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PAEA OBGYN EOR Topics Latest
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1. G2 P
2. G4 P
- G3 P2103 ✔✔1. currently pregnant, 1 term delivery, 1 living child
- currently pregnant, 1 term delivery, 1 preterm delivery, 1 abortion/miscarriage, 1 living child (cannot tell if it is term or preterm child by formula)
- currently pregnant, twins at term, 1 at preterm, 3 living children
G (# pregnancies)
T (# term deliveries at 37 weeks or more including stillbirths)
P (# preterm deliveries at 20-37 weeks)
A (abortions <20 weeks including miscarriages)
L (# living children)
a previable fetus is defined as ✔✔<24 weeks old (varies w/ guidelines)
what are the routine test during the first prenatal visit? ✔✔blood pressure, blood type & Rh, CBC, UA (glucose & protein), random glucose, HBsAg, Hep C, HIV, syphilis, rubella titer, VZV titer, pap, sickle cell & CF screening
diagnosis of pregnancy can be detected by serum B-hCG at ____ days after conception and by urine B-hCG at ____ days after conception ✔✔serum B-hCG: 5 days after conception
urine B-hCG: 14 days after conception
how is estimated date of delivery (EDD) determined? ✔✔Naegele's Rule: from 1st day of LMP
- subtract 3 mos, add 7 days, add 1 year
- add 9 mos & 7 days
ex: LMP started 8/7/16 = EDD: 5/14/
when estimating gestational age on US what measurements can you use? ✔✔1. crown rump length (CRL)
- biparietal diameter
- head circumference
- abdominal circumference
- femur length
*amniocentesis offered around 15-18 weeks w/ same indications as CVS (both can diagnose chromosomal abnormalities and have risk of spontaneous abortion)
the uterus softening at 6 weeks is what sign? ✔✔Ladin's sign
the uterine isthmus softening after 6-8 weeks gestation is what sign? ✔✔Hegar's sign
bluish coloration of the cervix & vulva around 8-12 weeks is what sign? ✔✔Chadwick's sign
a palpable lateral bulge or softening of the uterine cornus (where uterus meets fallopian tubes) at 7-8 weeks gestation is what sign? ✔✔Piskacek's sign
cervical softening of the cervix and vulva around 8 - 12 wks ✔✔Goodell's sign
what are the # weeks in each trimester? ✔✔1st tri: 1- 12
2nd tri: 13- 27
3rd tri: 28-birth
what should be checked at routine first trimester visits? ✔✔BP, weight, urine dipstick, measurement of uterus/fundal height, auscultation of fetal heart sounds at 10-12 weeks (nml 120-
what week should the uterus/fundal height measure above the pubic symphysis? midway between pubic symphysis/umbilicus? at umbilicus? 2-3cm below xiphoid process? ✔✔-above the pubic symphysis? 12 wks
-midway between pubic symphysis/umbilicus? 14-16 wks
-at umbilicus? 20 wks
-2-3cm below xiphoid process? 38 wks
after 20 weeks gestation, the fundal height should measure +/- ____cm from the # of weeks ✔✔+/- 2 cm
when are fetal heart tones audible with doppler US? what rate is nml? ✔✔10-12 weeks (end of 1st trimester) at 120-160 bpm
what is the quad screen test for? what are the tests? when is it performed? ✔✔-to screen for trisomy 21 (down syndrome), trisomy 18, and NTD like spina bifida
estradiol: low
inhibin-A: high (always high in chromosomal abnormalities)
the anatomy ultrasound (checking for amniotic fluid level, fetal viability, growth, and anatomy) is performed at how many weeks? ✔✔18-22 weeks
when is gestational diabetes screened for? what is the screening test & BS limit? what is the diagnostic test and & BS limits? ✔✔-24-28 weeks
-glucose loading test (GLT): 50g given and serum glucose checked 1 hr later- failed if BS ≥
- glucose tolerance test (GTT): fasting BS checked (≥95) then 100g glucose given and BS checked at 1 hr (≥180), 2 hr (≥155), 3 hr (≥140); failure = at least 2/
when is "quickening" aka fetal movement felt? ✔✔16-20 weeks
how often are OB visits scheduled? ✔✔Q4 weeks first 2 trimesters, 1-28 wks
Q2 weeks 28-36 wks
Qwk 36-birth
what tests/physical examinations should be performed at third trimester visits? ✔✔-repeat Ab titers in unsensitized Rh(-) mothers followed by RhoGAM @ 28 weeks & w/I 72 hrs of childbirth
-group B streptococcus screening @ 32-37 weeks via vaginal-rectal Cx
-H/H @ 35 weeks
