PAEA OBGYN EOR
Topics,Questions and Answers
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
Topics,Questions and Answers
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
