Ob/gyn

Front 1

Biophysical Profiles (BPP)

Back 1

1. 5 Components using U/S scoring from 0 - 2:
a. amnionic fluid volume
b. fetal tone
c. fetal activity
d. fetal breathing movements
e. nonstress test (NST)
2. BPP of 8-10 is reassuring

Front 2

Differential Diagnosis of First-Trimester Bleeding:

Back 2

1. Spontaneous abortion
2. Postcoital bleeding
3. Ectopic pregnancy
4. Vaginal or cervical lesions or lacerations
5. Extrusion (pushing out) of molar pregnancy
6. Non-pregnancy causes of bleeding

Front 3

Risk factors for cervical incompetence:

Back 3

1. History of cervical surgery, such as cone biopsy or dilation of the cervix
2. History of cervical lacerations with vaginal delivery
3. Uterine anomalies
4. History of DES exposure

Front 4

Recurrent SABs:

Back 4

1. Chromosomal abnormalities
2. Maternal systemic disease
3. Maternal anatomic defects
4. Infection
5. ~15% have antiphospholipid antibody syndrome
6. Luteal phase defect (lack of adequate level of progesterone to maintain the pregnancy
7. 30-50% etiology is never found

Front 5

FHR Baselines above 160 bpm - Concern for Fetal distress secondary to:

Back 5

a. Infection
b. Hypoxia
c. Anemia

Front 6

FHR Variability defined as: Absent

Back 6

< 3 bpm of variation
Flat tracing
Worrisome and demands another test to determine fetal well-being

Front 7

FHR Variability defined as: Minimal

Back 7

1. 3 to 5 bpm of variation
2. Not reassuring
3. Could occur while:
a. the fetus is asleep or inactive
b. After maternal drug intake
c. Reduced fetal CNS function
d. Asphyxia

Front 8

FHR Variability defined as: Moderate

Back 8

5 to 25 bpm of variation

Front 9

FHR Variability defined as: Marked

Back 9

more than 25 bpm of variation

Front 10

FHR is considered reactive if:

Back 10

• At least 2 accelerations of at least 15 bpm over the baseline that last for at least 15 seconds within a 20 minute period

Front 11

Early decelerations:

Back 11

1. Begin and end at approximately the same time as contractions
2. Etiology - ↑ Vagal tone secondary to head compression during contractions

Front 12

Variable decelerations

Back 12

1. Can occur any time and tend to drom more precipitously than either early or later decels (i.e., more spikey
2. Etiology: Result of umbilical cord compression
a. Repetitive variables with contractions can be seen when the cord is entrapped either under a fetal shoulder or around the deck and is compressed with each contraction

Front 13

Late decelerations

Back 13

1. MOST worrisome type of deceleration
2. Begin at the peak of a contraction and slowly return to baseline after the contraction has finished
3. Etiology: uteroplacental insufficiency
4. May degrade into bradycardias as labor progresses, particularly with stronger contractions

Front 14

Pre-eclampsia → Ask about

Back 14

1. Headache (HA)
2. RUQ pain (liver toxicity)
3. Vision changes
a. Usually scomata vs blurred vision

Front 15

Magnesium Sulfate Adverse Effects:

Back 15

1. Serious Reactions:
a. Cardiovascular collapse/depressed cardiac function
b. Pulmonary edema / Resp. paralysis
c. Hypothermia
d. Depressed
2. Common Reactions
a. Depressed reflexes
b. Hypotension
c. Flushing
d. Drowsiness
e. Depressed cardiac function
f. Diaphoresis
g. Hypocalcemia
h. Hypophosphatemia
i. Hyperkalemia
j. Visual changes

Front 16

Complications of pre-eclampsia:

Back 16

1. Eclampsia
2. Placental Abruption – placenta separates from the uterus
3. HELLP
4. ↓ blood flow to placenta
5. ↑ risk for future cardiovascular disease

Front 17

Homan’s Sign:

Back 17

1. Checks for DVT
2. Dorsiflex the foot and ask about pain
3. For DVT you might also notice swelling of legs
4. U/S can pick up a DVT

Front 18

Current pregnancy complications (list of things that can complicate a pregnancy:

Back 18

1. Past C-section
2. Asthma
3. Cigarette smoking
4. Incarceration (they’re in jail)
5. Preeclampsia

Front 19

4 Questions for pregnant mother:

Back 19

a. Any blood loss?
b. Any fluid loss?
c. Has the baby been moving/kicking?
d. Having any contractions?

Front 20

Bishop Score Components

Back 20

i. Cervical Dilation
ii. Cervical Effacement
iii. Station
iv. Cervical Consistency - Cervix feels firm, soft, or somewhere in
between
v. Cervical Position

--> Bishop Score > 8 is consistent with a cervix favorable for both spontaneous labor and, as it is commonly used, induced labor.

Front 21

The Cardinal Movements of Labor (Mechanisms of Labor)

Back 21

i. Engagement
1. When the fetal presenting part enters the pelvis it has undergone engagement
ii. Descent
1. After engagement, the head will descend into pelvis, followed by flexion
iii. Flexion
1. Allows the smallest diameter to present to the pelvis
iv. Internal Rotation
1. With descent into the midpelvis, the fetal vertex undergoes internal rotation from an occiput transverse (OT) position so that the sagittal suture is parallel to the anteroposterior diameter of the pelvis commonly to the occiput anterior (OA) position
v. Extension
1. As vertex passes beneath and beyond the pubic symphysis, it will extend to deliver
vi. External Rotation (aka restitution or resolution)
1. Once the head delivers, external rotation occurs and the shoulders may be delivered