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24 Cards in this Set
- Front
- Back
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Be able to write out all the parts of an initial HISTORY of the prenatal exam
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OB HISTORY
-Menstrual hx: menarche/interval/duration, regularity of cycles, last normal menstrual period. OB index: -year/termination date/type of delivery -age (<17, >35 risk) -abortions (#induced, habitual=>3) -previous infants (preterm, SGA/LGA) -birth weight (>4000g) -perinatal death -genetic/congenital problems PAST PREG COMPLICATIONS -Hemorrhage: placenta previa, abruption, post partum, lacerations (uterine or cervical) -Pregnancy-induced medical problems: HTN, GDM, other GYN HX -history of infertility -uterine/cervical abnormality -previous uterine surgery -hx previous infections -hx cervical procedures (like leep) MED-SURG HX -hear dx -pulmonary dx -genitourinary problems -renal dx -DM -thyroid dx -seizures -past surgeries/blood transfusions FAM HX -HTN'-multiple births -DM -hemoglobinopathies -DES exposure -mental retardation -congenital anomalies -allergies PSYCHOSOCIAL HX -education -employment -substance use -planned pregnancy -living situation & arrangements -financial/insurance needs -social support system |
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List all of the components (areas of the body only, not how to do them) of the PHYSICAL of the initial prenatal exam
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-skin
-HEENT -mouth -thyroid -lungs -breasts -nipples -heart -abdomen (including CVAT) -extremities -neurologic -perineum -vulva -vagina -cervix -uterus -adnexa -rectovaginal septum -pelvimetry |
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What puts a woman at most risk for pre-term birth?
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a hx of preterm birth
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What are the defining characteristics of a gynecoid pelvis?
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-"female type"
-41-42% of all women -wide pubic arch (90degrees or more) -pelvic brim in a transverse ellipse (nearly a circle) -Most favorable for delivery |
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What are the defining characteristics of a android pelvis?
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-"male type"
-32.5% of white women -15.7% of all others -pelvic brim in triangular -convergent side walls (widest posteriorly) -prominent ischial spines -narrow pubic arch -more common in white women -increased OP presentation -increased perineal lacerations |
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What are the defining characteristics of a anthropoid pelvis?
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-pelvic brim is an anteroposterior ellipse
(like the gynecoid pelvis turned 90 degrees, so more 'deep') -narrow ischial spines -more common in black women: 40.5% of non-white women 23.5% of white women |
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What are the defining characteristics of a platypelloid pelvis?
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-found in less than 3% of all women
-pelvic brim is transverse kidney shape -flattened gynecoid shape |
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What is the diagonal conjugate, the approximate length (compared to your hand), and what length is considered adequate?
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-distance from sacral promontory to symphysis pubis
-approximate length of fingers, introitus to sacrum -adequate diagonal conjugate is >11.5cm |
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What is the intertuberous diameter, the approximate length (compared to your hand) and what length is considered adequate?
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-distance between ischial tuberosities
-approximate width of fist -adequate intertuberous diameter >10cm |
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What are the other factors in determining adequacy of the pelvis besides the diagonal conjugate and intertuberous diameter?
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-prominence of ischial spines
-pelvic angle (+/-90 degrees) -pelvic planes -true pelvis: *pelvic inlet: the line between the narrowest bony points formed by the sacral promontory and the inner pubic arch is termed the obstetric conjugate. It should be 11.5cm or more. This anterposterior line at the inlet is 2cm less than the diagonal conjugate (distance from the under surface of the pubic arch to sacral promontory) *Midpelvis: the line between the narrowest bone points connects the ischial spine; it typically exceeds 12cm. *Pelvic Outlet: the distance between the ischial tuberosities (normal >10cm), and the angulation of the pubic arch. |
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Describe simple digital evaluation of the pelvis step by step that you would perform at the initial prenatal exam.
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-Measuring the DIAGONAL CONJUGATE: inset two fingers into the vagina until they meet the sacral promontory. The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 11.5cm.
