Term
|
Definition
Embryo: fertilization - 8 weeks
Fetus 8 weeks to birth
Infant: birth to 1 year |
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Term
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Definition
| # of days since fertilization |
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Term
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Definition
| # of days/weeks after LMP (2 weeks longer than DA) |
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Term
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Definition
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Term
|
Definition
| fertilization until 12 (DA) or 14 (GA) weeks |
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Term
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Definition
| 12(DA)/14(GA) to 24(DA)/26(GA) |
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Term
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Definition
| 24(DA)/26(GA) weeks until delivery |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
a: Full Term
b: Pre-term
c: Abortions
d: Living children |
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Term
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Definition
| Softening of cervix, 4 weeks, first sign |
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Term
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Definition
| Softening of the midline of uterus, 6 weeks |
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Term
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Definition
| Blue discoloration of vagina and cervix, 6-8 weeks |
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Term
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Definition
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Term
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Definition
| hyperpigmentation of face, 2nd trimester |
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Term
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Definition
| line of hyperpigmentation from xiphoid to pubic symphysis, 2nd trimester |
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Term
| Diagnostic test for pregnancy |
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Definition
beta-HCG
-increases since fertilization, peaks at weak 10, does down during 2nd trimester, increases in third trimester (20-30,000 IU) |
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Term
5 weeks of pregnancy
findings on US and bHCG |
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Definition
gestational sac on ultrasound
b-HCG > 1000IU |
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Term
| Cardiac changes in Pregnancy |
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Definition
Increase in CO, HR
Lower BP (lowest at 24-28 weeks) |
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Term
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Definition
Morning sickness (caused by increased estrogen, progestrone, HCG)
Reflux: decrease LES tone
Constipation: decreased large intestinal motility |
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Term
| Renal changes in pregnancy |
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Definition
Increased kidney and ureter size
Increased likelihood of pyelonephritis due to ureter compression by uterus
Increase GFR (due to 50% increase in plasma volume)
-decrease bun/cr |
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Term
| Hematological changes in pregnancy |
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Definition
Anemia (increased plasma volume)
Hypercoagulable state
-normal coags
-increas fibrinogen
-Venous stasis |
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Term
| Prenatal care: 1st Trimester |
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Definition
Routine visit every 4-6 weeks
11-14 weeks US for gestational age and nuchal lucency
pap smear, chlymidia/gonorrhea
non-invasive screening |
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Term
| Prenatal care: 2nd trimester |
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Definition
Triple or Quad screen
-maternal serum AFP (MSAFP) : increase -> dating error, neural tube defect
-b-HCG
-estriol
-inhibin A
Auscultation of fetal heart rate
16-20 weeks : quickening
18-20 weeks: routine US |
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Term
| Prenatal care: 3rd trimester |
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Definition
| Routine visits (2-3 weeks) until 36th week, weekly visits after |
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Term
| Braxton-Hicks Contractions |
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Definition
sporadic contractions in 3rd trimester, no cervical dilation
if regular, check cervix for preterm labor |
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Term
| Ectopic pregnancy risk factors |
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Definition
PID
IUD
previous ectopic pregnancies |
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Term
| Ectopic pregnancy presentation |
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Definition
unilateral lower abdominal pain
pelvic pain
vaginal bleeding
if ruptured, hypotensize with peritoneal irritation |
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Term
| Ectopic pregnancy diagnostic tests |
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Definition
b-HCG: positive
Ultrasound
Laparoscopy |
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Term
|
Definition
Unstable: IV fluids, OR
Stable:
CBC, type & screen, transaminases, b-HCG
tx with MTX, successful is b-HCG decreases by 15% in 7 days.
