OB Flashcards by Salvatore Liotta

What do the TPAL of Parity stand for?

Term: deliveries between 37 and 42 weeks
Preterm: between 20-37 weeks
**considered viable after 23 weeks
Abortion: spontaneous or induced prior to 20 weeks
Living: living children

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How long does pregnancy last

280 days

40 weeks

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Technically when does the post partum period end?

6 weeks after delivery

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Nagele’s Rule

Due date: add 7 days to last menstrual period and subtract 3 months

ex. LMP: 2.20.18, EDD: 11.27.19

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Gestational age

age of fetus calculated from 1st day of LMP (includes 2 weeks when woman is not pregnant

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Fetal age

age of fetus calculated from time of implantation.

Gestational age - 2 weeks

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Which trimester are fetus most sensitive to teratogens?

1st trimester

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Embryo timeframe

fertilization to 8th week of pregnancy

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How are the trimesters broken up?

First trimester: 1-12 weeks
Second trimester: 13-28 weeks
Third trimester: 28-40 weeks

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What is the recommendation for folic acid supplementation for low risk and high risk?

low risk: 0.4 mg

high risk: 4 mg

*start these prior to pregnancy

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What is the hCG level around the time of missed menses?

~25. Then increases exponentially for 10 weeks then plateaus

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Progesterone secretion in early pregnancy

Corpus luteum makes for ~6 weeks

Placenta makes progesterone after 6 weeks

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How much does beta hCG increase in a normal pregnancy

doubles every 48 hours

-this is responsible for nausea and vomiting

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Goodell’s Sign

softening of the cervix

-4-6 weeks gestation

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Hegar’s Sign

softening of uterine isthmus

-6-8 weeks gestation

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Chadwick’s Sign

bluish discoloration of cervix

-8-12 week’s gestation

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Initial OB Visit

Labs: CBC, Blood type and Rh, Rubella, Syphilis, Hep B antigen, HIV, Chlamydia and gonorrhea cultures

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When can fetal heart activity be detected?

5-6 weeks

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When is the Quad screen done?

2nd trimester

Blood testing
AFP, hCG, Estriol, Inhibin-A

Increased AFP -> neural tube defects, multiple gestations
Abnormal tests (all 4) –> trisomy 18 or 21

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When is Chorionic Villus Sampling done?

1st trimester (extracts placental cells)

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When is Amniocentesis done?

2nd trimester (extract amniotic fluid)

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Frequency of visits

initial: 6-8 weeks after LMP
Monthly for 1st and 2nd trimesters

Bimonthly 28-36 weeks
Weekly 36 weeks - delivery

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Fetal heart tones

120-160 bpm is normal

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When do you begin measuring fundal height?

20wks

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When do you start cervical exams?

37 wks

When you measure fundal height at the umbilicus what is the gestational age?

20 weeks = umbilicus

When do you need to screen for gestational diabetes?

24-28 weeks

When do you do repeat antibody screen for Rh negative women

26-28 weeks

When is hemoglobin and hematocrit screened?

3rd trimester | -35 weeks

When do you perform group B strep screen?

35-37 weeks

How many 3 hour Glucose Tolerance tests need to be abnormal to diagnose gestational diabetes?

2 or more

If a women that is Rh (negative) when do you administer RhoGAM?

28 weeks -attaches to Rh antigen preventing mothers immune system from attacking fetal red blood cells

What is the best treatment for a women with group B strep giving vaginal delivery?

Ampicillin IV or Clindamycin (if PCN allergic)

Why do pregnant ladies need to avoid deli meat, hot dogs and soft cheese during pregnancy?

Listeria monocytogenes

Why do pregnant ladies need to avoid raw milk and cheese?

Brucellosis

Which vaccines should pregnant ladies get?avoid?

Do: Tdap and Flu Don't: Live vaccines; MMR, varicella

Presenting parts

Vertex: head Breech: feet Transverse, Compound --> c-section

Acceleration: abrupt increase in heart rate from baseline

reassuring sign of fetal well being

Variable deceleration: abrupt decrease in heart rate from baseline

extremely common

Late deceleration: gradual symmetrical decrease in heart rate

may indicate fetal distress (ex. fetal hypoxia, maternal hypotension)

What can be given if there is hypocontractile uterine activity

give pitocin

What is the most common complication of early pregnancy?

Abortion (chromosomal abnormalities ~50%)

Abortion Types

Threatened: vaginal bleeding + closed cervix Inevitable: vaginal bleeding + open cervix Missed: pregnancy retained despite death of fetus

What drug induces uterine contractions and is used to expel conceptus with abortion?

Misoprostol (prostaglandin analogue)

Septic Abortion: Tx

- Hospitalize | - IV antibiotics (cefoxitin and Doxycycline)

What is the medical regimen for an elective abortion?

1. Mifepristone (day 1) 2. Misoprostal (day 2 or 3) **Used only for <70 days gestation

Elective abortion: surgery 1st versus 2nd trimester

1st trimester: suction curettage 2nd trimester: Dilation and evacuation

Where do most ectopic pregnancies occur?

fallopian tube (mostly the ampullary portion)

Ectopic pregnancy: Tx

1. Give RhoGAM in Rh (-) women 2. Methothrexate IM (hCG needs to be below 5000, no cardiac activity for this to work)

What is the diagnosis if the patient has a large uterus, no fetal heart tones, hyperemesis and pre-eclampsia like symptoms prior to 20 weeks with "snow storm" within endometrium

Gestational trophoblastic disease

What is the most common type of gestational trophoblastic disease and which ethnic groups are susceptible?

- Hydatiform mole | - Asians and American Indians

If your patient has a hydatiform mole, what patient education do they need to get?

Avoid pregnancy for 12 months

With a placenta previa (covering the cervical os) what must you NEVER do?

Never perform cervical exam --->hemorrhage! -avoid intercourse

Painful bleeding versus Painless bleeding after 20 weeks?

Painful --> placental abruption Painless --> placenta previa

What are some risk factors for premature rupture of membranes?

- Genital tract infection (bacterial vaginosis) | - smoking

What is the treatment for premature rupture of membranes?

corticosteroids to promote lung maturation <34 weeks

What is a classic diagnostic finding in sample fluid from premature rupture of membranes?

"ferning" under microscope

What is the most common cause of post-partum hemorrhage?

uterine atony (lack of contractons so blood vessels are constricted)

What is the treatment for post-partum hemorrhage?

- uterine massage - IV fluids - Oxytocin/misoprotol/methergine

Most twins are monozygotic (identical) or dizygotic (fraternal)?

dizygotic "fraternal twins" -2 amniotic sacs

In the 1st trimester you see a "lamda sign" on US, what does this indicate?

Dichorionic twins (fraternal)

What does a "T sign indicate?

Monochorionic twins (identical)

When does pregnancy-induced HTN technically occur?

>20 weeks (no proteinuria)

Pre-eclampsia

- New onset HTN and proteinuria after 20 weeks mild: BP >140/90, AND 0.3 or more protein in 24 hr urine specimen Severe: BP >160/110 (need 2 separate readings)

Eclampsia

seizures in a women with pre-eclampsia

In a pre-eclampsia patient when is medication indicated and which HTN meds do you use?

Use if >160/110 IV labetalol or hydralazine