NM/WHNP
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| Nulligravida | never been pregnant
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| Gravida | currently pregnant or has been pregnant irregardless of outcome
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| Parity | number of pregnancies carried to VIABLE gestational age
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| Nullipara | first pregnancy and has NOT given birth
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| Multipara | given birth 2+ times
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| Grand Multipara | given birth 5+ times
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| Primipara | given birth ONCE before
Pregnant with 2nd child
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| Multigravida | pregnant more than one time
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| Abortion | termination of pregnancy PRIOR to viability
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| SAB Spontaneous Abortion | miscarriage, unintentional expulsion before the 24th week gestation
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| Lie Normal Lie: Abnormal Lie: | Relationship of the fetus to the long axis of the mother spine
Normal Lie: longitudinal, cephalic
Abnormal Lie: transverse, oblique
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| Attitude Normal Attitude Abnormal Attitude | presenting part
Normal Attitude: Fetus in full flexion
Abnormal Attitude: Fetal head is extended
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| Fetal Position | position of fetal denominator: Occiput or Vertex
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| Types of Fetal Presentation LOA LMA LST | Cephalic/Vertex presentation- LOA, LOP etc
Face Presentation- (mentum), LMT, LMA
Breech Presentation- Sacral- LST, LSA
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| Breech is abnormal after ___ weeks | abnormal after 32 weeks
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| Smallest fetal head diameter: | Suboccipitalbregmatic (LOA, LOT, LOP)- all
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| Largest head diameter: type of presentation | body parts in FLEXED POSITION
Occipitomental - increases diameter 3 cm over flexed head. May result in failure to progress. (Head extended, not flexed)- Brow presentation
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| What are some potential causes of FACE PRESENTATION? | grand multiparous patients, large fetus and contracted pelvis, neck swelling (thyroid goiter), anencephaly
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| What is presenting in a Compound Presentation and it is more common in _____ | presentation: hand prolapse alongside fetal head.
Common in prematurity
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| Shoulder presentation occurs in what kind of lie? | Shoulder presentation occurs in a transverse lie. Nothing will be felt in the inlet.
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| Demominator | the lowest presenting part of the fetus
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| Engagement | at the point when the widest diameter of the presenting part has passed through the pelvic inlet
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| Station | relationship of the lowermost part of the presenting part in the imaginary line drawn between the ischial spines.
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| Location of - station (-4, -3) High or low | high station (above ischial spines)
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| Location of + station (+4, +3) High or low | low station (below ischial spines)
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| GTPAL 11303 | first pregnancy with 3 preterm infants @ 34w, no AB
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| G- # T- # P-# A-# L-# | letter- # pregnancies
letter- # delivered after 36 weeks
letter-# delivered between 20-36 weeks
letter-# delivered before 20 weeks
letter -# living
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| Initial Pregnancy Labs (9) | CBC
Rpr/VDRL
Blood type- RH
Rubella
HepBsAg
GC/CT
U/A
Urine C & S
HIV- offer
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| Labs of 24-28 weeks | CBC
GCT or GTT
T & S depending on RH status
Possibly RPR/VDRL
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| Labs of 35-37 weeks | GBS culture
GC/CT if positive earlier in preg or new RF
Possibly HIV
Possibly Urine Tox
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| Rx for Pregnant Patients (3) if indicated | Prenatal Vitamin,
Folic Acid,
Iron Supplements
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| OB visits consist of | every 4 weeks until 28 weeks
every 2 weeks until 35 weeks
every 1 week until delivery
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| What week do you give GTT/GCT | 28 weeks
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| What week do you perform GBS Screening | 35-37 weeks
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| What week do you administer Rhogham in pregnancy if indicated | 28 weeks
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| Breast size increases during which months? | 4th and 5th
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| Pharm relief measures for nausea in pregnancy | Pyridoxine (Vit B6) 25 mg QID or 50 mg BID OTC
or
Unisom 25mg qhs
Combo therapy B6 25mg bid + 50 Unisom or 1/2 tab TID
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| Ptyalism | excessive saliva
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| Would you Rx Alka-Selzer in pregnancy | no, it can cause increased edema- Substitute Maalox, mylanta, MOM,
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| Why are my gums bleeding now that im in my 2T? | Hyperemia
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| If I am ___ weight, I should gain ___ pounds underweight normal weight overweight obese | underweight- 28-40
normal weight-25-35
overweight-15-25
obese-11-20
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| After 1T how many calories should be increased per day | 350 calories
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| What week do you begin to assess fundal height | 20
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| Patient was Rh -... What is your plan? | recheck antibody screen (checking sensitization) and administer Rhogam at 24-28 weeks and again PP.
