PD E3- OB Exam

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90 Terms

1
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What is a glycoprotein produced by the developing placenta shortly after implantation that is found in urine and plasma; often used to test for pregnancy?

Beta subunit of human chorionic gonadotropin (hCG)

2
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Would you obtain a urine hCG or plasma hCG for the following?

  • diagnosing ectopic pregnancy

  • monitoring trophoblastic tumors

  • screening fetal abnormalities

  • serial levels to r/o spontaneous abortions

Plasma hCG

3
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When does a home urine pregnancy test become positive?

4 wks LMP

*low false positive / high false negative rate

4
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What is the most accurate way to diagnose pregnancy, and is accurate before missed menses?

Serum beta hCG

5
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When do you start obtaining transabdominal US?

≥ 6 wks (once gestational sac is present)

6
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When can you start to detect fetal heart tones with electronic doppler device?

8-14 weeks

7
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What is hegar’s sign?

Softening of isthmus of uterus

8
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What is Chadwick’s sign?

Increased vascularity throughout pelvic region → bluish discoloration of vagina and cervix

<p>Increased vascularity throughout pelvic region → bluish discoloration of vagina and cervix </p>
9
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When does nausea / “morning sickness” usually improve?

After 12-16 wks

10
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What causes heartburn in pregnancy?

Progesterone causes GE sphincter to relax → enlarged uterus presses upward pressure on the stomach → decreases gastric motility & acid secretion → delayed digestion

11
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<p>What is brownish-black pigment along the midline of the abdomen?</p>

What is brownish-black pigment along the midline of the abdomen?

Linea nigra

12
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What is diastasis recti?

Rectus abdominis muscles separate at midline (noticeable in later trimesters)

13
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How does the abdomen enlarge throughout pregnancy?

Uterus rises out of pelvis into abdomen by 12th week → inc in abdominal girth apparent by 15th week

*enlargement may appear earlier if multiparous female

14
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What causes backaches during pregnancy?

Estrogen & progesterone relax pelvic joints, increased uterine weight increases lumbar lordosis, & abdominal muscles stretch and lose tone

15
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What urinary changes occur during pregnancy?

Inc frequency around the 6th week, inc vascularity & pressure from uterus, & symptoms improve when uterus rises above pelvis until fetal head settles into maternal pelvis near term

16
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What is the sensation of fetal movement that usually begins at 20 wks in primigravida or 17-18 wks in multipara?

Quickening

17
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What is “dropping” late in pregnancy (3rd trimester) when the fetus descends into the lower pelvis?

Lightening

18
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How often should prenatal visits occur?

≤ 28 wks: every month

28-36 wks: every 2-3 wks

≥ 36 wks: once per wk until delivery

19
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What is performed at the 10-13 week prenatal visit?

Nuchal translucency screen, mother’s lab work, UA & culture

20
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What is performed at the 16-18 week prenatal visit?

1st sonogram, UA & culture, amniocentesis / CVS (if indicated), & triple screen (trisomy 16, 18, 21)

21
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What is performed at the first prenatal visit?

Pap smear, Rh w/ blood type, STI screen- GC/ chlamydia, HIV, rubella, syphillis, HBV, TB, labs- H&H, UA & culture

22
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What is performed at the 26-28 week prenatal visit?

Fetal: FHT, fundal height, position

Labs: DM, CBC, Ab screen, GC/chlamydia, UA & C, syphilis (optional)

Give rhogam if indicated

23
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What is performed at the 36 week prenatal visit?

GBS culture

24
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What is performed at the 40 week prenatal visit?

Focused fetal exam, UA & C, fetoplacental function tests (PRN)

25
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WHa tis the time of pregnancy counting from the first day of LMP?

Gestational age

26
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What is the time of pregnancy counting from fertilization?

Developmental age

27
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What is the first trimester?

0-14 wks

28
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What is the second trimester?

14-28 wks

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What is the third trimester?

28 wks - birth

30
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What is fertilization to 8 wks?

Embryo

31
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What is 8 wks to birth?

Fetus

32
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What is pre viable?

Before 24 wks (trending towards 20 wks)

33
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What is preterm?

24-26 wks

34
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What is term?

37-42 wks

35
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What is the total number of pregnancies?

Gravity (G)

36
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What is the number of deliveries > 500g or ≥ 20 wks GA?

Parity (P)

37
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What is GP status if a patient has twins?

G1P2

38
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What is the number of pregnancies lost before 20 wks or fetus < 500 g?

Abortus (Ab)

39
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What is the number of successful pregnancy outcomes?

Living children (LC)

40
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What is “painless” uterine contractions occurring after the 28th week?

Braxton-hicks contractions

41
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What is pelvic pain occurring at mid cycle and related to ovulation?

Mittelschmerz

42
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The following signs are associated with what condition?

  • uterus increases rapidly in size shortly after implantation

  • persistent vaginal bleeding, no fetal movement, no FHT by 12 weeks

  • N/V more intense

  • grape like clusters of tissues may be expelled through vagina

Hydatidiform mole / molar pregnancy

43
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What characterizes the level of descent of the presenting part of the fetus?

  • 0 = fetal occiput (vertex presentation) has reached level of maternal ischial spines (engagement)

  • -1 = 1 cm above

  • +1 = 1 cm below

Station

<p>Station </p>
44
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What is the degree to which the cervix has thinned, expressed as a number of cm in which cervix has changed?

