4.2 part 2 Flashcards
(204 cards)
1
Q
abnormal placenta placement over or close to the internal cervical os
A
placenta previa
2
Q
complete placenta previa
A
complete coverage of cervical os by placenta
3
Q
partial placenta previa
A
partial coverage of cervical os by the placenta
4
Q
marginal placenta previa
A
adjacent to the internal os (leading edge of the placenta is < 2 cm from the internal os)
5
Q
risk factors for placenta previa
A
previous placenta previa
previous c-section
multipara
multiple gestations
6
Q
clinical manifestations of placenta previa
A
sudden onset of painless vaginal bleeding in the third trimester (may be bright red) after 24 weeks
ABSENCE OF ABDOMINAL PAIN OR UTERUS TENDERNESS
7
Q
should you perform digital vaginal or speculum exam if placenta previa is suspected?
A
NO NEVER
8
Q
Diagnosis of placenta previa
A
transabdominal ultrasound with confirmation by transvaginal ultrasound
9
Q
what is preferred in complete, major degrees, and with fetal distress
A
C-section
10
Q
partial or complete premature separation of the placenta from the uterine wall after 20 weeks gestation but prior to delivery of the fetus
A
abruptio placentae
11
Q
Most common risk factor associated with abruptio placentae
A
maternal hypertension
12
Q
other risk factors associated with abrupt placentae
A
prior abruption, smoking, cocaine
13
Q
clinical manifestations of abruption placentae
A
sudden onset of uterine bleeding – painful third trimester vaginal bleeding (often dark red) – can be either external or concealed, severe abdominal pain (uterine contractions)
14
Q
what will you see on PE for abruptio placentae
A
tender rigid uterus
15
Q
Should a pelvic exam be performed if abruptio placentae is suspected
A
NO NEVER
16
Q
Think PP and AA
A
Previa is Painless
Abruptio is associated with Abdominal pain
17
Q
fetal vessels are present over the cervical os
A
vasa previa
18
Q
triad for vasa previa
A
rupture of membranes
painless, vaginal bleeding
fetal distress (bradycardia)
19
Q
Management for vasa previa
A
delivery immediately via C-section
20
Q
abnormal adherence of placenta to myometrium
A
placenta accreta
21
Q
placenta grows at least halfway through the uterine wall and attaches to uterine muscle
A
placenta increta
22
Q
placenta grows completely through uterine wall
A
placenta percreta
23
Q
1st trimester
A
week 1 to week 12
24
Q
2nd trimester
A
week 13 to week 26
25
third trimester
week 27 through end of pregnancy (40 weeks)
26
gestational age
measured from first day of last menstrual period
27
fetal age
2 weeks after gestational age; calculated from date of conception
28
mullerian ducts fuse together to form
uterus, Fallopian tubes, majority of vagina
29
mullerian anomalies
septate uterus
bicornuate uterus
unicornuate uterus
uterine didelphys
30
the external shape of the uterus is normal, but the cavity is divided by an extra wall of tissue called a septum, which runs down the middle of the cavity
septate uterus
31
the external shape of the uterus is abnormal with a large indentation in the funds which causes the upper cavity to further divide into two cavities
bicornuate uterus
32
only half of the uterus develops
unicornuate uterus
33
the entire uterus and cervix is duplicated which creates two uteri and 2 cervices
uterine didelphys
34
two Müllerian ducts only partially fusing together
bicornuate uterus
35
only one Müllerian duct develops
unicornuate uterus
36
two Müllerian ducts not fusing together at all
uterine didelphys
37
a pregnancy that ends before 20 weeks gestation
spontaneous abortion
38
almost 80% of spontaneous abortions occur prior to
12 weeks
39
what is the only type of spontaneous abortion that is potentially viable
threatened
40
most common cause of spontaneous abortion
chromosomal abnormalities
41
clinical manifestations of spontaneous abortion
crampy abdominal pain and vaginal bleeding
42
Ultrasound and cervical findings for threatened
products of conception intact
cervical os closed
43
management for threatened
observation at home, bedrest, close follow up
serial beta hCG to see if doubling if viable
44
