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51 Cards in this Set
- Front
- Back
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OB HPI focus on what?
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types contraception
menstrual hx + pregnancy test sx of pregnancy |
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Describe the GXpX system and give an example of twins.
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G - # pregnancies
P - outcome of pregnancy => G1P2 is twins after birth http://en.wikipedia.org/wiki/Parity_(biology) |
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TPAL system
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When this is used drop the P term so G(x)P(tpal)
T- EDD+/-2wks P- 20wks-36wk6d A- <20wks L- Offspring living |
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What is conjugate diameter
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Lower pubic symphysis to sacral promontory
- palpate up & back for sacral promontory (often not felt) - Not felt then CD > length hand |
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What is the approximate location of ischial spine on palpation?
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2" into vagina at 4 & 8 O'Clock position
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What is transverse diameter?
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distance between ischial tuberosities
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What questions should be asked for LMP based dating?
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-1st day of LMP
(assess integrity of LMP dating) -Length/variability of menstrual cycles -Use of OCPs/breast feeding 6mo prior to conception |
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When and where are we able to 1st hear FHT ?
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By fetoscope - 17-20wks
By US - 12wks typically located midline through wk 28 |
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What are the cut off in wks for trimesters of pregnancy?
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1 Tri - 0-12wks (13wk)
2 Tri - 13-28wks (16wk) 3 Tri - 29-39wks (11wk) |
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What is measured for dating by US in each trimester ?
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1 Tri - crown rump length
2 Tri - biparietal diameter or femur length 3 Tri - not helpful accuracy is +/- 3wks |
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What is used for dating LMP or US?
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LMP is used unless >1wk from the US dating. Then dating is based on US
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What constitutes referral to high risk OB?
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-h/o preterm delivery
-h/o IUFD -h/o loss betw/ 14-20wks -multiple gestation -3rd tri bleeding or placenta previa (>26wks) -isoimmunization -h/o serious medical prob -h/o DVT or PE |
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what is the ROUTINE Ob visit schedule?
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Q4wks until 28wks
Q2wks until 36wks Q1wk until birth |
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What is typical weight gain during pregnancy?
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based on pre pregnancy BMI
0.5lb/wk until 28wks 1lb/wk after 28wks |
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Why are we concerned about massive wt gain near the end of pregnancy ? Like 5lbs/wk.
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could be a sign of pregnancy induced HTN
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What is the general trend of BP in pregnancy? What values make us concerned?
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Drop in 2nd Tri -AND- Rise in 3rd Tri
>140/90 concerns us >160/110 warrants emergent steps be taken |
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What should be done is proteinuria is 2+ on a routine visit ?
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Repeat with a clean catch midstream sample.
-Culture should be checked if UTI is suspected. -BP checked to r/o pregnancy induced HTN |
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What should you do if urine comes back suspect for Glucose ?
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Perform 2nd trimester DM screening earlier then normal 24-28wks
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How should we assess edema ? Treatment ?
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Assess
-Seen in 75% of women. No longer in triad for preg induced HTN. -Sudden onset -OR- >3lb/wk gain suspect dz process Treatment -Sitting legs up/lying down during day (often not practical) |
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Why is GDM more common late in pregnancy? What was the old days outcome?
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-Often 2y to HPL secreetion which is proportional to the wt of the placenta
-Seen in 1-2% pregnancies AND prior to use of Insulin 50% moms died |
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What is screening for GDM ?
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1H GTT - want <140mg/dl
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What is dx for GDM ?
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Abnormal 3H GTT
Fasting - 105mg/dl 1H - 190mg/dl 2H (drops 25) - 165mg/dl 3H (drops 20) - 145mg/dl |
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What are the letter/number classifications for GDM ?
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A1 - fasting <105mg/dl
A2 - fasting >105mg/dl B1 - fasting >130mg/dl B2 - T2DM prior pregnancy C - DM onset age 10-19 D - DM onset prior age 10 -OR- >20y F/R/H - w/ nephropathy/retinopathy/heart probs |
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Relationship of GDM and T2Dm ?
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about 50% of GDM will develop T2DM later in life. Recommend screening.
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24-28wk screening tests ?