  • also expressed as percentage

  • determined by digital exam

  • 4 cm = is unchanged

Effacement

<p>Effacement </p>
45
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What is the number of cm of the opening of the internal os, determined on exam with 1-2 fingers?

Dilation

46
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What is calculated with GaPbcde?

a: total # of pregnancies

b: full term ≥ 37 wks

c: preterm 20-36 wks

d: abortions & ectopic < 20 wks

e: living children

47
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What rule is used to calculate estimated date of confinement (EDC)?

Naegele’s rule → first day of LMP - 3 months + 1 year & 7 days

48
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What is the fundal height at 12 weeks?

Uterus at level of pubic symphysis

49
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What is the fundal height at 16 weeks?

Uterus between pubic symphysis and umbilicus

50
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What is the fundal height at 20 weeks?

Uterus at the level of umbilicus

51
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What can compression of the descending aorta and IVC during the OB exam cause (patient should sit briefly before proceeding to pelvic exam to avoid- semi-sitting position with knees bent)?

Supine hypotensive syndrome

52
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What is considered gestational HTN?

≥ 140/90 after week 20 without proteinuria

53
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What is chronic HTN in pregnancy?

≥ 140/90 before pregnancy, before week 20 and after 12 weeks PP

54
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What is pre-eclampsia?

≥ 140/90 after week 20 with proteinuria

55
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Mid pregnancy blood pressure is normally ______ than in the non-pregnant state

Lower

56
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First trimester weightless should NOT exceed what amount of prepartum weight?

5%

57
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What is mammary soufflé?

Increased blood flow through dilated internal mammary artery → easily heard in 2nd & 3rd interspace in parasternal areas

58
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Which murmurs, if heard in pregnancy, may accompany anemia & should be investigated?

Diastolic murmurs & dyspnea

59
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Regular uterine contractions +/- pain or bleeding occurring is considered abnormal (preterm labor) before what timeframe?

Before 37 wks

60
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What should you consider if the fundal height is > 4 cm than expected?

Large fetus, extra amniotic fluid, uterine leiomyoma

61
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What should you consider if the fundal height is < 4 cm than expected?

Missed abortion, transverse lie, growth restriction or false pregnancy

62
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What might a lack of audible FHR indicate?

Fetal demise or false pregnancy

63
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Fundal height chart

knowt flashcard image
64
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What does a pink cervix indicate?

Non-pregnant state

65
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<p>Routine labs / diagnostics chart</p>

Routine labs / diagnostics chart

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66
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How can pregnancy be diagnosed with US?

Once yolk sac is present, easier with TVUS than pelvic

*excludes ectopic pregnancy except in rare instance of heterotopic

67
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What is a blighted ovum or an embryonic pregnancy?

GS > 10 mm and no yolk sac is identified

68
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What is a normal FHR?

120-160 bpm

*higher earlier in pregnancy

69
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When should FHR increase with movement?

after 32-34 weeks

70
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What is the best place to auscultate FHR if breech (back on right)?

RUQ

71
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What is the best place to auscultate FHR if head is down?

LLQ

72
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When can FHR be heard without doppler amplification (US), using a fetoscope instead?

20 weeks

73
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What is the relationship of the long axis of the fetus to the mother?

*99% vertex (head first) or breech (buttocks first)

Lie

<p>Lie</p>
74
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What is the lowest part of the fetus in the birth canal, palpated through the cervix?

Presentation

75
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What is the relation of the presenting part of the fetus to maternal R or L side of birth canal, anteriorly (A), transversely (T), or posteriorly (P)?

Position

76
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What term describes the position of the arms, legs, spine, neck and face?

Attiude / posture / habitus

77
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<p>What is the normal presentation?</p>

What is the normal presentation?

Head flexed w/ chin on chest, posterior fontanel is the presenting part

78
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What is shoulder dystocia/

Fetal head delivered, shoulder is impacted behind pubic symphysis

79
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What is face presentation?

Neck is extended, sinciput presentation, anterior fontanel presents first

80
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<p>What is breech presentation?</p>

What is breech presentation?

Buttocks presents first (frank MC)

81
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What is brow presentation?

Eyebrow presents first

82
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What is maneuvers provide useful information to assess the lie and presentation of the fetus from the 28th week & on?

Leopold’s maneuvers

83
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What are the 4 parts of Leopold’s maneuvers?

Determine what fetal part occupies fundus: buttocks feels firm but irregular, head feels hard & moveable

Determine what side is fetal back: one side rounded but firm, other is irregular, lumpy, & moves

Identify descent of presenting part: if lower pole not engage, moveable part will be felt

Identify cephalic prominence: confirm presentation part & locate side of cephalic prominence

84
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What should a prenatal multivitamin contain?

Atleast 400 mcg folic acid

85
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What food / nutrition should be a voided in pregnancy?

Unpasteurized dairy products, undercooked meats, excess vitamin A, shark, swordfish, king mackerel, canned tuna

86
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pregnancy weight chart

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87
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What exercise should patient avoid after first trimester?

Anything in supine position → compresses IVC and decreases blood flow to placenta

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What vaccines should be avoided in pregnancy?

Live vaccines (VZV, MMR)

89
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What vaccines can be given in pregnancy?

Tetanus, influenza, pneumococcal, meningococcal, HBV

90
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What is a typical meal plan recommendation for pregnancy?

3 meals per day → additional 300 kcal