PAINE #PANCE Pearl – OBGYN



Question

 

What the anatomic landmarks for estimation of gestational age based on fundal height measurements?

 



Answer

 

Measuring fundal height is a skill PA students must acquire on their OBGYN rotation.  Using a rolled tape measure, the distance is measured (in cm) from the pubic symphasis to the highest part of the uterus.  Note that it may not be mid-line and you will need to do some palpation to find the apex.

Image result for fundal height measurement

 

Anatomic landmarks can help estimate gestational age based on fundal height measurements:

  • 12 weeks – just above the pubic symphasis
  • 16 weeks – halfway between pubic symphasis and umbilicus
  • 20 weeks – at the level of the umbilicus

Image result for fundal height measurement

 

 

After 20 weeks, gestational age is estimated at 1 cm per week…..that is to say 25 weeks gestational should have a fundal height measurement of 25 cm (+/- 2 cm).


References

  1. Mackenzie AP, Stephenson CD, Funai EF. Prenatal assessment of gestational age, date of delivery, and fetal weight. UpToDate. 2017. Accessed February 10, 2018.

Ep-PAINE-nym



Chadwick’s Sign

 

Other Known Aliasesnone

 

DefinitionBlue-red passive hyperemia of cervix that may appear after the 6th week of pregnancy

Related image

 

Clinical SignificanceThis is one of the earliest physical exam findings of pregnancy and is a result of increased uterine blood flow to support the newly implanted embryo.

 

History – Named after James Reed Chadwick (1844-1905), who was an American gynecologist and received his medical doctorate from Harvard in 1871. He published in 1887 describing this finding, but gave due credit of the initial discovery to Étienne Joseph Jacquemin (1796-1872) who first noted it 1836.

He also help found the American Gynaecological Society and Boston Medical Library, and is also well known as being a noted librarian and scholar.  He was also a fervent advocate of women in the practice medicine and published extensively in support of this endeavor.

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Chadwick JR. The value of the bluish discoloration of the vaginal entrance as a sign of pregnancy. Transactions of the American Gynecological Society. 1877;11:399–418.
  6. Gleichert JE. Etienne Joseph Jacquemin, discoverer of ‘Chadwick’s sign’. Journal of the history of medicine and allied sciences. 1971; 26(1):75-80. [pubmed]
  7. Chadwick JR.  The Study and Practice of Medicine by Women.  1879. [Link]
  8. Chadwick JR.  Admission of Women to the Massachusetts Medical Society. 1882. [Link]

Ep-PAINE-nym



Apt-Downey Test

 

Other Known Aliases – alkali denaturation test

DefinitionLab test where the blood sample is hemolyzed using sterile water and centrifuged to produce a hemoglobin supernatent.  This is then mixed with 1% NaOH.  Fetal hemoglobin will stay pink, while maternal hemoglobin will turn yellow/brown.

fig-2-the-complete-vasa-previa-testing-setup-shown-a-beaker-of-014-m-naoh-and-two

Clinical SignificanceHelps differentiate maternal from fetal blood in cases of vaginal bleeding or neonatal hematemesis/hematochezia.

History – Given to Dr. Leonard Apt and Dr. William Downey, Jr., who were physicians at Harvard Medical School and Children’s Medical Center in Boston, MA in the mid-1900’s.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com
  3. Apt L, Downey WS. Melena neonatorum: the swallowed blood syndrome; a simple test for the differentiation of adult and fetal hemoglobin in bloody stools. The Journal of Pediatrics. 47(1):6-12. 1955. [pubmed]

PAINE #PANCE Pearl – OB/GYN



  1. Women should be screened for gestational diabetes at 24-28 gestation.
  2. There are 2 different recommended testing strategies:
    1. Two-Step (most common)
      1. 50g glucose challenge
        1. Given regardless of when last meal was.
        2. Serum glucose measured at 1-hour
          1. ≥130-140 mg/dL is positive test
            1. The lower the threshold the higher sensitivity, but increased false positives
            2. The higher the threshold the higher the specificity, but with decreased sensitivity
      2. If 1st step positive, a 100g glucose challenge given
        1. Overnight fast and measured at:
          1. Fasting –> (+) if ≥ 95 mg/dL
          2. 1 hour –> (+) if ≥ 180 mg/dL
          3. 2 hour –> (+) if ≥ 155 mg/dL
          4. 3 hour –> (+) if ≥ 140 mg/dL
    2. One-Step
      1. 75 glucose challenge
        1. Given after overnight fast and measured at:
          1. Fasting –> (+) if ≥ 92 mg/dL
          2. 1 hour –> (+) if ≥ 180 mg/dL
          3. 2 hour –> (+) if ≥ 153 mg/dL

References

  1. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstetrics and Gynecology. 2013;122(2 Pt 1):406-16. [pubmed]
  2. Hod M, Kapur A, Sacks DA. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. International journal of gynaecology and obstetrics. 2015;131 Suppl 3:S173-211. [pubmed]
  3. Moyer VA, . Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Annals of internal medicine. 204;160(6):414-20. [pubmed]

Ep-PAINE-nym



Ferguson’s Reflex

 

Other Known AliasesFetus Ejection Reflex

DefinitionStimulation of the cervix leading to contraction of the uterus through oxytocin release.

Clinical SignificanceDemonstrates positive feedback during labor and delivery to increase uterine contractions as cervical dilation progresses. Long standing belief that epidural anesthesia before cervical dilation increased risk of cesarean section (this was debunked in 2005).

History – Given to Dr. James Ferguson, a Canadian obstetrician, in 1940 after he showed this physiologic effect in rabbits and postulated it to be true in humans.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Wong CA, Scavone BM, Peaceman AM. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. The New England journal of medicine. 2005;352(7):655-65. [pubmed]
  3. Newton N.  The fetus ejection reflex revisited.  Birth.  1987;14(2):106-108.