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OB/GYN at Southside Hospital – Things to know Note: Although I made an effort to summarize/define some things it would behoove you to research anything else further that you do not understand. a. G is total number of pregnancies b. P 2 (preg. to term) 0 (preg that are pre-term) 1 (num of abortions aka less than 20 wks) 2) Naegel rule: Substract 3 months add 7 days to the LMP to calculate EDC a. Consider Jan month number 13, Feb number 14 and March 15 to make subtractions 3) Preeclampsia classification (mild and severe) a. Mild – BP over 140/90 with proteinuria of 300mg/24hr or less i. Attempt to get patient to term if it gets more severe deliver b. Severe – BP over 160/110 with proteinuria of 500mg/24hr or more ii. Manage with MgSO4 to prevent seizures a. H – Hemolytic Anemia b. EL – Elevated Liver enzymes c. LP – Low Platelet count 5) Methotrexate used for ectopic pregnancies for abortion a. Dosage is 50mg/m^2 b. Can only use if B-HcG is below 5000, ectopic is not ruptured, and no fetal heart rate is a. Fully dilated, bladder empty, +2 station, vertex position b. check fontanelas, check equipment c. Place vacuum far posterior and pull with contractions in perpendicular force 7) Classification of IUGR (below 10th percentile of growth) a. Symmetric – head circumference is proportional to the rest of the body b. Asymmetric – head circumference is larger than rest of the body and typically an error 8) PAP classification: Sample from endocervix a. Bethesda system – adequate, description, diagnosis a. Trichomonas – posterior cervix b. GC/Chlamydia – Endocervix c. GBS – rectum 10) Fetal fibronectin – sample from posterior vault. False positive with cervical mucus therefor always ask when the last intercourse was. Used to detect onset of labor and if positive labor is expected to begin within a week. 11) Indication for Non-Stress Test (NST) – A test for fetal well-being 12) Interpretation of NST (Always present in the following order) a. Baseline FHR b. Variability (mild, mod, marked) c. Accelerations (15 or more above baseline lasting for 5 seconds or more) d. Decelerations (15 or more below baseline lasting for 5 seconds or more) i. Early – Decel before contraction caused by head compression (vagus) ii. Variable – Decel sometime around contraction caused by cord compression (tracing will show shoulder humps on either side of decal) iii. Late – Decel after contraction caused by placenta failure i. You can only comment on reactivity if the strip has run for 20 mins or more. ii. Reactive is mod variability with at least 2 accelerations in 20 mins and no decels 1. Spotting 2. Abdominal pain radiating to the back and left shoulder ii. Spontanious abortion (#1 reason is chromosomal abnormalities) 1. Missed Ab – cervix closed and only one without bleeding. Fetus is dead 2. Incomplete Ab – cervix open, some products expelled and some remain 3. Complete Ab – cervix closed, all products of conception have been 4. Threatened Ab – bleeding without assessment of viability 5. Inevitable Ab – cervix is open but fetus has not been expelled iii. Blight ovum – empty sac without fetal parts a. PID – Admit to hospital and treat with antibiotics b. Endometritis c. Cervicitis a. Contractions and cervical changes before term b. Confirm with fetal fibronectin c. Give tocolytics (terbutaline, MgSO4, nifedipine), beta methasone, and if GBS positive antibiotics (GBS is shown to cause preterm labor) a. Based on 5 things: Cervical dilation, Cervical position, Cervical consistency, Cervical b. Score of 8 or more means expect normal spontaneous vaginal delivery (NSVD). c. Score of 5 or less means induction may be needed/stared a. Flagyl (metrodinazole) b. Azithromycin c. Rocephin (ceftriaxone) d. Gentamycin e. Penicillin G f. Clindamycin g. Azactam h. Macrobid 19) UTI/Asymptomatic bacteria 20) AST (mitochondrial)/ALT (cytoplasmic) 21) Fensteil incision and layers of abdomen in C-Section surgery 22) Clinical Pelvimetry 23) Gestational Diabetes (leads to large for gestational age fetus aka macrosomia leading to complications such as shoulder dystocia which is delivered using McRoberts position) a. Class A – seen only during pregnancy b. Class B - onset at age 20 or older or with duration of less than 10 years c. Class C - onset at age 10-19 or duration of 10–19 years d. Class D - onset before age 10 or duration greater than 20 years e. Class E - overt diabetes mellitus with calcified pelvic vessels (can lead to small for a. If over the age of 50 and cyst is greater than 3cm assume cancer until proven otherwise b. Anything decreasing ovrian activity in life will decrease risk of cancer including: a. Combination oral contraceptive 2 pills within 72 hours and 2 pills 12 hours after the first b. This is an anti-implantation NOT an anti-contraceptive since conception has occurred by the time the pills are given and the only affect is to flush the endometrial lining and prevent embryo from implanting

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