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35 Cards in this Set
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- Back
- 3rd side (hint)
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What is important about a woman who has had a C-section
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A women who has had a previous C-S should be encouraged to attempt vaginal delivery (VDAC) with a subsequent pregnancy, provided there are no medical or surgical contraindications, such as:
Classical uterine incision Rare: vertical incision into uterus, rupture An active herpes infection at term Myomectomy with penetration into the endometrium Labor in a successive pregnancy is usually safe in patients with one prior transverse scar should be offered a trial of labor. |
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A pregnant woman who is short or underweight is at risk for what?
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- perinatal morbidity and mortality
- delivering a low birth weight infant - preterm delivery |
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What are some pregnancy complications assoc. w/ obesity?
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- Hypertension
- Diabetes - Aspiration of the gastric contents during the administration of anaesthesia - Wound complications - Thromboembolism |
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How is EDD estimated?
(HInt: Naegele's Rule) |
Add a year & 7 days to the 1st day of the last normal menstrual cycle & subtract 3 months.
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Ex: LMP = 8 may 2009
+ 1 year = 8 May 2010 - 3 months = 8 February 2010 + 7 days = 15 February 2010 |
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What are some Physical Signs of Pregnancy?
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- hCG in the blood
- missed period - increased BBT - Chadwick's, Goodell's, and Hegar's signs - Linea nigra |
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When can you test for pregnancy?
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- Blood levels of hCG are detectably elevated 8-10 after fertilization (3-3.5 weeks after the LMP)
- hCG rises in geometric fashion during T1, producing different ranges for each week of gestation. |
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What is the preferred way to test for hCG?
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Urine hCG is the preferred method. Total urine hCG closely parallels plasma concentration.
- First morning specimens have < variability in relative concentration and generally higher levels, improving accuracy - Assays detecting 25 mU/mL recognize pregnancy with 95% sensitivity by 1 week after the first missed menstrual period |
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When are plasma hCG levels drawn?
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Used when quantitative information is needed.
- Diagnosing ectopic pregnancy - Monitoring trophoblastic tumors - Screening for fetal abnormalities |
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When can fetal heart sounds be heard?
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An electronic Doppler device can detect fetal heart tones 8-11 weeks’ GA. An ultrasound should be performed to document a viable intrauterine pregnancy
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When do you use Ultrasound Scanning?
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- To confirm an intrauterine pregnancy
- To confirm the presence of a fetal HR - To diagnose multiple pregnancy - To estimate gestational age - To screen for fetal structural abnomalies - this is not generally used to diagnose pregnancy, but can do so once a gestational sac is present within uterus. |
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What are some limitations of Ultrasound Scanning?
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Scan dating becomes progressively less accurate and should be utilized only up to 20 weeks’ GA:
-- Scan dating is useful up to 20 wks GA when menstrual data is unreliable or conflicts with clinical findings (FH). -- Biologic variation in size increases as gestation advances. |
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How is ultrasound used to estimate gestational age?
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Measurement of a crown-rump length during the first trimester (1-13 weeks) will give a gestational age that is usually accurate to within 3 days of the actual due date.
During the second trimester (14-28 weeks), measurement of the biparietal diameter will accurately predict the due date within 10-14 days in most cases. In the third trimester, the accuracy of ultrasound in predicting the due date is less, with a plus or minus confidence range of as much as 3 weeks. |
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How is the development method used to stage pregnancy?
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This uses actual developmental stages to divide up a pregnancy. From LMP to 12 weeks the embryo develops all the major organs and becomes a fetus, T1. From 12 weeks to 27 weeks the fetus continues developing and reaches viability, T2. From 27 weeks on the fetus finishes development and prepares for delivery, T3.
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How is the gestational method used to stage pregnancy?
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With this method you take the 40 weeks of gestation and divide into three equal stages. Here the second trimester begins at 13w 3d and the third at 26w 6d.
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How is the conception method used to stage pregnancy?
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This method is where you take the 38 weeks of post conception development, divide by three, into the three equal trimesters. Here the second trimester begins at 14w 5d and the third at 27w 3d.
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What are some of the probable signs of pregnancy?
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- Chadwick’s - congestion of pelvic vasculature causes blue to purple discoloration of cervix & vagina
- Goodell’s - cyanosis & softening of cervix due to increased vascularity of cervical tissue (4w) - Ladin’s - softening of uterus in anterior midline @ uterocervical junction (6w) - Hegar’s - compessibility of isthmus; widening of softened area of isthmus resulting in compressability of isthmus on bimanual exam (6-8 w) - McDonald’s - uterus becomes flexible @ uterocervical junction (7-8w) - Von Fernwalds – irregular softening of fundus over site of implantation (4-5w) Leukorrhea – increased vaginal discharge consisting of cervical mucus & epithelial cells due to hormonal stimulation |
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What are some probably signs of pregnancy?
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- joint softening
- abdominal enlargement - contractions - ballottement of the uterus |
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What are some examples of pelvimetry (shape of the pelvis)?
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Gynecoid: Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet: best chances for normal vaginal delivery.
Android: triangular inlet, and prominent ischial spines, more angulated pubic arch. Anthropoid: the widest transverse diameter is less than the anteroposterior (obstetrical) diameter. Platypelloid: Flat inlet with shortened obstetrical diameter. |
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What is the fetal significance of engagement?
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The fetus is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet.
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What is the fetal significance of station?
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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.
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What is the fetal significance of attitude?
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Relationship of fetal head to spine: flexed, neutral (“military”), or extended attitudes are possible
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What is the fetal significance of position?
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Relationship of presenting part to maternal pelvis, i.e. ROP=right occiput posterior, or LOA=left occiput anterior.
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What is the fetal significance of presentation?
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Relationship between the leading fetal part and the pelvic inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow, mentum or shoulder presentation
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What is the fetal significance of lie?
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Relationship between the longitudinal axis of fetus and long axis of the uterus: longitudinal, oblique, and transverse.
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What is the fetal significance of caput?
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edema typically formed by the tissue overlying the fetal skull during the vaginal birthing process.
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What are some laboratory Pearls in pregnancy?
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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 |
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How often do mothers come for prenatal visits?
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Every 4 weeks until 28 weeks' gestation
Every 2-3 weeks until 36 weeks' gestation Every week from 36 weeks to delivery |
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What are some things to ask the mother when she comes for prenatal visits?
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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 +) |
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What are some exams that are performed at every prenatal visit?
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Bp/Wt
UA (RBC, WBC, PRO, GLU) FHT and Fetal Movement Fundal Height Edema |
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How much weight should a woman gain while pregnant?
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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 |
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What are some things to consider if the fundal height measurement is too small?
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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. |
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What are some things to consider if the fundal height measurement is too big?
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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. |
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What are some things to clinically assess during the first trimester?
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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 |
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When do you assess for nuchal translucency?
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11-14wks
Thickness of fetal neck Done with plasma protein & β-hCG level Finds 87% Down Syndrome |
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what are some things to clinically assess in the 2nd trimester.
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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 |
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