US and cervical findings in inevitable
products of conception intact
cervical os DILATED
45
management for inevitable
surgical evacuation
-D&C <16 weeks or dilation and evacuation > 16 weeks
Misoprostol
46
US and cervical findings for incomplete
some products of conception expelled
cervical os DILATED
47
management for incomplete
allow POC to fully pass
D&C <16 weeks or dilation and evacuation > 16 weeks
Misoprostol
48
US and cervical findings for complete
all products of conception expelled from uterus
cervical os usually closed
49
management for complete
RhoGAM if Rh negative
follow up beta hCG
50
US and cervical findings for missed
products of conception intact
cervical os closed
51
management for missed
dilation and curettage < 16 weeks or dilation and evacuation > 16 weeks
Misoprostol
52
US and cervical findings for septic
some products of conception retained
cervical os closed
CERVICAL MOTION TENDERNESS
Foul brown discharge, fever, chills
53
Management for septic
D&E to remove products of conception + broad spectrum antibiotics
54
severe excessive form of morning sickles with weight loss and electrolyte imbalance
Hyperemesis gravidarum
55
when does hyperemesis gravid arum usually develop and persist
develops during 1st or 2nd trimester and persists > 16 weeks gestation
56
Clinical manifestations of hyperemesis gravidarum
weight loss of 5% of pre-pregnant weight and acidosis (from starvation)
hypokalemia, hypochloremic metabolic alkalosis, ketones
57
Initial management of choice for hyperemesis gravidarum
ginger
small and frequent meals
avoid trigger foods
increase fluids
58
first line medical management for hyperemesis gravidarum
pyridoxine (vitamin B6) with or without doxylamine
59
benign cysts that form due to malformation of lymphatic system
cystic hygroma
60
where are cystic hygromas most commonly found
posterior triangle of the neck
61
abnormal interstitial fluid collection in 2 or more compartments of FETUS
fetal hydrops
62
most common serious medical condition seen in pregnancy
pyelonephritis
63
when should ALL pregnant women be screen for asymptomatic bacteriuria
first prenatal visit -- clean catch!!!!!!!
64
most common organism for UTI in pregnancy
E. coli
65
when should pregnant patients follow up after UTI treatment
2-4 weeks after treatment for follow up culture to see if reinfection
66
gestational HTN
BP >/= 140/90 without protein in urine or other organ damage that develops after 20 weeks of gestation
67
when should true gestational HTN resolve
by 12 weeks postpartum
68
gestational HTN + proteinuria or end organ dysfunction
preeclampsia
69
preeclampsia with severe features (any of the following)
SBP >/= 160 and/or DBP >/= 110 + proteinuria at least 5 g in a 24 hour urine specimen
thrombocytopenia
impaired liver function (may have severe/persistent epigastric or RUQ pain)
progressive renal insufficiency
pulmonary edema or peripheral edema
vertebral or visual disturbances
HELLP syndrome
70
management for preeclampsia without severe features
delivery at 37 weeks
expectant management until 37 weeks
corticosteroids for fetal lung maturity prior to 34 weeks
71
management of preeclampsia with severe features
DELIVERY due to maternal morbidity
antihypertensive therapy
magnesium sulfate for seizure prophylaxis
72
what is NOT recommended in management of preeclampsia without severe features
antihypertensives
bed rest
magnesium sulfate
73
definitive treatment of preeclampsia
delivery
74
amniotic fluid abnormalities
oligohydramnios
polyhydramnios
75
decreased amniotic fluid surrounding fetus
oligohydramnios
76
what makes up most of amniotic fluid
fetal urine
77
two most common causes of oligohydramnios
too little fetal urine due to fetal kidney disease
amniotic fluid loss due to rupture of membranes
78
clinical manifestations of oligohydramnios
uterine size/fundal heigh less than expected
easily palpated fetus
decreased fetal movement
79
diagnosis of oligohydramnios
US for amniotic fluid index (AFI)
AFI < 5 cm or single deepest pocket < 2 cm
80
treatment of oligohydramnios
maternal hydration
amnioinfusion
81
excessive amniotic fluid amount surrounding fetus
