Lecture 10: Vaginal & Vulvovaginal Disorders

Question 1

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

Answer 1

Early signs of pregnancy

Question 2

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?

Answer 2

+ 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)

Question 3

When is the EGA ideally determined by?

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

Answer 3

6-8 wks GA

EGA = due date

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

Question 4

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

What measurement provides an accurate EDD?

Answer 4

EDD = (LMP - 3 mo) + 7 days

Crown Rump Length (CRL) provides accurate EDD

Question 5

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?

Answer 5

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

Question 6

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

Answer 6

EDD determined by US

Question 7

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

Answer 7

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

Question 8

2 MC CA dx during preg?

Answer 8

BCA and cervical CA

Question 9

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?

Answer 9

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

Question 10

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?

Answer 10

dont start new aggressive exercise regimen

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

Question 11

What vaccines should be avoid during preg and why?

2 vaccines encouraged to get while preg?

Answer 11

avoid live vaccines while pregnant –> can cause fetal malformations

1. influenza
2. Tdap

Question 12

Why is Tdap given in EVERY preg during 3 trimester?

Answer 12

Tdap –> prev pertussis in BABY

Question 13

Travel during preg:

1. when should you avoid travel?
2. What should you do every 2 hrs when traveling? why?

Answer 13

1. avoid travel > 36 wks

2. move every 2 hrs —> prevent VTE

Question 14

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 _____

Answer 14

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

Question 15

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?

Answer 15

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

Question 16

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)

Answer 16

1. Aneuploidy (Trisomy 13, 18, 21)

2. Neural tube defects

Question 17

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

What are the screening for?

Answer 17

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

screening for Trisomy 13, 18, 21

Question 18

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?

Answer 18

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)

Question 19

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

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

Answer 19

NIPT = Non-invasive Prenatal testing

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

Question 20

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

Answer 20

look at b hCG

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

Question 21

What is a normal NT value?

Answer 21

normal NT: < 3 mm

Question 22

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

Answer 22

Trisomy 21: high b hCG + Inhibin

everything low in Trisomy 18

Question 23

2 Types of genetic TESTING?

• what is genetic testing looking for?
• which is done earlier in preg

Answer 23

• genetic testing looking for chrom abnormalities

1. CVS - chronic villus sampling
   - done earlier
2. Aminocentesis
   - done > 15 wks

Question 24

Anteatal Testing: 
\_\_\_\_\_  includes :
1. Fetal growth + anatomy
2. Sex 
3. Chrom abn/birth defects
4. Placentation 
5. Cervix length

Answer 24

Routine Anatomy US

Question 25

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)

Answer 25

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

Question 26

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?

Answer 26

1. MC complaint = round ligament pain (relief w/positioning) 2. Detect fetal movement 3. give Rhogam (28 wks) if Rh (-) mother

Question 27

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_

Answer 27

GCT - Glucose Challegene Test Diagnostic Test = GTT (Gluc Tolerance Test)

Question 28

How is the GCT performed? What value indicates failure? How is GTT performed? What is considered a (+) test?

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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)

Answer 30

< 37 wks - contractions Q15 min for > 1 hr > 37 wks - contractions Q5 min (last 1 min) for 1 hr

Question 31

4 types of fetal assessment

Answer 31

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

Question 32

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?

Answer 32

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)

Question 33

2. Fetal Non-Stress Test - when performed? why? - What is considered reactive NST (normal)? - what should be done if non-reactive?

Answer 33

2. 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)

Question 34

What is a negative vs positive CST? | which is more concerning?

Answer 34

- CST: no late decelerations | + CST: late decelerations more worrisome

Question 35

What is a negative vs positive CST? | which is more concerning?

Answer 35

- CST: no late decelerations | + CST: late decelerations more worrisome

Question 36

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

Answer 36

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)

Question 37

Biophysical Profile: 1. how to score 2. What score is reassuring 3. What score is abn/why?

Answer 37

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)

Question 38

4 ways to prevent post-term pregnancy?

Answer 38

1. Sweeping of membranes 2. Ambulate 3. Sex 4. Stimulate the nipple

Question 39

1. How to do Sweeping of membranes to prevent post-term fetal preg? result? 4. How can stimulating nipple cause labor?

Answer 39

Sweeping of mem - move finger along fetal head--> rel of PGs --> +/- cervical dilation stim nipple --> rel of oxytocin --> contractions

Question 40

When is induction of labor recommended?

Answer 40

> 42 wks