OB-gyne notes Flashcards
1
Q
Birth rate
A
Live births per 1000 females
2
Q
Fertility Rates
A
Live births per 1000 females aged 15-44 y/o
3
Q
Perinatal period
A
birth - 28 days
4
Q
Infant
A
Until 1year of age
5
Q
Abortion
A
- <20 weeks AOG or
- <500 grams
6
Q
Preterm
A
<37 weeks AOG
7
Q
Postterm
A
>42 weeks
8
Q
Term
A
37-42 weeks
9
Q
Puerperium
A
Time from delivery lasting about 4-6 weeks
10
Q
Early abortion
A
<12 weeks
11
Q
Later abortion
A
>12 weeks AOG but <20 weeks AOG
12
Q
Early UTZ
A
<20 weeks AOG
13
Q
Late UTZ
A
>20 weeks AOG
14
Q
Layers of the anterior abdominal wall
A
Skin Camper’s (fatty layer) Scarpa’s fascia (membranous -> colles fascia) Muscles
15
Q
Blood supply of the anterior abdominal wall
A
Superficial epigastric Deep/inferior epigastric artery
16
Q
Male Homologues
A
- Labia Minora - Penile urethra, skin of Penis
- Labia Majora - Scrotum
- Clitoris - Penis
- Skene’s glands - prostate gland
- Bartholin’s gland - Cowper’s gland
17
Q
Borders of the Vulva
A
- Superior: Mons pubis
- Lateral: Labiocrural fold
- Inferior: Perineal Body
18
Q
Management for Bartholin duct cyst
A
Marsupialization
19
Q
Components of the Pelvic diaphragm
A
Levator ani
- Pubococcygeus
- Pubovaginalis
- Puboperinealis
- Puboanalis
- Puborectalis
Ileococcygeus
Coccygeus
20
Q
Components of the Striated Urogenital Sphincter Complex
A
- Sphincter urethrae
- Compressor urethrae
- Urethrovaginal urethrae
21
Q
Blood supply of the uterus
A
- Ovarian artery
- Uterine artery
22
Q
Vaginal Blood supply
A
Proximal portion : Vaginal and uterine
Posterior vaginal wall: Middle rectal
Distal: Internal pudendal
23
Q
Location of the ovaries in relation to the internal iliac
A
Medial
24
Q
Ligaments (Internal female genitalia)
A
- Round ligament
- Broad Ligament
- Cardinal or transverse cervical (Mackenrodt ligament)
- Uterosacral ligament
25
What ligament provides the main support of the Uterus?
Cardinal ligament and Uterosacral ligament
26
Mesosalpinx
Around the fallopian tube
27
Mesoteres
Around the round ligament
28
Mesovarium
Over the uterovarian ligament
29
Parts of the Pelvis
False Pelvis
True Pelvis
* Pelvic inlet
* Midpelvis
* Pelvic outlet
30
Arteries entering the true pelvis
"MISO"
* Median sacral
* Internal iliac
* Superior rectal
* Ovarian
31
Abnormal levels of hemoglobin
1st trimester: \<10 g/dl
2nd trimester: \<10.5g/dl
3rd trimester: \<11 g/dl
32
Presumptive evidence of Pregnancy
* Morning sickness
* Fatigue
* Frequency in urination
* Quickening
* Cessation of menses
* Beading cervical mucus
* Chadwick's sign
* Changes in breast
* Skin changes
* Increased temperature
33
Morning sickness
6-18 weeks
peak of HCG is 8-10 weeks plateus at 16 weeks
34
Quickening
16-20 weeks
* primigravid 18-20 weeks
* Multigravid 16-18 weeks
35
Beading cervical mucus
6 weeks
poor crystallization or beading is due to PROGESTERONE
36
Ferning
sign of increased estrogen, makes pregnancy unlikely
also observed as a result of amniotic fluid leakage
37
Chadwick's sign
6 weeks
Vaginal mucosa becomes dark-bluis red and congested
38
Chloasma/Melasma
Mask of pregnancy due to MSH
39
Spider telangiectasia
increased estrogen
40
Increased temperature
6 weeks due to increased PROGESTERONE
41
PROBABLE evidence of Pregnancy
* Enlargement of abomen
* Hegar's sign
* Goodell's sign
* Braxton Hick's contractions
* Physical outlining of fetus
* ballottement
* Detection of B-HCG
42
Hegar's sign
6-8 weeks
softening of the uterine isthmus
43
Goodell's sign
softening of the cervix
44
POSITIVE SIGNS of pregnancy
* FHT
* perception of fetal movement by examiner
* Sonographic recognition
45
Fetal heart tone
**Normal**: 120-160
**Auscultaion**: 16 weeks
**Doppler**: 10 weeks
**TV-UTZ**: 5 weeks
46
75 g OGTT
24-28 weeks
Human placental lactogen is produced during this time
has growth hormone like action and causes insulin resitance, lipolysis, and increased fatty acids
47
Biophysical profile
24-28 week
48
10 danger signs of Pregnancy
* Headache
* BOV
* Prlonged Vomiting
* Fever
* Nondependent edema
* Epigastric/RUQ pain
* Dec. fetal movement
* Dysuria
* Bloody vaginal d/c
* Watery vaginal d/c
49
Signs of Preeclampsia
