Indications and patient history for OB

Indications for OB exams

Size and dates, growth, vaginal bleeding, fetal presentation or number, IUD, BPP, abnormal AFP, F/U anomalies, ectopic, molar pregnancy and more

Patient history

LMP, Gravida, parity, term fetus, abortions/miscarriages, living children

Primigravida

Pregnant for the first time

Grand multiparity

Has already delivered five or more infants who have achieved gestational age of 24 weeks or more

Great grand multiparity

Has already delivered nine or more infants who achieved GA of 24 weeks or more

Hegar sign

Softening of the lower uterine segment that occurs with pregnancy; physician palpates area on manual exams

Chadwick sign

Venous congestion of vaginal mucosa that normally occurs with pregnancy; causes a bluish discoloration of the mucosa; physician visualizes this on pelvic exam

Cullen sign

Bluish discoloration around the maternal umbilicus associated with intraperitoneal hemorrhage; can be seen with ruptured ectopic pregnancy

hCG found in maternal urine 7-10 days after _______

Ovulation

hCG doubles every ___ days in first tri through week 8 when it levels off before declining

2-3

Threshold level

bhCG levels in blood that correspond with the first possible sonographic visualization of the GS: 390-1000 units/ml

Discriminatory zone

bhCG levels in blood must correspond with the sonographic visualization of the gestational sac: 2000 units/ml

TA exams see IUP w/

4000 units/ml hCG

TV exams see IUP w/

1000-2000 units/ml hCG

Low levels of hCG:

Fetal demise

Ectopic

Wrong date for LMP

Missed abortion

High levels of hCG

Multiple fetuses

GTD

Wrong date for LMP

Triple AFP screen

Testing maternal serum for high levels of AFP, hCG, and Estriol

(Quad includes inhibin-A)

Most common reason for elevated MSAFP

Inaccurate dating of pregnancy

Increased AFP

Incorrect LMP

Multiple pregnancy

Abdominal wall defects

NTD

IUGR

Renal abnormalites

Decreased AFP

Incorrect LMP

Fetal demise

Molar pregnancy

Trisomy 13, 18, 21

TA exam first visualizes IUP at ______ (1st IRP) or ___________ bhCG (second international standard)

4000 units/ml; >1800 units/ml