Rationalization skill 1 OB

 Most common breech presentation: FRANK PRESENTATION- lower extremity located at anterior
part of the body. Maneuver used: Mauriceaus & prague manuever (bemonc;imminent)

Manuever’s
Shoulder dystocia:
 woodcorkscrew manuever
 Mcroberts- pressing the supra-pubic area
 zavenille manuever

 The organ frequently injured during traumatic vaginal breech delivery: liver

Caput succedaneum - crosses the suture lines

Cephalhematoma- localized

 Transverse lie/ horizontal lie (shoulder presentation) is more common among: grandmultiparity

 Post mature- 42 weeks and beyond

 Growth retardation due to dryness inside the uterus
 Parchment like skin
 Meconium aspiration syndrome
 Labor induction if baby is stable
 STAT CS

 Fetal macrosomia is associated w/: maternal diabetes

 DM1 - juvenile onset
- insulin dependent- pancreas does not produce insulin
 DM2- adult onset
- non insulin dependent
- oral hypoglycemic- metformin: teratogenic to baby
- pancreas produce insulin yet insufficient
 GDM- gestational dm
- might develop dm2 in the future
- insulin given
-insulin resistance (HPL)
 Macrosomia- preterm labor
- hypoglycemia

 Risk factors:
1. Maternal obesity
2. Familial/genetics
3. Age 25 above
4. Sedentary lifestyle
5. Previous gdm
6. Pcos hx

 Treament of GDM:
Diet
Insulin
Exercise - brisk walking

Artery in uterus: 2 ovarian, 2 uterus

 The organism most commonly associated w/ puerperal mastitis: staphylococcus aureus - skin
 Smoking during pregnancy is associated w/: low birthweight
IUGR, Mental Retardation
 Alcohol, SGA, FAS- fetal alcohol syndrome , mental retarded
- shabu, marijuana, cocaine- mental retardation
Smoking , drugs is associated w/ preterm labor & lbw

 Clothing that should be avoided during pregnancy: restricting garters

 Fetal goiter results from: iodine deficiency by the mother

 Sources of iodine: all that can be seen in the sea

 Premature delivery of the placenta by cord traction may lead to: inversion of the the uterus
 Brandt-Andrew’s Manuever

 Not part of pelvis: lumbar vertebrate

 The posterior border of the pelvic inlet inlet is: sacral promontory
 Linea terminales - divides the true and false pelvis

 The breech presentation where lower extremities are flexed at the hips and extended knees:
frank
 A short cord can lead: abruptio placenta
 Long cord: nuchal cord, true knot formation
 CORD PROLAPSE:
 PROM
 unegaged presenting part
 breech presentation
 ruptured bow
 O2 deficiency
 MGT: Knee chest, trendelenburg
- maintain sterility by putting gause wet w/ nss
-refer

Bleeding in 3rd tri

 Placenta previa
-Implantaion in the lower uterine segment

 Risk factors:
1. High GP
2. Late maternal age
3. Fibroid tumor - myoma
4. Prior CS
5. Smoking
6. Previous surgery - myomectomy, d&c
7. Uterine abnormalities
8. Multi-fetal pregancy

 Types:
1. Low lying - implanted in the lower uterine segment
2. Marginal- the edge of cervical os
3. Partial- portion covers the internal os
4. Total- covers entire os

Dx by utz
 Sign & symptoms:
- painless bright red bleeding
-start w/ spotting - 20wks and above

NO IE for px w/ placenta previa

 Sequate: result
- schock due to blood loss
- fetal death
- PRETEM BABY

 BEFORE REFER UNDER BEMONC

1. NO IE
2. IVF- D5LR
3. ANTENATAL STEROID- dexamethasone, betamethasone: fasten lung maturity

 Normal placenta weight: 500 mg

 A large placenta is associated w/: Syphilis - treponema pallidum
 Symptoms: chancre/ painless ulcer
- sepsis, still birth, bone damage, enlarge spleen, blindness,jaundice
- blueberry muffin lesion
*Layer that protects from syphilis: langher

 Increase incidence of down’s syndrome: advance maternal age

*Cri-du-chat- cat’s cry- adv paternal age
 The secratory phase of menstrual cycle dependent on: progesterone
Hormones of mother: estrogen
Women- estrogen
Tempt: progesterone
 Component of bf not present in animal milk: IG A
- MCROPHAGES
- bifidus factor
- protein- lacto albumin
- iron- lacto ferrin

