definition of embryo?
- up to 8 weeks
- 8weeks to birth
- birth to one year old
how do you estimate the date of delivery?
LMP - 3 months +7 days
difference between developmental age and gestational age?
- developmental age is time since fertilization
- gestational age is time since LMP
how many weeks is a term fetus?
what is the first physical sign of pregnancy?
softening of cervix at 4 weeks
at how many weeks o what level of beta hcg, can ultrasound detect an intrauterine pregnancy?
5 weeks or 1000
enlarged nuchal transulency is seen in what ?
when are fetal heart sounds heard?
at the end of 1st trimester
what is hte most accurate way of establishing gestational age?
what is screened for in 1st trimester?
- nuchal translucency via ultrasound
- karyotype/genetic diseases via Chorionic v. sampling
when is chorionic villi sampling done?
chorionic vi. sampling-12 weeks
after how many weeks are visits to the ob every week?
after 36 weeks
what kind of contractions occur in 3rd trimester?
braxton hicks contractions
what should you do with continued braxton hicks contractions?
check the cervix
what needs to be given with iron supplements?
what 3 tests are done in 3rd trimester?
- 1-cbc--anemia if present give oral iron
- 2-glucose load if above 140 give glucose tolerance
- 3- cervical cultures for chlamydia and gbs
how is glucose load testing done and what is the management if the levels are high?
- glucose load--50 mg whether fasting or not, check at 1 hour if >140
- then give 100mg while fasting and check at 1, 2, 3 hrs
when is fetal blood sampling done
- need fetus' cbc
- rh isoimmunization
diagnostic tests for ectopic pregnancy?
- beta hcg
how is ectopic pregnancy managed?
if pt is stable and ectopic intact-mtx--observe for 15% drop in beta hcg--if not present--give another dose of mtx..if it fails..surgery
- if ectopic is rupture--surgery
- if ectopic is ruptured and pt is unstable--stablizize pt and then surgery
exclusion criteria for mtx for ectopic?
- pt completed their families
- ectopic larger than 3.5
- liver disease
- pt is non compliant
- fetal heart beats
what is the procedure called for surgery for an ectopic?
- salpingostomy--cut in the fallopian tube
- salpingectomy-- removal of fallopian tube
when do spontaneous abortions take place, how many weeks?
before 20 weeks
most common cause of spontaneous abortions?
how does each of the following abortions present on ultrasound? rx?
- 1-no products of conception-follow up in office
- 2-some products of conception -d/c
- 3-products of conception present but dilated cervix with intrauterine bleeding-d/c
- 4- products of conception present, intrauterine bleeding but no dilated cervix- rest
- 5- death of fetus but all products of conception in the uterus - d/c
- 6-infection of uterus and the surrounding areas- d/c and antibiotics
during what procedures should mothers receive anti- D Rh ig?
salpigectomy and during d/c
how do multiple gestations present?
- rapid growth
- high beta hcg and maternal fetal protein than expected
how is preterm labor defined? during what time
premature rupture of membranes?
- combinations of contractions and cervical dilation
- between 20-37 weeks
- blood loss
diagnosis of multiple gestations?
multiple fetuses on on ultrasound
when should you deliver a preterm baby?
- pre ecclampsia, ecclampsia
- fetal death
- maternal hemorrhage
- maternal cardiac dz
- cervix dilation >4cm
what 2 conditions dictate stopping premature labor?
- weight <2500grams
- 24-33 EGA
how is preterm labor stopped?
how do you check for magnesium toxicity?
deep tendon reflexes
what is the most commonly used tocolytic?
which tocolytics is not an answer?
management of premature rupture of of the membranes?
- if preterm and no chorioamniotitis--amp/gent with tocolytic, steroids
- if term and no chorioamniotis--wait 6 to 12 hours and deliver
- if term and chorioamnionitis--deliver now
4 complications of premature rupture of the membranes?
- cord prolapse
- premature labor
- placental abruption
placenta over the internal cervical os
next step in management of painless vaginal bleeding in a 32 week ga?
transdominal ultrasound to rule out placenta previa
digital vaginal exam in not done in what trimester?
what allows for diagnosis of premature rupture of membrane
- gush of fluid
- amniotic fluid examination--ferning pattern
placental vasa previa is what?
fetal blood vessels lying over the internal cervical os
rx for placenta previa?
when do you do immediate cesearean section for it?
- c section if cervix >4cm
- severe hemorrhage
- fetal distress
3 types of placental invasion?
- acreta--attaches to superficial uterine wall
- increta-uterine myometrium
- percreta--uterine serosa, bladder and rectum wall
causes of placental abruption?
- cocaine use
- prior abruption
placenta previa vs placental abruption presentation?
- previa--painless bleeding
- abruption--painful bleeding
2 types of placental abruption?
concealed--placenta is most likely detached and complications are severe
extenal--placenta is semi detached and complications are minimal
risk factors or uterine rupture?
- previoius c sections--
- 1- longitudinal
- 2-low transverse
- large baby
- placenta percreta
rx for uterine rupture?
laparatomy and delivery..no c section
erythroblastosis fetalis is cuased by?
gestational hypertension vs preecclampsia?
- gestations htn is htn without proteinuria or edema
- it starts after 20 weeks of gestation
rx for chronic htn, gestational htn?
- alpha methyl dopa
rx for mild precclampsia in the following situation?
- betamethasone and mgso4 for prophylaxis
severe--mgso4 for prophylaxis, hydralazine
ecclampsia presents with what?
what is HELLP syndrome?
- elevated liver enzymes
- low platelets
mg and hydralazine
rx of pregestational diabetes mellitus?
