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Flashcards in NCCPA Deck (32)
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1

Nageles Rule

Subtract 3 mo from LMP and add 7 days for EDC

2

Parity

# delieveries; FPAL - full term (>37w), preterm (20-36), abortion (<20) and living children #

3

Fetal heart tones can be heard at

10-12 w

4

Quickening

First awareness of fetal movements (18-20w in nullip and earlier (14-16) in multiparous woman)

5

Trimesters

1: week 1-12
2: week 13-27
3: week 28-40

6

Screening: first trimester

nuchal US, PAPP-A and b-HCG detects 82-87% of trisomy 21s
abn US, elevated b-HCG and dec PAPP-A
if positive, can offer chorionic villus sampling (CVS) or amniocentesis
*10-13 wks

7

Screening: second trimester

unconjugated estriol, AFP, inhibin A
abn low estriol/AFP and high inhibin A = trisomy 21/genetic dx
high AFP = NTD (can detect 75-85% open defects

*amnio also performed in 2nd trimester - 15-18wks
lower risk of abortion but later test if abortion desired

8

Screening: third trimester

NST, BPP

9

NST

normal if two accels (hr inc >15bpm) for 15 sec when tested for 20 min w no decels
abn: decels

10

BPP - biophysical profile

five parameters (2pts ea; total 10pts)
NST
amniotic fluid level
gross fetal movt
fetal tone
fetal breathing

11

Ectopic preg

MC in fallopian tube
risks=prev ectopic, saplingitis, abd/tubal surg, IUD, and assisted repro
serum levels of hCG double q 48h - if less think ectopic
transvag US makes dx in 90% (should see gestation when hCG>1500)

12

Ectopic treatement

Methotrexate can treat 80% (serum hCG <3.5cm, hemodynamically stable, compliant pt)
laparoscopy

13

Gestational trophoblastic disease (GTD)

complete/partial hydatidiform moles; placental site invasive moles; trophoblastic tumors; choriocarcinomas

Treat tumors with chemo; rad and surg PRN

14

Hydatidiform moles

Bengin form of GTD.

Complete: MC. empty egg. "grapelike vesciles" or "snowstorm pattern" on US. 20% progress to malignancy.
partial: fetus present but nonviable. 100,000)

15

Complications of gestational DM

maternal: preeclampsia, hyperacceleration of DM comps, traumatic birth/dystocia, risk of DM post-birth
fetal: macrosomia, prematurity, fetal demise, and delayed fetal lung maturity

16

gestational DM screening

24-28 weeks with glucose challenge test at 1 hour. if abn, need 3 hr OGTT
test high risk (prev lg infant, >25 yo, glucosuria, fam hx DM, non-wt ethnicity) also in 1st tri

17

Gestational DM tx

oral agents not useful
need insulin if fasting >105 or 2hr PP >120

18

tx of chronic htn in preg and preg-induced htn (after 20 wks)

monthly US for growth retardation, serial BPs and urine protein, weekly NST in 3rd tri

Meds only if severe - methyldopa is drug of choice; labetalol is alternative

19

classic triad of preeclampsia

HTN, edema and proteinuria (edema not nec for dx)
risk if extremes of gae, multigestation, DM, chronic HTN
Eclampsia is seizures

20

pre/eclampsia

>20 wks; can occur 6 wks post-partum

21

HELLP syndrome

pre-eclampsia with Hemolysis, Elevated Liver enzymes and Low Platelets

22

Rho-Gam

admin routinely at 28-29 wks to all Rh-neg moms. Given again following delivery if baby is Rh-pos.

also given after ectopic, spon/ther abortions, CVS, amniocentesis, trauma

23

MCC third tri bleeding

abruptio placentae

24

first stage of labor

onset of reg contractions to full dilatation
6-20h nullip; 2-14 multip

25

second stage of labor

full dilatation to delivery
30min to 3h nulip; 5-60min multip

26

third stage of labor

separation and delivery of placenta; 5 min

27

fourth stage

first hour after delivery - assess tears, lacs, hemorrhage

28

early decels

mirror contractions; often head compression prior to second stage

29

variable decels

no pattern; usu cord compression; benign if mild/infreq

30

late decels

bad; need delivery; denote uteroplacental insufficiency