 Added to most infant milk formulas making it superior to breast milk after 6 moths of breast
feeding: iron
 The prominent vaginal rugae: nullipara
 Bleeding w/ cervical dilatation and rupture of membranes is present: inevitable abortion
 Modified’s Credes maneuver is method for: delivery of placenta
 Crede’s prophylaxis: opthalmic ointment - preventing opthalmia neonaturm
 Immediately after delivery the uterus weights: 500g
 Contraceptive pills prevent: ovulation
 Vertex presentation: extreme flexion
 Mismanagement of 3rd stage of labor may lead to: dystocia
 The greatest transverse diameter of fetal head is the : biparietal
 Class V pap smear: Malignant cell
 The decidua that remains after the placenta is delivered is: zona basalis
 Blood vessesls that carry the highest o2 content: umbilical vein
 Nuchal cord: cord coil around the neck
 Gestational age also known as menstrual age
 Causes vaginal ph to be acidic: douderlein bacili
 Alkaline: skenes,batholin, cervical mucus
 14th day fertile\
 Endometrial thickening- proliferative
Secreteory-gabasa basa
Pms- ischemic
 Characterized by increase:
 Grafiaan folicle is acted by release: LH
 Purpose of menstrual cycle: prepares uterus for pregnancy
 Ligament damaged during childbirth will result inversion: cardinal
Round ligament: pain
 Damaged to this muscle can lead to cystocele, rectocele, & urine incontinence: pubococcygeus
 The shortest anterio-posterior diameter of the pelvic inlet where fetal head could have difficulty
passing thru: obstetric conjugate
*Diameter between 2 ischial spine: biischial diameter
 The fetal’s head’s bigger fontanelle is located at ruq: lop
 A client has a history of thrombophebitis,contraindicated: hormonal
 Homan’s sign- pain on calf muscle on dorsiflexion
 Depoprovera- 90 days im- no massage
 A post partum woman for discharge which contraceptive she should not use: OCP
 Pap smear should be suggested to a woman using which contraceptive method: cervical cap
 The most common problem that has been associated w/ IUD when used is: spontaneous
expulsion
 IUD: interferes w/ either fertilization or implantation
 Ovum is viable for 24-36 hrs
 The time ovulatiob can be taking the bbt during ovulation the tempt drops slightly and then
rises- 0.2-0.6
 A woman after btl is considered sterile after operation
 A woman ‘s unsafe period in a regular 30 day cycle will be 12to 20th day
 Fundic height slightly above the umbilicus estimated duration of pregnancy: 24th week
 Iron given to 4th month of pregnancy. To prevent physiologic anemia.
 Iron in 1st tri can trigger n&v
 Evaluation of pelvic organs of reproduction is accomplished by: hysterosalpingogram
 Biopsy-tumor
 Culdoscopy- coldesac of douglas
 Cystoscopy- uroinary bladder
 2nd tri bleeding
 H- Mole
 Risk factors:
1. Asian/orientals
2. Advanced maternal age
3. Low socio economic stat
4. Hx molar pregnancy
5. Hx abortion
6. Radiation exposure
7. Hx of fertility

 Types:
 Partial- evidence of fetal formation, tiploid, aneoploid
 Total- grape like vesicle- choriocarcinoma

Dx. By Utz.
Snowstorm pattern/snowball pattern

 Signs & symptoms:

1. Bleeding 2nd tri
2. Abnormal uterine enlargement
3. No fhb
4. Hyperemesisi gravidarum
5. +H
6. Quantitative count of hcg - millions
7. PIH like symptoms
- edema
-protenoria
-hypertension

 Meds after D&C

- methiotrexate- prevent chariocarcinoma
- no pregnancy for at least 1 yr
Incompetent cervix/ premature cervical dilatation/ cervical insufficiency
Risk gfactors
1. Des (Diethylstilbestrol) exposure
2. Congenital malformation cervix
3. Previous hx of cervical surgery- frequent d&c
4. Cervical injury- related to child birth- laceration
5. Habitual abortion- 3 or more

S/sx- cbq- painless cervical dilatation

- bulging of membrane - speculum
- leaking BOW

Complications:
-prom
- infection - sepsis
- abortion/preterm birth
- cord prolapse