-biophysical profile/BPP if there are complications: (5 variables: fetal breathing, fetal tones, amniotic fluid levels, NST (nonstress test), & gross fetal movements - 2 pts each)
-non-stress testing: baseline fetal HR 120-
-Leopold maneuvers to determine fetal presentation, or US if cannot determine (can do external cephalic version if breech presentation)
-after 37 weeks sweeping membranes offered at weekly visits to help induce labor
In high risk individuals what tests are run again in the third trimester? prophylactic tx? ✔✔-G/C Cx
-if + HSV, prophylactic acyclovir initiated at 36 weeks
-if + GB strep, IV PCN given when presenting in labor
what are the hematologic effects of pregnancy? ✔✔-dilutional anemia (plasma vol inc by 50% but RBCs only inc by 20-30%)
what kidney changes occur in pregnancy? ✔✔-50% inc in GFR
-the kidneys inc in size and the ureters dilate (cause of inc r/o pyelonephritis)
what are the effects of pregnancy on the endocrine system? ✔✔-hyperestrogenic state (produced by placenta)
-placenta also produces hCG (doubles Q48 hrs in early pregnancy peaking at 10-12 wks) which maintains corpus luteum early on
-corpus luteum produces progesterone which maintains uterine lining
-human placental lactogen is produced by placenta and responsible for nutrient supply to fetus but can cause a diabetogenic state (bc insulin antagonist)
-prolactin greatly increases
-inc in T3/4 while fT4 and TSH remain minimally changed
what are the effects of pregnany on the msk system? ✔✔-change in center of gravity = low back strain
-carpal tunnel syndrome is common
what are the effects of pregnancy on the dermatologic system? ✔✔-spider angiomatas
-palmar erythema
-hyperpigmentation of nipples, umbilicus, abdominal midline (linea nigra), perineum, face (melasma)
approximately what increase in calories is recommended in nml BMI pregnant patients? what amount of weight gain is recommended in underweight, nml, and overweight patients? ✔✔ 300 cal per day (500 cal when breastfeeding)
-underweight: 28-40 lb
-nml: 20-30 lb
-overweight: 15-25 lb
what nutritional requirements requirements besides caloric intake increase during pregnancy? ✔✔-protein
-iron (IDA common in pregnancy)
-folate (prevent NTD)
-calcium
-other vitamins and minerals
what is the most common fetal position inside the womb during the third trimester? what are other potential positions? ✔✔-MC: cephalic (vertex)
fraternal twins are ____zygotic whereas identical twins are ____zygotic ✔✔fraternal: dizygotic (2 ova fertilized by 2 different sperm)
identical: monozygotic (1 ova fertilized by 1 sperm that divides after fertilization) - inc r/o fetal transfusion syndrome and discordant fetal growth
what are the maternal complications of multiple gestations? ✔✔-preterm labor
-spontaneous abortion
-preeclampsia
-anemia
-placenta previa
-cervical incompetence
-gestational diabetes
-postpartum hemorrhage
what are the fetal complications that can occur in multiple gestation? ✔✔-intrauterine growth restrictions (small for gestational age/SGA)
-placental abnormalities
-breech presentation
-umbilical cord prolapse
-preeclampsia
what labs will be elevated in multiple gestation? ✔✔-B-hCG
-human placental lactogen (HPL)
-materal serum a-fetoprotein (MSAFP)
APGAR score is performed at ___ & ___ minutes after birth; again at ___ if abnormal ✔✔1 & 5 min postpartum; again at 10 min if abnormal
a baby is born crying with a pink body but blue extremities, HR of 157, grimaces feebly on stimulation, flexes arms/legs and resists extension; what is the APGAR score? ✔✔ 8
what is the difference between contractions of pregnancy and Braxton-Hicks contractions? ✔✔Braxton-Hicks are not associated with cervical dilation
what are the cardinal movements of labor? ✔✔1. engagement
- flexion
- descent
cervical examination of a pregnant patient in labor is done by what 5 criteria that make up the Bishop score? ✔✔
______ of labor is the attempt to begin labor in a nonlaboring patient, whereas ______ of labor is intervening to increase the already present contractions ✔✔induction vs augmentation
what are the indications for induction of labor? how do you induce? ✔✔indications: postterm pregnancy, preeclampsia, LGA, nonreassuring fetal testing, intrauterine growth restriction, chorioamnionitis, IUFD, etc.
