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Repro > Lecture 10: Vaginal & Vulvovaginal Disorders > Flashcards

Lecture 10: Vaginal & Vulvovaginal Disorders Flashcards

1
Q
  1. Amenorrhea
  2. N/V, Food aversions
  3. breast enlargement/tenderness
  4. incr freq of urination (no dysuria)
  5. Fatigue
  6. Cramps
  7. Constipation
  8. Heartburn
  9. Nasal congestion
  10. Mood changes
A

Early signs of pregnancy

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2
Q

If a women takes an at home urine preg test and it is positive what is the range of b-hCG? Which test is able to detect pregnancy sooner?

A

+ urine b hCG = Serum b h CG > 25-50

serum can detect preg faster (5 days -1 wk after conception vs 2 wks for urine test)

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3
Q

When is the EGA ideally determined by?

What does EGA mean?
What two terms are used synonymously to indicated this?

A

6-8 wks GA

EGA = due date

  • EDD = estimated deliv date
  • EDC = estim date of confinement
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4
Q

What is the formula for Naegle’s Rule to calculate the EDD?

What measurement provides an accurate EDD?

A

EDD = (LMP - 3 mo) + 7 days

Crown Rump Length (CRL) provides accurate EDD

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5
Q

What 2 things on US confirm a viable pregnancy?
When on US are these 2 things typically visible?

What measurements are used later in the preg ( > 12 wks) to confirm it? 4 measurements?

A

Viable Pregnancy confirmed w/:

  1. Fetal pole at 6 wks
  2. FHM (fetal heart motion) at 6.5 wks

Hadlock measurements used later in preg to confirm it

  1. BPD - biparietal diameter
  2. FL - femur length
  3. AC - abd circumference
  4. HC - head circum
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6
Q

When determining due date and there is a larger than normal discrepancy b/t LMP and US EDD what should be used?

A

EDD determined by US

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7
Q

How do you document a women’s OB Hx (what system)?

What does para stand for?

What does each of the 5 letters stand for?

What is the notation for a women who had 1 pregnancy with twins to full term, both now living

A

GTPAL system

P: para = # of births

G: gravida = # of preg
T: term deliv (> 37 wks)
P:Preterm deliv (> 20 wks)
A: abortion (< 20 wks)
L: # of Living kids

NOTE: twins = ONLY 1 PREGNANCY and DELIVERY

1 pregnancy with twins to full term, both now living= G1P1002

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8
Q

2 MC CA dx during preg?

A

BCA and cervical CA

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9
Q

What is the recommended wt gain for a preg woman w/normal BMI

What if under vs overwt/obese (general wt gain)

What is baby at risk for if inadequate wt gain? 3 things if too much wt gain?

A

norm BMI –> gain 25-35 lbs

underwt –> gain more
overwt/obese –> gain less (DONT LOSE WT)

inadequate wt gain –> restricted preterm growth

gain too much wt–> poor preg outcomes, macrosomia, postpartum obesity

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10
Q

Recommended 30 min/day for 3-5 days/wk of exercise at usual activity level during preg ….what is not advised for exercise?

What can lead to neural tube defects?

A

dont start new aggressive exercise regimen

HOT things –> risk of neural tube defects (hot yoga, hot tubs, saunas)

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11
Q

What vaccines should be avoid during preg and why?

2 vaccines encouraged to get while preg?

A

avoid live vaccines while pregnant –> can cause fetal malformations

  1. influenza
  2. Tdap
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12
Q

Why is Tdap given in EVERY preg during 3 trimester?

A

Tdap –> prev pertussis in BABY

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13
Q

Travel during preg:

  1. when should you avoid travel?
  2. What should you do every 2 hrs when traveling? why?
A
  1. avoid travel > 36 wks

2. move every 2 hrs —> prevent VTE

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14
Q

Prenatal vitamins:

  1. when to start them?
  2. Why is 400 mcg of Folic Acid given? when should dose be increased?
  3. other two things to given while preg?

Too much caffeine may incr risk of _____

A
  1. start vit 1 month before trying to conceive
  2. folic acid prev neural tube defects
    - incr dose to 4 mg if h/o neural tube defects
  3. DHA, Iron

Too much caffeine may incr risk of miscarriage

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15
Q

Fundal Ht at prenatal visits:

  1. when do you start assessing?
  2. How to measure?
  3. how should it correspond to GA?
  4. When is it not reliable? (3)
  5. where should fundus be at 20 wks?
A
  1. start assessing at > 20 wks
  2. measure pubic symphysis to fundus
  3. how should it correspond to GA?
    - fundal ht should be +/- 2 cm of GA (28 wks = 26-30 cm)
  4. When is it not reliable? (3)
    - obese
    - twin preg
    - large fibroids
  5. fundus should be at level of umbilicus at 20 wks
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16
Q

What 2 things are you primarily screening for during genetic testing of preg women?

Note: genetic tests are not diagnostic, they only indic woman’s risk vs women her age ( + screen = higher than age related risk)

A
  1. Aneuploidy (Trisomy 13, 18, 21)

2. Neural tube defects

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17
Q

What are the 3 genetic tests done during the first trimester?

What are the screening for?

A
  1. PaPP-A
  2. B hCG
  3. Nuchal Translucency (NT)

screening for Trisomy 13, 18, 21

18
Q

What is the name of the genetic screening test done in the 2nd trimester? what is included in it?

How does this screening differ from 1st trimester screen?

Which quad screening test is specifically for neural tube defects?

