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\author{Madmik}
\pdfinfo{
  /Title (ob-gyn-guidelines.pdf)
  /Creator (Cheatography)
  /Author (Madmik)
  /Subject (OB/GYN Guidelines Cheat Sheet)
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{OB/GYN Guidelines Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Madmik} via \textcolor{DarkBackground}{\uline{cheatography.com/179539/cs/37352/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Madmik \\
  \uline{cheatography.com/madmik} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 26th February, 2023.\\
   Updated 27th February, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Infertility}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition: failure to conceive after {\bf{one year}} of regular, unprotected intercourse.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology: {\bf{males}} 40\% - abnormal spermatogenesis. {\bf{Females}} - anovulatory cycles or ovarian dysfunction = 30\%, congenital or acquired disorders.} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{DX: {\bf{hysterosalpingography}} to evaluate tubal patency or abnormalities.} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Management: 1. {\bf{Clomiphene}} — induces ovulation. 2. If amenorrhea or oligomenorrhea, correct endocrine problems. 3. In vitro fertilization} \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Uncomplicated Pregnancy Physical Exam}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ladin's sign}} & Uterus softening after 6 weeks \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Hegar's sign}} & Uterine isthmus softening after 6-8 weeks \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Piskacek's sign}} & Palpable lateral bulge or softening of uterine Cronus 7-8 weeks \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{Goodell's sign}} & Cervical softening due to increased vascularization, 4-5 weeks \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Chadwick's sign}} & Bluish coloration of cervix and vulva, 8-12 weeks \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
{\bf{Fetal Heart tones}} & 10-12 weeks, {\bf{normal = 120-160 bpm}} \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
{\bf{Pelvic Ultrasound}} & Fetus detected 5-6 weeks \tn 
% Row Count 16 (+ 2)
% Row 7
\SetRowColor{white}
{\bf{Fetal Movement}} & 16-20 weeks \tn 
% Row Count 18 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.39356 cm} x{3.58344 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Fundal Height Measurement}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{12 weeks}} & Above pubic symphysis \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{16 weeks }} & Midway between pubis and umbilicus \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{20 weeks }} & At umbilicus \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{38 weeks}} & 2-3 cm below diploid process \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Prenatal Care}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Estimated Date of Delivery (Naegle's Rule) }}: 1st day of LMP + 7 days - 3 months} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Blood pressure} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Blood type \& Rh} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{CBC} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{UA (glucose \& protein)} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Random glucose} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{HBsAg — hepatitis surfaced antigen, measures acute or chronic} \tn 
% Row Count 9 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{HIV} \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Syphilis} \tn 
% Row Count 11 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Rubella Titer} \tn 
% Row Count 12 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Sickle cell and cystic fibrosis screen} \tn 
% Row Count 13 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{PAP smear} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Rh Alloimmunization}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Rh(D) negative women carry Rh(D) positive fetus —\textgreater{} exposure to fetal blood mixing D-positive RBCs} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Causes maternal alloimmunization and maternal anti-Rh(D) IgG antibodies} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Subsequent pregnancies —\textgreater{} antibodies may cross placental and attack fetal RBCs = hemolysis of fetal RBCs} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{If mother is Rh(D) negative and father is Rh(D) positive, 50\% chance} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Anti-D Rh immunoglobulin (RhoGAM)}} 300 micrograms given @ 28 weeks, within 72 hours of delivery of Rh(D) positive baby, AND after any potential mixing of blood (spontaneous abortion, ectopic pregnancy, amniocentesis, etc.)} \tn 
% Row Count 14 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{First Trimester Screening: Weeks 1-12}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{ Free beta-hCG }} & Abnormally high or low may indicate chromosomal abnormalities \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{PAPP-A }} & Serum pregnancy-associated plasma protein-A — Low with fetal Down syndrome \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Nuchal translucency US }} & {\bf{10-12 weeks}} — trisomies 13, 18, and 21. Increased thickness = abnormal, offer chorionic billows sampling or amniocentesis. \tn 
% Row Count 13 (+ 6)
% Row 3
\SetRowColor{white}
{\bf{Fetal US }} & {\bf{10-12 weeks }}, transvaginal can detect at 5-6 weeks after LMP \tn 
% Row Count 16 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Uterine size and gestation }} & If abnormal, offer CVS or amniocentesis \tn 
% Row Count 18 (+ 2)
% Row 5
\SetRowColor{white}
