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Flashcards in Obstetrics Deck (175):
1

Which hormone triggers a surge in LH?

Estrogen during the follicular phase

2

What does a surge in LH lead to

ovulation

3

Which medications have placental transmission?

- Acutane
- Antidepressant (sodium valproate)
- Anticonvulsants
- Anticoagulants
- Vitamins ADEC in excess

4

When would you refer for genetic counseling?

- advanced maternal age
- suspected carriers for gene
- family condition/trait
- recurrent SAB
- unexplained fetal death
- SIDS hx

5

Carrier tests are available for which conditions?

- Sickle Cell
- Tay Sachs
- Thalassemias
- Cystic Fibrosis

6

T/F: Tay sachs screening is offered if both parents are Jews

True

7

What percentage of pregnancies are unplanned?

50%

8

Define infertility

inability to conceive after 1yr of trying

9

When should you intervene with an eval and workup for infertility?

If <35yo, wait 1yr;
If >35yo, wait only 6mo

10

What are the 3 primary causes of infertility?

1- *Pelvic factors* (PID, adhesions, inflam)
2- *Semen defect* (amount, motility, morph)
3- *Ovulatory defect* (progesterone, cycle, luteal phase defect)

11

What is labs are performed on an infertility workup?

- Fertility awareness edu.
- TSH
- FSH
- Progesterone
- Prolactin
- Semen analysis

12

When would you perform a hysterosalpingogram w/ infertility?

Checking for potency of tubes or anatomical obstructions

13

When would you perform laparoscopy w/ infertility?

checking for adhesions and fibroids or cysts

14

Which are 3 requirements for successful conception?

Egg, sperm, good environment

15

Where does conception occur?

FIMBRIA OR AMPULLA

16

How long is the egg viable for, once released?

24hrs

17

When is hCG produced?

When egg burrows into endometrium
- hCG triggers corpus lute to secrete prog past its normal 14 days

18

Once implantation occurs, how long does the corpus lute secrete prog for?

12-16th week, until placenta takes over

19

Why might there be increased hCG on pregnancy test?

- Pregnancy (normal or complicated)
- Ovarian tumor
- Testicular cancer

20

What is the pattern of hCG increase with pregnancy?

- doubles every 48-72hrs
- peaks at 50-75 days

21

What timeframe is considered for spontaneous abortion?

loss of fetus before 20 weeks gestation

22

Describe threatened abortion

spotting/bleeding w/ NO significant cramps/clots

23

Describe inevitable abortion

- Heavy bleeding, cramps, cervix dilated, ROM, no FHTs
- decrease in hCG
- before wk 10 - natural course
- after wk 10 = D&C

24

Describe incomplete abortion

Part or all of POC (products of conception) remained in uterus

25

What are s/sx of incomplete abortion? Next steps?

- bleeding and pain
- monitor for infection/hemorrhage and refer for D&C

26

Describe complete abortion

all POC expelled
- 2-3wk follow up with provider

27

Describe missed abortion

Death of embryo or fetus with retained POC
- requires D&C

28

What is habitual abortion?

3 successive pregnancy losses
- requires referral

29

What is a septic abortion?

POC infected, may lead to systemic infection

30

What are s/sx of septic abortion?

- increased bleeding
- malodorous vaginal d/c
- pain
- fever/chills
- leukocytosis

31

What is a blighted ovum?

- Egg gets fertilized and implants- but does NOT develop

32

What is the usual cause for an anembryonic pregnancy/blighted ovum?

chromosomal abnormality

33

What is the presentation of ectopic pregnancy?

bleeding, pain, s/s of pregnancy

34

How do you dx ectopic pregnancy?

decreasing or low hCG levels and ultrasound

35

What are the risk of ectopic pregnancy?

- hemorrhage and death
- future infertility
- increased risk of future complications

36

what occurs when there is an overproduction of placental cells with an abnormally high hCG level?

hydatidiform mole

37

What is the typical presentation for a molar pregnancy?

- Large for gestational age
- bleeding and pain
- no fetal mvmt.
- more nausea than normal (hCG)
- no FHTs

38

Presence of a hydatidiform mole increases the risk for developing ________.

Choriocarcinoma

39

what are the common causes for first trimester SAB?

chromosomal abnorm, reproductive hazards and unknown

40

What are the common causes for second trimester SAB?

incompetent cervix, uterine septum, trauma

41

Which criteria help form a "Presumptive" pregnancy dx?

- Amennorhea
- N/V
- Mastodynia
- Quickening (baby moving)
- Urinary freq.
- Wt gain
- Fatigue
- Increase BBT
- Chloasma/linea nigra/darkened areola

42

Which criteria help form a "Probable" pregnancy dx?

