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OME Cards > OB > Flashcards

OB Flashcards

1
Q

Best initial test in the setting of suspected fetal anemia?

A

1) Transcranial doppler of fetal middle cerebral artery
2) Percutaneous Umbilical Blood Sampling (PUBS) gives you the hemoglobin definitively (best diagnostic, confirmatory test) and gives access to transfusion. Done AFTER the transcranial Doppler tells you that there may be fetal anemia.

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2
Q

Woman comes in complaining of decreased fetal movement… what next?

A

Non-stress test (NST), then non-stress test with vibroacoustic stimulation (NST-VAS), then biophysical profile (BPP) or Contraction stress test (CST)

You only go to the next step if you fail the test before it.

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3
Q

Eclamptic patient actively seizing

A

1) Stabilize the seizure by infusion of magnesium sulfate

2) Emergent delivery of the fetus by C section

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4
Q

Mom with prolonged active phase (should be 6cm–> 10 cm within 4 hrs). What to do next?

A

Problem with the power, the passenger, or the passage. An intrauterine pressure catheter allows us to evaluate the strength/power of her contractions and if weak give oxytocin.

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5
Q

What are Variable decelerations?

A

At least 15 beats from baseline, lasting more than a few seconds but less than a couple of minutes, and having no association with contractions.

Due to Umbilical cord compression

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6
Q

What is the treatment for variable decelerations?

A

Reposition mom while providing supplemental oxygen is usually enough to fix the issue

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7
Q

What are late decelerations?

A

Due to fetal-placental insufficiency

Baby is hypoxemic and will die if not delivered soon

TX: C section

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8
Q

What is chorioamnionitis?

A

Ascending infection of the amniotic fluid or placenta while the baby is still inside the uterus.

Fever, leukocytosis, and fetal tachycardia

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9
Q

Gestational Diabetes Management

A

In GESTATIONAL DIABETES the blood glucose control must be much tighter, that is, < 95 on fasting glucoses.

Diet and exercise–> insulin

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10
Q

What is HELLP syndrome?

A

RUQ pain, hemolysis, low hemoglobin, elevated bili and LFTs, Low platelets–> “curable DIC” or HELLP syndrome

TX: Prompt delivery of baby

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11
Q

Management of arrest of 3rd phase of delivery?

A

If placenta delivery is arrested (more than 30 mins) try:

1) Uterine massage
2) Oxytocin
3) manual retrieval

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12
Q

What is placental abruption?

A

Occurs when there is a mechanical trauma, cocaine use, or severe hypertension.

Placenta rips out of the wall of the uterus, and mom bleeds.

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13
Q

When does uterine rupture occur?

A

Often occurs in women who are undergoing trial of vaginal birth after previous C section TOLAC

Mom’s uterus tears. Mom knows: she hurts and her vitals change

Baby gets sick fast because of hemorrhage and loss of placental perfusion

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14
Q

What is placenta vs vasa previa?

A

“Vasa Previa” means “the vessel is in a bad spot so it tears when the os opens”- mom will have painless bleeding

“Placenta Previa” means “the placenta is in a bad spot so that it tears when the os opens- mom will have painful bleeding

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15
Q

A paracervical block is performed with subcutaneous lidocaine and suddenly the fetal heart monitor shows a fetal bradycardia. Next step?

A

Only instance where fetal bradycardia can be offered reassurance.

Procedure of the block gets some lidocaine into baby. It is not a big deal - it is temporary and will wear off

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16
Q

Epigastric pain in pregnancy

A

GERD or Eclampsia range disease

In case of exclampsia- pain is due to stretch on organs due to high BP

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17
Q

what is mild pre- Eclampsia?

A

> 140 / >90

Sustained after 20 weeks

> 300mg/dL protein

Tx: >36 wks: Mag+Deliver

<36 Weeks: Deliver

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18
Q

What is Severe Pre- Eclampsia?

