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82 Cards in this Set
- Front
- Back
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What are some specific conditions to which poor maternal and neonatal oucomes are often attributed? (8)
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-pretern or postterm delivery
-perinatal infections -intrauterine growth restiction -HTN -diabetes mellitus -birth defects -mutliple gestation -abnormal placentation |
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Obstetric care is designed to do what 4 things?
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1-easy access to care
2-patient involvement 3-provide a team approach 4-establish protocols for screeing for high-risk conditions |
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In a women w/ a hx of regular periods, a hx of what strongly suggest pregnancy?
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one or more missed periods
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The dx of pregnancy should be made using what?
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pregnancy test, not nonspecific symptoms
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On physical exam, softening and enlargement of the pregnant uterus becomes apparent when?
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6 or more weeks after the last normal menstrual period
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When is the uterus large enough to palpate in the lower abdomen?
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about 12 weeks
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Congestion and a bluish discoloration of the vagina is what sign?
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Chadwick sign
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Softening of the cervix is what sign?
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Hegar Sign
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Palpation of fetal parts and the appreciation of fetal movement and fetal heart tones are what?
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diagnostic of pregnancy
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Quickening is usually felt when?
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16-18 weeks and as late as 20 weeks
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When are fetal heart tones first heard?
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at or beyond 18-20 weeks
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An electronic Doppler device can detect fetal heart tones as soon as how many weeks?
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12 weeks
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Urine pregnancy tests detects what hormone?
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human chorionic gonadotropin (hCG)
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hCG shares an alpha-subunit with what other hormone?
and this means what? |
LH
-levels of hCG must be high enough to avoid a false positive |
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Standard lab urine pregnancy test become positive after how many weeks?
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4 weeks
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Why are serum pregnancy test more sensitve and specific?
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b/c they test for the unique B-subunit of hCG.
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A progestrone concentration level of what is dx of pregnancy?
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>25 ng/mL
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An ultrasound can detect pregnancy when?
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5-6 weeks
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Transvaginal ultrasound can detect pregnancy at how many weeks?
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3-4 weeks
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If the B-hCG concentrations is greater than ________ mIU/mL the embryo should be visualized by all techniques.
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4000
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What are the 15 rountine obstetric lab tests ordered?
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1-CBC
2-UA 3-Blood group/Rh 4-antibody screen 5-RPR,VDRL 6-Hep B 7-Rubella titer 8-Cervical cytology (Pap) 9-N. gonorrheoae/chlamydia 10-hemoglobin electrophoresis 11-HIV titer 12-glucose screening (1 hr glucola) for high risk pts 13-MSAFP @ 15-18 weeks 14-Hematocrit at 25-28 weeks 15-Glucose screening at 24-28 weeks |
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For every pregnancy it is very important to establish what?
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gestational age
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Normal pregnancy lasts how long?
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40 +/- 2 weeks
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Why is the date of onset of the last normal menses crucial?
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to estabolish an accurate gestational age
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Pelvic exam is accurate in determining the gestational age w/in how many weeks until the second trimester?
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1-2 weeks
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From 16-18 until about 36 weeks, what is roughly equal to the number of weeks of gestation age?
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fundal height in centimeters
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At 20 weeks, the uterine fundus is at where?
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the umbilicus
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What is the most accurate measurement available in the determination of gestational age?
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obstetric ultrasound examination
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For a normal pregnancy, antepartum visits are made how often?
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-every 4 weeks until 32 weeks
-every 2 weeks from 32-36 weeks -weekly there after |
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Decreased fetal movement is what?
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a bad sign
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What is the only lab test done at every prenatal visit?
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glucosuria and poteinuria
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What are the maternal physicl findsing done at each prenatal visit?
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-BP
-weight -assessment for edema |
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In pregnancy, BP usually ________ at the end of the first trimester, and _______ in the third trimester.
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-declines
-raises |
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An increase in systolic above _______ and an increase in diastolic above _____ is diagnostic of HTN in pregnancy.
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-30
-15 |
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What is the weight gain recommenadation in pregnancy?
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25-35 lbs
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At each monthly visit, there should be a weight gain of how much?
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3-4 lbs
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What are the obstetric findings made at each visit?
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-uterine size by pelvic examination or fundal height measurement
-rate of fetal heart tones -determination of the presentation of the fetus |
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Until 18-20 weeks the uterine size generally stated how?
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in weeks size (12 week size)
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At how many weeks does the fetus usually move downward into the pubic symphysis?