- OTC pregnancy test (pos @ 12-14 days)
- Blood test (pos @ 9-11 days)
- Uterine changes (hegar's & goodell's)
- Ballotable mass
- Braxton-Hicks contractions

43

What is a ddx for probable pregnancy?

- choriocarcinoma, hydatidiform mole, ectopic pregnancy.
- obesity or neoplasm
- muscle spasm

44

Which findings suggest a definitive "POSITIVE" pregnancy?

FHTs, Ultrasound and X-Ray

45

What is the role of "relaxin"?

softens tissues and joints, secreted through breastfeeding

46

What is role of prostaglandins in pregnancy?

Present in amniotic fluid, menstrual blood and semen; ripens cervix and induces contractions

47

What is the role of progesterone in pregnancy?

- Secreted by CL then placenta
- promotes breast gland growth
- maintains pregnancy

48

Which form of estrogen is dominant through pregnancy?

E3 - Estriol, 1000x higher while prego

49

What is the role of prolactin in pregnancy?

Develops alveolar and glandular cells to help promote lactation and produces lactose and lipids

50

What is the role of oxytocin in pregnancy?

"Contractor hormone"
- secreted from post. pit. to express milk and stimulate the uterus
- induces labor and controls PP hemmorhage

51

What is piskacek's sign?

asymmetric enlargement of the body of the pregnant uterus, an indication of pregnancy

52

What is goodell's sign?

cervical softening, an indication of pregnancy

53

What is hegar's sign?

Uterine isthmus softens. indication of pregnancy

54

What is chadwick's sign?

bluish discoloration- increased vascularization of vaginal walls, indicating prengnancy

55

Which hormone inhibits egg maturation?

Progestin

56

Which hormone preserves corpus lute?

hCG

57

How does estrogen influence chloasma + similar conditions?

Estrogen stimulates melanocytes

58

Why and how is GI tract affected during pregnancy?

Relaxin from placenta causes GI relaxation, slowing food and water digestion

59

What are montgomery's tubercles?

small glands around the nipples that secrete oils which lubricate and protect against infection

60

At what times do breasts become more enlarged w/ modularity and when do they express colostrum?

- nodularity/enlargement by 8wks
- colostrum (rich in Ab/PRO, low in lipids) by 12wks

61

What are the normal cardiovascular changes with pregnancy?

- CO increases, peaks @ 20-24wks
- BP decreases in 2nd tri
- HR increases by 10-15bpm
- LE edema/neous congestion

62

Why will pregnant women appear anemic on lab tests?

- Plasma increases more than RBC mass increases;
- Will appear anemic on labwork as there is a RELATIVE decrease in hematocrit and hemoglobin. "Macrocytic anemia" d/t hemodilution

63

Which respiratory changes are important with pregnancy?

increase in tidal volume and O2 uptake

64

Which GI condition is common in pregnancy?

cholestasis

65

Which skin conditions are very common w/ pregnancy?

- spider angiomas and varicosities
- hyperpigmentation

66

What is the difference between gravid and gravida?

one has an "a";
- gravid = currently pregnant
- gravida = has been pregnant

67

Define nulligravida

never been pregnant

68

Define primigravida

pregnant for the first time

69

Define para

carried fetus to viability

70

Define primipara and multipara

carried one fetus and multiple fetuses to viability

71

Define parturient

woman IN labor

72

What is post-partum

post-parturient = after labor

73

What is puerpera?

woman who has just given birth

74

What is GPA

Gravida-Para-Aborta

75

What is Naegle's rule?

due date calculation:
- subtract 3mo from LNMP
- Add 7 days to day of LNMP
- Add year, if appropriate

76

How much do caloric needs increase/day for a pregnant woman?

200-300kcal

77

Which are the prenatal vitamins?

Folic acid, Iron, Calcium citrate and Mg malate

78

Can you have caffeine while pregnant?

Yes, limit to 200mg per day

79

What are the pregnancy risk factors?

- High BP
- Heart, lung, liver, kidney dz
- STI or UTI
- Diabetes (type 1)
- asthma
- seizure or psychiatric disorders
- hypothyroidism

80

What is the proposed frequency of visits throughout pregnancy?

1/mo until 28wks
2/mo from 28-36wks
1/wk from 36-40wks

81

What procedures are performed on an initial prenatal visit?

- Blood and Rh type
- CBC
- Rubella titer
- Syphilis screen (VDRL/RPR)
- Hep/HIV
- Urinalysis
- PAP smear and infection
- Toxoplasmosis

82

What is the QUAD screen?

Maternal serum screen at 16-18wks:
- AFP
- HCG
- Estriol
- Inhibit A

83

When is the diabetes screen performed?

24-28wks

84

When does the uterus become an abdominal organ during pregnancy?

First day of 2nd trimester

85

What tests are performed on prenatal visits?