polyhydramnios
82
causes of polyhydramnios
increased placental blood flow
increased fetal urine production
decreased amniotic fluid swallowing/absorption
83
clinical manifestations of polyhydramnios
uterine size/fundal heigh greater than expected
difficulty palpating fetal parts
84
diagnosis of polyhydramnios
US using AFI
AFI >/= 24 cm or single deepest pocket >/= 8 cm
85
Treatment for polyhydramnios
Indomethacin
Amnioreduction or amniotic fluid removal
if not severe, continue to monitor
86
what can result for oligohydramnios
potter sequence
87
what is the potter sequence
pulmonary hypoplasia
oligohydramnios
twisted skin
twisted face
extremity malformation
renal agenesis
88
2 most common types of neural tube defects
spina bifida
anencephaly
89
increased incidence of neural tube defects is associated with
maternal folate deficiency
90
most common type of spina bifida
spina bifida with myelomeningocele
91
mildest form of spina bifida
spina bifida occulta
92
screening for NTD
increased maternal serum alpha-fetoprotein followed by amniocentesis showing increased ALPHA-FETOPROTEIN and increased ACETYLCHOLINESTERASE
93
is there dilation of the cervix in Braxton hicks contractions
NO NO NO NO
94
when could Braxton hicks contractions start
6 weeks gestation
95
do Braxton hicks contractions get closer together
NOOOOOO
96
rule of thumb for Braxton hicks contractions
if you can sleep through them, it ain't true labor
97
direct measurement of surfactant production by type 2 pneumocytes
lamellar body count
98
normal value for lamellar body count
> 30,000; 100% chance that infants lungs are mature enough to not experience RDS
99
Lecithin/sphingomyelin (L/S) ratio
measures phospholipids in amniotic fluid
L/S ratio of 2:1 or greater is highly indicative that fetal lungs and fetus are mature
100
when are baby's lungs usually fully developed
35-36 weeks
101
preterm prelabor
regular uterine contractions >4-6/hour + progressive cervical effacement and dilation between 20-36 weeks gestation
102
what is cervical effacement
when the cervix thin, softens, and shortens
103
clinical manifestations of preterm prelabor
nonspecific -- menstrual like cramping, low back pain, pressure in vagina, vaginal discharge of mucus
104
what is it called when you see blood in vaginal discharge after mucus plug is gone lol
bloody show
105
what supports diagnosis of preterm prelabor
cervical dilation > 3 cm in the presence of uterine contractions at 20 to 36+6 weeks and >80% effacement
106
what is predictive of an increased risk for preterm birth in all populations
a short cervix less than 30 mm before 34 weeks gestation
107
Lab eval for person in preterm prelabor
Rectovaginal group B culture
Urine culture for asymptomatic bacteriuria
Fetal fibronectin
108
what is fetal fibronectin
a protein that keeps the amniotic sac glued to the uterus
testing helps differentiate between true and false labor
109
management for preterm labor >/= 34 weeks
admission to give birth
110
management for preterm labor < 34 weeks and cervical dilation 3 or more cm
delay delivery with tocolytic for up to 48 hours
antibiotics for group B strep if indicated
antenatal betamethasone for fetal lung maturity
111
first line tocolytic for 32 weeks or less
indomethacin
112
first line tocolytic for greater than 32 weeks
nifedipine
113
normal fetal presentation
cephalic
114
most common abnormal fetal presentation
occiput posterior presentation
115
types of breech positions
frank
complete
incomplete
116
frank breech position
hips flexed
knees flexed
feet by face
117
complete breech position
hips flexed
knees flexed
118
incomplete breech position
one or both hips partially flexed
119
maneuver to turn baby from breech to cephalic presentation
external cephalic version
trial of vaginal delivery if successful
C-section if unsuccessful
120
failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head due to impaction
shoulder dystocia
121
what shoulder is generally stuck behind the mother's pubic bone in shoulder dystocia
anterior shoulder
122
what shoulder is generally stuck behind the sacral promontory in shoulder dystocia
