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MS3 > OBGYN 2 > Flashcards

OBGYN 2 Flashcards

1
Q

Tx of inverted uterus

A

Try to manually reduce. If that fails then . . .

Uterine relaxing agent (e.g. Terbutaline, Magnesium sulfate, Halothane)

Then either replacement with gloved hand or surgery

Also TREAT THE HEMORRHAGE (fluids!)

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2
Q

What do you do if placenta has not delivered after 30 min

A

Attempt manual extraction of the placenta

^ Do this instead of attempting uterotonics

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3
Q

What is the cause of massive hemorrhage involved in uterus inversions

A

Inverted uterus leads to inability for an adequate myometrial contraction effect

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4
Q

What is shoulder dystocia

A

Inability of the fetal shoulders to deliver spontaneously, usually due to the impaction of the anterior should behind the maternal pubic symphysis

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5
Q

3 major risk factors for shoulder dystocia

A

(1) Prior shoulder dystocia
(2) Fetal macrosomia
(3) Maternal gestational DM

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6
Q

Tx of shoulder dystocia

A

McRoberts maneuver
- Maternal thighs are sharply flexed against the maternal abdomen to straighten the sacrum relative to the lumbar spine and rotate the symphysis pubis anteriorly toward the maternal head

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7
Q

What part of the brachial plexus is damaged in Erb-Duchenne palsy

A

Superior trunk (C5-C6)

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8
Q

Describe deficits in Erb palsy

A

Weakness of:

  • Deltoid (cannot abduct - arm hangs by side)
  • Infraspinatous (cannot abduct - arm hangs by side)
  • Flexors (cannot flex/supinate - arm extended and internally rotated)
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9
Q

What is the danger of rupturing membranes with an unengaged fetal presentation

A

Umbilical cord prolapse

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10
Q

Tx of umbilical cord prolapse

A

Immediate C-section

Trendelenburg in the meantime + keep hand in vagina to keep pressure off the cord

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11
Q

First step in dealing with fetal bradycardia

A

Must distinguish fetal HR from maternal via US or fetal scalp electrode

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12
Q

Describe symptoms of pre-eclampsia

A
  • Headache*
  • Vision changes*
  • Shortness of breath (pulmonary edema)*
  • Epigastric/RUQ pain*
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13
Q

Describe signs of pre-eclampsia

A
  • Hypertension >140/90, >160/110*, two measurements 4 hours apart
  • Proteinuria (>300 mg on a 24 hour urine, P:C >0.3)
  • Elevated hematocrit
  • Hemolysis (elevated LDH)
  • Thrombocytopenia (<100,000)*
  • Elevated liver enzymes (AST/ALT twice normal)*
  • Renal insufficiency (Cr>1.1 or twice baseline)*
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14
Q

How do pre-eclampsia and HELLP syndrome compare

A

HELLP = preeclampsia + hemolytic anemia

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15
Q

Which vaccinations are recommended during pregnancy

A

Tdap, inactivated influenza virus, Rho(D) immunoglobulin

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16
Q

Management for pt >37 wk gestation with breech presentation

A

External cephalic version (ECV)

If that fails - C-section

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17
Q

How can you tell the difference between placenta previa and placenta abruption

A

Placenta abruption = painful bleeding

Placenta previa = painless bleeding

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18
Q

What is considered a reactive nonstress test

A

NST = External fetal heart rate monitoring for 20-40 minutes

Normal results: Reactive: >/= 2 accelerations in a 20 min period

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19
Q

What is a biophysical profile

A

• Nonstress test plus US assessment of the following:
o Amniotic fluid volume
o Fetal breathing movement
o Fetal movement
o Fetal tone
• 2 point per category if normal and 0 points if abnormal (max 10/10)

20
Q

What is a contraction stress test

A

♣ Description
• External fetal heart rate monitoring during spontaneous or induced (e.g. oxytocin, nipple stimulation) uterine contractions

♣ Normal result
• No late or recurrent variable decelerations

21
Q

What does a BPP of <6/10 indicate?

A

Fetal hypoxia due to placental dysfunction

22
Q

Common side effect of depo provera (Medroxyprogesterone) shot?

A

Weight gain

23
Q

Management of recurrent variable decelerations

A

♣ Maternal repositioning to reduce cord compression
♣ Amnioinfusion
♣ C-section if there is loss of FHR variability

24
Q

What is septic pelvic thrombophlebitis

A

o Is a thrombosis of the deep pelvic or ovarian veins that becomes infected

25
Q

Presentation of septic pelvic thrombophlebitis

A

♣ Fever unresponsive to abx
♣ No localizing signs/symptoms
♣ Negative infectious evaluation
♣ Diagnosis of exclusion

26
Q

Tx of septic pelvic thrombophlebitis

A

♣ Anticoagulation

♣ Broad-spectrum antibiotics

27
Q

Next step in management of decreased fetal movement

A

NST

28
Q

Most common cause of postpartum hemorrhage in vaginal delivery

A

Uterine atony

29
Q

Definition of postpartum hemorrhage in vaginal

and Csx delivery

A

Vaginal = Loss of 500 mL or more

C-sx = loss of 1000 mL or more

30
Q

Tx of uterine atony

A

First line:
- Dilute IV oxytocin + bedside uterine massage

If first line is ineffective:

  • Prostaglandin F2-alpha (Hemabate)
  • Rectal misoprostol
31
Q

What is the most common cause of late postpartum hemorrhage (after the first 24 hours)

A

♣ Subinvolution of the uterus
• Occurs when the placental implantation site does not decrease in size as expected, thus when the eschar overlying the placental site falls off (7-10 days after deliver)
• Tx = uterotonic agents such as ergot alkaloids or misoprostol

32
Q

Describe alpha fetoprotein levels in neural tube defects

A

o AFP is a glycoprotein made by the fetal liver

• AFP will be elevated when there is an opening in the fetus not covered by skin (e.g. NTD)

33
Q

Describe AFP levels in chromosomal trisomies

A

Decreased AFP

34
Q

Describe b-hCG, estriol, and Inhibin A levels in Down syndrome

A

♣ Decreased alpha-fetoprotein
♣ Increased b-hCG
♣ Decreased estriol
♣ Increased Inhibin A

35
Q

Describe b-hCG, estriol, and Inhibin A levels in Trisomy 18

A

♣ Decreased alpha-fetoprotein
♣ Decreased b-hCG
♣ Decreased estriol
♣ Normal Inhibin A

ALL LEVELS ARE LOW

36
Q

Normal HbA1C

A 
Normal = 4-5.6%
Pre-DM = 5.7-6.4%
DM = <6.5%
37
Q

DM Class A1

A

♣ Gestational, no medication

38
Q

DM Class A2

A

♣ Gestational, medication

39
Q

DM Class B

A

♣ Onset >20 y/o; duration <10 years

40
Q

DM Class C

A

♣ Onset 10-19 y/o; duration 10-19 years

41
Q

DM Class D

A

♣ Onset <10 y/o; duration >20 years

42
Q

DM Class R

A

♣ Proliferative retinopathy

43
Q

DM Class F

A

♣ Nephropathy (>500 mg/day)

44
Q

DM Class H

A

♣ Atherosclerotic heart disease

45
Q

DM Class T

A

♣ Prior renal transplant

MS3 (88 decks)

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