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| What week do you screen for GDM? | 24-28 weeks
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| When do you begin assessing fetal position | 24-28 weeks
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| When do you assess for GBS? | 35-37 weeks
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| Pt was + early in pregnancy for GC/CT and or HSV. What is your plan? | Test again at 35-37 weeks; if HSV + consider suppression therapy
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| Examples of Presumptive Pregnacy | amenorrhea
N/V/increased salvation
breast changes
urinary frequency
increased basal body temp
Chadwick sign (blue cervix)
Skin changes (cholasma)
Quickening (fetal movement)
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| Examples of Probable Pregnancy | abdominal enlargement
uterine enlargement
palpation of fetus
ballottement of fetus
Hegar's sign (softening of isthmus)
Goodell's sign (softening of cervix)
Endocrine pregnancy test (BHCG)
+ preg test urine or serum
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| Positive Signs of Pregnancy | Fetal Heart tones
Palpation of fetal movement, palpation of the fetus
Visualization of the fetus on US
Delivery
XRAY
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| Serum Beta Hcg you want to see the numbers do what? | The levels should double every 48 h (2 days)
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| T/F: HCG is a protein thus antigenic | True
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| Discuss what happens with immunologic assay of Hcg pregnancy testing when combined with antisera | Preg Urine with Hcg neutralizes the Antibodies and INHIBITS agglutination = POSITIVE (NO CLUMPING)
Non-preg with no HCG cannot neutralize => AGGLUTINATION = NEGATIVE (CLUMPING)
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| Chadwicks Sign | bluish discoloration of the vulva, vagina and cervix starting at 6 weeks
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| Goodell's Sign | softening of the cervix at 6 weeks (lips vs nose)
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| Hegar's Sign | softening of the uterine isthmus at 6 weeks
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| Piskacek's Sign | 8-10 w of preg, an asymmetrical uterus
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| FHT should be heard via doppler and fetascope at what weeks | doppler- 9-12w
fetascope-18-20w
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| US due date taken during the 1T are more/less accurate than later and the most precise method in 1T. | US due date taken during the 1T are MORE accurate than later and the most precise method in 1T.
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| US discrepancy: # days in 1 T # days from 12-20 weeks # days from 28w+ | US discrepancy:
7 days in 1 T
10 days from 12-20 weeks
15.6 days from 28w+
ACOG recommends changing EDD if > above days
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| Naegele's Rule and what does it depend on and what do you rely on to determine EDD? | LMP + 7 days - 3 months
Pending cycle length, ability to recall LMP, bleeding, BCP, BF.
If the above, do NOT use Rule. Instead rely on US in combo with clinical findings.
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| Prem's Rule | Calculates EDD from conception using basal body temp charts. 1st day of thermal shift - 7 days + 9 months = final EDD
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| uterine growth in early pregnancy is due to ____, not products of conception | hyperplasia
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| How is the uterine wall strengthened | Uterine wall is strengthened by increased number of muscle cells, increased elastic tissue, and accum of fibrous tissue.
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| Advancing pregnancy stimulates uterine enlargement due to ___ | hypertrophy (increase cell size)
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| Why is gestational dating important | important for screening, size estimation, and evaluation of fetal growth
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| Sensitivity | % of AFFECTED individuals WITH the DISEASE who have a POSITIVE result on the screening test
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| Specificity | % of UNAFFECTED individuals, those WITHOUT the disease, who have NEGATIVE results on the screening test.
