Quick Ob Review

Front 1

Definition:

child at fertilization to 8 weeks

Back 1

Embryo

Front 2

Definition:

child at 8 weeks to delivery

Back 2

Fetus

Front 3

Definition:

Softening and cyanosis of the cervix at or after 4 weeks

Back 3

Goodell's sign

Front 4

Definition:

softening of the uterus (after 6 weeks)

Back 4

Ladin's sign

Front 5

Definition:

first trimester

Back 5

fertilization to 12 weeks

Front 6

Definition:

second trimester

Back 6

12 weeks to 24 weeks

Front 7

Definition:

third trimester

Back 7

24 weeks to delivery

Front 8

Definition:

child delivery less then 24 weeks

Back 8

Priviable

Front 9

Definition:

Quickening

Back 9

Patient's initial presentation of fetal movement

Front 10

what are the changes in CO, HR, SV, TPR and BP during pregnancy?

Back 10

Inc CO, HR, SV

Dec TPR,

Dec BP (returns to nml >24 weeks)

Front 11

(4) Respiratory changes during pregnancy

Back 11

Inc Tidal volume,

Inc PaO2 and PAO2,

Dec lung capacity,

Mild Respiratory Alkalosis

Front 12

(3) GI changes during pregnancy

Back 12

Inc vomiting,

Dec motility (constipation),

Prolonged gastric emptying (GERD)

Front 13

(4) Renal changes during pregnancy

Back 13

Inc kidney size,

Inc GFR (by 50%) leading to...

Dec BUN and Creatinine by 25%,

Inc Renin, Aldosterone and Na absorption
(balanced by Inc GFR)

Front 14

(4) Blood changes during pregnancy

Back 14

Inc plasma volume (50%),

Inc RBC (20%),

both percents lead to Dec Hct,
possibly causing Iron deficiency anemia,

Inc Fibrinogen and factors VII - X leading to...
Inc Thromboembolism

Front 15

what hormones are maintained by the placenta in pregnancy?
(4)

Back 15

Estrogen,

hCG,

hPL,

Progesterone (after initial maintenance from corpus luteum)

Front 16

what causes increased Thyroid Binding Globulin?

how does this affect T3 and T4?

Back 16

Inc estrogen

T3 and T4 inc binding to TBG leading to low serum levels of free T3 and T4

Front 17

what is the cause of gestational diabetes?

how?

Back 17

hPL

it is an insulin antagoinist
(inc diabetic effect and leading to inc insulin and protein synthesis)

Front 18

what is the adequate amount of nutrition needed in pregnancy?

breast feeding?

Back 18

Pregnancy: 300 kcal/day

Breast feeding: 500 kcal/day

Front 19

how often should prenatal visits be?

Back 19

every 4 weeks until week 28

week 28 - 36: every 2 weeks,

36 to term: every week

Front 20

when is genetic screening done?
what are the (3) main tests?

Back 20

during second trimester
(usu 15 - 20 weeks)

MSAFP,

b-hCG,

Estriol

Front 21

which germ cell ovarian tumor has a different treatment method then the others?

what is the Tx?

Back 21

Dysgerminoma

Tx:
Radiation

Front 22

what is tested in pregnancy b/t 27 and 29 weeks?
(3)

Back 22

Glucose Loading Test (for gestational diabetes),

Hematocrit (for iron levels),

Glucose Tolerance Test if GLT is positive

Front 23

how is the Glucose Loading Test performed?

(2)

Back 23

give 50g oral glucose and check in one hour

if > 140 mg/dL, then do GTT

Front 24

How is a Glucose Tolerance Test performed?

What are the blood glucose values for fasting, one, two and three hour intervals?

Back 24

Fasting glucose:

give 100 g oral glucose and test at 1, 2 and 3 hours

Gestational Diabetes =
Fasting glucose > 105 mg/dL
or
any two values over 180, 155 or 140 respectively

Front 25

what can dehydration lead to later in pregnancy?

Back 25

Braxton-Hicks contractions

Front 26

what causes edema of lower extremities, feet and ankles, and hemorrhoids in pregnancy?

Tx?

Back 26

Compression of IVC and pelvic veins

Tx:
elevating feet

Front 27

what is the best test for fetal lung maturity?

normal levels?

Back 27

Lecithin/Sphingomyelin ratio

nml > 2

Front 28

describe a positive Non-Stress Test

Back 28

2 increases in FHR in 20 min that are >15 beats above nml and for >15 seconds

Front 29

describe a positive Oxytocin Challenge Test

Back 29

3 contractions in 10 minutes

Front 30

(5)* categories of the Biophysical Profiles

Back 30

Test the Baby MAN!:

Fetal Tone,
Fetal Breathing,
Fetal Movement,
Amniotic Fluid volume,
NST

(zero or 2 points each; nml is 8 - 10)

Hint 30

Test the Baby MAN!