Treatment:
cervical cerclage:
Shrodkur
Mcdonalds
 Tentative diagnosis of hmole- hypotension
 Advocates slow breathing, deep relaxation and a person to act as coach: new childbirth
 Leg cramps- dorsiflex the foot while extending the knee
 FHR can be auscultated w/ fetoscope as early as: 16 wks
 Preterm labor
-True labor that occur between above 20 wks below 37 wks
 Risk factors:
1. Infection- std/stts torch
2. Maternal drug abuse-
3. Smoking
4. Multifetal pregnancy
5. Hx of ivf
6. Hx of pretem labor
7. Placental anomalies
Meds:
Tocolytic- relax the uterus
< 3cm cervical dilatation
BEMONC
1. Nefidipine
2. Terbutalate so4
3. Duvadilan (isosuxprine na)
Antenatal steroids: dexamethasone, betamethasone - prevents rds

 Complications:
1. Infection/sepsis
-chorioamnionitis
2. Cord prolapse
3. Preterm birth
- more lanugo
-lungs- rds/ hyaline membrane disease
- eyes are sensitive due to oxygen
- retolental fibroplasio / retinopathy of prematurity
 The placenta does produce: somatotropin / hpn/ hcg/ progesterone precursor subs
 After 1st 3 months of pregnancy the chief source of estrogen & progesterone: corpus luteum
 Fetal blood vessels the oxygen is highest in the: ductus venosus
 Rh determination is routinely performed during pregnancy to predict whether the fetus is at risk
of developing: hemolytic anemia
Rhogam: within 72 hrs after birth
 An increase in vaginal secretions during pregnancy
-production of estrogen
 Alpha fetoprotein test will probably be done to detect the presence of:
 Trisomy 21
 Neural tube defects
 Chromosomal aberrations
 Turner’s syndrome- uterus does not develop
 Positive signs of pregnancy
-fetal outline by the examiner
 Refers to the normal discomfort of pregnancy like N and V manifested by the woman’s husband
-Couvade syndrome
 Primary function of HCG during preg
-to prolong the life corpus leutum
 Do not lie down - lead to transfer of hypertension
 Frequency of contraction: from beginning of contraction to the beginning of 2nd contraction
 Duration: beginning of contraction to end of same contraction
 Interval: end of contraction to start of next contraction
 Normal amniotic fluid; clear almost colorless, containing little white specs
 After rupture of bow monitor FHB
 Labor induction
- laminari stent
- oxy drip (mixed w. d5lr)
-Prostaglandin gel - dinprostone (prestin z) - prostaglandin e2 alpha
 Vulvar gaping- the perineum is begging to bulge at each contraction
 A multigravida is transferred to DR at 9 cm
 2nd satage of labor- fetal expulsion stage
 When the fetal head is in the pelvic outlet and the mother can no longer push and bear down,
which should be done: low forcep delivery
-forcep delivery
- need consent
 High - floating
 Mid - level of ischial spine
 Low- dipping
- bel’s palsy - facial paralysis
- nerve injury - facial nerve
 Anterior asynclitism: sagittal suture near the maternal sacrum.
 Hyperemesisi gravidarum : increased hcg level
 Thick, mucoid, yellowish vaginal discharge accompanied by dysuria, the condition can be a
sequelae of this disease: gonorrhea: opthalmia neonutarum
 Ectopic pregnancy is suspected if client complaint of : sharp lower right or left abdominal pain
radiating to the shoulder
 The most common cause of spontaneous abortions: germ plasma defects
 Vaginal staining but no pain. Hx reveals amenorrhea in the last 2 months and pregnancy is
confirmed after missed period: threatened abortion
 Abruptio placenta: PIH
 Birth hazard associated w/ breech del: compression of cord
 The safest position for a woman in labor when midw noted prolapsed cord: trendelenburg
 Rhogam: 28 weeks aog or 72 hrs after del of baby
 Woman w/ aids feed her baby: bottle-feed the new born infant only if (AFAS)
 Most contraindicated procedure to any px presenting w/ profuse bleeding per vagina: IE
 Fundus above the umbilicus to the Left of midline : full bladder
 Endometritis: puerperal infection
 The pituiatry hormone that stimulates the production of milk from mamary gland: prolactin
 Most likely predispose px to post partum hemorrhage: macrosomia
 2 hrs after del the fundus is at level of umbilicus. 1 finger breath per week.