Obgyn Pregnancy And Prenatal Care Blueprints

Front 1

Developmental age

Back 1

conceptional age in weeks and days since fertilization

Front 2

Gestational Age

Back 2

age of fetus and weeks and days since LMP (unadjusted from time of conception)

Front 3

converting gestational age to developmental age

Back 3

subtract 2 weeks (since gestational age includes 2 weeks more--time after LMP before conception)

Front 4

How do you calculate estimated delivery date (EDD)?

Back 4

Subtract 3 months from the LMP and add 7 days (or 280 days after certain LMP)

Front 5

How accurate is crown-rump dating?

Back 5

within 3-5 days

Front 6

when can fetal heart rate be heard by doppler US?

Back 6

10 weeks

Front 7

1. What is quickening?
2. When does it occur?

Back 7

1. maternal awareness of fetal movement
2. 16-20 weeks

Front 8

What is the threshold of viability?

Back 8

23-24 weeks

Front 9

post-term pregnancy?

Back 9

>42 weeks gestation

Front 10

What happens to CO during pregnancy? What is the primary determinant?

Back 10

CO increases by 30-50% primarily because of increased SV

Front 11

What happens to SVR during pregnancy?

Back 11

It decreases-- probably because of progesterone which acts as a smooth muscle relaxant. BP decreases in the 2nd trimester and then slowly returns to pre-preg values

Front 12

How does tidal volume change during pregnancy?

Back 12

increases by 30-40%

Front 13

What is the etiology or morning sickness?

Back 13

elevated estrogen, progesterone and BhCG (possibly due to hypoglycemia)

Front 14

When does the n/v of pregnancy typically reside?

Back 14

14-16 weeks

Front 15

hyperemesis gravidarum

Back 15

severe morning sickness in which women lose greater than 5% of their prepregnancy weight and go into ketosis

Front 16

What causes gastric reflux during pregnancy?

Back 16

decreased lower esophageal tone, decreased gastric emptying time

Front 17

1. What happens to the kidneys during pregnancy? ureters?
2. GFR

Back 17

1. kidneys increase in size, ureters dilate-- inc risk of pyelo
2. GFR inc 50%-- BUN and Cr dec by 25%

Front 18

What happens to...
1. plasma volume
2. RBCs
3. hematocrit
4. WBCs
...during pregnancy?

Back 18

1. plasma volume inc 50%
2. RBC volume inc 20-30%
3. Hct dec--> dilutional anemia
4. WBC inc to 10.5- may get as high as 20 due to stress of labor

Front 19

What happens to platelet count during pregnancy? At what point is further evaluation necessary?

Back 19

Platelet conc decreases slightly due to a dilutional effect-- but should not decrease below 100 million/ mL

Front 20

Where is the majority of estrogen produced during pregnancy? What is the significance of a low estrogen level?

Back 20

the placenta-- poor fetal outcome

Front 21

What happens to levels of b hCG throughout various times during pregnancy?

Back 21

early on levels inc 66% every 48 hours
Max levels are reached by 10-12 weeks then decline until steady state is reached in 15 weeks

Front 22

What produces hCG and what is its function?

Back 22

the placenta, it maintains the corpus luteum in early pregnancy-- which produces progesterone in the first trimester in order to maintain the endometrium

Front 23

What is human placental lactogen (hPL) and what is its function?

Back 23

hormone produced by the placenta that is important for ensuring the a constant nutrient supply to the fetus
- aka human chorionic somatomammotropin
- causes lipolysis-- inc FFA
- insulin antagonist-- diabetogenic effect

Front 24

What skin changes can be observed during pregnancy? What are these the result of ?

Back 24

1. spider angiomata and palmar erythema due to inc estrogen
2. hyperpigmentation of the nipples, umbilicus, abdominal midline (linea nigra), perineum and face (melasma or chloasma) due to in melanocyte stimulating hormone

Front 25

How much does caloric increase during pregnancy?
breastfeeding?

Back 25

pregnancy- inc 300 kcal/day
breastfeeding- inc 500 kcal/day

Front 26

1. How much weight should the average woman gain during pregnancy?
2. overweight women?
3. underweight women?

Back 26

1. 20-30 lbs
2. 15-25 lbs
3. 28-40 lbs

Front 27

What should be done during the first physical exam at a prenatal visit?

Back 27

a pap smear plus bimanual exam unless one has been done in the last 6 months and screening for gonorrhea and chlamydia

Front 28

Lab tests during the first trimester?

Back 28

CBC
- blood type and screen
- RPR or VDRL for syphilis,
- rubella antibody screen
- HBsAg
- urinalysis, and urine culture.
- often toxoplasma titer
- offer HIV screen
-PPD
- if no hx of chicken pox- check a VZV titer
- early screening for aneuploidy (nuchal translucency on US plus serum markers)

Front 29

What should be assessed during all routine perinatal visits?

