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18 Cards in this Set

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What are some examples of pelvimetry (shape of the pelvis)?
Gynecoid: Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet: best chances for normal vaginal delivery.
What is the fetal significance of engagement?
The fetus is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet.
What is the fetal significance of station?
Relationship of the bony presenting part of the fetus to the maternal ischial spines. If at the level of the spines it is at “0 (zero)” station, if it passed it by 2cm it is at “+2” station.
What is the fetal significance of attitude?
Relationship of fetal head to spine: flexed, neutral (“military”), or extended attitudes are possible
What is the fetal significance of position?
Relationship of presenting part to maternal pelvis, i.e. ROP=right occiput posterior, or LOA=left occiput anterior.
What is the fetal significance of presentation?
Relationship between the leading fetal part and the pelvic inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow, mentum or shoulder presentation
What is the fetal significance of lie?
Relationship between the longitudinal axis of fetus and long axis of the uterus: longitudinal, oblique, and transverse.
What is the fetal significance of caput?
edema typically formed by the tissue overlying the fetal skull during the vaginal birthing process.
What are some laboratory Pearls in pregnancy?
Repeat all STI screening in 3rd trimester if high risk (36 wks)
At risk: GC, Tb, red indices for thalassemia (eg, MCV <80)
Hemoglobin electrophoresis: Hemoglobinopathies (eg, sickle cell, thalassemias), if +, check FOB, if +, genetics referral
AA, Mediterranean
Alpha-thalassemia in Asian patients
Hexosaminidase A for Tay Sachs (leukocyte assay) in Jewish patients, cystic fibrosis carrier testing, toxoplsmosis screen, Hep C antibodies
How often do mothers come for prenatal visits?
Every 4 weeks until 28 weeks' gestation
Every 2-3 weeks until 36 weeks' gestation
Every week from 36 weeks to delivery
What are some things to ask the mother when she comes for prenatal visits?
At these visits, you will want to ask the patient about any interval changes. You'll also want to know about any vaginal discharge or bleeding, fetal movements, and uterine contractions.
At each visit, perform a limited physical exam, consisting of weight, BP, edema, FH, FHR, proteinuria and glucosuria.
At times, it may be important to determine fetal orientation (36 weeks +)
What are some exams that are performed at every prenatal visit?
Bp/Wt
UA (RBC, WBC, PRO, GLU)
FHT and Fetal Movement
Fundal Height
Edema
How much weight should a woman gain while pregnant?
12.5-18 kg (28-40lbs): BMI <19.8
7-11.5 kg (15-25 lbs): BMI >26
11.5-16 kg (25-35 lbs): BMI 19.8-26.0
What are some things to consider if the fundal height measurement is too small?
Your estimate of gestational age may be incorrect
There may be very little amniotic fluid (oligohydramnios).
The baby may be small for gestational age (or growth retarded)
The baby may be normal, but simply constitutionally small.
What are some things to consider if the fundal height measurement is too big?
Your estimate of gestational age may be incorrect
There may be too much amniotic fluid (polyhydramnios)
The baby may be large for gestational age (as is seen in gestational diabetes)
The baby may be normal, but constitutionally large.
What are some things to clinically assess during the first trimester?
BP, wt, FH (fetal growth), FHT, fetal presentation, fetal activity, UA (protein, glucose)
9-12 wks
FHR should be heard
Transvaginal US can determine fetal viability as early as 5.5-6.5 wks
Aneuploidy testing for nuchal translucency thickness
When do you assess for nuchal translucency?
11-14wks
Thickness of fetal neck
Done with plasma protein & β-hCG level
Finds 87% Down Syndrome
what are some things to clinically assess in the 2nd trimester.
First detection of fetal movement (quickening): 17 wks in multigravid, 19 wks in primigravida.
Document fetal movement at each visit after 17 wks
Vaginal bleeding, vaginal discharge
CTX, symptoms of PTL
Document FHR