Obstetrics - general
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What does G mean?
Gravidity - total number of pregnancies (not fetuses), multiple gestations - 1 pregnancy
What does P include?
# infants delivered after 20weeks or weighing more than 500g
What does A include?
Abortions therapeutic or spontaneous of less than 20 weeks or <500g
Beta-hCG rule of 10s
10IU at conception, 100,000 IU at 10 weeks(peak), 10,000 IU at term
What can you see on TVUS @ 5 weeks?
Gestational sac (if B-hCG ≥ 1200-1500 mIU/mL)
What can you see on TVUS @ 6 weeks?
What can you find on TVUS @ 7-8 weeks?
Fetal heart tones
Transabdominal US @ 6-8 weeks?
Can confirm intra-uterine pregnancy if B-hCG> 6500 mIU/mL
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
- LMP (1st day of last period) + 7days - 3months = EDC
- add 1 day per day longer than 28d of cycle
What should they get if LMP unreliable?
Early dating US between 8-12 weeks
If US is >1 week away from LMP, which do you use?
Use US dates. Use LMP if discrepancy ≤ 6 days
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
Other early pregnancy investigations
Urinalysis and C&S (screen for bacteria and proteinuria), pap smear, GC/CT and BV swab
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
Things to ask at every visit:
Ask about: fetal movements, uterine bleeding, leaking fluid, cramping/contractions
Things to do on P/E at every visit:
BP, weight gain, fungal height, Leopold's (in T3)
Ix to do at every visit:
Urine dip for glucose, pr, ketones and FHR > 12 weeks
DDx of small for dates:
wrong date, IUGR, Fetal demise, Oligohydramnios
DDx for large for dates:
Wrong date, multiple gestation, polyhydramnios, macrosomia
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)
When to fetal movements begin to be noticed?
DDx of decreased fetal movements?
hunger/thirst, sleeping, amniotic fluid decreased, fetal death
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
Baseline and variability in a normal NST
baseline 110-160bpm, variability 6-25(moderate)
Decels in a normal NST
None or occasional variables less than 30s long
Accels in normal NST
If term - 2 access ≥15bpm x ≥15s within 40 min of NST
Accels in preterm normal NST
>2 access of >10bpm x 10s within 40 min of NST
What makes an NST abnormal - baseline?
brady < 100, tacky > 160 for > 30min or erratic baseline
≤5 btbv x 80min or sinus rhythem
Abnormal NST - decels
variable decels lasting >60s or lates
Abnormal NST - accels in term
less than 2 accels of 15bpm x 15s in >80min
Abnormal NST - accels in preterm
less than 2 accels of 10bpm x 10s in >80min
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
Indications for BPP
NST not normal (non-reassuring), post-term, decreased fetal movement, suspected fetal distress or uteroplacental insufficiency
Which features suggest chronic hypoxia?
Oligohydramnios on Amniotic Fluid Volume
Which features suggest acute hypoxia?
No breathing, 2 or less limb movements, no movements for fetal tone
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