* headache
* BOV
* Prolonged Vomiting
* Epigastric/RUQ pain
* Nondependendent edema
50
Estimated date of Confinement
Naegele's rule
EDC= LNMP + 7 days - 3 months
51
fundal height
cm
top of the pubis syphysis to the top of the fundus
**b/w 20-34 weeks, fundus correlates closely with AOG**
52
Fundal height
**12 weeks** - uterus becomes an abdominal organ
**16 weeks** - fundus is midway b/w the pubis symphisys and the umbilicus
**20 weeks**- level of the umbilicus
53
Frequency of Prenatal check-up
**\<28 weeks** (monthly)
**28-36 weeks** ( every 2 weeks)
**\>36 weeks** (every week)
54
Recommended weight gain
BMI:
* **\<18.5** = 28-40 lbs
* **18.5-24.9** = 25-35 lbs (37-54 lbs if twins)
* **25-29.9** = 15-25 lbs (31-50 lbs if twins)
* **\>30** = 11-20 lbs (25-42 lbs if twins)
55
Recommended dietary allowances
* **Calories** ( increase 100-300 kcal/day)
* **Protein** (5-6 g/day)
* **Iron** (27 mg elemental FE/day) - if large/twins (60-100) - start giving 2nd trimester
* **Folic acid** (400 mcg) (4 mg if with history of NTD)
56
Caffeine intake (OB)
Max; 3 cups of 4 oz
57
Travel (OB)
safe up to 36 weeks
58
Fetal lie
Relation of the fetal long axis to that of the mother
59
Fetal presentation
Portion of the body that is foremost within the birth canal
60
Fetal attitude
Posture or Habitus
61
Fetal Position
Relationship of fetal presenting part to the right or left of birth canal
62
Predispositon factors for transverse lie
* Multiparity
* Placenta previa
* Hydramnios
* Uterine anomalies
63
caput succedaneum
local edema
molding refers to bony changes in the fetal head, which results in shortened suboccipitobregmatic diameter
64
Phases of partutiton
* **Phase 1 (Quiescence)** - prelude to parturition
* **Phase 2 (Activation)** - Preparation for labor
* **Phase 3 (stimulation)** - Processes of Labor
* **Phase 4 (Involution)** - Parturient recovery
65
QUIESCENT phase
* Prelude to parturition
* Begins even before implantation
* Contractile unresponsiveness
* Cervical softening
* Braxton Hicks contractions may be felt
66
ACTIVATION phase
* preparation of labor
* during the last 6-8 weeks of pregnancy
* Myometerial unresponsiveness suspeded: OXYTOCIN receptors increase
* Formation of the LUS
* Cervical ripening, effacement, and loss of structural integrity
67
Treatment to promote cervical ripening
* PGE2
* PGF2
* progesterone antagonist
68
STIMULATION phase
* processes of labor
* Uterine contraction
* cervical dilatation,
* fetal and placental expulsion
69
INVOLUTION phase
* parturient recovery
* Uterine involution
* Cervical repair
* Breastfeeding
70
LABOR
uterine contractions that bring about demonstrable effacement and dilatation of the cervix
71
FIRST stage of Labor
Starts with painful regular contractions ends with cervical dilatation
Bloody show - spontaneous release of blood-tinged mucus plug from the cervical canal
72
Ferguson reflex
mechanical stretching of the cervix enhances uterine activity
73
Ring of Bandl
Pathological retraction ring
* thinning of the LUS is extreme
74
SECOND stage of Labor
Begins with complete cervical dilatation (10 cm)
Ends with fetal delivery
75
the most important force in fetal expulsion
Intraabdominal pressure
76
Station
describes the descent of the fetal biparietal diameter in relation to a line drawn between **two maternal ischial spines**
77
THIRD stage of labor
Delivery of the placenta
78
7 cardinal movements of labor
* Engagement
* Descent
* Flexion
* Internal rotation
* Extension
* External rotation
* Expulsion
79
Engagement
BPD passes thru the pelvic inlet
80
Descent
Due to 4 forces:
* Pressure of the amniotic fluid
* Pressure of the fundal contractions
* Maternal effort
* Straightening of fetal body
81
Flexion
OFD shifts to SOBD
82
Internal rotation
Occiput moves toward pubis symphysis
83
Extension
Due to 2 opposing forces:
* Pressure of fundal contraction
* resistance of pelvic floor
84
External rotation
BSD to APD
85
Functional division of Labor
Preparatory Division
Dlatational Division
Pelvic Division
86
Abnormal labor progression in the active phase
cervical dilatation**\<1.2 cm/hour in nulliparas**