{\bf{CVS }} & {\bf{10-13 weeks }} if abnormalities or if at increased risk of abnormalities (\textgreater{}35 yo) \tn 
% Row Count 22 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Second trimester screening: Weeks 13-27}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Triple screening @ 15-20 weeks}} & {\bf{Alpha-feta protein:}} if high, indicates open neural tube defects / spina bifida. {\bf{Beta-hCG:}} high = Down syndrome/ trisomy 21, low = trisomy 18. {\bf{Unconjugated Estriol:}} often low in trisomy 21 and 18. \tn 
% Row Count 11 (+ 11)
% Row 1
\SetRowColor{white}
{\bf{Gestational Diabetes @ 24-28 weeks}} & 1 hour \& 3 hours abnormal = \textgreater{}140 \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.14011 cm} x{2.83689 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Third Trimester Screening: Weeks 27-birth}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Repeat antibody titers}} & In RH(D) negative, antibody negative —\textgreater{} {\bf{give RhoGAM 300 micrograms @ 28 weeks}} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Hemoglobin \& Hematocrit}} & 35 weeks \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Group B Streptococcus}} & 36 0/7 to 37 6/7 weeks, if positive —\textgreater{} prophylactic abx during labor w/in 4 hours of delivery with {\bf{IV PCN G}} 5 million units, then 2.5 million units every 4 hours. Second line = Ampicillin, Cefazolin, Clindamycin, Vancomycin \tn 
% Row Count 17 (+ 11)
% Row 3
\SetRowColor{white}
{\bf{Biophysical Profile}} & Fetal breathing, fetal tones, amniotic fluid levels, NST, and gross fetal movements (2 points each) \tn 
% Row Count 22 (+ 5)
% Row 4
\SetRowColor{LightBackground}
{\bf{Non-stress testing}} & {\bf{Reactive Test}}: \textgreater{}/= 2 accelerations of fetal HR \textgreater{}/= 15 bpm from baseline lasting 15 seconds over 20 minutes — fetal well being, repeat weekly-biweekly. {\bf{Nonreactive test}}: No fetal HR accelerations or \textless{}/= 15 bpm lasting \textless{} 15 s— indicates sleeping, immature, or compromised fetus —\textgreater{} vibratory stimulus to wake or contraction stress test. \tn 
% Row Count 38 (+ 16)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.14011 cm} x{2.83689 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Third Trimester Screening: Weeks 27-birth (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
{\bf{Contraction Stress Testing}} & {\bf{Negative test:}} No late decelerations in presence of 3 contractions in 10 minutes = fetal well being. {\bf{Positive CST}}: repetitive late deceleration following \textgreater{}/= 50\% of contraction = worrisome, hospitalize for fetal monitoring or delivery. \tn 
% Row Count 12 (+ 12)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Intra Partum (onset of labor-delivery of placenta)}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Braxton Hicks }} & Spontaneous uterine contractions late in pregnancy {\bf{not associated with cervical dilation}} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Lightening}} & Fetal head descending into the pelvis causing a change in abdomen's shape and sensation \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Ruptured Membranes}} & Sudden gush of liquid or constant leakage of fluid \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Bloody Show}} & Passage of blood-tinged cervical mucus late in pregnancy, occurs with cervix is thinning (effacement) \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
{\bf{True Labor}} & Contractions of uterine fundus with radiation to lower back \& abdomen. Regular + painful contraction of uterus causes cervical dilation and fetus expulsion \tn 
% Row Count 20 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.4931 cm} x{3.4839 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Cardinal Movements of labor}}  \tn
% Row 0
\SetRowColor{LightBackground}
Engagement & When the fetal presenting part enters the pelvic inlet \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Descent & Passage of the head into pelvis (lightening) \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Flexion & Flexion of head to allow smallest diameter to present to pelvis \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
Internal Rotation & Fetal vertex moves from occiput transverse position to position where the Sagittarius suture is parallel to the anteroposterior diameter of pelvis \tn 
% Row Count 13 (+ 6)
% Row 4
\SetRowColor{LightBackground}
Extension & Vertex extends as it passes beneath the pubic symphysis \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
External Rotation & Fetus externally rotates after the head is delivered so that the shoulder can be delivered \tn 
% Row Count 19 (+ 4)
% Row 6
\SetRowColor{LightBackground}
Expulsion & Of fetus and placenta \tn 
% Row Count 20 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Stages of Labor}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Stage 1: Onset of labor (true \seqsplit{contractions-cervical} dilation @ 10 cm}} & {\bf{Latent phase:}} cervix effacement with gradual cervical dilation. {\bf{Active Phase:}} rapid cervical dilation (begins @ 3-4 cm) \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
{\bf{Stage 2: full dilation-delivery of fetus}} & {\bf{Passive Phase:}} complete cervical dilation to active maternal expulsive efforts. {\bf{Active phase:}} from active maternal expulsive efforts-delivery of fetus. \tn 
% Row Count 15 (+ 8)
% Row 2
\SetRowColor{LightBackground}
{\bf{Stage 3: postpartum until delivery of placenta (0-30 mins)}} & {\bf{Signs of placental separation:}} 1. Gush of blood. 2. Lengthening of umbilical cord. 3. Anterior-caphalad movement of uterine fundus (becomes globular and firm) after placenta detaches. \tn 
% Row Count 25 (+ 10)
% Row 3
\SetRowColor{white}
Stage 4: after delivery & Mother is assessed for complications, 1-2 hours after \tn 
% Row Count 28 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}