Ob/gyn

Front 1

When does beta-HCG peak and at what level?

Back 1

by 10 weeks gestation, peaks at 100,000mIU/mL

Front 2

Embryo

Back 2

fertilization until 8 weeks (10 weeks GA)

Front 3

Fetus

Back 3

8 weeks until birth

Front 4

Previable

Back 4

delivery before 24 weeks

Front 5

Preterm

Back 5

delivery between 24 and 37 weeks

Front 6

Postterm

Back 6

delivery beyond 42 weeks

Front 7

Gravity

Back 7

# of times a woman has been pregnant

Front 8

Parity

Back 8

# of pregnancies that have led to a birth at or beyond 20 weeks GA or weighing >500g

Front 9

TPAL

Back 9

# of Term, Preterm, Abortuses and Living Children

Front 10

Chadwick's sign

Back 10

bluish color of vagina and cervix

Front 11

Goodell sign

Back 11

softening and cyanosis of the cervix at or after 4 weeks

Front 12

Ladin sign

Back 12

softening of the uterus after 6 weeks

Front 13

Gestational age (GA)

Back 13

age in weeks and days since LMP

Front 14

Developmental age (DA)

Back 14

(conceptional age) is number of weeks and days since fertilization

Front 15

Nagle rule

Back 15

to calculate the estimated date of delivery:
LMP - 3 months + 7 days

Front 16

Cardiac output

Back 16

increases by 30-50% during pregnancy (most during 1st trimester)

Front 17

Systemic vascular resistance

Back 17

decreases during pregnancy--causes fall in BP, probably due to increased progesterone causing smooth muscle relaxation

Front 18

Tidal Volume

Back 18

increases by 30-40% despite the TLC decreasing by 5% b/c of diaphragm rising

Front 19

GFR

Back 19

increases by up to 50% causing a BUN and Cr levels to decrease by about 25%

Front 20

Plasma volume

Back 20

increases by up to 50% but the plasma only increases by 20-30% so hematocrit decreases

Front 21

Hormones with the same alpha-subunit

Back 21

alpha-HCG, LH, FSH and TSH

Front 22

Human placental lactogen (hPL or hCS)

Back 22

made by placenta, important for fetal nutrition, causes lipolysis and increase in free fatty acids

Front 23

Normal weight gain

Back 23

20-30 lbs

Front 24

Protein requirement during pregnancy

Back 24

increases to 70-75g/day (from 60g/day)

Front 25

Calcium intake during pregnancy

Back 25

1.5g/day

Front 26

Folate requirement during pregnancy

Back 26

increases to 0.8mg/day (from 0.4mg/day)

Front 27

Maternal Serum Alpha Fetoprotein screening (MSAFP)

Back 27

usually between 15-18 weeks.

Front 28

Elevated MSFAP

Back 28

increased risk of neural tube defects

Front 29

Decreased MSFAP

Back 29

seen in some aneuploidies (including Down syndrome)

Front 30

Biophysical profile (BPP) components

Back 30

amniotic fluid volume, fetal tone, fetal activity, fetal breathing movements, and nonstress test (NST) of the fetal heart rate

Front 31

Fetal lung maturity measurement

Back 31

Usually use the lecithin to sphingomyelin (L/S) ratio. It should increase

Front 32

Lab tests for an ectopic pregnancy

Back 32

Beta-HCG should double approximately every 48 hours

Front 33

Medical management of uncomplicated ectopic pregnancies

Back 33

Methotrexate--in reliable patients due to necessary follow up

Front 34

Incidence of ectopic pregnancies

Back 34

1%

Front 35

Spontaneous Abortion (SAB)

Back 35

before 20 weeks gestation

Front 36

Abortus

Back 36

fetus lost before 20 weeks, less than 500g, or less than 25cm

Front 37

Complete Abortion

Back 37

complete expulsion of all the POC before 20 weeks gestation

Front 38

Incomplete Abortion

Back 38

partial expulsion of some but not all POC before 20 weeks' gestation

Front 39

Inevitable Abortion

Back 39

no expulsion of products, but bleeding and dilation of cervix such that a viable pregnancy is unlikely

Front 40

Threatened Abortion

Back 40

any intrauterine bleeding before 20 weeks, without dilation of the cervix or expulsion of any POC