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36 weeks
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What are some possible causes for a large for date reading?
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-incorrect due date
-multiple pregnancy -macrosomia -hydatidifrom mole -hydramnois |
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What are some causes for small for date babies?
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-incorrect gestational age
-hydatidiform mole -fetal growth restiction -oligohydramnios -intrauterine fetal demise |
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What is the normal fetal heart rate?
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120-160 bpm
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If the head is hard and well defined by ballottement, it usually means that the fetus is what?
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in normal position, aka not breech
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Evaluation of the fetus can be convenienctly categorized into what 3 categories?
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1-growth
2-well-being 3-maturity |
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A deviation of more than _____ in fundal height from expected btw 18-36 weeks should prompt a repeast measurement and may lead to further evaluation.
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2 cm
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A deviation of more than _____ from expected at a particular gestation age is of great concern.
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4cm
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In early pregnancy, determination of what and what correlates closely with gestational age.
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gestational sac diameter and crown to rump length
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Later in pregnancy, what is used to assess gestational age?
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-measurement of biparietal dimeter of the skull
-abdominal circumference -femur length -cerebellar diameter |
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For gestational age, measurements made when are most reliable.
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late first semester and early second trimester
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Tests of fetal well being ahve a wide range of uses including what?
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-assessment of fetal status at a certain time
-prediction of fetal status for varying time intervals |
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What does a NST measure?
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respose of the fetal heart rate to fetal movement
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What is a normal or reactive NST?
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when the fetal heart rate increased by at least 15 bpm over a period of 15 seconds following a fetal movment at 32 weeks or more
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At less than 32 weeks a NST is normal when there are how many bpm?
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at least 10 bpm
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What does a CST measure?
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the response of the fetal heart rate to the stress of a uterine contraction
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Decelerations of of the late variety are what?
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nonreassuring
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Repetitive declerations following each contraction when three contractions occur in a 10 minute window constitute what?
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a positive or abnormal CST
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An abnormal CST is usually indicative of what?
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expedited delivery
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What are the 5 tests that make up the biophysical profile?
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1-fetal breathing
2-gross body movement 3-fetal tone 4-reactive fetal heart rate 5-qualitative amniotic |
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A score of what is normal for the biophysical profile?
-Further evaluation -abnormal |
8-10
6 <4 |
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What the inability of the newborn to ventilaate successfully because of the immaturity of the lungs/
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neonatal RDS
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In utero, the production of servactant is increased when?
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after 32-33 weeks
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RDS is manifested by what signs?
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-grunting
-chest retractions -nasal flaring -hypoxia leading to acidosis and death |
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What are 4 tests that can be used to assess surfactant?
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1-Licithin:Sphingomyelin (L:S) ratio
2-phosphatidylglycerol (PG) 3-Foam stability index (FSI) 4-Fetal Lung maturity (FLM) |
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What is the traditional time for maturnity leave/
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1 month before deliver and up to 6 weeks post partum
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Can a woman exercise during pregnancy?
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yes
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A fetum will triple its weight when?
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last 12 weeks of pregnancy
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What are some benefits of breastfeeding?
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-nutrition
-immunologic protection -mroe rapid uterine involution -bonding time |
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In addition to the averse maternal effects, ________ from burning tobacco and paper covering are quickly transferred form the patient to the fetus.
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metabolites
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Is sex restricted during normal pregnancy?
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no
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Headaches are common when in pregnancy?
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early on
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What is the treatment for fatigue early in pregnancy.
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Rest and reassurance that the symptoms will disappear in the second trimester
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What are some tx for leg cramps in pregnancy?
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-walking
-oral calcium supplement -K supplement -tonic water |
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Round ligament pain is more common on which side of the body?
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right
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What are some tx for hemorrhiods?
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sitz baths and local preparations
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Surgical correction of varicose veins or hemorrhoids should not be undertaken for about how long postpartum
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6 months
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If maternal death occurs during pregnancy and is caused by an obstetric disease is is classified as what?
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direct death
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If maternal death is caused by a disease that is amde worse by pregnancy it is classified as what?
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indirect death
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If maternal death is caused by an accident, it is classified as what?
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nonmaternal
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What is maternal death rate?
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number of deaths of obstetiric cause per 100,000 live births
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Stillbirth rate is what?
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number of stillbirths per 1,000 infants born
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Neonatal death refers to an infants death within _______ days of life and is expressed as what?
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-28
-neonatal mortality rate |
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How is fertility rate expressed?
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number of live births per 1,000 females aged 15 -45 in the population
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