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Foundations III-Women's Health > OB lecture (Part 1 to slide 102) > Flashcards

OB lecture (Part 1 to slide 102) Flashcards

1
Q

what is antepartum? intrapartum? postpartum?

A

before birth, prenatal

childbirth, labor and delivery

postnatal period until 6wks following delivery

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2
Q

TPAL stand for?

A

term
preterm
abortion
living children

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3
Q

what is considered a preterm infant?

A

born prior to 37wk gestation

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4
Q

what is considered a fetus?

A

9th wk of pregnancy –> birth

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5
Q

What is Nagele’s rule?

A

add 7 days to LMP and subtract 3 mo’s

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6
Q

what is gestational age?

A

age of fetus calculated from 1st day of LMP including 2wks when women is not pregnant

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7
Q

how long does pregnancy last? (EDC)

A

280 days, 40 wks

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8
Q

what is 1st, 2nd, and 3rd trimester?

A

1-12wks gestation
13-28wks
29-40wks

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9
Q

what skin changes can pregnant women get?

A

Melasma = mask of pregnancy >16wk

linea nigra –> darkening at midline btwn pubis and umbilicus

striae

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10
Q

what respiratory changes can pregnant women get?

A

incr. tidal volume and PO2

decr. expiratory reserve volume and PCO2

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11
Q

what cardiac changes during pregnancy?

A

incr. CO and SV

decr. systemic vascular resistance

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12
Q

effects of pregnancy on kidneys?

A

increased GFR

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13
Q

preconception counseling includes:

A

wt. management, substance use/abuse, folic acid supplementation, manage existing comorbidities

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14
Q

how much folic acid should you recommend?

A

0.4mg low risk
4mg high risk
Most prenatal vitamins contain 1mg

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15
Q

when soon can home pregnancy tests come out positive?

A

by the time of missed menses +/- 1wk

HCG level ~25

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16
Q

how long does HCG rise exponentially?

A

for 10wks then plateus

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17
Q

how often should beta-HCG double?

A

every 48hrs in normal pregnancy

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18
Q

2 hormones responsible for most pregnancy sxs in 1st trimester?

A

beta-HCG and progesterone

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19
Q

PE findings during pregnancy

A

systolic ejection murmur, Chadwick’s sign (bluish cervix), Hegar’s sign (soft uterine isthmus), Goodell’s sign (soft cervix)

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20
Q

routine labs/diagnostic at initial OB visit

A 
CBC
Blood type and Rh
Antibody screen
Rubella immunity
Syphilis testing
Hepatitis B antigen testing
HIV
UA C&S
Chlamydia/gonorrhea cultures
Pap smear
U/S (5-6wk fetal heart activity)
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21
Q

when does genetic screening occur?

A

11-13wk gestation

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22
Q

what are you looking for on U/S in regards to genetic screening during 1st trimester?

A

nuchal translucency (assoc w/ Down Syndrome)

fetal nasal bone

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23
Q

what genetic screening can be done during 2nd trimester?

A

Quad screen: AFP, HCG, estriol, inhibin-A

incr. AFP: neural tube defects, multiple gestation
abn. levels all 4 tests: trisomy 18 or 21

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24
Q

what are some invasive diagnostic tests and when are they performed?