Front 41

Missed Abortion

Back 41

death of the embryo of fetus before 20 weeks with complete retention of POC; these often proceed to complete abortions in 1-3 weeks but are sometimes retained for much longer

Front 42

Treatment of incomplete, first trimester abortion

Back 42

expectant management, D&C, or prostaglandins (misoprostol)to induce contractions and cervical dilation

Front 43

Incompetent cervix

Back 43

Painless dilation and effacement of cervix, often in 2nd trimester--causes ~15% of 2nd trimester losses. Can lead to infection, PTL or PPROM

Front 44

Cerclage

Back 44

suture placed vaginally around the cervix to close it--one possible treatment for an incompetent cervix

Front 45

Recurrent pregnancy loss

Back 45

3 or more consecutive SABs

Front 46

Sickle cell disease

Back 46

AR, single point mutation in gene for beta chain in hemoglobin

Front 47

Tay-Sachs disease

Back 47

AR, deficiency of hexosamindase A (hex A)--buildup up Gm2 gangliosides in lysosomes, esp. in brain

Front 48

Beta-thalassemia

Back 48

Sx seen several months after birth when beta would normally replace gamma chains

Front 49

Alpha-thalassemia

Back 49

Hb Bart (4 alleles)
HbH (3 alleles)
Alpha thal trait (2 alleles)
(1 allele)-mild microcytic anemia

Front 50

Triple Screen

Back 50

MSAFP, estriol, beta-hCG

Front 51

Quad Screen

Back 51

MSAFP, estriol, beta-hCG PLUS inhibin A

Front 52

1st semester Down Syndrome screen

Back 52

Ultrasound for nuchal translucency (NT)and serum for free beta-hCG and pregnancy associated plasma protein A (PAPP-A) give an 80% sensitivity together

Front 53

Trimsomy 18

Back 53

Edward syndrome: die by 2 years old--can often be detected by US or triple screen. Clenched fists, overlapping digits, rocker bottom feet.

Front 54

Trisomy 13

Back 54

Patau syndrome: 85% die by 1 year. Similar signs as Trisomy 18. Can use US to screen but not triple screen.

Front 55

Turner Syndrome

Back 55

45X,0:

Front 56

Klinefelter syndrome

Back 56

47XXY

Front 57

Morula

Back 57

16 cells, by day 4

Front 58

Blastocyst

Back 58

Inner cells--embryo
Outer cells--trophoblast
Implants in endometrium by end of day 7

Front 59

Trophoblast differentiation

Back 59

By start of week 2
give rise to placenta

Front 60

Inner cell mass differentiation

Back 60

by start of week 2
divides into bilaminar germ disc (epiblast and hypoblast)

Front 61

Gastrulation

Back 61

during 3rd week
formation of a primative streak on epiblast--invagination of epilbast cells into 3 germ layers

Front 62

Endoderm layer

Back 62

GI and respiratory systems

Front 63

Mesoderm layer

Back 63

CV, musculoskeletal, and GU systems

Front 64

Ectoderm layer

Back 64

nervous, skin, and many sensory organs (hair, eyes, nose, ears)

Front 65

Neural Tube Defects

Back 65

develop d/t defective closure by week 4

Front 66

Spina Bifida

Back 66

can be seen with US, elvated MSAFP

Front 67

Eisenmenger physiology

Back 67

VSD causing RV hypertrophy, pulmonary HTN, eventual right-to-left shunt

Front 68

Tetrology of Fallot

Back 68

VSD
Overriding aorta
Pulmonary Stenosis or atresia
RV Hypertrophy

Front 69

Potter Syndrome

Back 69

Bilateral renal agenesis causing anhydramnios, pulmonary hypoplasia and fetal contractures

Front 70

Nuchal Translucency (NT)

Back 70

screen for aneuploidy (Down in particular)--measures the posterior fetal neck in profile (~70% sensitive)

Front 71

Triple screen sensitivity alone

Back 71

60%

Front 72

3 ways to obtain fetal cells

Back 72

1-amniocentesis
2-chorionic villous sampling
3-fetal blood sampling

Front 73

Amniocentesis

Back 73

after 15 weeks, can get fetal karyotype--place needle transabdominally thru the uterus into the amniotic sac to withdraw fluid (c sloughed fetal cells)

Front 74

Fluorescent in-situ hybridization (FISH)