Do not use MTX if:
-immunodeficiency
-poor compliance
-ectopic > 3.5cm
-fetal heart beat present
RhoGam for Rh negative patients |
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Term
Complete abortion
Findings
Tx |
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Definition
No product of conception found
Routine follow-up |
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Term
Incomplete abortion
Findings
Tx |
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Definition
Some product of conception found
D&C/Medical |
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Term
Inevitable abortion
Findings
Tx |
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Definition
Products of conception intact, intrauterine bleeding, dilation of cervix
D&C/medical |
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Term
Threatened abortion
Findings
Tx |
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Definition
products of conception intact, intrauterine bleeding, no dilation of cervix
Bed rest/pelvic rest |
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Term
Missed abortion
findings
Tx |
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Definition
Death of fetus, all product of conception present
D&C/medical |
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Term
Septic abortion
findings
tx |
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Definition
Infection
D&C + abx (levoquin or flagyl) |
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Term
Multiple Gestation
Presentaiton |
|
Definition
Exponential utero growth
Rapid maternal weight gain
elevated b-HCG and MSAFB |
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Term
Multiple Gestation
Complications |
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Definition
Spontaneous abortion
Premature Labor
Placenta Previa
Anemia |
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Term
| Pre-term labor risk factors |
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Definition
Premature rupture of membranes
Multiple gestation
previous history of pre-term labor
Placental abruption
Maternal factors
-Uterine anomaly
-infections
-pre-eclampsia |
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Term
| Pre-term labor presentation |
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Definition
contractions
dilation of cervix
between 20-37 weeks |
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Term
| Situations to NOT use tocolytics in pre-term labor |
|
Definition
pre/eclampsia
maternal cardiac dz
maternal cervical dilation
maternal hemorrhage
Fetal death
chorioamnionitis |
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Term
| situations to USE tocolytics |
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Definition
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Term
| utility of betamethasone in pre-term |
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Definition
mature fetus lungs
decrease RDS
Peaks at 48hrs, lasts 7 days. |
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Term
|
Definition
Decrease uterine contractions, and slow the progression of cervical dilation
Magnesium sulfate
-most common
-decrease tone and contractions
-side effects: flushing, headaches, diplopia, fatigue
Calcium channel blockers
Mag toxicity can lead to respiratory depression and cardiac arrest |
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Term
Pre-mature rupture of membranes
Diagnosis |
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Definition
speculum exam
-fluid in posterior fornix
-fluid turns nitrazine paper blue
-fluid has ferning pattern |
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Term
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Definition
| -labor starts 24 hours before delivery |
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Term
| Complications of premature rupture |
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Definition
-preterm labor
-cord prolapse
-placental abruption
-chorioamnionitis |
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Term
Premature rupture
Treatment |
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Definition
If chorioamionitis: delivery now
betamethasone
ampicillin
azithromycin |
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Term
Third trimester bleeding
2 types |
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Definition
Placental previa
Placental invasion |
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Term
Placental previa
definition |
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Definition
| abnormal implantation of placenta over the internal cervical os |
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Term
Placental previa
risk factors |
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Definition
previous c-sections
previous uterine surgery
multiple gestation
previous placental previa |
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Term
placenta previa
presentation
dx |
|
Definition
painLESS vaginal bleeding
Dx
Transabdominal ultrasound |
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Term
|
Definition
complete: complete covering of internal cervical os
partial
marginal: adjacent to internal cervical os
vasa previa: fetal vessel over internal cervical os
low lying: implantation in lower segments of uterus |
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Term
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Definition
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Term
|
Definition
abnormal adherence of placenta to different areas of uterus
hemorrhage
tx: hysterectomy |
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Term
placental abruption
definition |
