WH Flashcards
What is an appropriate measure of FHR variability from baseline?
6-25 bpm
Normal baseline FHR?
110 - 160 bpm
What are some things that can cause minimal/absent variability in FHR?
Acidemia Fetal sleep Fetal tachycardia Meds (narcotics, anesthesia) Prematurity Cardiac arrhythmias Pre-existing neuro injury
Define an accel of FHR.
How frequently should these occur?
Rise over baseline of 15+ bpm for at least 15 seconds.
At least two should occur over 20 minute span.
Define recurrent late decels
Occur with 50%+ of contractions
Fetal decels that mirror the timing of maternal contractions are likely from what cause?
Fetal head compression - these are “early” decels and benign
VEAL CHOP: early = head
Decels that occur without contraction are likely from what cause?
Cord compression - these are “variable” decels
VEAL CHOP: variable = cord
Decels that are gradual, lasting 30 seconds to 2 minutes, with the nadir after the peak of contractions are likely from what cause?
Placental insufficiency - these are “late” decels and are a concerning finding
When is the fetal yolk sac usually visible?
From week 5 until ~week 10-12
When is fetal cardiac activity detectable?
Around week 6
When do weekly prenatal visits begin?
Week 36
When do bimonthly prenatal visits begin?
32 weeks, until 36 when weekly visits begin
When is a GBS swab collected in pregnancy?
37 weeks
When is TDAP offered to a pregnant patient?
28 weeks
When is a GTT performed on a pregnant patient?
28 weeks
Associate types of twinning with timing of embryonic cleavage
Early (days 1-3) = di/di
Mid (days 4-8) = mo/di
Late (days 8-13) = mo/mo
Very late (days 13/15) = conjoined
Naegle’s Rule?
(LMP) - 3 months + 7 days
What does a risk of Down’s look like on quad screen?
Low estriol, low AFP
High inhibin A
What quad screen finding is associated with higher risk of neural tube defects?
High AFP
If AFP, estriol, and BHcg and high and inhibin A is low on quad screen, what is this concerning for?
Trisomy 18
What are the age criteria for primary amenorrhea?
14YO w/NO pubertal development or
16 YO w/ pubertal development
What are some endocrine causes of primary amenorrhea?
HyperGnRH hypogonadism:
ex: Turners - high FSH, loss of oocytes
HypoGnRH hypogonadism:
ex: Kallman’s - low FSH, no small
ex: Sheehan’s: hypopituitarism = low FSH
Chronic illness
EuGnRH hypogonadism: PCOS, congenital adrenal hyperplasia, hyperprolactinemia, hypothyroidism
Basic, normal physiologic hormone cascade of menstruation
Hypothalamus releases GnRH –>
Pituitary releases FSH, LH –>
FSH/LH stimulates ovaries and uterus:
- FSH causes follicle to develop
- LH surge causes rupture of follicle/release of ovum
Estrogen from granulosa cells dominates during follicular phase and builds endometrium
Progesterone from corpus luteum stabilizes the uterine lining and promotes production of “uterine milk”
Giant multinucleated cells on Tzank smear - Dx and Tx?
HSV, give valcyclovir 1g BID x 10 days
