ObGyn - Ob Hx and Phys Exam Flashcards

Terms Definitions
What should you always assume when beginning an ObGyn exam?
- All reproductive aged women are pregnant until proven otherwise

- All pregnant women have an ectopic (life-threatening) pregnancy until proven otherwise
What is "G"?
G = gravidity = number of pregnancies
What is "P"?
P = parity = outcome of pregnancies

Subdivided:
A = full term delivery (>37 wks)
B = preterm delivery (22-36 wks)
C = abortion/ectopic/miscarriage (<22 wks)
D = number of living children
What does it mean when P < G?
Patient is currently pregnant
What is "LMP"?
LMP = first day of Last Menstrual Period

(used to calc age of pregnancy)
What is "EDC"?
EDC = Estimated Date of Confinement
("due date")
What is "EGA"?
EGA = Estimated Gestational Age

- used to determine/interpret certain values during pregnancy - e.g., what a normal amniocentesis should show at that time
What is the format of an ObGyn chief complaint?
A --- year old Gx Px with LMP --- and EDC --- presents at --- weeks EGA complaining of ---.
What are the 4 cardinal questions of Ob when a patient presents with a chief complaint?
1. Are you bleeding?
2. Has your water broken?
3. Are you having contractions?
4. Is the baby moving?


Note: 1-3 involve whether or not patient is in labor; 4 involves baby's health
What does an Obstetrics HPI include?
History of the current pregnancy:
- presence/absence of prenatal care
- complications during pregnancy
- results of any labs/radiological studies
What does a pregnancy history include?
Details of all previous pregnancies:
- dates
- outcomes
- modes of delivery
- use of anesthesia
- ante/peri/post partum complications
What parts of the history are required when a patient presents to the labor floor?
- HPI
- Pregnancy History
- Gynecological Hx
- PMH - esp surgeries; asthma, hypertension, diabetes
- PSH
- Medications
- Allergies
- Social Hx - esp smoking, drinking
- Family Hx
What are the steps of an obstetric physical exam?
- Observation (patient acuity)

- Vital signs of mother AND fetus

If presenting in early pregnancy:
- gynecologic exam
- pregnancy sizing

If presenting on labor floor:
- heart
- lungs
- breast
- abdomen
- pelvis
- extremities
What is a normal fetal HR?
110-150 bpm (~130 bpm with good variability)
What is determined in an obstetric abdominal exam?
- acuity - is the pt about to deliver?

- age/size of pregnancy

- postition/presentation/lie of fetus
How is Gestational Age measured on physical exam?
distance (cm) from pubic symphysis to top of fundus
--> correlates in centimeters to weeks (after 20 wks gestation)
How is the presentation of the fetus determined on physical exam?
Leopold's Maneuvers
What is "presentation" of the fetus?
Fetal part closest to birth canal
- cephalic/vertex (head-first)
- breech (bottom-first)
What is "lie" of the fetus?
Relation of the long axis of the fetus to the mother
- longitudinal
- transverse
What is "position" of the fetus?
Relation of the fetal presenting part to the R or L of the maternal pelvis
- Right
- Left
What is examined during an obstetric pelvic exam?
- external genitalia - masses, lesions

- vagina - fluid, bleeding (ruptured membranes)

- cervix - lesions, dilation, effecement, station

- uterus and adenexa - masses
What is the diagnosis for LABOR?
contractions causing cervical change
-- cervical change: dilation and effacement
What is complete dilation and effacement? What does this mean?
CERVIX:
10 cm dilated
100% effaced
= READY FOR BIRTH
What is the digital exam? Purpose?
2 fingers insterted into vagina up to cervix to determine if it has begun to dilate/efface

- 2 fingers = ~2 cm dilated
What is Effacement?
Shortening and thinning of cerxis (length) from ~2cm to paper thin.... shortens until becomes almost one with uterine wall
What are the cardinal movements of delivery? (in order)
- engagement - diameter of head reaches pubic bone
- flexion
- descent
- internal rotation
- extension - head comes under pubic bone, then extends up and out... then shoulders come out
- external rotation
What are the 10 essential steps of delivery?
1. assess position of fetal head (head crowns)
2. protect perineum
3. fetal nasal and oral suction
4. assess for nuchal cord
5. deliver anterior shoulder
6. deliver posterior shoulder
7. deliver remaining fetus
8. clamp and cut umbilical cord
9. deliver placenta
10. assess for/repair any lacerations
What are indications for cesarian section pre-labor?
- previous uterine incision/c-section
- non-vertex presentation
- placental abnormality
- infectious disease (HIV, HSV)
- severe preeclampsia
- multiples
- other
What are indications for cesarian section during labor?
- non-reassuring fetal monitoring due to:
- umblical cord prolapse
- placental abruption
- placental insufficiency
- other

- arrest of dilation

- arrest of descent
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