PBL: Obstetrics Answer Key and Tips
Day 1
Questions
1. What are some of the interventions you plan to do during the initial visit?
Check urine for pregnancy
Comprehensive health history. Because Mary is establis
...
PBL: Obstetrics Answer Key and Tips
Day 1
Questions
1. What are some of the interventions you plan to do during the initial visit?
Check urine for pregnancy
Comprehensive health history. Because Mary is established in your clinic, you may just need to
review some of her medical health hx, and focus on her obstetric history:
o Previous OB hx
o Family genetic hx
o Psychiatric disorders
o Contraceptive hx
o Medications taken since LMP, menstrual hx
o Social habits, environmental exposures, domestic abuse
o Sources of social support and health promotion
Depending on time, the PE may also be performed. Many practitioners have the pt return in 2
weeks to perform a PE d/t the time taken for history and blood tests.
o CBC, rubella titer, HIV (with pt’s consent), syphilis (rapid plasma reagin or RPR), Hepatitis B
surface antigen (HBSAg), blood type and Rh factor, antibody screen, tuberculosis testing,
urine culture and sensitivity and BV screening.
o Optional labs: HgbA1c, thyroid profile and Hepatitis C
o This is also the time to advise Mary on the pregnancy – health promotion, dietary
recommendation, exercise, smoking, etc. This includes normal changes, discomforts, and
concerns during pregnancy. Even if this is not her first pregnancy, Mary should have a review
of these items.
2. What physical exam would you do on this visit? Include your rationale for performing a specific PE, if
any.
Depending on time, the PE may not necessarily be performed during this initial visit. However, if
time permits, other tests can be performed with the PE.
PE: VS, note postural hypotension and tachycardia
o Inspect general appearance, examine peri-pad to determine amt of bldng
o Palpate abd (rebound, signs of internal hemorrhage, uterine size (measure fundal ht))
o Check iliopsoas and obturator muscle tests.
o Auscultate heart, lungs, and bowel sounds
o Pelvic exam – Assess for Chadwick’s sign, look for vaginitis/cervicitis and other s/s of
infections that could be causing the bldng.
Bimanual exam: Check Hegar’s sign, evaluate cervical dilatation, CMT (often present with ectopic
pregnancy), and bulging cul-de-sac (represents hemoperitoneum); adnexal mass is present in
50% of ectopic pregnancy.
3. What are some of the questions you would ask Mary that is specific to a pregnant pt?
This study source was downloaded by 100000831988016 from CourseHero.com on 05-18-2022 13:49:54 GMT -05:00
https://www.coursehero.com/file/46798810/N675-PBL-Obstetrics-Answer-Key-and-Tips-w8docx/
Per above comment, but primarily: nutritional habits, FH of congenital anomalies and heritable
diseases, prior STDs
Recent travel to determine the possibility of exposure to the Zika virus
Screen for domestic violence (DV)
Additional Information that you may find useful:
G: gravida (number of pregnancies)
P: para (number of births of viable offspring)
A or Ab: abortions
T – term births
P – preterm births (prior to 37 weeks gestation)
A – abortions
L – living children
GPAL – usually shortened version utilized
Day 2
CC: Worsening cramps
PE: 100/65 – 37.8 – 100 – 24 – 98% Currently at 5/10
Note for postural hypotension and tachycardia. Hemodynamic instability may be noted in cases of profuse
bleeding. Be on alert for hypotension, tachycardia, tachypnea, and/or labored breathing. A pregnant pt
does not demonstrate s/s of hypovolemic shock until she has lost 30% of her circulating volume.
Gen: A&Ox4, anxious, guarding abd
ENT: PERRLA, conjunctiva pink and moist. Oral mucosa pink, moist, neg LAD
Skin: Diaphoretic
Pulm: CTAB
CV: Tachy 104,
GI: Hypoactive bowels, neg Cullen’s sign, abd soft, tender to touch lower quads, neg rebound
GU: Wearing large peri-pad, slightly saturated
In the United States, undiagnosed or undetected ectopic pregnancy is one of the most common causes of
maternal death during the first trimester. Prepare pt for emergency transport to a hospital even if she is
hemodynamically stable.
Dx: Ectopic pregnancy
Questions
1. What are your differential diagnoses (ddx)?
First trimester vaginal bleeding – Threatened/Inevitable/Spontaneous abortion, hydatidiform mole,
benign or malignant genital tract lesion, genital trauma
Acute appendicitis, acute pelvic inflam
[Show More]