A

amniocentesis (2nd trimester) 15-20wk gestation

chorionic villus sampling (1st tri) 10-12wk

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25
frequency of prenatal visits?
Initial visit ~ 6 – 8w after LMP Monthly until 28w gestation Bimonthly 28w – 36w gestation Wkly 36w until delivery
26
what is included in a routine prenatal care visit for mom?
wt. gain 1.5-3lbs 1st trimester, 0.8lb/wk during 2nd trimester and beyond total wt. gain 25-35lbs BP, edema, UA (proteinuria and glucosuria)
27
when can you measure fetal heart tones and what is the bpm?
10-12w 120-160bpm
28
how do you detect fetal movement?
begins around 18-20wk for 1st pregnancy using "count to 10" method --> 10 FM's over 2hrs
29
at 12wk where do you measure the fundal ht? at 20wks?
12w --> pubic symphysis 20w --> umbilicus
30
when do you perform Group B strep screen?
35-37w
31
how do you dx gestational dm?
screen at 24-8w 50g 1hr glucose challenge test value >130 = 3h GTT need 2 or more abn. results
32
when do you perform Rh antibody screening? and what is the tx?
26-28w gestation if negative --> RhoGAM at 28w
33
If women are Group B strep (+) what is the tx?
intrapartm IV abx if vaginal delivery: Ampicillin or Clinda w/ PCN allergy
34
T or F: most women in labor prior to GBS screen require empirical abx therapy?
FALSE. all women!
35
what are some dietary recommendations?
calories --> 350 additional per day protein --> 1g/kg/day iron --> 30mg/day Calcium--> 250mg/day carbs--> 175g/day Folic acid --> 0.4mg/day Vit D --> 600IU/day fish w/ low mercury content caffeine --> <200mg/day
36
what foods should women avoid in pregnancy?
unpasteurized dairy products or undercooked meats
37
what exercise should women avoid during pregnancy >20w gestation?
any exercise on the back bc it can decr. blood flow to etus by compressing IVC
38
vaccines in pregnancy?
update Tdap and inactive influenza avoid ALL live vaccines
39
what is effacement?
Thinning or shortening of the length of the cervix Normal length is > 2.5cm
40
what is complete dilation?
10cm dilation and 100% effacement | diameter of cervical os in cm
41
Process of labor: what is station?
Degree of descent of the presenting part in the birth canal in relationship to the ischial spines (+ or -)
42
what are the 3P's of labor?
power: uterine contractions passenger: size, position attitude of presentation pelvis/passage: bony and soft tissue of maternal pelvis
43
Characteristics of first stage of labor:
latent phase: 1st regular contractions to 3-4cm dilation active phase: ends w/complete dilation
44
how is hypocontractile uterine activity (power) measured? what is the solution?
external tocometry or internal pressure catheter (IUPC) solution --> augment labor w/pitocin
45
what is cephalopelvic disporportion? solution?
non-gynecoid pelvis, previous injury or illness causing contracted pelvis solution = abd. delivery
46
what is an abortion?
loss of pregnancy prior to 20w gestation d/t chromosomal abnormalities or teratogens
47
what is the MC complication in early pregnancy?
abortion (80% in 1st trimester)
48
what is a threatened abortion? inevitable abortion?
threatened--> vaginal bleeding w/a closed cervix inevitable --> vaginal bleeding w/open cervix
49
what is a missed abortion?
pregnancy is retained despite death of the fetus
50
what are some RF's for complicated pregnancy abortion?
Advanced maternal age, prior spontaneous abortion, multigravity, alcohol, illicit drug use, smoking
51
physical exam/labs for a complicated pregnancy abortion?
Blood w/in vagina, open vs. closed cervix CBC βHCG quant Transvaginal u/s (heart tone, fetal pole, yolk sac) blood type and RH
52
Tx for complicated pregnancy abortion?
expectant management --> pregnancy test 2wks later surg = dilation and curettage medical = misoprostol 80mcg per vagina, repeat U/s 24h later, preg test 2w later
53
Tx for septic abortion
hospitalization for IV abx = cefoxitin (+) doxycycline
54
medical options for elective abortion?
day 1 - Mifepristone 200mg 24-48hr later = Misoprostol 800mcg buccaly ONLY up to 70 days gestation
55
surgical elective abortion options?
suction curettage: 1st trimester pregnancy dilation and evacuation: 2nd trimester, laminaria placed w/in endocervix 24-48h prior to procedure
56
surgical abortion complications:
hemorrhage, uterine perforation, infx/retained products, death, postabortal pregnancy tx--> methergine and D&C
57
RF's for ectopic pregnancy
prior ectopic, previous tubal surgery, hx of PID
58
clinical presentation of ectopic pregnancy
pelvic/abd pain, vag bleeding, orthostatic s/s
59
Diagnostic/labs for ectopic pregnancy?
CBC, βhCG, CMP, LFT's, Rh factor, blood type, BUN, Cr | Transvaginal u/s
60
medical tx for ectopic pregnancy?
administer RhoGAM in Rh (-) women Methotrexate IM
61
parameters for dosing methotrexate IM in ectopic pregnancy?
inhibits DNA synthesis and fetal cells HCG < 5,000, no cardiac activity, sac <4cm repeat HCG on days 4 and 7 ( >15% HCG decline)
62
contraindications to methotrexate?
Renal / liver / pulmonary compromise, at risk for loss to follow up, breastfeeding, heterotopic pregnancy, immunodeficiency
63
surgical tx options for ectopic pregnancy?
administer RhoGAM if (-) laparoscopy vs. laparotomy indicated: hemodynamically unstable, impending or active rupture, methotrexate failure, heterotopic pregnancy
64
what is Gestational Trophoblastic Disease?
Abn. proliferation of trophoblastic tissue (epithelium) of the placenta 2/2 abn. fertilization maternal tumor arises from gestational tissue
65
what are the 4 types of gestational trophoblastic dz?
Hydatiform Mole = MC (80%) Invasive Mole Placental site nodule Choriocarcinoma
66
what is complete and partial hydatiform mole (molar pregnancy)
complete: no chromosomes or 2 copies of paternal partial: 2:1 paternal vs. maternal DNA
67
clinical presentation of gestational trophoblastic dz?
``` Abn. uterine bleeding/Amenorrhea Uterine size greater than dates Absent fetal heart tones Hyperemesis Pre-eclampsia “like” sx prior to 20w ```
68
what will you see on U/S for gestational trophoblastic dz?
"snow storm" or "grape-like clusters" w/in endometrium | uterine is enlarged
69
Tx for hydatiform mole?
D&C to evacuate contents of uterus, pelvic rest for 4-6 wk, close monitoring of hCG levels for 6-12 mo's, avoid pregnancy 12mo's
70
what is placental abruption?
Premature separation of a normally implanted placenta after 20th wk gestation d/t rupture of maternal vessels
71
clinical presentation of placental vaginal bleeding:
Abrupt PAINFUL vaginal bleeding Abd/back pain Contractions
72
tx for placental abruption?
closely monitor hemodynamic status, continuous fetal monitoring, expectant management in stable mom's only unstable --> C-section
73
what is placenta previa?
An abnormal location of the placenta over, or in close proximity to, the internal cervical os (unknown etiology)
74
RF's for placenta previa?
Prior c- section Multiple gestation Prior Hx of previa Advanced maternal age
75
clinical presentation for placenta previa?
PAINLESS vaginal bleeding after 20wk gestation
76
what is a low-lying placenta previa?
located near but not directly adjacent to internal os?
77
dx for placenta previa?
U/S Never perform cervical exam bc hemorrhage can occur
78
Tx fo placenta previa?
asx. --> avoid intercourse, decr. physical activity, may resolve w/advanced gestational age sx. --> admit to hospital, C-section
79
what is the MC cause for pre-term delivery?
premature rupture of membranes (before onset of uterine contractions
80
what is pre-PROM?
Rupture of membranes before 37w gestation without the presence of uterine contractions
81
RF's for premature rupture of membranes?
genital tract infx (BV), smoking, previous pre-term delivery
82
Dx for premature rupture of membranes:
Speculum exam reveals amniotic fluid coming out of the cervical os or pooling of fluid in the vaginal fornix Sample vaginal fluid and look for “ferning” under microscope high concentration (+) alpha-fetoprotein vaginal fluid pH is 7.0-7.3
83
Tx for premature rupture of membranes?
corticosteroids to promote lung maturity < 34w If GBS status unknown administer abx prophylaxis Expectant management until delivery
84
what is the etiology of post-partum hemorrhage?
uterine atony (#1): lack of effect contractions following delivery trauma, coagulopathy
85
PE for post-partum hemorrhage?
Tachycardia Oliguria ↓O2 saturation Hypotension
86
tx for post-partum hemorrhage
``` Uterine massage IV hydration Oxytocin/misoprostol/methergine Blood transfusion Surgery ```

Foundations III-Women's Health (13 decks)

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