Back 74

can ID aneuploidy from amniocentesis in 24-48 hours (normal culture takes 5-7 days)

Front 75

Risk of amniocentesis

Back 75

1 in 200

Front 76

Chorionic Villous Sampling (CVS)

Back 76

fetal karyotype sooner than amniocentesis--at 9-12 weeks. Place catheter in intrauterine cavity and aspirate chorionic villi from placenta

Front 77

CVS risk

Back 77

higher than 1 in 200

Front 78

Fetal Blood Sampling (via PUBS)

Back 78

needle placed transabdominally into uterus and phlebotomizing the umbilical cord

Front 79

Fetal Lie

Back 79

whether the infant is longitudinal or horizontal

Front 80

Fetal Presentation

Back 80

either breech or vertex (cephalic)

Front 81

PROM

Back 81

Premature rupture of membranes--at least one hour before onset of labor (occurs in 10%)

Front 82

PPROM

Back 82

Preterm, premature rupture of membranes--before 37 weeks

Front 83

Components of Bishop score

Back 83

1-dilation
2-effacement
3-fetal station
4-cervical position
5-consistency of the cervix

Front 84

station

Back 84

relation of the fetal head to the ischial spines
0--presenting part is level wtih ischial spines--goes + from there

Front 85

Cervical consistency

Back 85

firm, soft or in between

Front 86

Labor

Back 86

contractions that cause cervical change in either effacement or dilation

Front 87

Normal fetal heart rate

Back 87

110-160 bpm

Front 88

Early decelerations

Back 88

begin and end at approximately the same time as contractions--d/t increased vagal tone secondary to head compression

Front 89

Variable decelerations

Back 89

occur at any time and can drop more precipitously than early or late decels. D/t umbilical cord compression

Front 90

Late decelerations

Back 90

begin at peak of contraction and slowly return to baseline after contraction is over. D/t uteroplacental insufficiency--worrisome--may become brdaycardia as labor progresses

Front 91

External Electronic Monitor

Back 91

External tocometer--belt that goes around fundus--measures during contractions as belly gets firmer

Front 92

Fetal Scalp Electrode (FSE)

Back 92

more sensitive. C/I include hx of HIV or maternal hepatitis or fetal thrombocytopenia

Front 93

Intrauterine Pressure Catheter (IUPC)

Back 93

used if timing a/o strength of contractions is crucial. Catheter is threaded past presenting part into uterine cavity

Front 94

Cardinal movements of labor

Back 94

1-Engagement
2-Descent
3-Flexion
4-Internal rotation
5-Extension
6-External Rotation (restituion/resolution)

Front 95

Engagement

Back 95

fetal presenting part enters pelvis

Front 96

Descent

Back 96

head descends into pelvis

Front 97

Flexion

Back 97

allows smallest diameter to present to the pelvis

Front 98

Internal Rotation

Back 98

from an occiput transverse (OT) position so that the sagittal suture is parallet to the AP diameter of the pelvis, often to the OA position

Front 99

Extension

Back 99

as vertex passes beneath and beyond the pubic symphysis

Front 100

External Rotation

Back 100

once head is delivered, so that shoulders can be delivered

Front 101

First Stage of Labor

Back 101

Onset until full dilation and effacement of cervix

Front 102

Second Stage of Labor

Back 102

From full dilation and effacement until delivery of infant

Front 103

Third Stage of Labor

Back 103

After delivery of infant until delivery of placenta

Front 104

Average time for 1st stage of labor

Back 104

10-12 hours for nulliparous
6-8 hours for multiparous

Front 105

2 phases of 1st stage of labor

Back 105

Latent: onset until 3-4cm dilation with slow cervical change.
Active: until greater than 9cm of dilation, slope increases.

Front 106

Factors affecting the Active Phase of the 1st Stage

Back 106

3Ps:
Powers: strength and size of contractions
Passenger and Pelvis: babe may be too big for pelvis, etc (cephalopelvic disproportion-CPD)

Front 107

Average time for 2nd stage of labor

Back 107

nulliparous: within 2 hours or 3 with epidural
multiparous: within 1 hour or 2 with epidural

Front 108

Uterine hypertonus

Back 108

a single contraction lasting more than 2 minutes

Front 109

Uterine tachysystole

Back 109

>5 contractions in a 10-minute period

Front 110

Ritgen manuever

Back 110

moderate upward pressure on fetal chin with posterior hand while suboccipital region is held against pubic symphysis

Front 111

Time Frame for Placental Seperation

Back 111

usually within 5-10 minutes of fetal delivery but up to 30 minutes is normal.