Back 29

BP, weight, urine dipstick, measurement of the uterus, ausc fetal heart

Front 30

What might large weight gains near the end of pregnancy signify?

Back 30

preeclampsia-- edema and third spacing of fluid

Front 31

Tests during the second trimester

Back 31

MSAFP/ triple or quad screen
ob US
amniocentesis for women wanting prenatal dx

Front 32

What tests should be done in the third trimester?

Back 32

HCT
RPR/VDRL
GLT
GBS rectovaginal culture

Front 33

What is MSAFP and when should it be performed?
if high?
if low?

Back 33

Maternal Serum Alpha Fetoprotein
should be performed in the 2nd trimester between 15-18 weeks
if high--> neural tube defects possible
if low--> down syndrome possible (or other aneuploidy)

Front 34

Triple Screen?
Quad screen?

Back 34

alpha fetoprotein
BhCG
estriol

Quad screen adds- inhibin A

- these tests help dx aneuploidies

Front 35

Frequency of prenatal visits from 28-36 weeks gestation?
after 36 weeks?

Back 35

1. every 2-3 weeks
2. every week

Front 36

When is Rhogam given for Rh negative mothers?

Back 36

at 28 weeks and then again after delivery if baby is Rh +

--additionally it should be given anytime there is a inutero-procedure (including external cephalic version) or chance for fetomaternal hemorrhage (placental abruption etc)

Front 37

1. What is a Glucose Loading Test (GLT)?
2.When is it performed?
3. What does it involve?

Back 37

1. screening test for gestational diabetes
2. At 27-29 weeks
3. A 50 g oral glucose load is given and then blood sugar is checked in 1 hour-- if it is above 140 mg/dL then a glucose tolerance test (GTT) is performed

Front 38

What is a Glucose Tolerance Test (GTT)

Back 38

diagnostic test for GDM
1st check fasting glucose then give 100 g glucose loading dose and check blood sugars every hour for 3 hours. If two or more blood sugars meet the following thresholds then GDM is diagnosed
fasting > 95
1 hr > 180
2 hr > 155
3 hr > 140

Front 39

When is GBS testing done?

Back 39

at 36 weeks-- give IV penicillin when presenting in labor if positive

Front 40

Braxton Hicks contractions

Back 40

occassional irregular contractions that do not lead to cervical change
(may happen up to several times/hr)
- precipitated by dehydration -- drink 10-14 glasses of water/day

Front 41

What causes lower extremity edema in pregnant women?

Back 41

compression of the IVC and pelvic veins by the gravid uterus-- pt should sleep on side and elevate feet above heart to relieve

Front 42

How are hemorrhoids treated during pregnancy?

Back 42

topical analgesics and steroids
prevention-- inc fluid and fiber intake, stool softeners

Front 43

What is round ligament pain? When does it typically occur?

Back 43

pain in the adnexa or lower abdomen that occurs in the late 2nd or early 3rd timester-- rapid expansion of the uterus stretches the ligament.
tx- conservative, tylenol

Front 44

What does a routine screening ultrasound at 18-20 weeks assess?

Back 44

1. amniotic fluid levels
2. placental location
3. gestational age
4. any obvious malformations

(note that gender determination is not necessarily a part of this exam)

Front 45

What does a biophysical profile (BPP) include?
What scores are reassuring?

Back 45

1. amniotic fluid volume
2. fetal tone (fine movement)
3. fetal activity (gross movement)
4. fetal breathing movements
5. and non-stress test (NST)-- test of fetal heart rate
* each is awarded 2 points
A score of 8-10 is reassuring

Front 46

Non-stress test?
What is a reassuring result?

Back 46

fetal heart rate monitoring
reactive/reassuring test = at least fetal heart rate accelerations of 15 bpm for at least 15 seconds at a time during a 20 minute recording

Front 47

what is an oxytocin challenge test (OCT) and when is it generally performed?

Back 47

contraction stress test -- get at least 3 contractions in 10 minutes and watch fetal heart rate for at least 2 accelerations of 15 bpm for at least 15 seconds
- usually performed if fetal heart tracing is worrisome (decels) or BPP is non-reassuring

Front 48

1. What is Percutaneous Umbilical Blood Sampling (PUBS)?
2. When is it done?

Back 48

1. transabdominal needle is placed in the uterus and into the umbilical vein-- can get a fetal blood sample
2. This may performed to check fetal Hct in the setting of maternal Rh alloimmunization, giving fetal transfusion, karyotype analysis, and checking fetal platelets in alloimmune thrombocytopenia

Front 49

How can you assess fetal lung maturity (FLM)?

Back 49

amniocentesis performed to check the lethicin to sphingomyelin (L/S) ratio
(lethicin increases as lungs mature and sphingomyelin decreases after 32 weeks)--so L/S should in
L/S ratio > 2 is indicative of good FLM
(other tests of FLM include phosphatidyl glycerol, SPC, lamellar body count, S/A ratio)