A

QUAD Screen

  1. msAFP = neural tube defects
  2. b hCG
  3. Estradiol
  4. Inhibin

QUAD screen can only screen for Trisomy 18, 21 (1st trimester does all 3 types)

19
Q

What other genetic blood test screens for trisomy 13, 18, 21?

When is this test better?
What does it also tell you?

A

NIPT = Non-invasive Prenatal testing

  • better for older women
  • tells you baby’s sex
20
Q

What should you look at on 1st trimester screen to determine if Trisomy 13, 18 or 21?
What are the value differences?

A

look at b hCG

  • high = trisomy 21
  • very low = trisomy 18
  • low = trisomy 13
21
Q

What is a normal NT value?

A

normal NT: < 3 mm

22
Q

What is the difference in lab results b/t Trisomy 21 and 18 seen on QUAD screen?

A

Trisomy 21: high b hCG + Inhibin

everything low in Trisomy 18

23
Q

2 Types of genetic TESTING?

  • what is genetic testing looking for?
  • which is done earlier in preg
A
  • genetic testing looking for chrom abnormalities
  1. CVS - chronic villus sampling
    - done earlier
  2. Aminocentesis
    - done > 15 wks
24
Q 
Anteatal Testing: 
\_\_\_\_\_  includes :
1. Fetal growth + anatomy
2. Sex 
3. Chrom abn/birth defects
4. Placentation 
5. Cervix length
A

Routine Anatomy US

25
Q

Women comes in for 1st trimester visit (0-13 wks) and is complaining of N/V…what can you give her to combat these sxs? (3)

A
  1. Vit B6
  2. Doxylamine (unisom)
  3. +/- zofran, reglan
26
Q

2nd trimester visit (14-28 wks):

  1. What is MC complaint of women during this time?
  2. What else is detected during this time?
  3. What should be given to women ppx during this time?
A
  1. MC complaint = round ligament pain (relief w/positioning)
  2. Detect fetal movement
  3. give Rhogam (28 wks) if Rh (-) mother
27
Q

What is the name of the SCREENING test for GDM?

What is the name of the Diagnostic Test for GDM (only done if fail screening test_

A

GCT - Glucose Challegene Test

Diagnostic Test = GTT (Gluc Tolerance Test)

28
Q

How is the GCT performed?
What value indicates failure?

How is GTT performed?
What is considered a (+) test?

A

GCT: pt drinks 50g of sugar –> check sugar 1 hr later
- fail = BS > 140

GTT: pt drinks 100g of sugar –> test BS every hr for 3 hrs
- (+) = 2+ values above cutoff

29
Q

What is the main lab that needs obtained at 3rd trimester visit b/t 35-36 wks? and why?

A

GBS

- risk of GBS bacteremia/septicemia in BABY (mom not at risk)

30
Q

Labor precautions in 3rd trimester:

if mother is < 37 wks (preterm) what is length/duration of contractions?

if mother > 37 wks what is length/duration of contractions

(concerning for labor)

A

< 37 wks
- contractions Q15 min for > 1 hr

> 37 wks
- contractions Q5 min (last 1 min) for 1 hr

31
Q

4 types of fetal assessment

A
  1. Fetal Kick Counts
  2. Fetal Non-Stress Test (NST)
  3. Contraction Stress Test
  4. Biophysical Profile
32
Q
  1. Fetal Kick Counts

When (during preg/general) should they be done?

What should you tell pt to do to perform it?

What value are you looking for?

A
  1. Fetal Kick Counts
    - do > 28 wks + when dont feel movement for awhile
  • tell pt to eat something w/sugar, sit/lay down to count kicks
  • feel for 10 kicks in 2 hrs
    (if not get eval)
33
Q
  1. Fetal Non-Stress Test
    - when performed? why?
    - What is considered reactive NST (normal)?
    - what should be done if non-reactive?
A
  1. Fetal Non-Stress Test
    - perform at > 28 wks to ensure adeq oxygenation
  • reactive NST = > 2
    accelerations w/in 20 min
  • if non-reactive –> CST (contraction stress Test)
34
Q

What is a negative vs positive CST?

which is more concerning?

A
  • CST: no late decelerations

+ CST: late decelerations
more worrisome

35
Q

What is a negative vs positive CST?

which is more concerning?

A
  • CST: no late decelerations

+ CST: late decelerations
more worrisome

36
Q

5 components of the 30 min US for the Biophysical Profile?

A
  1. NST (done separate)
  2. Fetal Breathing (30 sec)
  3. Fetal Tone (1 movement)
  4. AFI - Amino Fluid index (deepest = 2 cm)
  5. Fetal movement (2- 3 gross)
37
Q

Biophysical Profile:

  1. how to score
  2. What score is reassuring
  3. What score is abn/why?
A
  1. scoring for each category = all or nothing (0 or 2 points)
  2. > 8/10 = reassuring
  3. < 4/10 = abn –> risk of asphyxia/hypoxemia (probs need to deliver)
38
Q

4 ways to prevent post-term pregnancy?

A
  1. Sweeping of membranes
  2. Ambulate
  3. Sex
  4. Stimulate the nipple
39
Q
  1. How to do Sweeping of membranes to prevent post-term fetal preg? result?
  2. How can stimulating nipple cause labor?
A

Sweeping of mem
- move finger along fetal head–> rel of PGs –> +/- cervical dilation

stim nipple –> rel of oxytocin –> contractions

40
Q

When is induction of labor recommended?

A

> 42 wks

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