Front 31

Definition:

multiple gestation w/ at least one IUP and at least one ectopic

Back 31

Heterotrophic Pregnancy

Front 32

at what b-hCG levels should you detect an IUP on vaginal US?

Back 32

IUP should be seen on US w/ b-hCG of
1500 – 2000 mIU/mL

Front 33

at what b-hCG levels should you detect a fetal heartbeat w/ trans-abdominal US?

Back 33

Fetal heartbeat should be seen w/ b-hCG > 5000 mIU/mL

Front 34

Tx for Ruptured Ectopic

Back 34

Exploratory Lap

(and maintain fluid levels)

Front 35

what hormone best resembles b-hCG?

how?

Back 35

LH

they also have similar beta units
(in addition to similar alpha)

Front 36

what is the criteria to use Methotrexate for an ectopic?
(2)

Back 36

ectopic must be < 3.5 cm,

w/o heartbeat

Front 37

what is the progesterone level in a nonviable intra- or extra-uterine pregnency?

Back 37

< 5 ng/mL

Front 38

what is the progesterone level in 98% of intrauterine pregnancies?

Back 38

> 25 ng/mL

Front 39

what does G5P2124 indicate?

Back 39

Twins

Front 40

Definition:

Spontaneous abortion time

Back 40

pregnancy ending < 20 weeks

Front 41

Type of Abortion:

any IU bleeding < 20 weeks w/o dilation or expulsion of POC

Back 41

Threatened abortion

Front 42

Type of Abortion:

death of embryo of fetus < 20 weeks w/ complete retention of POC (usu leads to complete SAB)

Back 42

Missed abortion

Front 43

Type of Abortion:

no expulsion of POC, but bleeding and dilation of cervix such that viability is unlikely

Back 43

Inevitable abortion

Front 44

(2) ways an incomplete abortion can be taken to completion in first trimester

Back 44

D&C

Prostaglandins (Misoprotol)

Front 45

causes of abortion in second trimester
(4)

Back 45

Congenital abnormalities

cervical / uterine abnormalities,

trauma,

systemic Dz or infection

Front 46

(3) ways an incomplete abortion can be taken to completion in second trimester

Back 46

D&E,

Prostaglandins (Misoprostol),

Oxytocin at high doses

Front 47

Definition:

Painless dilation leading to infection, Preterm Premature Rupture of Membranes (PPROM) or PTL

Back 47

Incomplete cervix

Front 48

what should be done if patient is in first trimester and has a history of incomplete cervix?

when?

Back 48

Cerclage

12 - 14 weeks

Front 49

(3) tests to verify if patient has ruptured membranes

Back 49

Pool - collection of fluid in vagina

Nitrazine - turns blue (alkaline)

Ferning

Front 50

Definition:

Rupture of membranes > 1 hour before onset of labor

Back 50

Premature Rupture of Membranes
(PROM)

Front 51

(5) parts of a Bishop score

Back 51

Dilation,

Effacement,

Station,

Cervical consistency,

Cervical position

Front 52

Bishop score points zero - 3 for:

Dilation

Back 52

zero: Closed

1 point: 1 - 2

2 points: 3 - 4

3 points: > 5

Front 53

Bishop score points zero - 3 for:

Effacement

Back 53

zero: 0 - 30%

1 point: 40 - 50%

2 points: 60 - 70%

3 points: > 80%

Front 54

Bishop score points zero - 3 for:

Station

Back 54

zero: -3

1 point: -2

2 points: -1 to zero

3 points: +1 - +3

Front 55

Bishop score points zero - 3 for:

Cervical consistency

Back 55

zero: Firm

1 point: Medium

2 points: Soft

3 points: (none)

Front 56

Bishop score points zero - 3 for:

Cervical position

Back 56

zero: Posterior

1 point: Mid

2 points: Anterior

3 points: (none)

Front 57

Definition:

Lengthening (thinning) of the cervix

Back 57

Effacement

Front 58

Definition:

relationship of fetal occiput to maternal pelvis

Back 58

Fetal Position

Front 59

(4) ways to Induce labor

Back 59

Pitocin,

Prostaglandins (Cervadil or Misoprostol),

Mechanical dilation of cervix,

Rupture of membranes (Amniotomy)

Front 60

MC 4 steps to Augment and monitor labor progress

Back 60

water broke?
if not -> Amniotomy

change?
if not -> IUPC

change?
if not -> Pitocin

change?
if not -> C-section

Front 61

what does an IUPC measure with respect to contractions?
(2)

Back 61

1. Time of contraction

2. Strength of contractions

Front 62

Name the (6)* movements of labor in order and what each means

Back 62

Engagement - biparietal diameter (largest) part of head enters pelvis,
Flexion - smallest diameter of head enters,
Descent - head completely into pelvis,
Internal rotation - from OT to OA or OP,
Extension - vertex passes beyond pubic synthesis; crowning occurs
External rotation - after delivery of the head as the head rotates to face forward