labor is induced with prostaglandins (to "ripen" cervix; misoprostol or PGE2), oxytocic agents (oxytocin aka Pitocin), mechanical dilation of the cervix, and/or artificial ROM (amniotomy)
an external tocometer is placed on the pt's abdomen near the fundus and is used to measure ✔✔contractions by sensing pressure when abdomen gets firmer- best for measuring frequency of contractions and to monitor fetal heart rate accels/decels
what degree of fetal heart rate variability is reassuring? ✔✔moderate (little variability may mean fetus is asleep or inactive and absent variability may mean fetal death) aka lines will appear squiggly instead of flat like top line
a reactive fetal heart tracing is defined as ___ accelerations of at least ___ beats per minute over the baseline that last for at least ___ seconds within 20 minutes ✔✔2 accelerations, at least 15 bpm above baseline, for at least 15 seconds in 20 minutes
what kind of fetal heart deceleration is a result of fetal head compression during a contraction? ✔✔early decel (begins and ends with contraction)
what kind of fetal heart deceleration is a result of umbilical cord compression? ✔✔variable decel (can occur at any time and drops more precipitously than early or late decels)
what type of fetal heart deceleration is a result of uteroplacental insufficiency and are the most worrisome type? ✔✔late decel (begin at peak of contraction and slowly return back to baseline after contraction has finished) they may degrade into bradycardias as labor progresses
when is a fetal scalp electrode indicated (FSE) to monitor fetal heart tracings? ✔✔a fetus with late decels bc the FSE is more sensitive by tracking the potential difference created by depolarization of the fetal heart; it also is better because the tracings do not get lost during contractions or fetal position changes like they do with the Doppler
during the second stage of labor, what types of decels are normal as long as they resolve quickly after each contraction and there is no loss of variability ✔✔early and variable decels are common
-nonreassuring fetal status during 2nd stage: repetitive late decels, bradycardias, or loss of variability
in nonreassuring fetal status during 2nd stage of labor (repetitive late decels, bradycardias, or loss of variability) what actions should be taken? ✔✔-O2 face mask
-turned to left side to dec IVC compression and inc uterine perfusion
-oxytocin (if being used) should be d/c'd
what are the highest risks of operative vaginal deliveries (forceps and vacuum extraction)? ✔✔- forceps (facial nerve palsies)
-vacuum (cephalohematomas and shoulder dystocias)
*these can be performed during a prolonged 2nd stage, maternal exhaustion or need to hasten a delivery
what is given during stage 3 of labor to strengthen uterine contractions to decrease placental delivery time and blood loss? ✔✔oxytocin (pitocin)
retained placenta is defined as placental delivery/stage 3 lasting >___ minutes; it is common in preterm deliveries but can also be a sign of _________; how is it removed? ✔✔>30 minutes
-sign of placenta accreta (placenta invaded into or byond endometrial stroma)
-manual extraction (hand placed in intrauterine cavity and fingers used to shear placenta off surface of uterus)
what are the indications for cesarean section? ✔✔-2-4 hrs w/o cervical change in setting of adequate uterine contractions in active phase of labor
-breech presentation
-transverse lie
-shoulder presentation
-placenta previa
-placental abruption
-fetal intolerance of labor
-nonreassuring fetal status
-cord prolapse
