OB/GYN Final Exam Comprehensive Review PDF

OB/GYN Final Exam Comprehensive Review Section 1: Antepartum Care Pregnancy Changes Breast: Size increases; pigmentation changes. Cardiac Output: Circulatory volume increases by 50%. Watch for DVT and PE. Hematologic Changes: Hemodilution (increased plasma volume relative to RBC...

OB/GYN Final Exam Comprehensive Review Section 1: Antepartum Care Pregnancy Changes Breast: Size increases; pigmentation changes. Cardiac Output: Circulatory volume increases by 50%. Watch for DVT and PE. Hematologic Changes: Hemodilution (increased plasma volume relative to RBCs), increased fibrinogen (hypercoagulable state), and slight decrease in hemoglobin and hematocrit. Supine Hypotensive Syndrome: Avoid lying flat to prevent vena cava compression. Action: Turn to the left. GI System: Slows down → risk for constipation. Endocrine: Increased progesterone and relaxin cause muscle relaxation (watch for UTIs). Psychosocial: Normal ambivalence in early pregnancy. Key Mnemonics 1. Danger Signs of Pregnancy ("BURNT HOT"): ○ B: Blurry vision ○ U: Urinary pain or urgency ○ R: Red vaginal bleeding ○ N: Nausea/vomiting (severe) ○ T: Temperature > 101°F ○ H: Headaches (severe) ○ O: Oliguria (low urine output) ○ T: Trauma (e.g., falls, accidents) 2. Weight Gain Targets: ○ Normal BMI: 25-35 lbs ○ Overweight BMI: 15-25 lbs ○ Underweight BMI: 28-40 lbs 3. Nutritional Requirements: ○ Protein: Increase by 10g/day. ○ Folic Acid: Essential for neural tube development (400-800 mcg/day). ○ Iron: Increase to 27 mg/day, best absorbed with Vitamin C. ○ Calcium: 1,000 mg/day for bone and tooth formation. ○ Hydration: 2-3 L/day; avoid excessive caffeine (limit to 200-300 mg/day). Conditions 1. Preeclampsia: ○ High BP with proteinuria after 20 weeks.  ○ Severe Signs: Vision changes, headaches, epigastric pain, hyperreflexia. ○ Management: Deliver the baby if severe; magnesium sulfate for seizure prevention. ○ HELLP Mnemonic: H: Hemolysis EL: Elevated Liver Enzymes LP: Low Platelets 2. Gestational Diabetes: ○ Diagnosis: 1-hour glucose challenge test (>140 mg/dL); confirm with 3-hour test. ○ Complications: Macrosomia, shoulder dystocia, neonatal hypoglycemia. ○ Management: Diet, exercise, insulin if needed. ○ Monitoring: Blood glucose target 70-110 mg/dL. 3. Placenta Previa vs. Abruption: ○ Previa (P-CLUB): P: Painless bright red bleeding C: C-section required L: Low-lying placenta U: Ultrasound diagnosis B: Bedrest/pelvic rest ○ Abruption (P-BAD): P: Painful dark red bleeding B: Board-like abdomen A: Abrupt onset D: Decelerations (fetal distress) Section 2: Intrapartum Care Labor Mnemonics 1. VEAL CHOP: ○ V: Variable decelerations → C: Cord compression → Reposition. ○ E: Early decelerations → H: Head compression → OK. ○ A: Accelerations → O: Oxygenated → OK. ○ L: Late decelerations → P: Placental insufficiency → Stop pitocin, reposition, give oxygen. 2. Stages of Labor: ○ 1st Stage: Onset to 10 cm dilation. Latent phase: 0-6 cm. Active phase: 6-10 cm. ○ 2nd Stage: 10 cm to delivery. ○ 3rd Stage: Delivery of placenta. ○ 4th Stage: Recovery and stabilization. Emergencies 1. Prolapsed Cord: ○ Intervention: Trendelenburg or knee-chest position, relieve pressure with sterile hand, prepare for C-section. 2. Shoulder Dystocia: ○ Action: McRoberts maneuver, suprapubic pressure. 3. Uterine Rupture: ○ Signs: Sudden, severe abdominal pain, loss of fetal station, no uterine contractions. ○ Management: Emergency C-section, supportive care. Section 3: Postpartum Care BUBBLEHE Assessment: B: Breasts (engorgement, latch). U: Uterus (firm, midline, fundal height). B: Bladder (voiding issues, distension). B: Bowel (constipation, hemorrhoids). L: Lochia (rubra, serosa, alba). E: Episiotomy (lacerations, healing). H: Homan's Sign (DVT check). E: Emotions (bonding, baby blues). 4 T’s of Postpartum Hemorrhage: 1. Tone: Uterine atony (boggy fundus). 2. Tissue: Retained placenta. 3. Trauma: Lacerations, hematomas. 4. Thrombin: Coagulopathy. Lochia Stages: 1. Rubra: Days 1-3 (dark red). 2. Serosa: Days 4-10 (pink/brown). 3. Alba: Days 11-6 weeks (yellow/white). Section 4: Newborn Care Thermoregulation:  Keep baby warm and dry to avoid cold stress. Signs of Cold Stress: ○ Hypoglycemia ○ Increased oxygen demand ○ Decreased surfactant production Interventions: Skin-to-skin contact, warm blankets, hat, warm room. Newborn Reflexes: Moro: Startle reflex. Rooting: Baby turns head toward touch. Babinski: Toes fan out when sole is stroked. Palmar Grasp: Baby grips finger. Breastfeeding Tips: Feed 8-12 times/day. Look for proper latch: Areola should be inside the baby’s mouth. Engorgement Relief: ○ Breastfeeding: Warm compress. ○ Not breastfeeding: Cold compress. Signs Baby is Feeding Well: 6-8 wet diapers/day, yellow stools after a few days. Section 5: Key Medications Magnesium Sulfate: Uses: Preeclampsia seizure prevention. Toxicity Signs (BURP): ○ B: Blood pressure drop. ○ U: Urine output