OB Flashcards by Mike Baird

Define embryo, fetus, and infant

Fertilization to 8 weeks
8 weeks to birth
Birth to 1 year

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Naegle rule of estimating date of delivery

LMP - 3 months + 7 days

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Developmental age vs gestational age

Number of days since fertilization

Days or weeks since LMP (usually DA + 2 weeks)

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What screens occur in each trimester?

1- fetal heart sounds
2- quad screen, movement @20 weeks, an atomic U/S @20
3- frequent visits to check for labor

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What is a term pregnancy?

37 weeks -

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Interpret a GP number

G(# of pregnancies) P(full term births/pre term/abortions/living kids)

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What are the first signs of pregnancy and when?

Goodell sign - 4 weeks - softening of cervix
Ladin sign - 6 weeks - softening of midline of uterus
Chadwick sign - 7 weeks - vagina/cervix turn blue
Telangectasias/palmar erythema - 1st trimester
Chloasma - 16 weeks - mask of pregnancy
Linea Nigra - 2nd trimester - hyper pigmented line on abdomen

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When does the bhcg peak?

10 weeks (can visualize gestation at 5 weeks)

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What are cardiology changes of pregnancy?

Increased cardiac output (increases HR)

Slightly lower blood pressure (trough 26 weeks)

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What are renal changes of pregnancy

Increase in size of kidney and ureters

Increase in GFR

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What are the hematologic changes of pregnancy

Anemia (plasma volume increases by 50%)

Hypercoagulable

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What tests are completed in the 1st trimester

11-14 weeks: u/s to confirm gestational age, check for NT
Blood tests
Pap
GC
Down syndrome screen

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What is the best way to establish gestational age

U/S

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What screenings occur in the 2nd T

15-20 weeks: triple/quad screen (AFP/Bhcg/estriol + inhibin)
-AFP: dating error/NTD/abdominal wall defect
-other 3 tests: increase sensitivity of AFP
Fetal heart rate
16-20: quickening (feel for fetal movement)
18-20: U/S to look for malformation

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What should you do if you have continued Braxton hicks contractions

Check the cervix (cervix should not be open)

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What are 3T tests?

26: glucose load (if >140 then do oral tolerance test)
27: CBC (iron if hb

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Name 2 tests for obtaining fetal karyotype and how they are done

CVS: 10-13 weeks into intrauterine cavity
Amniocentesis: 11-14 weeks transabdominally into amniotic sac

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Most common site of ectopic pregnancy

Ampulla

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Risk factors for ectopic

Previous ectopic&raquo_space; PID = IUD

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When do you avoid MTX in patients with ectopics?

Immunodeficiency
Non compliant
Liver disease
Larger than 3.5cm
Heartbeat present

How do you define an abortion

Before 20 weeks or less than 500 grams

What is required to differentiate abortion types

Ultrasound

What are the 5 main types of abortion and their tx?

Complete: follow up
Incomplete: D&C or medical
Inevitable (cervix dilated): D&C or medical
Threatened (no cervical dilation): bed/pelvic rest
Missed (fetus dead but products present): D&C or medical

What is the first clue of multiple gestations?

Elevated AFP and BHCG

What are the 2 twin types?

Mono: 1 egg/1sperm --> identical Di: 2 eggs/2sperm --> fraternal

What is morning sickness due to and when does it occur

Increase in placental release of BhCG | 12-14 weeks

Define preterm labor

Contractions with cervical dilation

When do you wish to delay delivery and what do you administer?

24-33 EGA, 600-2500 grams | Administer betamethasone and tocolytics (MgSulfate>Ca2+ blockers=Terbutaline)

Do you deliver if in PROM?

Chorio? Then yes | Term with no chorio? Wait 6-12 hours and then induce if no SVD

What should you never do in 3rd T bleeding?

Digital vaginal (abdominal U/S instead)

How do you define a low lying placenta?

Not covering the os (0

Differences between placenta Accreta/Increta/Percreta?

Superficial uterine wall myometrium serosa/bladder/rectum invasion

When is prenatal Ab screening completed

28 and 35 weeks --> unsensitized at 28 weeks get rhoGAM

How do you handle a patient sensitized to Rh (>1:4)?

no treatment necessary | >1/16 --> serial amniocentesis to evaluate fetal bili

What 3 drugs are safe for chronic HTN in pregnancy?

Methyl dopa Labetalol Nifedipine

What is different in mild and severe preE

>140/90 Vs >160/110 >300mg protein vs >5g hand/feet/face vs generalized edema No AMS/vision changes/liver issues vs Yes to all

Treat eclampsia

Mag Sulfate Hydralazine Delivery

What tests do you get weeks 32-37?

32-36: weekly NST and U/S for fetal size >36: 2 tests per week of NST and BPP (amniotic fluid) 37: L/S ratio

How do you evaluate for gestational DM?

1) glucose load test (nonfasting ingestion of 50mg and measure 1 hour later 2) >140 = oral glucose tolerance test (100mg fasting and measure at 1 2 and 3 hours)

Gestational DM treatment vs Type 2 DM

Diet and walking +/- metformin and glyburide | Insulin

What is the definition of a reactive NST and what is 1 reason for a bad test?

2 fetal movements + acceleration of >15bpm for 15-20 seconds | Baby may be sleeping

BPP consists of:

``` NST Fetal chest expansions (1+ over 30 min) Fetal movement (>3 in 30 min) Fetal muscle tone (flex an extremity) AFI ```

What are the 5 stages of labor?

``` 1: onset to full dilation Latent: onset to 4cm Active: 4cm to full 2: full to delivery 3: delivery to placenta ```

Steps of stage 2

Engage - descend - flex - internal rotation - extend - external rotation - delivery of anterior shoulder - delivery of posterior shoulder

What patients should not get PGE2?

Asthmatics (may cause bronchospasm)

``` Define: Prolonged latent stage Protracted cervical dilation Arrest of descent Arrest of cervical dilation ```

Takes >20 hours to reach 4cm Cervix does not dilate more than 1.2cm in an hour Fetal head does not move down the canal No dilation of the cervix for >2 hours

What are the 3 breeches?

Frank: hips flexed with extended knees Complete: hips and knees flexed Footling: feet are first (one or both)

Define postpartum hemorrhage and the most common cause

>500mL blood after delivery | Atony: no contractions of the uterus after delivery

How do you treat atony?

1) Examine to ensure there is no rupture 2) Bimanual compression and massage 3*) oxytocin to induce contraction