PAEA OBGYN EOR Topics questions and answers| verified

PAEA OBGYN EOR Topics questions and answers| verified 1. G2 P1001 2. G4 P1111 3. G3 P2103 1. currently pregnant, 1 term delivery, 1 living child 2. currently pregnant, 1 term delivery, 1 preterm delivery, 1 abortion/miscarriage, 1 living child (cannot tell if it is term or preterm child by formula) 3. currently pregnant, twins at term, 1 at preterm, 3 living children G (# pregnancies) T (# term deliveries at 37 weeks or more including stillbirths) P (# preterm deliveries at 20-37 weeks) A (abortions 20 weeks including miscarriages) L (# living children) a previable fetus is defined as 24 weeks old (varies w/ guidelines) what are the routine test during the first prenatal visit? blood pressure, blood type & Rh, CBC, UA (glucose & protein), random glucose, HBsAg, Hep C, HIV, syphilis, rubella titer, VZV titer, pap, sickle cell & CF screening diagnosis of pregnancy can be detected by serum B-hCG at ____ days after conception and by urine B-hCG at ____ days after conception serum B-hCG: 5 days after conception urine B-hCG: 14 days after conception how is estimated date of delivery (EDD) determined? Naegele's Rule: from 1st day of LMP 1. subtract 3 mos, add 7 days, add 1 year 2. add 9 mos & 7 days ex: LMP started 8/7/16 = EDD: 5/14/17 when estimating gestational age on US what measurements can you use? 1. crown rump length (CRL) 2. biparietal diameter 3. head circumference 4. abdominal circumference 5. femur length what physical exam and lab tests should be performed on initial visit of a pregnant patient? full physical exam, BP, pelvic exam w/ pap smear (unless done in last 6 mos), G/C Cx's, bimanual exam to check size of uterus and help estimate # weeks into pregnancy, US if unsure of LMP to date # weeks labs: CBC (r/o anemia), blood type & Ab screen + Rh status, RPR, HBSAg, rubella Ab screen, VZV Ab screen if no h/o chickenpox, UA w/ Cx, blood glucose, HIV, sickle cell/CF screen, PPD in high risk pts, screening for aneuploidy offered (inc or dec free B-hCG, PAPP-A low w/ down syndrome, inc nuchal translucency @10-13 weeks US) what are the screening tests for aneuploidy (including down syndrome)? when are they performed? ALL offered around 10-13 weeks 1. free B-hCG (high or low can be indicative of abnormalities) 2. PAPP-A (usually low w/ DS) 3. nuchal translucency (inc thickness on US) 4. if any above + can be offered chorionic villus sampling (or if they have any RF for aneuploidy such as advanced maternal age/AMA, previous child w/ chromosomal abnmlity, abnml US, prior pregnancy losses) but inc r/o spontaneous abortion w/ procedure *amniocentesis offered around 15-18 weeks w/ same indications as CVS (both can diagnose chromosomal abnormalities and have risk of spontaneous abortion) the uterus softening at 6 weeks is what sign? Ladin's sign the uterine isthmus softening after 6-8 weeks gestation is what sign? Hegar's sign bluish coloration of the cervix & vulva around 8-12 weeks is what sign? Chadwick's sign a palpable lateral bulge or softening of the uterine cornus (where uterus meets fallopian tubes) at 7-8 weeks gestation is what sign? Piskacek's sign cervical softening of the cervix and vulva around 8-12 wks Goodell's sign what are the # weeks in each trimester? 1st tri: 1-12 2nd tri: 13-27 3rd tri: 28-birth what should be checked at routine first trimester visits? BP, weight, urine dipstick, measurement of uterus/fundal height, auscultation of fetal heart sounds at 10-12 weeks (nml 120-160) what week should the uterus/fundal height measure above the pubic symphysis? midway between pubic symphysis/umbilicus? at umbilicus? 2-3cm below xiphoid process? -above the pubic symphysis? 12 wks -midway between pubic symphysis/umbilicus? 14-16 wks -at umbilicus? 20 wks -2-3cm below xiphoid process? 38 wks after 20 weeks gestation, the fundal height should measure +/- ____cm from the # of weeks +/- 2 cm when are fetal heart tones audible with doppler US? what rate is nml? 10-12 weeks (end of 1st trimester) at 120-160 bpm what is the quad screen test for? what are the tests? when is it performed? -to screen for trisomy 21 (down syndrome), trisomy 18, and NTD like spina bifida -tests: alpha-feto protein, B-hCG, estradiol, and inhibin-A -performed at 15-20 weeks -can be performed w/ 1st trimester screening - called "integrated screening" what would you expect with the quad screen if a baby had down syndrome? a-FP: low B-hCG: high estradiol: low inhibin-A: high (always high in chromosomal abnormalities) when can a fetus be detected by pelvic US? 5-6 weeks what would you expect with the quad screen if a baby had a neural tube defect? a-FP: high B-hCG: N/A estradiol: N/A inhibin-A: high (always high in chromosomal abnormalities) what would you expect with the quad screen if a baby had trisomy 18? a-FP: low B-hCG: low estradiol: low inhibin-A: high (always high in chromosomal abnormalities) the anatomy ultrasound (checking for amniotic fluid level, fetal viability, growth, and anatomy) is performed at how many weeks? 