvis not lg enough! 2. Powers..refers to the strength of contractions that are needed to dilate the cervix 3. Passenger..refers to the baby. The bigger the baby (esp the head), the more difficult

What drug can you give if contractions are inadequate

Oxytocin (Pitocin)

What is the leading indication for C sections?

Dystocia

The birth of the fetus through an incision in the abdominal and uterine walls (about 32% of deliveries in US)

C section

1. repeat C sections 2. dystocia 3. failure to progress 4. breech presenation 5. fetal distress

most common causes of C sections

Greater chance of thromboembolic events, increased bleeding and development of infection

Risks of C section

A low transverse uterine incision is usually made because of...

decreased blood loss associated with it!

This is considered when prolongation of pregnancy might expose the mother or fetus to complications and when vaginal delivery is not contraindicated

Induction of labor

Prostaglandin gel put directly on cervix ..is this used for early or late induction?

EARLY

Oxytocin (Pitocin) given IV ..is this used for early or late induction?

LATE

Artificially rupturing the membranes with a small hook to induce labor

Amniotomy

Blood loss requiring transfusion or a 10% decrease in hematocrit between admission and the postpartum period

Postpartum hemorrhage | third leading cause of maternal mortality in advanced gestation

Occurs less than 24 hours after delivery and is associated with abnormal involution of placental site, cervical or vagina lacerations and retained portions of placenta

Early postpartum hemorrhage

Occurs more than 24 hours after delivery to 6 weeks post part and most commonly caused by sub involution of uterus, retained products of conception or endometritis

Late postpartum hemorrhage

- Initially, uterine massage and compression - Establish IV access and prepare blood components - Use IV oxytocin if early **may require surgical intervention depending on severity

Management of postpartum hemorrhage

Green PANCE book- OB Flashcards

(75 cards)