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| Screening vs Diagnosing | Screening is for asymptomatic pts
Diagnosing is for intention of dx
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| What is your plan if a lab comes back Hbg <10 g/dl? Dx? | Iron Deficiency Anemia. begin iron supplementation 300 mg Ferrous sulfate TID and taken with meals, add 1.0 mg of folic acid in cases where folate is low or use Vit C enriched food to aid with absorption
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| Reasons for high Hgb | dehydration, burns, diarrhea
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| H/H cut off values: 1T, 2T, 3T | 1T= 11.0/33.0
2T= 10.5/32.0
3T= 11.0/33.0
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| What does a "shift to the left" mean? | increase in bands or immature neutrophils, indicating response to infection
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| What is your plan if PLT are <150,000 | testing including antiplatelet antibody screening and peripherial smear. Coag studies, Consultation with physician is required for mgt plan. In majority of cases, no tx will be necessary. NO FSE OR VACUUM.
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| MCV (average size of RBC) is high indicates? | Macrocytic Anemia- B12/folate deficiency
check serum folate and B12 levels
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| MCV (average size of RBC) is low indicates? | Microcytic Anemia- iron deficiency, thalassemia (confirms iron deficiency if ferritin also low)
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| What is your FU for Hgb <10? | FeSO4 and dietary counseling
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| Spirochete- Treponema pallidum | Syphilis (VDRL/RPR)
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| Sensitized women (>1:4) who are Rh - develop which kind of antibodies. What can it cause in next pregnancy? Treatment? Refer? | anti-D antibodies. Can cause fetal RBC hemolysis, severe anemia, cardiac decompensation, hydrops, fetal or NN death.
RhoGAM- ab that prevents isoimmunization 28w and 72h PP, miscarriage, vag bld, trauma. Refer to high risk OB
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| When can you not receive RhoGAM? | if delivered 3 weeks after given or 1 month past delivery
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| Teaching after administering Rubella vaccination. Lab titer for immune vs non-immune | Avoid pregnancy for 4 wks after vaccination
Ab titer of 1:10 or higher = IMMUNE
Ab titer of 1:64 or higher = acute infection
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| Give VZIG within 96 hrs of exposure of what?(mom and or baby) | Varicella/ Chicken Pox
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| The antigen is what we screen for in pregnancy is refering to what test? | HepBsAg (Hep B Virus Screening)
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| Flagyl 2g, rpt culture q3m until 37w, risk for PTD,withold BF for 12-24h after last dose- Which STI? | Trich
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| GC/CT Testing: who tested, timing, procedure, FU | All preg women, High risk: (new partner, >1), <25yo, hx STI,
Timing- NOB, 3T if +
Procedure- Gen-Probe- no lube, insert 1 cm 10-30 sec into Os, rotate prior to removal
FU-Treat and TOC of +, retest in 3T if +
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| Discuss GCT 1 hour Glucose Challenge test Timing, Performed, grams, Fasting or not, levels | 24-28w
50g glucose loading= serum glucose checked after 1 hr
Normal value= below 130-140
FU > 140 = 3 GTT
FU > 200 = dx for DM does NOT need GTT
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| GTT 3 hour Glucose Tolerance Test | Diagnostic test
FASTING
100g glucose mixture = blood draws at 1 hr, 2 hr and 3 hr
Values: 2+ abnormal = GDM
1 abnl=nutritional counseling, rpt 1 month, consider mgt as GDM
FASTING > 126 = GDM
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| Preg HgA1C level is >6.5 interpret | Type 2 DM.
A1C values are LOWER in pregnancy
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| T/F: GBS + can cause PTL | FALSE: GBS + will NOT cause PTL
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| Triple Screen includes what 3 -Down Syndrome levels- if +, add what test? -Trisomy 18 levels -NTD levels | AFP, Estriol, hCG
-Down's: Low AFP, Low Estriol, High hCG.
**Quad Screen- adds inhibin A- elevated
-Trisomy 18: all low levels
-NTD: elevated AFP
-NTD levels
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| CVS performed ___ weeks. What do you administer after procedure | 10-12 weeks
RhoGAM
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