18-22 weeks when is gestational diabetes screened for? what is the screening test & BS limit? what is the diagnostic test and & BS limits? -24-28 weeks -glucose loading test (GLT): 50g given and serum glucose checked 1 hr later- failed if BS ≥140 -glucose tolerance test (GTT): fasting BS checked (≥95) then 100g glucose given and BS checked at 1 hr (≥180), 2 hr (≥155), 3 hr (≥140); failure = at least 2/4 when is "quickening" aka fetal movement felt? 16-20 weeks how often are OB visits scheduled? Q4 weeks first 2 trimesters, 1-28 wks Q2 weeks 28-36 wks Qwk 36-birth what tests/physical examinations should be performed at third trimester visits? -repeat Ab titers in unsensitized Rh(-) mothers followed by RhoGAM @ 28 weeks & w/I 72 hrs of childbirth -group B streptococcus screening @ 32-37 weeks via vaginal-rectal Cx -H/H @ 35 weeks -biophysical profile/BPP if there are complications: (5 variables: fetal breathing, fetal tones, amniotic fluid levels, NST (nonstress test), & gross fetal movements - 2 pts each) -non-stress testing: baseline fetal HR 120-160 -Leopold maneuvers to determine fetal presentation, or US if cannot determine (can do external cephalic version if breech presentation) -after 37 weeks sweeping membranes offered at weekly visits to help induce labor In high risk individuals what tests are run again in the third trimester? prophylactic tx? -G/C Cx -if + HSV, prophylactic acyclovir initiated at 36 weeks -if + GB strep, IV PCN given when presenting in labor what are the hematologic effects of pregnancy? -dilutional anemia (plasma vol inc by 50% but RBCs only inc by 20-30%) -WBC increases (especially during stress of labor- ppl confuse this with sepsis) -platelets dec -hypercoagulable state (inc thromboembolic events d/t Virchows triad- venous stasis, endothelial damage, hypercoagulability & inc in factors VII-X and fibrinogen) -iron deficiency anemia (d/t inc demand on hematopoiesis) nonstress testing is reactive when? -2 or more accelerations in 20 minutes -fetal HR inc 15 or more bpm from baseline lasting 15 or more seconds what are the effects of pregnancy on the heart and BP? -CO increases by 30-50% (first in SV then in HR and a dec in SVR) -BP decreases slightly (so if there is an inc be suspicious of preE/eclampsia) dyspnea of pregnancy occurs in 60-70% of pts and is d/t dec PaCO2 levels, inc tidal volume, decrease TLC what GI changes occur in pregnancy? N/V (70%), delayed gastric empyting & dec gastroesophageal sphincter tone (= GERD), dec motility of lg bowel (= constipation) what kidney changes occur in pregnancy? -50% inc in GFR -the kidneys inc in size and the ureters dilate (cause of inc r/o pyelonephritis) what are the effects of pregnancy on the endocrine system? -hyperestrogenic state (produced by placenta) -placenta also produces hCG (doubles Q48 hrs in early pregnancy peaking at 10-12 wks) which maintains corpus luteum early on -corpus luteum produces progesterone which maintains uterine lining -human placental lactogen is produced by placenta and responsible for nutrient supply to fetus but can cause a diabetogenic state (bc insulin antagonist) -prolactin greatly increases -inc in T3/4 while fT4 and TSH remain minimally changed what are the effects of pregnany on the msk system? -change in center of gravity = low back strain -carpal tunnel syndrome is common what are the effects of pregnancy on the dermatologic system? -spider angiomatas -palmar erythema -hyperpigmentation of nipples, umbilicus, abdominal midline (linea nigra), perineum, face (melasma) approximately what increase in calories is recommended in nml BMI pregnant patients? what amount of weight gain is recommended in underweight, nml, and overweight patients? 300 cal per day (500 cal when breastfeeding) -underweight: 28-40 lb -nml: 20-30 lb -overweight: 15-25 lb what nutritional requirements requirements besides caloric intake increase during pregnancy? -protein -iron (IDA common in pregnancy) -folate (prevent NTD) -calcium -other vitamins and minerals