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Definition
premature separation of placenta from uterus
large separation leads ot hemorrhage, uterine tetany, DIC, premature delivery |
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|
Term
placenta abruptio
etiology |
|
Definition
maternal hypertension
history of abruption
maternal cocaine use
maternal trauma
maternal smoking |
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Term
placenta abruptio
presentaiton |
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Definition
3rd trimester PAINFUL bleeding
contractions
possible fetal distress |
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|
Term
placental abruptio
diagnosis |
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Definition
| transabdominal ultrasound |
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Term
| Types of placental abruption |
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Definition
concealed:
-blood in uterine cavity
-placenta more likely to be completely detached
-Serious complication
-DIC
-uterine tetany
-fetal hypoxia
-fetal death
-sheehan
external
-blood drains through cervix
-placenta partially detached
-smaller with minimal complication |
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Term
placental abruption
Treatment |
|
Definition
C-section if
-uncontrollable maternal hemorrhage
-rapidly expanding concealed hemorrhage
-fetal distress
-rapid placental separation
vaginal delivery if
-placental separation is limited
-fetal heart tracing is assuring
-separation is extensive and fetus is dead |
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|
Term
Uterine rupture
definition |
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Definition
| life-threatening to both mother and fetus and usually during labor |
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Term
uterine rupture
risk factors |
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Definition
classical c-sections
trauma
uterine myomectomy
uterine overdistention
-polyhydramnios
-multiple gestations
-placenta percreta |
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Term
| uterine rupture presentation |
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Definition
suddent onset extreme abdominal pain
abnormal bump in abdomen
no uterine contractions
regression of fetus |
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Term
| uterine rupture treatment |
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Definition
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Term
| Hemolytic disease of newborne |
|
Definition
Rh incompatibility
-fetal anemia
-extramedullary erythopoeisis
-increase bilirubin and heme
-high fetal cardiac output |
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Term
|
Definition
| Rh antibody screening test |
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Term
|
Definition
-Amniocentesis
-abortion
-vaginal bleeding
-placental abruption
-delivery |
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Term
| Prenatal antibody screening |
|
Definition
| unsensitived patient at 28 weeks need to receive RhoGAM |
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Term
|
Definition
hypertension that starts after 20 weeks gestation
-no proteinuria, no edema |
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Term
| Why are ACE and ARB contraindicated |
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Definition
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Term
|
Definition
chronic hypertension
renal disease |
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Term
|
Definition
| seizure in patient with a history of pre-eclampsia |
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Term
|
Definition
If pre-term
Magnesium sulfate for seizure
hydralazine for HTN
bethamethasone for Lung
Delivery the babby
If term, deliver baby |
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Term
|
Definition
| Hemolysis, Elevated liver enzymes, low platelets |
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|
Term
Pregestational Diabetes
definition |
|
Definition
| Pt with diabetes prior to pregnancy |
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|
Term
pregestational diabetes
complications |
|
Definition
Maternal
-4x preeclampsia
-2x abortion
-infection
-postpartum hemorrhage
Fetal
-heart and neural tube defects
-macrosomia
-preterm labor |
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|
Term
pregestational diabetes
evaluation |
|
Definition
EKG
24 hours urine cr and protein
HbA1C |
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|
Term
Gestational diabetes
complications |
|
Definition
preterm birth
fetal macrosomia
birth injuries
neonatal hypoglycemia |
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Term
|
Definition
glucose load 1st
glucose tolerance 2nd |
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Term
|
Definition
NPH before bed
aspart before meal |
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Term
| Intrauterine growth restriction |
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Definition
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|
Term
|
Definition
symmetric before 20wks
asymmetric brain weight not increased after 20 weeks, abdomen < head |
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Term
|
Definition
chromosomal abnormality
neural tube defects
infections
multiple gestations
maternal HTN |
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Term
|
Definition
Check for fetal well-being in utero
Measures fetal movement and HR |
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Term
|
Definition
2 fetal movements
acceleration of fetal HR > 15 bpm lasting 15-20 seconds |
