Obstetrics - general

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Author:
dohertys
ID:
108542
Filename:
Obstetrics - general
Updated:
2011-10-12 21:03:50
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Obstetrics
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General Obs stuff
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  1. What does G mean?
    Gravidity - total number of pregnancies (not fetuses), multiple gestations - 1 pregnancy
  2. What does P include?
    # infants delivered after 20weeks or weighing more than 500g
  3. What does A include?
    Abortions therapeutic or spontaneous of less than 20 weeks or <500g
  4. Beta-hCG rule of 10s
    10IU at conception, 100,000 IU at 10 weeks(peak), 10,000 IU at term
  5. What can you see on TVUS @ 5 weeks?
    Gestational sac (if B-hCG ≥ 1200-1500 mIU/mL)
  6. What can you see on TVUS @ 6 weeks?
    Fetal pole
  7. What can you find on TVUS @ 7-8 weeks?
    Fetal heart tones
  8. Transabdominal US @ 6-8 weeks?
    Can confirm intra-uterine pregnancy if B-hCG> 6500 mIU/mL
  9. When should family doctors consider early consult to obs?
    Insulin depot GDM, VBAC, HTN, Multiple gestations, Malpresentation, Active antepartum hemorrhage, PTL/PPROM, Failure to progress/descend, Induction/augmentation if high risk, tears 3-4 degree, retained placenta
  10. Naegle's rule?
    • LMP (1st day of last period) + 7days - 3months = EDC
    • add 1 day per day longer than 28d of cycle
  11. What should they get if LMP unreliable?
    Early dating US between 8-12 weeks
  12. If US is >1 week away from LMP, which do you use?
    Use US dates. Use LMP if discrepancy ≤ 6 days
  13. Early pregnancy investigations - blood work
    CBC, blood group and type, Rh antibodies, infection serology - Hep B surface Ag, Syphillis Ig, HIV Ig P24, Rubella IgG
  14. Other early pregnancy investigations
    Urinalysis and C&S (screen for bacteria and proteinuria), pap smear, GC/CT and BV swab
  15. Visting schedule for uncomplicated pregnancies:
    • 1st visit before 12 weeks, then q4-6 weeks until 28 weeks,
    • then q2 weeks until 36wks, then q 1week until delivery
  16. Things to ask at every visit:
    Ask about: fetal movements, uterine bleeding, leaking fluid, cramping/contractions
  17. Things to do on P/E at every visit:
    BP, weight gain, fungal height, Leopold's (in T3)
  18. Ix to do at every visit:
    Urine dip for glucose, pr, ketones and FHR > 12 weeks
  19. DDx of small for dates:
    wrong date, IUGR, Fetal demise, Oligohydramnios
  20. DDx for large for dates:
    Wrong date, multiple gestation, polyhydramnios, macrosomia
  21. Steps of Leopold maneuever
    • 1) feel fetal part furthest away from pelvic inlet
    • 2) location of fetal back
    • 3) Pawlick's grip - feel fetal part lying above pelvic inlet
    • 4) locate fetal brow (just about step 3, usually)
  22. When to fetal movements begin to be noticed?
    18-20 weeks
  23. DDx of decreased fetal movements?
    hunger/thirst, sleeping, amniotic fluid decreased, fetal death
  24. What should woman do if suspect decreased FM?
    Do Kick count < 6 movements/ 2h - eat/drink/change position/room and count 2 more hours - if persist see MD
  25. Baseline and variability in a normal NST
    baseline 110-160bpm, variability 6-25(moderate)
  26. Decels in a normal NST
    None or occasional variables less than 30s long
  27. Accels in normal NST
    If term - 2 access ≥15bpm x ≥15s within 40 min of NST
  28. Accels in preterm normal NST
    >2 access of >10bpm x 10s within 40 min of NST
  29. What makes an NST abnormal - baseline?
    brady < 100, tacky > 160 for > 30min or erratic baseline
  30. Abnoraml variability
    ≤5 btbv x 80min or sinus rhythem
  31. Abnormal NST - decels
    variable decels lasting >60s or lates
  32. Abnormal NST - accels in term
    less than 2 accels of 15bpm x 15s in >80min
  33. Abnormal NST - accels in preterm
    less than 2 accels of 10bpm x 10s in >80min
  34. Features of Biophysical Profile
    Normal NST plus U/S showing: 2x2cm pocket of amniotic fluid, tone: limb extension + flexion, 3 discrete limb movements, 30s of breathing
  35. Indications for BPP
    NST not normal (non-reassuring), post-term, decreased fetal movement, suspected fetal distress or uteroplacental insufficiency
  36. Which features suggest chronic hypoxia?
    Oligohydramnios on Amniotic Fluid Volume
  37. Which features suggest acute hypoxia?
    No breathing, 2 or less limb movements, no movements for fetal tone

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