- type 1--insulin pump
- type 2--subQ insulin
what other tests are done for diabetics who are pregnant?
- 24 creatinine/protein
- EYE exam
are mothers with gestational diabetes more likely to develop diabetes?
when is gestational diabetes screened for?
- 3rd trimester--
- 24 weeks
- 28 weeks
rx for gestational diabetes?
diabetic diet and exercise
no weight loss
what kind of tests are done from 32 week to 38? if the patients are put on insulin
32-36 non stress tests and ultrasound weekly
- >36 twice a week non stress tests and biophysical profile
- 37 weeks L/S ratio
criteria for IUGR?
infants weigh in the bottom 10%
when does symmetric IUGR occur?
- before 20 weeks
- after 20 weeks
rx for macrosomia?
- induce labor if lungs are mature and fetus is <4500grams
- if fetus is >4500 grams, c section
what is a reactive nonstress test?
- 2 fetal movements
- hr increased by 15bpm for 15mins
biophysical profile consists of?
- feta chest expansions
- fetal movement
- fetaml muscle tone
- amniotic fluid index
what is normal fetal heart rate during labor?
- brady <110
- normal 110-160
- Tachy >160
what is the normal hr acceleration during labor?
hr increases by 15 beats for 15 seconds
how many Stages of Labor are there?
what happens during the 3 stages of labor?
- 1st stage--onset of labor to full dilation of cervix
- 2nd stage--full dilation of cervix to delivery
- 3rd stage-delivery of baby to delivery of placenta
signs of placental separation
- umbilical cord lengthening
- fresh bleeding
- uterine fundus rising
- uterus becoming firm
how is induction of labor done?
- puncture of the amniotic sac
in what pts you shouldnt give prostaglandin to induce labor?
what is an arrest of cervical dilation?
when the cervix does not dilate for 2 hours
what is prolonged latent stage?
in stage one when the cervix takes more than 20 hours to dilate 4 cm
rx for prolonged latent stage?
rest and hydration..labor progresses spontaneously
what is protracted cervical dilation?
slow dilation of the active stage of stage 1
etiology of protracted cervical dilation?
rx for protracted cervical dilation?
what is arrest of cervical dilation?
- no dilation for 2 hours
- no fetal descent for 1 hour
rx for arrest of cervical dilation?
how is a breech diagnosed?
what are the maneuvers in order to deliver a baby taht is at risk for shoulder dystocia?
- McRoberts maneuver
- Delivery of posterior arm
- deliberate fracture of fetal clavicle
- Zavanelli Maneuver
how much blood is lost in a post partum hemorrhage?
rx for postpartum hemorrgae?
- compression and massage
what is the work up of rh incompatibility?
- screen at 15 weeks
- if no antibodies, repeat at 28 weeks and if still negative give anti-D Rh IV
if positive at 15 weeks, titer, if titer is bigger than 1:16, do amnio and see if fetal cells rh negative, if they are..normal pregnancy
if fetal cells rh positive, look at bilirubin, if low, repeat amnio, if high, take blood sample and see hct and if low transfuse
teratogens cause abnormalities when?
between 2 adn 12 weeks
bluish discoloration of vagina
softening of the lower uterus
what causes glucose intolerance in pregnancy?
human placental lactogen
when should a woman not have sex in pregnancy?
- recurrent uti
- placenta previa
- history of spontaneous abortions
what seizure meds interrupt folate metabolism
what are the levels of afp, estriol, beta hcg and inhibin a?
in down syndrome
down--afp and estriol are down, beta hcg and inhibin are up
- edwards---everything is down except inhibin
- turner--just like down syndorm
low maternal papp-a is associated with what?
trisomy 21 and 18
when is percutaneous umbilical venous sampling done?
- thyroid disorder
- fetal anemia due to rh incompatibility
vaccines ok in pregnancy?
not ok in pregnancy?
- hep a and b
5 types of lacunar strokes?
- pure sensory
- pure motor
- ataxic hemiparesis
- dysarthia clumsy hand syndrome
- sensory motor
rx for cerebral palsy contractures?
brain tumors in kids?
exploration of neck after trauma?
- zone one--ct angiogram
- zone two--surgical
- zone 3--angiogram
most sensitive and specific test for chronic pancreatitis?
low fecal elastase level
what is a reactive non stress test?
2 15bpm accelerations of the heart held for 15 seconds in 20 minutes
what makes up the biophysical profile?
- amniotic fluid index
what is pathologic, early or late deceleration?
late deceleration due to placental insufficiency
acidosis in the baby will manifest itself as late or early deceleration?
sinusoidal heart rate means what?
cause of fetal tachy?
- maternal infection
- maternal thyrotoxicosis
- fetal arrythmia
when does arrest of labor occur?
in the active phase >2 hours
what is uterine hyperstimulation?
5 contractions/10 minutes
when is breast feeding contraindicated?
ocp for lactating woman?
post partum bleeding for vaginal delivey?
rx for uterine atony/postpartum hemorrhage?
- uterine massage
rx for postpartum hemorrhage if hypertensive?
reasons for vertical incision for c section?
- transverse lie
- adhesions or fibroids
- hysterectomy planned
- cervical cancer
- postmortem delivery
when is c section done? for mother
- placenta previa
- prior uterine surgery
- cardiac disease
- cervical death
- maternal death
- for infant:
- acute fetal distress
- cord prolapse
- failel labor progression
- abruptio placenta
- cephalopelvic disproportion
adverse events after a vbac?
- uterine ruprue1/100
- baby or mother death 1/1000
rx for post partum endometritis?
amp and gent
mx of breech baby after 36 weeks?
extenral cephalic version
arrest of descent?
> hours in stage 2