- Gestational age
- Wt
- BP
- Urine
- FHR (120-160bpm)
- Fetal presentation

86

When can you hear FHTs via stethoscope ?

20wks

87

When can you hear FHTs via doppler?

12wks

88

At what rate does the uterine fundal height grow?

@ 12/14wks = above pubic bone;
@ 20wks = at umbilicus +1cm for each week

89

What infection do you test for at 36wks?

Group B strep (GBS)

90

What are the safest weeks for a pregnant woman to travel?

18-32wks

91

What is the MC cause of mental disabilities in the US?

Fetal Alcohol Syndrome (FAS)

92

Which facial features are characterized by FAS?

short eye opening, wide-set eyes, short nose, flat mid face, thin upper lip and small chin

93

What are the 3 primary characteristics of FAS?

- Characteristic facies
- Growth retardation
- CNS anomalies

94

Which minerals are important to supplement in pregnancy?

Zinc and Calcium

95

Which vitamins are important to supplement in pregnancy?

A (only in B-carotene form d/t teratogenic risk), B6 and B12

96

When would you perform amniocentesis and CVS?

Amnio - ONLY after 16wks
CVS - btw wks 9-12

97

What is oxytocin challenge aka stress test?

sees how baby reacts to oxytocin via HR monitor

98

How is biophysical profile test performed and evaluated?

- Uses U/S and Non-stress test to evaluate many parameters
- Scores up to 10, with 4pts or less being ominous

99

What is MC onset of pre-eclampsia/eclampsia?

3rd Trimester (may be 20wks to 6wks PP)

100

T/F: Progression of pre/eclampsia may be rapid

True

101

What is the presentation for pre/eclampsia?

HTN, proteinuria, wt gain, edema, HA, URQ or Epigastric pain

102

What is anasarca?

Generalized edema (pitting)

103

What s/sx would signify severe preeclampsia?

anasarca, oliguria, acute retinal hemorrhages, HA, CNS irritability

104

What is a major complication of preeclampsia?

HELLP
Hemolysis, Elevated Liver enzymes and Low Platelets

105

What is the most common complication of pregnancy?

gestational diabetes

106

What are s/sx of GD?

excessive thirst, hunger, fatigue or "not feeling right"
SCREEN @ 24-28wks

107

What are complications of GD?

SAB, polyhydraminos, preterm, HTN, dystocia, resp. distress, macrosomia

108

Which type of zygotic twins are riskier?

monozygotic

109

What are s/sx of preterm labor?

- back pain/pressure
- contractions >4x/hr
- mucoid d/c or ROM

110

When is "term"?

38wks

111

What is Franks breech position?

bum is facing outlet in pike position

112

What are complications of postterm birth?

placental insuff., asphyxia, aspiration of mecon., dystocia

113

What are red flags with post-date pregnancy?

- less mvmt
- bleeding
- severe HA/visual disturbance
- sudden wt gain
- abd. pain

114

Which drug while ingested during pregnancy will cause withdrawal s/sx

heroin

115

which organism is commonly found in soft cheeses, lunch meat and unpasteurized milk?

listeria monocytogenes

116

Which s/sx occur with toxoplasmosis?

fatigue, muscle pain and lymphadenopathy

117

Which prominent STIs are communicable in utero?

- Syphilis
- Herpes (HSV)
- CMV (salivary transmission too)
- Mycoplasma
- Hep B
- HIV

118

Which prominent STIs are communicable via birth canal?

- NG/CT
- GBS
- Herpes (HSV)
- CMV (salivary transmission too)
- HPV

119

When is HIV communicable?

in utero, delivery and via breastfeeding

120

What is trademark sign of CMV?

hepatosplenomegaly

121

Rubella is typically mild, however the congenital form may cause which problems?

deafness, heart dz, dev't delays

122

what is lightening?

when the baby drops lower into mother's pelvis

123

what is quickening?

first sign of fetal movement

124

What is "lie" fetopelvic relationship?

relationship of long axis of fetus to long axis of mother (long/transverse/oblique)

125

What is "presentation" fetopelvic relationship?

part of fetus presenting to pelvic inlet - usually vertex

126

What is "attitude" fetopelvic relationship?

relationship of fetal parts to each other (flex/ext of head on trunk)

127

What is "denominator" fetopelvic relationship?

point on PRESENTING part to describe position (i.e. Occiput, mentum or sacrum)

128

What is most common denominator? Why?

Left occiput anterior d/t liver

129

What is "position" fetopelvic relationship?

relationship of denominator to the front, back or side of maternal pelvis

130

What is the order of cardinal movements?

*EDIERAP*
- engagement
- descent, flexion
- internal rotation
- extension
- restitution (90 deg rot.)
- anterior shoulder
- posterior shoulder

131

How many cm is the cervix dilated in each stage of labor?