Front 112

3 signs of placental separation

Back 112

cord lengthening, gush of blood, and uterine fundal rebound

Front 113

1st degree perineal laceration

Back 113

involves the mucosa or skin

Front 114

2nd degree perineal laceration

Back 114

extend into the perineal body but don't involve the anal sphincter

Front 115

3rd degree perineal laceration

Back 115

extend into or completely through the anal sphincter

Front 116

4th degree perineal laceration

Back 116

if anal mucosa is entered

Front 117

Pudendal nerve

Back 117

just posterior to ischial spine at its juncture with the sacrospinous ligament

Front 118

Epidural vs. spinal anesthesia

Back 118

Epidurals: more common during labor
Spinal anesthesia: one time dose, more rapid onset, more common with C-sections

Front 119

Placenta Previa

Back 119

abnormal implantation of the placenta over the internal cervical os (complete, partial or marginal)--occurs in 0.5% of all pregnancies and accounts for 20% or all antepartum hemorrhages

Front 120

Vasa Previa

Back 120

rare, when a fetal vessel lies over the cervix

Front 121

Placenta Accreta

Back 121

abnormal adherence of the placenta to the uterine wall-causes inability of the placenta to seperate from the uterine wall after delivery

Front 122

Placenta Previa symptoms

Back 122

sudden and profuse painless vaginal bleeding, usually after 28 weeks gestation

Front 123

Circumvallate Placenta

Back 123

occurs when the membranes double back over the edge of the placenta, forming a dense ring around the periphery of the placenta--considered a variant of placental abrubtion

Front 124

Placenta Increta

Back 124

abnormal placentation where the placenta invades the myometrium

Front 125

Placenta Percreta

Back 125

Abnormal placentation where the placenta invades thru myometrium to the uterine serosa

Front 126

Velamentous Placenta

Back 126

When the blood vessels insert b/t the amnion and teh chorion, away from the margin of the placenta. Leaves the vessels unprotected and vulnerable to compression or injury

Front 127

Succenturiate Placenta

Back 127

An extra lobe of the placenta that is implanted at some distance away from the rest of the placenta. Fetal vessels may course between the 2 lobes, possibly over the cervix, leaving these blood vessels unprotected and at risk for rupture

Front 128

Placental Abruption (Abruptio Placentae)

Back 128

premature separation of the nornally implanted placenta from the uterine wall, causing hemorrhage b/t uterine wall and placenta--occurs in 0.5-1.5% of all pregnancies and is the cause of 30% of 3rd trimester bleeding

Front 129

Placental Abruption symptoms

Back 129

3rd trimester vaginal bleeding with severe abdominal pain a/o frequent, strong contractions. 20% have no symptoms d/t concealed hemorrhage.

Front 130

Apt test

Back 130

test for vaginal bleeding to see if fetal blood cells (nucleated) are present

Front 131

Low Birth Weight Infant (LBW)

Back 131

born weighing less than 2500g

Front 132

Tocolytic agent

Back 132

Ritodrine--only FDA approved drug for preventing contractions--can only prolong birth by ~48 hours

Front 133

Betamethasone

Back 133

a glucocorticoid used to enhance fetal lung maturity when PTL is anticipated

Front 134

Dehydration and contractions

Back 134

a dehydrated patient will have more ADH, which is similar in structure to oxytocin and also made in the hypothalamus--so correcting dehydration may reduce contractions

Front 135

Ritodrine MOA

Back 135

Beta-mimetic. Increases conversion of ATP-cAMP which decreases the levels of free calcium (via sequestration into sarcoplasmic reticulum ) which decreases uterine contractions

Front 136

Magnesium sulfate

Back 136

Decreases uterine tone and contractions by acting as a calcium antagonist and membrane stabalizer

Front 137

Calcium Channel Blockers

Back 137

especially nifedipine--decrease influx of calcium into smooth muscle cells--diminish uterine contractions

Front 138

Prostaglandin Inhibitors

Back 138

Indomethacin (NSAID)-used as a tocolytic--many potential fetal complications

Front 139

Rate of Preterm Delivery

Back 139

occurs in up to 10% of all pregnancies