-Measure the TRANSVERSE OUTLET DIAMETER (or intertuberous diameter) by pressing your closed fist against the perineum. Compare the previously measured diameter of your fist to the palpable distance between the ischial tuberosities. Greater than 10cm bituberous (or biischial, or transverse outlet) is considered normal. -To determine the PROMINENCE OF THE SPINES, feel the ischial spines for their relative prominence or flatness. Spinal prominence narrows the transverse diameter of the pelvis, should be >10cm. Then, feel the pelvic sidewalls to determine if they are parallel (OK), diverging (even better), or converging (bad). True outlet obstruction is fortunately rare. |
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What labs/test would you do/order at the initial prenatal visit?
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-HCG (urine or serum)
-blood type and Rh factor -antibody screen -VDRL/RPR -CBC with differential -urinalysis and urine culture -vaginal cultures: *PAP & HPV *GC and chlamydia *wet mount -rubella titer/varicella titer -hepatitis titer -cystic fibrosis screen -hemoglobin electrophoresis -HIV screen -ultrasoundography |
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What labs/tests would you do/order at return evaluations (ROB) ?
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*8-18wks: US, amniocentesis, CVS
*10-14wks: 1st trimester screen, NT *16-18wks: 2nd trimester screen, survey US *26-28wks: diabetes screen, repeat hgb/hct *28wks: Rh neg antibody screen (if indicated), THEN rhogam *32-36wks: US, testing for std (syphilis, gonococcal, chlamydia if at risk), h/h *36wks: GBS culture |
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What screens are common "if indicated"?
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-urine toxicology
-sickle cell -thyroid -genetic screening/chromosomal studies (like the Jewish panel) -diabetes testing (more than the standard) -amniocentesis |
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At the ROB, what OB developments, parts of the physical exam will you do (objective)?
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-weight gain/loss
-uterine growth/fundal height *IUGR *macrosomia *hydramnios/oliguria *myomata *multiple fetuses *size/dates discrepancy -fetal lie/presentation -fetal heart tones -VS including BP -urine dip (protein/glucose) |
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What is MacDonald's rule?
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Fundal Height: this is a measure of the size of the UTERUS used to assess FETAL GROWTH and development. It is measured from the top of the PUBIC BONE to the top of the uterus in centimeters. It should match the FETUS' gestational age in weeks within 1-3cm, e.g., a pregnant woman's uterus at 22wks should measure 19-25cm.
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How is gestational dating done?
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-last normal menstrual period
-ultrasound -bimanual examination -serum B-hCG testing (not accurate)? ...didn't understand what was meant by this slide, go back to recorded lecture or book... |
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Where is the fundal height in accordance to weeks from 12 weeks until term?
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put in pictures from slide!
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What is the normal fetal heart rate during pregnancy?
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110-160 bpm
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Why do we have women do kick counts?
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-Non randomized studies have shown that counting and recording fetal kicks every day and bringing the report to their physician can reduce the risk of stillbirth by 70% in low-risk women in antepartum and intrapartum management study.
-ACOG recommends that you time how long it takes you to feel 10 kicks, flutters, swishes, or rolls. Ideally you want to feel at least 10 movements within 2 hours. |
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How would you explain to a woman how to do her kick counts?
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-choose time of day
-get a watch -get a piece of paper and something to write with -mark a line for every movement your baby makes within 30 min -if your baby moves 10 times in 30 min you are done -if you have fewer than 10 times in 30 min then continue -this time lay on your left side -eat something -if you still do not have 10 movements in the next 30 min (or ACOG says 1.5 more hours for a total of 2 hours) then call your provider Tips: -wait until 28 weeks -choose a time of day your baby is usually active -ask your provider for variations on testing according to their opinion/protocol |
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What are common med-surg problems you may need to assess/reassess on ROBs?
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-DVT
-cardiopulmonary problems -anemias -hepatitis -surgical indications (fibroids, appy) -HTN -DM |
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What subjective symptoms do you want to assess for at ROBs?
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-S/S abortion including incompetent cervix
-hyperemesis -infections *TORCH (toxoplasmosis, other, rubella, cytomegalovirus, herpes) -flu syndrome -GU (upper and lower) *UA *C&S -bleeding >20wks *cervical *low lying placenta *unknown -pre-term labor -post dates -fetal death |
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What is the recommended visit schedule for ROBs according to ACOG?
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-Weeks 4-28: 1/month, q4 weeks
-Weeks 28-36: 2/month q2-3 weeks -Weeks 36-birth: q1 week |
