OB - 219

What is high-risk pregnancy?

Pregnancy where the mother and fetus have a higher-than-normal chance of problems/complications.

What is the optimal age for pregnancy according to the transes?

20–30 years old.

What maternal ages are considered risk factors?

What can vasoconstriction cause?

↓ cerebral perfusion → severe headache, blurred vision, possible convulsion.

What can hypertension in pregnancy cause to the fetus?

↓ oxygen and nourishment → SGA.

What is arteriosclerosis?

Hardening of arterial walls due to aging.

What is atherosclerosis?

Fat deposition on arterial walls.

What is SGA?

Small for Gestational Age; <10th percentile.

What is LGA?

Large for Gestational Age; >90th percentile.

What is AGA?

Appropriate/Average for Gestational Age.

What is microsomia?

SGA / small baby.

What is macrosomia?

LGA / large baby.

What is IUGR?

Intrauterine Growth Restriction; baby fails to grow at the expected rate in utero.

What can SGA potentially cause?

Neurologic impairment.

What can LGA affect during delivery?

May interfere with normal vaginal delivery and may require CS.

What is the normal birth weight according to the transes?

2.5–3 kg average; 4 kg maximum.

What is normal total pregnancy weight gain according to the transes?

24–30 lbs; average 27 lbs.

What is more important than total weight gain?

Pattern of weight gain.

How much weight gain in the 1st trimester?

About 1 lb/month or 3 lbs total.

How much weight gain in the 2nd trimester?

About 1 lb/week.

How much weight gain in the 3rd trimester?

About 1 lb/week.

What does sudden weight gain suggest?

Edema/manas.

Where do you first check for edema?

Feet/lower extremities.

If a pregnant woman has edema, what VS should you prioritize?

Blood pressure.

What are the 3 classical signs of PIH?

P = Proteinuria, I = Edema, H = Hypertension.

What causes proteinuria in PIH?

Vasoconstriction → ↓ renal blood flow → renal hypoxia → glomerular damage → protein leaks into urine.

What does protein normally help retain?

Fluid in the intravascular compartment.

What happens when protein is lost?

Fluid shifts to interstitial space → edema.

What are the 3 fluid compartments mentioned?

Intracellular, interstitial, intravascular.

What is CPD?

Cephalopelvic disproportion; baby’s head cannot pass through the maternal pelvis.

What maternal height is a risk factor for CPD?

What test assesses maternal pelvic dimensions?

X-ray pelvimetry.

When is X-ray pelvimetry performed according to the transes?

3rd trimester, 2 weeks prior to EDC.

When should X-ray pelvimetry NOT be performed?

1st trimester because of organogenesis.

What is infertility?

Absence of pregnancy after 1 year of regular, unprotected sex.

What is primary infertility?

No history of previous pregnancy.

What is secondary infertility?

Has a history of previous pregnancy but cannot become pregnant again.

What can grand multiparity cause?

Uterine atony → bleeding.

What is uterine atony?

Uterus cannot remain contracted / becomes relaxed.

What drug may be given for uterine atony?

Oxytocic drug.

What is cord prolapse?

Umbilical cord comes out before the baby.

Cord prolapse commonly happens when the baby is in what station?

Negative station.

What is VBAC?

Vaginal Birth After Cesarean.

What uterine incision is associated with VBAC?

Low transverse incision.

What type of previous uterine incision is an absolute contraindication to VBAC according to the transes?

Classical incision.

What is an emergency CS commonly associated with?

Fetal distress.

What is prolonged labor?

Labor exceeding 24 hours.

What type of contraction is associated with prolonged labor?

Hypotonic uterine contractions.

What is precipitate labor?

Labor lasting <3 hours.

What type of contraction is associated with precipitate labor?

Hypertonic uterine contractions.

What is the normal duration of labor for a primigravida according to the transes?

12–16 hours; average 14 hours.

What is the normal duration for a multigravida?

6–8 hours; average 7 hours.

What is polyhydramnios?

Excessive amniotic fluid.

What is the normal amniotic fluid amount in the transes?

500–1200 mL.

What can excessive amniotic fluid cause?

Larger uterus → increased fetal movement → cord may coil around the neck.

What condition can cause the fetus to not swallow amniotic fluid?

TEF.

What does TEF stand for?

Tracheoesophageal Fistula.

What can TEF cause?

Air enters stomach → abdominal distention; secretions enter lungs → aspiration.

What is PROM?

Premature Rupture of Membranes.

Why is PROM dangerous?

Increases risk of ascending infection.

What maternal diseases can make pregnancy high-risk?

Cardiac/pulmonary disease, diabetes, thyroid disease, chronic renal disease, chronic hypertension, STI/STD, hemoglobinopathies, malignancy.

What does smoking during pregnancy cause?

Vasoconstriction → possible SGA.

What can alcohol cause to the fetus?

Fetal Alcohol Syndrome and neurologic impairment.

Is there a safe amount of alcohol during pregnancy according to the transes?

No amount of alcohol.

What can drug abuse during pregnancy cause?

Neurologic impairment.

What does ultrasonography use?

High-frequency sound waves.

Is ultrasonography invasive?

No.

What does UTZ visualize?

Fetal structures/POC, fetal size, number of babies, placenta, position, amniotic fluid.

What is amniocentesis?

Aspiration of amniotic fluid.

How much amniotic fluid is aspirated during amniocentesis?

15–30 mL.

Is amniocentesis invasive?

Yes.

What is required before amniocentesis?

Informed consent.

What position is used for amniocentesis?

Semi-Fowler’s or dorsal recumbent with pillow under one buttock.

Why use a pillow under one buttock?

To displace the uterus and prevent compression of the IVC.

What should the mother do before amniocentesis?

Void.

Why should she void before amniocentesis?

To prevent hitting the bladder.

What are 3 important purposes of amniocentesis?

Chromosomal defects, neural tube defects, fetal lung maturity.

What is the L/S ratio for fetal lung maturity in the transes?

2:1.

When is fluid intake needed before UTZ?

If <20 weeks.

How much fluid is taken before UTZ according to the transes?

1,000–1,500 mL.

How often is the water taken?

1 cup every 15 minutes for 1½ hours.

What test checks chromosomal/genetic problems using maternal blood?

Maternal Serum Alpha-Fetoprotein.

What does triple screening measure?

AFP, hCG, unconjugated estriol.

What is NST?

Non-Stress Test.

What does NST observe?

FHR in relation to fetal movement.

At what gestational age is NST done according to the transes?

30–32 weeks.

What is a reactive NST?

FHR acceleration of at least 15 bpm.

What is CST?

Contraction Stress Test.

What does CST determine?

FHR response to uterine contractions.

When is CST done?

34–36 weeks.

What is a normal CST result?

Negative: no FHR decelerations.

What does a deceleration during CST suggest?

Possible fetal distress/hypoxia.

What is the purpose of oxytocin challenge test?

To assess fetal response to uterine contractions.

Common causes of bleeding in 1st trimester?

Abortion and ectopic pregnancy.

Common causes of bleeding in 2nd trimester?

Hydatidiform mole and incompetent cervix.

Common causes of bleeding in 3rd trimester?

Placenta previa and abruptio placentae.

What is ectopic pregnancy?

Implantation of pregnancy outside the normal uterine cavity.

What is hydatidiform mole?

Abnormal pregnancy involving abnormal trophoblastic growth.

What is incompetent cervix?

Cervix cannot maintain the pregnancy, leading to possible premature opening.

What is placenta previa?

Placenta is abnormally located near/over the cervical opening.