cervical dilataion **\<1.5cm/hour in multiparas**
87
Labor arrest
Absence of appreciable change in 2 hours in the presence of adequate uterine contractions
88
Signs of Placental separation
"up-down-up-down"
* Uterus becomes globular and firmer (CALKIN's sign)
* Sudden gush of blood
* Uterus rises in the abdomen
* Lengthening of the umbilican cord
89
Mechanisms of placental expulsion
Schultze
Duncan
90
Schultze Mechanism
Blood from the placental site pours into the membrane sac and does not escape externally until after extrusion of the placenta
Retroplacental hematoma follows the placenta or is found within the inverted space
91
Duncan Mechanism
Placenta separates first at the periphery and the blood collects between the membranes and the uterine wall and escapes from the vagina maternal surface appears first
92
Prolonged latent phase
\>20 hours (nullipara)
\>14 hours (multipara)
93
Protracted active phase
\<1.2 cm/hour (nullipara)
\<1.5 cm/hour (Multipara)
94
Protracted descent
\<1 cm/hour (nullipara)
\<2 cm/hour (multipara)
95
Prolonged deceleration phase
\>3 hours (NP)
\>1 hour (MP)
96
Secondary arrest of dilatation
\>2 hours (NP)
\>1 hour (MP)
\*\* of no cervical dilatation
97
Arrest of descent
\> 1 hour (NP)
\> 1 hour (MP)
\*\* must be in deceleration phase
98
Failure of descent
No descent on deceleration phase or 2nd stage of labor
99
Precipitous Labor
Expulsion of fetus in \<3 hours
Associated with:
* Abrutio placenta
* Meconium passage
* Postpartum hemorrhage
* Low APGAR
**TX:**
* B-mimetic
* MgSO4
* Lateral decubitus
100
Cepalopelvic disproportion
DC \<11.5 cm
BSD \<8cm
BTD \<8 cm
101
Asynclitism
lateral deflection of the sagittal suture, posteriorly toward the sacral promontory or anteriorly toward the symphysis pubis
102
Anterior Asynclitism
sagittal suture approaches the sacral promontory and the anterior parietal bone presents itself on the examiner's finger
103
Shoulder Dystocia Drill
A- Ask for help
L - lift legs (Mcrobert's position)
A - Anterior shoulder disempaction
R - Rotation of the posterior shoulder
M - Manual Extraction of the posterior arm
E - Episiotomy
R - Roll on all fours
104
McRobert's position
causes straightening of the sacrum, rotation of the pubis symphysis toward the maternal head, and a decrease in the angle of pelvic inclination
105
Mazzanti Maneuver
(Abdominal) - anterior shoulder disempaction with the heel of clasped hands, suprapubic pressure is applied by another member of the team to the posterior aspect of the anterior shoulder pressure may be sufficient to abduct the shoulder
106
Rubin's maneuver
(Vaginal) Physician's hand reaches the ost anterior fetal shoulder, which is then pushed toward the anterior surface of the fetal chest this abducts the shoulder, which reduces the shoulder to shoulder diameter
107
Woods corkscrew maneuver
delivery of the posterior shoulder then progressively rotating the posterior shoulder 180 degrees in a corksrcrew fashion
108
Gaskin maneuver
Moving the mother to an all fours position with the back arched, widening the pelvic outlet
109
Cleidotomy
Fracturing the clavicle with scissors
110
Symphysiotomy
Symphyseal cartilage is cut
111
Zavanelli
Return the head to the occiput anterior or posterior position
Give acute tolysis
Flex the head slowly push it back to the vagina
CS delivery is then performed
112
Guideline for intrapartal FHR monitoring (LOW RISK)
Auscultation:
* 1st Stage: every 15 minutes
* 2nd Stage: every 5 minutes
113
Guideline for intrapartal FHR monitoring (HIGH RISK)
Continuous EFM
Documented systematic assessment every hour
114
Baseline Heart Rate
Mean FHR rounded to increments of 5 beats over minute during a 10 minute segment excluding segments that differ by 25 bpm
Normal: 110-160
115
Baseline Variability
Fluctuations with irregular amplitude and inconstant frequency
* Absent: Amplitude range undetectable
* Minimal: Amplitude range detectable, but \<5 beats/min
* Moderate: 6-25 beats/min
* Marked: \>25 beats/min
116
Acceleration
Visually apparent abrupt increase in FHR above baseline, with the time from the onset of the acceleration to its acme \<30 seconds)