posterior shoulder
123
common sign in shoulder dystocia
turtle sign; retraction of the baby's head similar to a shoulder retracting into its shell
or red, puffy face
124
most common risk factor of shoulder dystocia
macrocosmic infants of diabetics
125
most common injuries associated with shoulder dystocia
brachial plexus injury (Erb's palsy or Klumpke's palsy)
126
most common type of fracture that can occur with shoulder dystocia
clavicular fracture
127
what maneuver is used for shoulder dystocia
McRoberts Maneuver
128
McRoberts maneuver
hyper flexion of mom's hips towards abdomen without and then with suprapubic pressure
episiotomy may need to be performed
129
if McRoberts is unsuccessful, what maneuver can you do next
Wood's corkscrew maneuver
130
Wood's corkscrew maneuver
rotation of the fetal shoulders 180 degrees
131
if Woods corkscrew maneuver also fails, what can you do next
Zavanelli maneuver -- push fetal head back into vaginal canal followed by c-section
132
prevention of shoulder dystocia
schedule c-section birth at 39 weeks if macrosomic ( >/= 4500 grams)
133
what maneuver is an initial choice for mom in a birthing bed with no or only local or pudendal anesthesia
Gaskin all-fours maneuver
134
amniotic membrane rupture before the onset of labor or regular uterine contractions at or greater than 37 weeks
pre labor rupture of the membranes (PROM)
135
common complications of PROM
chorioamnionitis or endometritis if prolonged >24 hours
136
Clinical manifestations of PROM
gush of clear or pale yellow fluid!!!!!
or persistant leakage of fluid from the vaginal, vaginal discharge
137
what will you see on sterile speculum exam for PROM
pooling of secretions in posterior fornix
138
nitrazine paper test for PROM
turns blue if pH > 6.5
139
Fern test for PROM
amniotic fluid dries in fern pattern due to crystallization of estrogen and amniotic fluid
140
management of PROM
prompt induction of labor in patients with term PROM if no C/I to labor
141
rupture of the amniotic membranes before the onset of labor occurring prior to 37 weeks
preterm pre labor rupture of membranes (PPROM)
142
management of PPROM if <34 weeks
expectant management
betamethasone for fetal lung maturity
prophylactic antibiotics
hospitalization for entire period of expectant management
143
management of PPROM if >/= 34 weeks
delivery if optimal gestational dating
144
when is prompt delivery indicated in PPROM
if signs of maternal or fetal infection or distress
145
how old does fetus have to be to be considered stillbirth
birth at 20 weeks or greater with no signs of life
146
what is PAPP-A produced by
trophoblast; levels greater than 0.5 is normal
147
what medications are commonly used in combination for abortion
Mifepristone + Misoprostol
148
twins who have their own chorions and amniotic sac
dichorionic-diamniotic
149
are dichorionic-diamniotic twins fraternal or identical
can be either
150
are most twins fraternal or identical
fraternal
151
share placenta but have own amniotic sac
monochorionic-diamniotic
152
share placenta and amniotic sac
monochorionic-monoamniotic
153
most common type of identical twin
monochorionic-diamniotic
154
if split occurs 1-3 days after fertilization
dichorionic-diamniotic
155
if split occurs 4-8 days after fertilization
monochorionic-diamniotic
156
if split occurs 8-13 days after fertilization
monochorionic-monoamniotic
157
if split occurs 13-15 days after fertilization
conjoined twins
158
most common cause of hyperthyroidism in the US
graves disease
159
iron supplementation in pregnancy
27 mg/day
160
calcium supplement for all women regardless of pregnancy status
1000 mg/day
161
variant of severe preeclampsia/eclampsia with hemolysis
HELLP syndrome
162
HELLP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
163
when does HELLP most commonly occur
third trimester (27 weeks and beyond)
164
diagnostic criteria for HELLP
hemolysis with LDH > 600
AST and ALT elevated more than 2x upper limit
Platelets <100,000
165
prophylaxis of HELLP in future pregnancies
low dose aspirin
166
Classic triad of amniotic fluid embolism
