Ob Kaplan Chap 4

Front 1

3 ways to dx pregnancy

Back 1

1. presumptive
2. probable
3. definitive

Front 2

What is the presumptive pregnancy dx

Back 2

Presumptive signs of pregnancy include
1. amenorrhea
2. breast tenderness
3. nausea and vomiting
3. increased skin pigmentation
4. skin striae.

Front 3

what is the probable pregnancy dx

Back 3

Probable signs of pregnancy include
1. enlargement of the uterus
2. maternal sensation of uterine contractions or fetal movement
3. Hegar sign (softening of the junction between the corpus and cervix)
4. positive urine or serum (3-human chorionic gonadotropin ((3-hCG) testing.

Front 4

what is the definitive pregnancy dx

Back 4

Positive signs of pregnancy include
1. hearing fetal heart tones
2. sonographic visualization of a fetus
3. perception of fetal movements by an external examiner
4. x-ray showing a fetal skeleton.

Front 5

what ways are gestational age established

Back 5

1. conception dating
2. menstrual dating
3. naegele's rule
4. basal body temp
5. Menstrual hx

Front 6

how does conception dating establish gestation age

Back 6

Normal pregnancy duration postconception is 266 days or 38 weeks. However, most women can't identify conception date accurately.

Front 7

how does menstrual dating establish gestational age

Back 7

Because the last menstrual period (LMP) is more easily identified than conception, pregnancy
duration in most cases is determined to be 280 days or 40 weeks from the LMP. We assume a 28-day menstrual cycle in which ovulation occurs on day 14 after the beginning of the LMP. Yet only 10% of women have a 28-day cycle. A normal cycle length can vary from 21 to 35 days.

Front 8

how does Naegele's rule establish gestational age

Back 8

Assuming 28-day cycles, the due date can be estimated as the LMP minus 3 months plus 7 days.

Front 9

how does the basal body temp establish gestational age

Back 9

The rise in BBT is assumed to be caused by the thermogenic effect of progesterone produced by the corpus luteum that formed after ovulation. The accuracy of BBT is ±1 week.

Front 10

how does the menstrual hx establish gestational age

Back 10

Menstrual dating assumes ovulation occurred on day 14 after the first day of the LMP. However, normal menstrual cycles can vary from 21 to 35 days, making ovulation possible on day 7 to day 21. Because most women's cycles are more or less than 28 days, adjustment of the due date may be necessary. Accuracy of menstrual dating is variable depending on the patient's memory and record keeping. The accuracy of menstrual history is ±1 week.

Front 11

When does the first trimester occur

Back 11

Assuming a 40 menstrual week pregnancy, the first trimester is assumed to extend from conception through to 13 weeks.

Front 12

when does the second trimester occur

Back 12

Assuming a 40 menstrual week pregnancy, the second trimester is assumed to extend from 13 to 26 weeks.

Front 13

when does the third trimester occur

Back 13

Assuming a 40 menstrual week pregnancy, the third trimester is assumed to extend from 26 to 40 weeks.

Front 14

What symptoms, average wt gain and complications are seen in first trimester

Back 14

1. Normal symptoms that are seen in the majority of pregnancies include nausea, vomiting, fatigue, breast tenderness, and frequent urination.
2.Spotting and bleeding: occur in 20% of pregnancies, 50% of which will continue successfully.
3. Average weight gain is 5-8 pounds.
4. Complications—spontaneous abortion.

Front 15

What symptoms, wt gain and complications are seen in second trimester

Back 15

1.Normal symptoms are an improved feeling of general well-being. Round ligament pain is common.
2.Braxton-Hicks contractions are painless, low-intensity, long-duration contractions that can be palpated as early as 14 weeks.
3.Quickening (maternal awareness of fetal movement) is detected at 18-20 weeks by primigravidas and 16-20 weeks by multigravidas.
4.Average weight gain is 1 pound per week after 20 weeks.
5.Complications include incompetent cervix (painless cervical dilation leading to delivery of a nonviable fetus); premature membrane rupture, and premature labor.

Front 16

what symptoms, wt gain and complications are seen in third trimester

Back 16

1.Normal symptoms include decreased libido, lower back and leg pain, urinary frequency, and Braxton-Hicks contractions.
2.Lightening describes descent of the fetal head into the pelvis resulting in easier maternal breathing, pelvic pressure.
4.Bloody show describes vaginal passage of bloody endocervical mucus, the result of cervical dilation before labor.
5.Average weight gain is 1 pound per week after 20 weeks.
6.Complications include premature membrane rupture, premature labor, preeclampsia, urinary tract infection, anemia, and gestational diabetes.

Front 17

What are normal pregnancy complaints

Back 17

1. Backpain
2.bleeding gums
3. beast enlargement
4. carpal tunnel
5. complexion changes
6. dizziness
7. fatigue
8. fluid restriction
9. hair and nails
10. headaches
11. leg cramps
12. morning sickness
13. nosebleeds
14. stretch marks
15. stress incontinence
16. varicose veins

Front 18

Safe immunizations

Back 18

Safe immunizations include antigens from killed or inactivated organisms:
• Influenza (all pregnant women in flu season)
• Hepatitis B (pre- and postexposure)
• Hepatitis A (pre- and postexposure)
• Pneumococcus (only high-risk women)
• Meningococcus (in unusual outbreaks)
• Typhoid (not routinely recommended)

Front 19

unsafe immunizations

Back 19

Unsafe immunizations include antigens from live attenuated organisms:
• Measles
• Mumps
• Polio
• Rubella
• Yellow fever
• Varicella

Front 20

What things are done at first prenantal visit>

Back 20

1. Pregnant? do BhCG, FHT, Sono
2. Gestational age? Menstrual hx, clinical landmarks, early sono
3. Risk factors? Obstetric, medical, sexual, family, social
4. Lab tests?
5. Return visit? q 4 wk<28wks, q 2 wks 28-36 wks, q1 wk >36 wks