Stage 1 = 0-10cm
Stage 2 = 10cm to birth

132

What are the 3 phases of stage 1 of labor?

Latent
Active
Transition

133

How are CXNs timed?

start of CXN to start of the next CXN

134

What is station?

“Zero station” means that the head is at the middle of the pelvis at the line of the sacroiliac spine, increasing numbers indicates head further below pelvis

135

What is effacement?

thinning of cervical wall

136

What is the frequency of contractions along all three phases of stage 1 labor?

Latent - 5-20min
Active - 2-4min
Transition - 2-3min

137

What is the frequency of contractions in stage 2 labor?

2-5min

138

T/F: Early decels in FHTs are ok, while only late decels are bad.

correct

139

What is crowning?

"ring of fire" = widest part of fetal head at vulvar ring w/out retraction

140

With a gush ROM, what should you be wary of?

check for prolapsed cord and monitor FHTs

141

What is the concern with preterm or prolonged ROM?

increasing risk of infection after 24hr

142

What is back labor?

baby is in occiput posterior position, fix with counter pressure on sacrum in quadruped position

143

What is turtle's sign?

shoulder gets stuck on pubic bone, causes dystocia

144

What condition may corkscrew procedure cause?

Erb's palsy

145

What occurs in stage 3 of labor?

separation and expulsion of placenta

146

What occurs with separation of placenta?

lengthening of cord, gush of blood and contractions

147

How do you examine placenta after delivery?

for completeness
- amniotic side is Shiny, Smooth and "Shultz"
- meaty side is dull "Duncan"

148

what is amniotomy?

artificial rupture of membranes

149

What is placental abruption?

Subchorionic hematoma displacing placenta from uterine wall, there will be decrease in FHTs, *painful*

150

What is placenta previa?

Placenta covers cervical os
S/sx = painless bright red bleeding late in pregnancy, requires c-section

151

What are the labor laceration classification?

1st- vaginal mucosa/labial skin
2nd- bulbocavernosal muscle
3rd- external anal sphincter
4th- anterior anal wall

152

What is lochia?

vaginal d/c post partum

153

What are the types of lochia?

Rubra - active bleeding, red, lasts few days
Serosa - pink w/ serum and WBCs, 5-10days
Alba - whitish brown, RBCs, mucous and tissue debris for up to 6wks

154

Pt has low back pain, CVA tenderness, fever and nausea post partum. What is their Dx?

UTI

155

What are 3 depressive states following pregnancy?

I. Baby Blues
II. Depression
III. Psychosis

156

Describe post partum depression

Mood has effect on ADLs, obsessive thoughts of harming baby or inability to care for baby

157

Describe post partum psychosis

Manic and severe depressive state, sleep deprives and volatile
- requires management

158

When should you screen for anemia post partum

4-6wks

159

What is diastasis recti?

separation of rectus abdomens 2.7cm or greater

160

What is APGAR?

-Appearance (color)
-Pulse (>100bpm)
-Grimace (flex irritability)
-Activity (mm. tone)
-Respiration

*score below 6 suggests neurologic sequelae*

161

What does Ballard assess?

determines actual age using physical assessment

162

Vernix caseosa and lanugo suggest baby is younger or older?

younger

163

Foot creases in baby suggest they are ______

older

164

What are s/sx of perinatal oxygen deprivation?

- decreased LOC/mvmt, poor tone, apnea spells and seizures
+ jittery/weak after 12hrs
+ brain stem/feedingw signs after 24hrs

165

What is newborn molding?

sutures fold in on each other, CONE HEADS

166

What is cephalohematoma?

blood btw periosteum and skull; DOES NOT CROSS SUTURE LINES

167

What is caput succedeneum?

edema of scalp, more diffuse and crosses suture lines; lasts 1-2 days

168

Why is baby jaundice important to manage?

potential for neuro defecits

169

When is it normal for babies to get jaundice?

2-4 days after delivery; within 24hrs signifies hemolytic condition (kernicterus)

170

What precautions should you take with sore nipples while breast feeding?

- avoid soapy water & drying agents
- air dry after feeding
- limit time on that nip
- avoid plastic lined breast pads

171

What is the causative agent of mastitis?

S. aureus

172

When is mastitis MC?

within 3 months

173

What are s/sx of mastitis?

unilateral redness, tenderness, warmth and fever
->Tx with Ab and regular expression

174

What is TORCH?

refers to a group of maternally acquired communicable diseases

175

What does TORCH stand for?

Toxoplasmosis
Other:
• Varicella
• Venezuelan equine encephalitis
• Mumps
• Coxsackie
• Parvovirus
• HIV
Rubella
Cytomegalovirus
Herpes