Obgyn - Ob Hx And Phys Exam

Front 1

What should you always assume when beginning an ObGyn exam?

Back 1

- All reproductive aged women are pregnant until proven otherwise

- All pregnant women have an ectopic (life-threatening) pregnancy until proven otherwise

Front 2

What is "G"?

Back 2

G = gravidity = number of pregnancies

Front 3

What is "P"?

Back 3

P = parity = outcome of pregnancies

Subdivided:
A = full term delivery (>37 wks)
B = preterm delivery (22-36 wks)
C = abortion/ectopic/miscarriage (<22 wks)
D = number of living children

Front 4

What does it mean when P < G?

Back 4

Patient is currently pregnant

Front 5

What is "LMP"?

Back 5

LMP = first day of Last Menstrual Period

(used to calc age of pregnancy)

Front 6

What is "EDC"?

Back 6

EDC = Estimated Date of Confinement
("due date")

Front 7

What is "EGA"?

Back 7

EGA = Estimated Gestational Age

- used to determine/interpret certain values during pregnancy - e.g., what a normal amniocentesis should show at that time

Front 8

What is the format of an ObGyn chief complaint?

Back 8

A --- year old Gx Px with LMP --- and EDC --- presents at --- weeks EGA complaining of ---.

Front 9

What are the 4 cardinal questions of Ob when a patient presents with a chief complaint?

Back 9

1. Are you bleeding?
2. Has your water broken?
3. Are you having contractions?
4. Is the baby moving?


Note: 1-3 involve whether or not patient is in labor; 4 involves baby's health

Front 10

What does an Obstetrics HPI include?

Back 10

History of the current pregnancy:
- presence/absence of prenatal care
- complications during pregnancy
- results of any labs/radiological studies

Front 11

What does a pregnancy history include?

Back 11

Details of all previous pregnancies:
- dates
- outcomes
- modes of delivery
- use of anesthesia
- ante/peri/post partum complications

Front 12

What parts of the history are required when a patient presents to the labor floor?

Back 12

- HPI
- Pregnancy History
- Gynecological Hx
- PMH - esp surgeries; asthma, hypertension, diabetes
- PSH
- Medications
- Allergies
- Social Hx - esp smoking, drinking
- Family Hx

Front 13

What are the steps of an obstetric physical exam?

Back 13

- Observation (patient acuity)

- Vital signs of mother AND fetus

If presenting in early pregnancy:
- gynecologic exam
- pregnancy sizing

If presenting on labor floor:
- heart
- lungs
- breast
- abdomen
- pelvis
- extremities

Front 14

What is a normal fetal HR?

Back 14

110-150 bpm (~130 bpm with good variability)

Front 15

What is determined in an obstetric abdominal exam?

Back 15

- acuity - is the pt about to deliver?

- age/size of pregnancy

- postition/presentation/lie of fetus

Front 16

How is Gestational Age measured on physical exam?

Back 16

distance (cm) from pubic symphysis to top of fundus
--> correlates in centimeters to weeks (after 20 wks gestation)

Front 17

How is the presentation of the fetus determined on physical exam?

Back 17

Leopold's Maneuvers

Front 18

What is "presentation" of the fetus?

Back 18

Fetal part closest to birth canal
- cephalic/vertex (head-first)
- breech (bottom-first)

Front 19

What is "lie" of the fetus?

Back 19

Relation of the long axis of the fetus to the mother
- longitudinal
- transverse

Front 20

What is "position" of the fetus?

Back 20

Relation of the fetal presenting part to the R or L of the maternal pelvis
- Right
- Left

Front 21

What is examined during an obstetric pelvic exam?

Back 21

- external genitalia - masses, lesions

- vagina - fluid, bleeding (ruptured membranes)

- cervix - lesions, dilation, effecement, station

- uterus and adenexa - masses

Front 22

What is the diagnosis for LABOR?

Back 22

contractions causing cervical change
-- cervical change: dilation and effacement

Front 23

What is complete dilation and effacement? What does this mean?

Back 23

CERVIX:
10 cm dilated
100% effaced
= READY FOR BIRTH

Front 24

What is the digital exam? Purpose?

Back 24

2 fingers insterted into vagina up to cervix to determine if it has begun to dilate/efface

- 2 fingers = ~2 cm dilated

Front 25

What is Effacement?

Back 25

Shortening and thinning of cerxis (length) from ~2cm to paper thin.... shortens until becomes almost one with uterine wall

Front 26

What are the cardinal movements of delivery? (in order)

Back 26

- engagement - diameter of head reaches pubic bone
- flexion
- descent
- internal rotation
- extension - head comes under pubic bone, then extends up and out... then shoulders come out
- external rotation

Front 27

What are the 10 essential steps of delivery?

Back 27

1. assess position of fetal head (head crowns)
2. protect perineum
3. fetal nasal and oral suction
4. assess for nuchal cord
5. deliver anterior shoulder
6. deliver posterior shoulder
7. deliver remaining fetus
8. clamp and cut umbilical cord
9. deliver placenta
10. assess for/repair any lacerations

Front 28

What are indications for cesarian section pre-labor?

Back 28

- previous uterine incision/c-section
- non-vertex presentation
- placental abnormality
- infectious disease (HIV, HSV)
- severe preeclampsia
- multiples
- other

Front 29

What are indications for cesarian section during labor?

Back 29

- non-reassuring fetal monitoring due to:
- umblical cord prolapse
- placental abruption
- placental insufficiency
- other

- arrest of dilation

- arrest of descent