**if \>32 weeks** : Peak is \>15 beats/min lasts \>15 seconds but \< 2 inutes.
**if \<32 weeks:** Peak \>10 beats/min above the baseline; lasts \>10 seconds but \< 2 minutes from onset to return to baseline
**Prolonged acceleration**: lasts \> 2 minutes but \< 10 minutes in duration
**Change in baseline**: if the acceleration lasts \>10 minutes
117
Decelerations
Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction;
Gradual FHR is defined as from onset to the FHR nadir is \>30 seconds
118
Early deceleration
The nadir deceleration occurs at the same time as the peak of the contraction
Head compression -\> vagal nerve activation
119
Late deceleration
Deceleration is delayed in timing, with the deceleration occuring after the contraction.
Uteroplacental insufficiency-\> hypoxia Maternal hypotension
* Excessive uterine activity
* Placental dysfunction
* Maternal disease
120
variable Deceleration
Visually aparent abrupt decrease in FHR;
an Abrupt decrease is defined as from onset to the FHR nadir \<30 seconds
Cord compression patterns occlusion of vein -\> reduced fetal blood return -\> acceleration occlusion of artery -\> fetal systemic hypertension -\> deceleration
121
Prolonged deceleration
Decrease in FHR from the baseline is \>15 beats/min lasting \> 2 minutes but \< 10minute in duration
122
Sinusoidal pattern
Visually apparent, smooth, sine wave like undulating patern in FHR baseline with a cycle frequency of 3-5 minutes that persists for 20 minutes or more
Severe fetal anemia
123
Uterine contractions
quantified as the number of contractions present in a 10 minute window, averaged over a 30 minute period
* **Normal**: \<5 contractions in 10 minutes
* **tachysystole** \> 5 contractions in 10 minutes (averaged over 30 minutes)
124
Category I FHR:
* Normal tracings
* Baseline: 110-160
* Moderate variability
* (-) late decelerations
* (+/-) accelerations
125
Category II FHR:
* Indeterminate tracings
* Requires continued surveillance
* Baseline: Tachycardia
* Bradycardia not accomapanied by no variability
* Variability: minimal
* Decelerations: Periodic or episodic
* Accelerations (-)
126
Category III FHR
Abnormal tracings
Predictive of abnormal fetal acid base status
Requires prompt evaluation and initiation of attempts to resolve
127
Nonstress test
tracing is labeled as nonstress when there is no contraction within the 20 minute trace.
* **Reactive**: \>2 accelerations within 20-40
* **NR:** \<2 accelerations
128
Resuscitative Measures for abnormal tracing
* Left lateral decubitus
* oxygen support
* Discontinue oxytocin
* IV fluid bolus (200cc)
129
How to give oxytocin
10-20 units in 1L = 10-20 mU/mL
start at 6mU/mL increase in 40 minute interval to 42 mU/mL
in PGH: 10 units in 1L start at 8 drops/min titrate by 2 cc/hr every 15-20 minutes
GOAL: q3-4 min contractions, moderate to strong, 60-90s but \< 7 contractions in 15 minutes
130
When to stop giving oxytocin
contractions are 5x in 10 minutes
contractions are 7x in 15 minutes
contractions are longer than 60-90 secs.
If fetal heart rate is non reassuring
131
Induction of labor
Stimulation of contraction before spontaneous onset of labor
132
Augmentation of Labor
Stimulation of sponteneous contraction that is inadequate
133
Indications of induction of Labor
* Rutpture BOW
* Maternal HPN
* Nonreassuring fetal status
* Postterm gestation
134
Contraindications for induction of labor
1. Uterine factors:
* Uterine scar,
* Classical CS
* Placenta previa
2. Fetal Factors
* Macrosomia
* Fetal congenital anomaly
3. Maternal factors
* Maternal size
* Pelvic anatomy
* Active genital herpes
135
Failed induction of labor
12 hours of Oxytocin after ruptured BOW without progress
136
Bishop scoring system
Predicts labor induction Dilatation
* Effacement
* Consistency
* Position
* Station
score of 9 : high likelihood
\<4: unfavorable
137
Agents for cervical ripening
* Dinoprostone (PGE2)
* Misoprostol (PGE1)
138
Mechanical Dilatation of the cervix
* Hygroscopic osmotic dilatation
* membrane stripping
* Transcervical catheter attached to dangling urine bag with 300mL water
