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Flashcards in 16 OB Deck (83)
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1

GBS
-when to give mom ppx (4)
-how to tx baby

Penicillin:
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

2

ROM, spontaneous
-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

3

Bloody show

bloody show (mucus plug released), happens beginning of labor, before/after contractions start

4

Immigrant pregnant female, going into labor at 35wks
-think what

GBS unknown

Do Penicillin in pROM or ppROM with unknown GBS status

5

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

6

Pregnant mom, maternal serum AFP is low.
think what

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.

7

Sxs, congential:

Toxo
CMV

triad:
diffuse calcifications
hydrocephalus
chorioreitinitis

periventricular calcifications
IUGR
microcephaly

8

twin twin transfusion
-what twin types

smaller twin does better (reduced bili load)

mono/di and mono/mono

9

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

10

Prolonged/Arrested active phase
-dx
-do what

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)
Passenger
Pelvis

-If contractions weak, do oxytocin. C/S if no improvement after 2h
-If contractions adequate, consider C/S

11

Hyperthyroid dz diagnosed in pregnancy
-how to tx

Can't do RAIU or anything radioactive
Surgery, wait until 2nd trimester (fetus already developed)

12

episiotomy
medial vs mediolateral

Medial: heals, hurts, possible recto-vag fistula
mediolat: no heal, no hurt

13

Postdates
-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)

14

How does TSH/T4 change in pregnancy

TBG increases, so:
higher total T4, but normal free T4 and TSH

15

Pregnant mom has Hep B Ag+
-do what for birth

Hep B acquired through birth canal

1. C/S
2. IVIG to baby, day of delivery
3. Hep B vaccine to baby, day of delivery

16

Pregnant mother 32 weeks. Has edema of legs. think preeclampsia.

leg edema can be normal late in pregnancy b/c uterus pressing on IVC

17

Normal labor, describe all stages/phases:

Remember graph

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

18

HELLP syndrome
-what is it
-do what

Hemolysis
Elevated LFTs
Low Platelets (petichiae)

Mg, Deliver now!!

Think of HELLP as a 'Curable DIC'

19

fetal monitoring: what are the accel/decel types

VEAL CHOP

variable--cord
early--head
accels--OK
late--placental insuff (BAD)

20

Prolonged latent phase
-dx
-MCC
-do what

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

21

postpartum bleeding
-MCC

-uterine atony

22

gest diabetes
-what meds
-how do you know it is controlled

no oral meds!
-insulin
-very tight control in gest diabetes. <95 fasting glucoses.

23

ppROM
-what is it
-do what

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

24

Twin types:
-what each is at risk for?

Risks are added from one above:

Di/Di, dizygotic--breech, preterm, placenta previa
Di/Di, monozygotic
Mono/Di--twin-twin transfusion
Mono/mono--conjoined twins, cord entanglement

25

3rd trimester labs
-what main things (3)

1. gest diabetes
2. anemia
3. Rh

26

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)

27

Prolonged 3rd stage
-definition
-do what

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

28

Prolonged 2nd stage
-definition
-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

29

Postpartum bleeding, algorithm
-ddx (5), their sxs/tx

>500ml vaginal, >1000ml C/S
Uterine palpation:

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)
Normal--vag lac
Normal--DIC

30

3rd trimester bleeding
-how to separate life threatening causes
-do what for each

Painless:
placenta previa--U/S (transverse lie), NST, then C/S
vasa previa--NST, then C/S

Painful:
uterine rupture--Crash C/S!
placental abruption--you have time for U/S and NST, then C/S