Flashcards in 16 OB Deck (83)
-when to give mom ppx (4)
-how to tx baby
1. any positive screen at weeks 35-38
2. asx bactiuria
3. GBS+ in the past, ever
4. prolonged ROM
newborn sepsis, assume GBS, give ampicillin
-means how long before delivery (normally)
-do what to confirm (3)
signals <1h to delivery, usu
1. confirm with speculum exam looking for fluid pooling
2. confirm with nitrazine test (paper turns blue) or fern sign
3. confirm with U/S to make sure now oligohydramnios
bloody show (mucus plug released), happens beginning of labor, before/after contractions start
Immigrant pregnant female, going into labor at 35wks
Do Penicillin in pROM or ppROM with unknown GBS status
When are tocolytics contraindicated?
think 3 categories
1. maternal: Preeclampsia
2. fetal: fetal distress
3. high OB risk: pROM for infxn, abruption
Obviously premature baby must be delivered now, going to NICU
Pregnant mom, maternal serum AFP is low.
What if high AFP?
low AFP, think Downs.
high AFP, think neural tube
But, get U/S to make sure dates correct. MCC abnormal AFP is wrong dates.
twin twin transfusion
-what twin types
smaller twin does better (reduced bili load)
mono/di and mono/mono
Pt with hypothyroidism on levothyroxine, presents for prenatal visit.
What to do for following thyroid
Increase levothyroxine dose now because need to make more thyroid hormone. Follow TSH but change dose now
Prolonged/Arrested active phase
Prime: >5h (1.2 cm/h), Multip: >4h (1.5cm/h)
Prolonged: slow change
Arrest: no change
Think causes as 3 P's:
Power--check contractions (3 in 10, 40mm)
-If contractions weak, do oxytocin. C/S if no improvement after 2h
-If contractions adequate, consider C/S
Hyperthyroid dz diagnosed in pregnancy
-how to tx
Can't do RAIU or anything radioactive
Surgery, wait until 2nd trimester (fetus already developed)
medial vs mediolateral
Medial: heals, hurts, possible recto-vag fistula
mediolat: no heal, no hurt
-what is postdates, what dangers (which most likely)
-how to manage/approach
>42weeks. danger of dystocia, macrosomia.
most likely is oligohydramnios
If dates correct:
If cervix good, induce. If cervix not good, C/S
If dates unsure: wait and C/S when baby ready/distress (follow baby with BPP NST, 2x/week U/S to check for oligohydramnios)
How does TSH/T4 change in pregnancy
TBG increases, so:
higher total T4, but normal free T4 and TSH
Pregnant mom has Hep B Ag+
-do what for birth
Hep B acquired through birth canal
2. IVIG to baby, day of delivery
3. Hep B vaccine to baby, day of delivery
Pregnant mother 32 weeks. Has edema of legs. think preeclampsia.
leg edema can be normal late in pregnancy b/c uterus pressing on IVC
Normal labor, describe all stages/phases:
Stage 1, Latent phase--regular contractions causing dilation/effacement. to 4cm cervix
Stage 1, active phase--4cm - full 10cm dilation
Stage 2--full dilation to delivery finishes
Stage 3--end of delivery to delivery of placenta
-what is it
Low Platelets (petichiae)
Mg, Deliver now!!
Think of HELLP as a 'Curable DIC'
fetal monitoring: what are the accel/decel types
late--placental insuff (BAD)
Prolonged latent phase
cervix <4cm. >20h in prime, >14h in multip
-MCC is analgesics (opioids given too soon, wait it out)
-once dx'd, check if contractions are adequate:
3 in 10min, and >40mm each
You can rest/wait. Or, speed things up with ripening (balloon) or oxytocin for stronger contractions
-how do you know it is controlled
no oral meds!
-very tight control in gest diabetes. <95 fasting glucoses.
-what is it
preterm, premature ROM: "Both Baby and Mom not ready"
24-36 weeks. If <24, nonviable
Dilemna of delivering now (lower infxn risk) vs keeping inside (develop lungs)
Get L/S ratio. If >2, lungs OK, deliver.
If <2, steroids, Amp-Gent. NO TOCOLYTICS b/c already ROM
-what each is at risk for?
Risks are added from one above:
Di/Di, dizygotic--breech, preterm, placenta previa
Mono/mono--conjoined twins, cord entanglement
3rd trimester labs
-what main things (3)
1. gest diabetes
Non stress test
-what is it, looking for what
-how often get it
Fetal heart rate monitoring
first test to assess fetus and r/o fetal demise
Looking for 15,15,2 in 20
15 sec of 15bpm increase, 2x in 20 min
high risk OB pts get NST q1week until delivery (from the time of low fetal mvmnt)
Prolonged 3rd stage
Should be 30min for placenta to come out. Dx is always power issue (uterus too tired to push)
1. uterine massage, then
2. oxytocin, then
3. manual manipulation if all else fails
Prolonged 2nd stage
-do what things
No epidural 2h, epidural 3h
Still assess Power (3 in 10, 40mm), Passenger, Pelvis. Increase power (oxytocin) if not strong enough.
If station 0 to -2, do C/S
If station 1,2: do Vacuum or Forceps
Postpartum bleeding, algorithm
-ddx (5), their sxs/tx
>500ml vaginal, >1000ml C/S
Boggy--uterine atony. massage, oxytocin
Absence--uterine inversion. speculum exam, push back in or surgery to tack
Firm--retained placenta. D+C/Surgery (accreta, increta, percreta)