Hint 62

Every Fetus Delivers Involving Excited Externs

Front 63

(3) P's of the Active Phase that may cause problems in delivery

Back 63

Power
(strength of contractions),

Passenger
(size and position of infant),

Pelvis
(shape)

Front 64

(5) steps of Tx in patient w/ Non-reassuring fetal status

Back 64

1. Give mother oxygen mask

2. turn her to Left side to decrease IVC compression

3. D/C Pitocin

4. if due to Hypertonus (long contraction) or Tachysystole (>5 contractions in 10 min), give Terbutaline to relax uterus

5. If 1 – 4 does not work, C-section patient

Front 65

Dx:

Painless vaginal bleeding in the third trimester

Tx for perterm patient (<36 weeks)?
(3)

Tx for term patient?

Back 65

Placenta previa

Tx for Preterm:
1. Monitor in hospital
2. Transfusion PRN
3. Tocolytic to prolong until 36 weeks

Tx for Term:
C-section

Front 66

Dx:

Vaginal bleeding, painful contractions, firm and tender uterus

Tx?

Back 66

Placental Abruption


Tx - Delivery
(by C-section if mother or baby is unstable)

Front 67

Dx:

sudden onset of intense abdominal pain assoc w/ pregnancy

Tx?

Back 67

Uterine rupture


Tx - immediate laparotomy

Front 68

Dx:

Vaginal bleeding and sinusoidal FHR pattern

MCC?

Tx?

Back 68

Fetal Vessel Rupture

MCC - Velamentous cord insertion

Tx - emergency C-section

Front 69

Dx:

contractions and changes in cervix at < 37 weeks gestation

Back 69

Preterm Labor

Front 70

The only Tocolytic approved by the FDA

MOA?

Back 70

Ritrodrine


MOA: Beta-agonist

Front 71

Tocolytic that acts as a calcium antagonist

Back 71

Magnesium sulfate

Front 72

what is the test to determine if patient is near a Magnesium sulfate toxicity?

Back 72

check DTRs continuously...they are depressed less then the toxic level of 10 mg/dL

Front 73

what Calcium channel blocker is used as a Tocolytic?

Back 73

Nifedipine

Front 74

what NSAID is used as a Tocolytic?

Back 74

Indomethacin

Front 75

MC concern w/ PROM?

Back 75

Chorioamnionitis

Front 76

when is it common to see maternal hypotension?

what can it cause in child?

what is Tx for maternal hypotension?

Back 76

After epidural

causes - Fetal bradycardia

Tx - IV hydration and Ephedrine

Front 77

Tx for fetal bradycardia lasting for longer then 4 - 5 minutes?

Back 77

C-section

Front 78

Monozygotic Twins:

separation before the differentiation of trophoblasts

Back 78

Dichorionic-Diamnionic

Front 79

Monozygotic Twins:

separation after trophoblast differentiation and before amnion formation

Back 79

Monochorionic-Diamnionic

Front 80

what type of twins can develop Twin-to-Twin Transfusion Syndrome?

Back 80

Mono-Di

(one big baby and one small)

Front 81

Twin type:

division of fertilized ovum

Back 81

Monozygotic

Front 82

Twin type:

fertilization of two ova by two sperm

Back 82

Dizygotic

Front 83

Monozygotic Twins:

separation after amnion formation

Back 83

Monochorionic-Monoamnionic

(highest mortality rate)

Front 84

Dx:

pregnant woman with HTN, edema, proteinuria

Back 84

Preeclampsia

Front 85

(3) risk factors for onset of Preeclampsia

Back 85

Nulliparity,

Multiple gestation,

Chronic HTN

Front 86

Tx for Preeclampsia near term and preterm

Back 86

Near term:
Delivery

Preterm (and Eclampsia Tx):
Mag sulfate - against seizures
Hydralazine - HTN

Front 87

with Eclampsia, what percentage of patients have seizures before labor, during labor and after labor?

Back 87

Before: 25%

During: 50%

After: 25%

Front 88

what anti-hypertensives are given to mothers with chronic HTN during birth?
(2)

Back 88

Nifedipine


Labetolol

Front 89

what tests should be performed if patient has chronic HTN w/ pregnancy?
(2)

why?

Back 89

Baseline ECG,
24-hr urine collection

helps differentiate superimposed preeclampsia

Front 90

How common is gestational diabetes?

Back 90

approx 15% of pregnancies

Front 91

(3) fetal complications of Gestational Diabetes

Back 91

Macrosomia,

Shoulder dystocia,

neonatal Hypoglycemia

Front 92

when is a C-section indicated in gestational diabetes?

Back 92

if fetal weight > 4500g

Front 93

How is the DM-1 patient managed during pregnancy?