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|
Term
Biophysical profile
define |
|
Definition
NST
fetal chest expansion (NL >1 per 30 minute)
fetal movement (>3 per 30 min)
fetal muscle tone
amniotic fluid index
each category is 2 points for max of 10 |
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Term
|
Definition
Normal 110-160
Brady <110
Tachy >160 |
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Term
|
Definition
| >15 increase in HR for longer 15s (NL twice in 20 minutes) |
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Term
|
Definition
Early decelerations
Variable decelerations
Late decelerations |
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|
Term
Early decelerations
define |
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Definition
decrease in heart rate that occurs with contractions
-head compression |
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|
Term
Variable deceleration
define |
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Definition
decrease in HR with no relations to contractions
-umbilical cord compression |
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Term
|
Definition
decrease in HR after contraction has started no return to baseline until contraction ends
-fetal hypoxia |
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Term
|
Definition
| fetal descent into pelvic brim (before labor) |
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|
Term
| Braxton-Hicks contractions |
|
Definition
| benign contractions with no cervical dilations |
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Term
|
Definition
| blood-tinged mucus from vagina with cervical effacement (before labor) |
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|
Term
|
Definition
Stage 1:
-onset to full cervical dilation (prim 6-18hr, multi 2-10hr)
Latent phase
-onset to 4cm dilation (prim 6-7hr, multi 4-5)
Active phase
-4cm to full dilation (prim 1cm/hr, mult 1.2cm/hr)
Stage 2
-full dilation to delivery (prim 30-3hr, mul 5-30min)
Stage 3
-delivery neonate to delivery of placenta (30min) |
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Term
|
Definition
Maternal BP/pulse
Fetal HR & contractions
Examine cervix for dilation, effacement
Station |
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Term
|
Definition
Engagement
-occiput enters pelvis
Descent
-uterine contraction & maternal pushing
Felxion
-fetal head fexion
Internal rotation
-head rotates at ischial spine
Extension
-head orientated forward and upward
External rotation
-give room for shoulder to extend
Delivery of anterior shoulder
Delivery of posterior shoulder |
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Term
|
Definition
Signs of placental separation
-fresh blood in vagina
-umbilical cord lengthening
-uterine fundus rising
-uterus becoming firm |
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|
Term
| Medications for inducing labor |
|
Definition
Prostaglandin E2 - cervical ripening
Oxytocin -
-exaggerate uterine contractions
Amniotomy
-puncture of amniotic sac using amnio hook |
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Term
Prolonged latent stage
definition |
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Definition
| latent phase last longer than 20 hours |
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|
Term
prolonged latent stage
etiology |
|
Definition
sedation
unfavorable cervix
uterine dysfunction w weak or irreg contractions |
|
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Term
|
Definition
rest and hydration
resolve 6-12 hours |
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|
Term
| Protracted cervical dilation |
|
Definition
active phase of stage 1 labor
less than 1.2cm/hour in primi and 1.5/hr in multi |
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|
Term
protracted cervical dilation
etio |
|
Definition
3P
Power: strength and frequency of uterine contractions
Passenger: size and position of fetus
Passage: cephalopelvic disproportion |
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|
Term
protracted cervical dilation
tx |
|
Definition
|
|
Term
|
Definition
Cervical dilations: No dilation for 2 hours
Fetal descent: no fetal descent for 1 hour |
|
|
Term
|
Definition
Cephalopelvic disproportion
-50% of all arrest
Malpresentation
-fetus > 36 weeks not presenting with head downward
Excessive sedation/anesthesia |
|
|
Term
|
Definition
lower half of fetus is presenting part
can be felt during physical exam
-leopold maneuver
-vaginal exam
Dx with ultrasound |
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|
Term
|
Definition
Frank breech- fetus hips are flex with extended knees
Complete breech- hips and knees are flex
Footling breech- feet first |
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|
Term
|
Definition
wait until 36 weeks
maneuver into position after 36 weeks |
|
|
Term
Shoulder dystocia
definition/etio/tx |
|
Definition
shoulder stuck in pubic symphisis after head has been delivered
macrosomia
late term delivery
tx
mcroberts maneuver
rubin maneuver
woods maneuver
deliberate fracture of clavicle |
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|
Term
Post-partum hemorrhage
definition
etio |
|
Definition
>500cc bleeding after delivery
uterine atony (80%)
laceration
retained parts
coagulapathy |
|
|
Term
|
Definition
anesthesia
prolonged labor
uterine over distention
laceration
retained placenta
coagulopathy |
|
|
Term
|
Definition
bimanual examination
-make sure not rupture or retained placenta
bimanual compression and massage
oxytocin |
|
|
Term
|
Definition
Headaches
Breast tenderness
pelvic pain/bloating
irratibility |
|
|
Term
|
Definition
decrease caffeine, alcohol, cigarettes, and chocolat.
