OB - 219

HIGH-RISK PREGNANCY

FRONT	BACK
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?	<18 years old and >35 years old
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?	<5 feet
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

DIAGNOSTIC EXAMS

FRONT	BACK
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

BLEEDING DISORDERS

MEMORIZE THIS BY TRIMESTER:

1st trimester → AEP
Abortion
Ectopic pregnancy

2nd trimester → HIC
Hydatidiform mole
Incompetent cervix

3rd trimester → PAP
Placenta previa
Abruptio placentae
Preterm labor/PROM

Cards

FRONT	BACK
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.
What is abruptio placentae?	Premature separation of the placenta from the uterine wall.
What is PROM?	Premature rupture of membranes.
What major complication is associated with PROM?	Ascending infection