Delivery?

Back 93

Pregnancy - insulin pump

Delivery - insulin drip

Front 94

What gestational age of onset would you stop considering using a tocolytic agent?

A steroid agent?

What is done after that?

Back 94

Tocolytic: >34 weeks

Steroid: >36 weeks

then: Expectant management

Front 95

how are lower UTIs treated versus pyelonephritis in pregnancy?

Back 95

Lower UTI - oral Abx

Pyelonephritis - IV Abx

Front 96

(2) complications of pyelonephritis during pregnancy for mother

Back 96

Septic shock


ARDS

Front 97

what can Bacterial Vaginosis cause during pregnancy?

Back 97

Preterm delivery

Front 98

Leading cause of Neonatal sepsis

Tx?

Back 98

Group B strep


Tx:
Ampicillin

Front 99

Dx:

maternal fever, uterine tenderness, high WBC, fetal tachycardia

Tx? (2)

Back 99

Chorioamnionitis


Tx:
Delivery,
IV Abx

Front 100

Dx:

nausea and vomiting in pregnancy to the extent where the patient cannot maintain adequate hydration and nutrition

(3) Tx?

Back 100

Hyperemesis Gravidarum

Tx:
IV hydration,
Electrolyte repletion,
Antiemetics

Front 101

Management of women w/ Epilepsy during pregnancy
(3)

Back 101

check antiepileptic drug levels monthly,

Level 2 Ultrasound at 19 - 20 weeks,

supplement w/ Vitamin K from 37 weeks to delivery

Front 102

what do women w/ mild renal dz have a risk of getting during pregnancy?
(2 pregnancy problems)

Back 102

Preeclampsia,

IUGR

Front 103

Leading cause of maternal death

Back 103

Pulmonary emboli

Front 104

Tx for pregnancy-related DVT and PE

Back 104

Heparin

Front 105

Management for Hyperthyroidism in pregnant woman
(3)

Back 105

Thyroid-stimulating immunoglobulins (TSI) should be screened.

if elevated, screen for fetal goiter and IUGR

continue w/ PTU medication

Front 106

Management for Hypothyroidism in pregnant woman

Back 106

Synthroid

(Increased Synthroid requirements during preg for somone already on meds)

Front 107

(3) common problems that can occur in the pregnant SLE patient.

what (3) meds can be used in these patients as prophylaxis?

Back 107

Risk for:
Pregnancy loss,
IUGR,
Preeclampsia

Meds:
Low-dose aspirin,
Heparin,
Corticosteroids

Front 108

how are Lupus flares and Preeclampsia differentiated in pregnancy?

Back 108

Complement levels

Front 109

SLE and Sjogren mothers with anti-Ro and Anti-La antibodies have risk of developing what fetal problem?

Back 109

Fetus w/ Congenital Heart Block

Front 110

Dx:

infant is delivered and has growth restriction, CNS problems, cardiac defects and abnormal facies

Back 110

Alcohol abuse during pregnancy
(FAS)

Front 111

Pregnancy Risk:

Caffeine > 150 mg/day

Back 111

Spontaneous abortions

Front 112

Pregnancy Risk:

Cigarette smoking
(4)

Back 112

Growth restriction,

Abruptions,

Preterm delivery,

Fetal death

Front 113

Pregnancy Risk:

Cocaine
(2)

Back 113

Placental Abruption,

CNS defects in children

Front 114

what is best for the pregnant woman on Heroin during pregnancy?

Back 114

Quitting outright will endanger fetus--need to be enrolled in a methadone clinic, then quit after delivery

Front 115

(2) central issues in the immediate postpartum period for the patient

Back 115

Pain management,

Wound care

Front 116

when do diaphragms and cervical caps need to be refitted postpartum?

Back 116

6 weeks

Front 117

what are the (3) hormonal contraceptives of choice postaprtum?
Why?

Back 117

Depo-provera,

Norplant,

Progesterone-only minipill

b/c they are less likely to decrease milk production in breast-feeding patients

Front 118

What are the causes of postpartum hemorrhage?
(6)*

Back 118

Coagulation Defect;
Atony;
Rupture;
Placenta (POC) retained;
Implantation site bleed;
Trauma

Hint 118

CARPIT

Front 119

what are the steps in managing a postpartum hemorrhage?
(4 steps)

Back 119

1. R/O cervical/vaginal lacerations

2. if still bleeding:
give Uterotonic agents (Oxytocin)

3. if still bleeding:
D&C

4. if still bleeding:
Laparotomy w/ bilateral O'Leary sutures to tie off uterine arteries

Front 120

Dx:
fever, high WBC, uterine tenderness 5 - 10 days post C-section

Tx?
(2)

Back 120

Endomyometritis

Tx:
D&C
broad-spectrum Abx until afibrile for 48 hrs