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CBC for Hct
-Anemia defined as <11mg/dl in trimesters 1-2 -AND- <10.5 in 3rd trimester |
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Rh negative mothers when recieve RhoGam ?
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28wks given to prevent Hemolytic Disease of Newborn for subsequent Rh+ babies
-Given for any procedure like amniocentesis/post-partum/abortion |
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Why is Rubella iGG routinely measured ?
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Often the German Measls dz is subclinical but may cause cataracts, cardiac defects, deafness in the fetus
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What is tx for reducing vertical transmission of HIV ?
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14-34wks initiate ZDZ 100mg 5/day + IV during labor + 6wks treat baby
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Why screen for HBV ?
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Vertical transmission can be decreased.
90% transmission rate when mom + E Ag -AND- S Ag reduced to 10% with IVIG in newborn -AND- starting HBV vaccines early in child |
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When and why screen mAFP levels ?
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15-20wks gestation
-Higher then expected levels = open NT defect/ IUFD = incorrect gestational age = twins -Lower then expected =chromosomal abnormalities (downs syn.) |
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What is the f/u to abnormal QUAD screen ?
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Gestational age/twins confirmation by US
Remains abnormal - amniocentesis + genetic screening + US for anomalies |
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What is time frame for amniocentesis ?
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Performed betw/ 14-18wks
Take 2-3wks culturing to et enough mass for Karyotype analysis |
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What is CVS ?
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Chorionic Villous Sampling
-10-12 wks (earlier then amniocentesis) - Fetal karyotype ascertained - Does NOT screen for NT defects - Slightly higher risk for loss pregnancy/limb reduction abnormalities compared to amniocentesis |
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What is the indication for a NST ?
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Decreased fetal movement after 28wks
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What STI's should be screened for? Treatments?
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Chlamydia, Gonnorhea - Erythromycin
Metronidazyl after 1st trimester |
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What Abxs should be avoided in pregnancy?
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-Sulfa near birth - displace bilirubin from carrier resulting in kernicterus
-Tetracycline - teeth discoloration -Nitrofuratoin - worsens hemolytic anemia |
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What are the signs of labor?
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>24wks
>4ctx/hr with pain for 2H or more |
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What is round ligament pain?
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Tender on lateral aspects Uterus
Roughly correlates to location of round ligament Tx - tylenol and heating pads |
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Leg cramps
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want to r/o DVT
-unilateral, erythema, painful swelling |
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Pregnancy circulation obstruction?
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Observed during labor but NOT prior to this time. Ok to sleep on your back
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What is critical in L&D triage ?
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-EGA if >36wks shouldn't be serious
-Presenting complaint MC are SROM + Contractions |
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How determine if SROM and f/u questions?
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+Fern test
Positive Nitrazine test + when pH is 7.1 to 7.4. 90% women have acidic urine (10% FP from urine) - Ask about quality (meconium/clear) |
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What does active labor include?
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-Contractions
-Dilation of cervix -Effacement |
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What is Friedman's curve?
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Not used for detail level but gives sense of progression
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What divides 1st and 2nd stage of labor ?
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Complete dilation marks end of the 1st stage and beginning of 2nd stage
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How is the 1st stage of labor divided?
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Often hard to differentiate in real time. Shift occurs when dilation rate increases. Generally occurs around 4cm
Latent - Cervical change w/ regular ctx Active - Rapid cervical change w/ regular ctx |
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What marks beginning and end of 3rd stage of delivery?
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3rd stage - ma take up to 30min
-Beginning = birth of baby -End = delivery of placenta |
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What are majority fetal orientations and presentations?
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96% are Vtx (head first)
95% are OA (looking at the ground) |
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What is slang for OP?
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Sunny side up - since looking up to mom's urethra
-labor is prolonged -May have more back pain |
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How long from time 100% effacement to delivery?
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This is stage 2 of labor and timing depends...
Primnup - 2.9H Multip - 1.1H |
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How long is active labor ?
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This is a portion of stage 1 of labor. Time depends but generally about 50% of latent labor. Multips are typicall about half the time for stage 1 labor.
Primnup - 11.7H active labor Multip - 5.2H active labor |