hypoxia
hypotension
coagulopathy
167
Diagnostic criteria for amniotic fluid embolism
1. Sudden cardiopulmonary collapse or hypotension (systolic blood pressure < 90 mmHg) with hypoxia (SpO2 < 90%)
2. DIC
3. Symptomatology either during labor or during placental delivery (or up to 30 minutes later)
4. No fever
168
fetal bradycardia
intermittent or persistent heart rate < 110 BPM
169
most common gene related cause of intellectual disability and autism spectrum disorder
fragile X syndrome
170
describe inheritance of fragile X syndrome
x linked dominant genetic disorder
171
what gene is nonfunctional in fragile X syndrome
fragile X mental retardation gene (FMR1)
172
clinical manifestations in young males for fragile X
MVP, hyper extensible joints, hypotonia, soft skin, flat feet, macrocephaly
173
clinical manifestations in older males for fragile X
long and narrow face, prominent forehead and chin
LARGE EARS
MACRO-ORCHIDISM
174
people with fragile x syndrome may have frequent bouts of
otitis media and sinusitis
175
behavioral issues in fragile X syndrome
expressive language deficits
mild to moderate intellectual disability
176
What will you see in genetic studies for fragile x syndrome
X chromosome in the q27 regions have repeating CGG segments
177
most common cause of homocystinuria
MTHFR mutation
178
what is increased in urine in someone with homocystinuria
homocysteine
179
what type of amino acid is methionine
essential -- we have to get it through our diet
180
symptoms of homocystinuria
marfans habitus
pectus excavatum
pectus carinatum
valgus knees
kyphosis
near-sightedness
seizures
intellectual disability
TIAs due to atherosclerosis and thrombosis
181
treatment for homocystinuria
diet high in B6, B12, folate, and cysteine
182
most common cause of dwarfism
achondroplasia
183
describe the inheritance of achondroplasia
autosomal dominant
184
what gene is mutated in achondroplasia
FGFR3
185
what bones are most commonly affected in achondroplasia
long bones like humerus and phalanges
186
clinical manifestations of achondroplasia
disproportionate short statue (~4 feet)
long bone shortening with normal trunk
macrocephaly and frontal bossing and saddle nose
brachydactyly (short digits)
varus knees
accentuated lumbar lordosis
187
when outstretched, what kind of "hand" do fingers make in achondroplasia
trident hand
188
prenatal US for achondroplasia
skull width : femur width higher than normal
189
most common skeletal dysplasia
achondroplasia
190
genetic disorder where XY male does not respond to androgens
androgen insensitivity syndrome
191
describe inheritance of androgen insensitivity syndrome
x linked recessive
192
serum testosterone and DHT in androgen insensitivity syndrome
elevated
193
umbilical cord extends past the presenting part of the fetus and protrudes into the vagina
umbilical cord prolapse
194
clinical manifestations of umbilical cord prolapse
sudden onset of severe, prolonged fetal bradycardia or moderate to severe variable decelerations after a previously normal tracing
195
management of umbilical cord prolapse
emergent c-section
196
overt prolapse
when the cord exits the cervix BEFORE the fetal passing part
197
occult prolapse
when the cord exits the cervix WITH the fetal passing part
198
until delivery is possible, what should you do for umbilical cord prolapse
funic decompression --> relieving pressure on the card by lifting the fetal presentation part
199
loop of umbilical cord around fetal neck
nuchal cord
200
inability to maintain pregnancy secondary to premature cervical dilation
cervical insufficiency/incompetent cervix
201
when is cervical insufficiency most likely to occur ****v important****
2nd trimester!!!!!
202
clinical manifestations of cervical insufficiency
usually asymptomatic
painless dilation and effacement of cervix on PE
203
Diagnosis of cervical insufficiency
transvaginal US; cervical length 25 mm or less before 24 weeks!!!!!
204
Management of cervical insufficiency
cerclage -- suturing of cervical os and bed rest if prior history
may also use weekly injection of 17 alpha-hydroxyprogesterone