SSRI |
|
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Term
|
Definition
permanent loss of estrogen (age 48-52)
Increase LH and FSH. |
|
|
Term
|
Definition
Menstrual irregularity
Sweats and hotflashes
Mood changes
Dyspareunia |
|
|
Term
|
Definition
atrophic vaginitis
decrease breast size
vaginal cervical atrophy |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hormone replacement therapy for symptom relief and prevent osteoporosis |
|
|
Term
Abnormal uterine bleeding
Dx |
|
Definition
CBC
PT/PTT
pelvic ultrasound |
|
|
Term
|
Definition
heavy and prolonged menstrual bleeding
endometriosis
uterine fibroids
IUD |
|
|
Term
|
Definition
light menstrual flow/spotting
obstruction(cervical stenosis)
ocp |
|
|
Term
|
Definition
intermenstrual bleeding
-endometrial polyps
-cancer
-exogenous estrogen |
|
|
Term
|
Definition
irregular bleeding
-endometrial polyps
-cancer
-estrogen |
|
|
Term
|
Definition
menstrual cycle >35 days
-pregnancy
-menopause
-weightloss
-estrogen secreting tumor |
|
|
Term
|
Definition
-cervical cancer
-cervical polyps
-atrophic vaginitis |
|
|
Term
Dysfunctional Uterine Bleeding
Define
Diagnosis |
|
Definition
unexplained abnormal bleeding.
Systemic reasons for anovulations (hypothyroid, hyperprolactin)
Endometrial biospy for pt > 35. |
|
|
Term
Dysfunctional uterine bleeding
Tx |
|
Definition
OCP
Acute hemorrhage
-D&C to stop bleeding. |
|
|
Term
|
Definition
excess androgenes
etiology
-21-B hydroxylase deficiency
-excess androgen
Tx:
Surgery |
|
|
Term
|
Definition
white thin skin from labia to perianal
tx: topical steroids
increased risk of cancer |
|
|
Term
| squamous cell hyperplasia |
|
Definition
associated chronic vulvar pruritus
raised white lesion (hyperkeratosis)
sitz bath, lubricants |
|
|
Term
|
Definition
30-60s
violet flat papules
tx: topical steroids |
|
|
Term
|
Definition
inflammation of bartholin glands (lateral vulva)
pain, tenderness, dyspareunia
Tx:
I&D, culture for gonorrhea and chlamydia |
|
|
Term
|
Definition
Abx use
diabetes
overgrowth of normal flora |
|
|
Term
|
Definition
Gardnella
gray white discharge
fish odor
clue cells
metronidazole/clindamycin |
|
|
Term
|
Definition
candida
white cheesy discharge
KOH pseudohyphae
miconazole/clotrimazole |
|
|
Term
|
Definition
trichomonas
green frothy discharge
motile flagellates
metronidazole for both partners |
|
|
Term
|
Definition
vulvar soreness and pruritis
red lesion with a superficial white coating
biopsy for diagnosis
tx: vulvectomy. |
|
|
Term
Squamous cell carcinoma
presentation |
|
Definition
pruritis
vaginal discharge
postmenopausal bleed
dx biopsy |
|
|
Term
|
Definition
0 carcinoma in situ
1 limited to vaginal wall <2cm
2 limited to vulva or perineum >2cm
3 tumor spread to urethra, anus, lymphnodes
4 bladder, rectum, bilateral lymphnodes
4a distant mets |
|
|
Term
|
Definition
invasion of endometrial glands into the myometrium
dysmenorrhagia, menorrhagia |
|
|
Term
|
Definition
| endometriosis, uterine fibroids |
|
|
Term
|
Definition
implantation of endometrial glands outside of endometrial cavity.
Cyclic pelvic pain that starts 1-2 weeks before menstration.
Abnormal bleeding.
nodular uterus, adnexal mass |
|
|
Term
|
Definition
| laparoscopy - rusty lesions, choclate cyst |
|
|
Term
|
Definition
analgesia
OCP
danazol, leuprolide to decrease FSH LH |
|
|
Term
|
Definition
Amenorrhea
Irregular menses
Hirsutism, obesity
Acne
T2D |
|
|
Term
|
Definition
pelvic ultrasound
LH:FSH 3:1 |
|
|
Term
|
Definition
Weightloss
OCP
clomiphene and metformin for those who want to conceive |
|
|