A

> 160 / >110

Sustained after 20 weeks

> 500mg/dL protein

Tx: Magnesium and Urgent delivery

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19
Q

Pregnant woman on levothyroxine

A

Dose will need to be increased during pregnancy

Estrogens increase so too do thyroid-binding globulins (TBG). Thyroid-binding globulins bind to thyroid hormone (T4) and thereby reduce the effective circulating amount of thyroid hormone.

20
Q

Screening during weeks 24-28?

A

Third trimester labs include screening for diabetes, CBC to check for anemia, and Rh assessment (give Rhogam if negative).

21
Q

What is sheehan syndrome?

A

Caused by decreased blood supply to the pituitary and subsequent ischemic necrosis during delivery–> panhypopituitarism (lethargy, weight gain, amenorrhea etc)

22
Q

When is forceps delivery indicated?

A

Indicated when baby is almost out - the station is +1 or +2.

23
Q

Breastfeeding mom wants contraception

A

Progestrin oral contraceptives are effective, reversible birth control that doesn’t impact breastfeeding in a new mother. IUDs are increasingly used in this scenario as well.

24
Q

Mom is Rh (D) antigen negative and dad is unknown

A

Type and screen is rechecked in the third trimester even if she has been screened at her first prenatal visit. If she has already developed antibodies to the Rh(D) antigen, giving Rhogam won’t help, so is not done. If the antibody screen is negative, then Rhogam is given to prevent her from developing antibodies in the third trimester.

25
Q

What criteria must mom meet to get Rhogam (Rh(D) antibody)?

A

You have to meet all three criteria:

1) Rh(D)-antigen-negative mom
2) Rh(D)-antibody-negative mom
3) Rh(D)-antigen-positive dad or dad is unknown

26
Q

What are early decelerations?

A

Early decelerations have good variability, but slowing of the heart rate that mirrors contractions

Early decelerations are benign and are caused by compression of the head.

27
Q

Cervical mucus

A

Cervical mucous is designed to keep out foreign bodies, including sperm. The only time the uterus will accept the presence of sperm is when the egg needs to be fertilized, right after ovulation. Ovulation results in the mucous becoming thin, stringy and stretchy, and ferns on slide prep.

28
Q

What is magnesium toxicity?

A

This is why mag checks are done

Magnesium toxicity: Hyporeflexia -> Respiratory Depression -> death

Mag antidote is calcium carbonate

29
Q

Labor in the setting of abruption

A

Labor can occur in the setting of abruption. Unless the mom or the baby is unstable, abruption in and of itself is not an indication for cesarean, and labor can be managed expectantly. If either the maternal or fetal status becomes unstable, cesarean may be indicated.

At 30 weeks, steroids would be given for fetal lung maturity and magnesium would be started for fetal neuroprotection.

Never use tocolysis in the setting of abruption- even if labor is progressing.

30
Q

What happens to TSH, FREE T4, and TOTAL T4 in pregnancy?

A

Normal TSH, high TOTAL T4 (increased thyroid binding globulin), and normal FREE T4

31
Q

What to do with different biophysical profile scores

A

(0-2):
Deliver the baby

(3-7):
>36 weeks gestation Baby is cooked so just get baby out

<36 weeks gestation-perform a contraction stress test or give steroids and repeat the BPP in 24 hours

(8-10):
Baby is fine. Repeat the BPP weekly to monitor

32
Q

When is screening for Group b strep done?

A

Screen is performed towards the end of pregnancy (weeks 36-37) as the infection is transmitted to baby in the delivery process.

33
Q

treatment if mom has already developed anti-Rh antibodies and in high titers

A

She has already made her own anti-D immune globulin. Giving her exogenous anti-D, will not change anything; it is already too late. Thus, all we can do is offer reassurance.

34
Q

Hyperthyroidism during the first trimester of pregnancy

A

Propylthiouracil during the first trimester of pregnancy.

Methimazole during 2nd and 3rd trimester

35
Q

Bishop score/ cervix score

A

1) Dilation 2) Effacement 3) Station 4) Cervical Consistency 5) Position of the cervix

Used to evaluate the favorability and probability of succeeding with induction of labor more than 8= vaginal

low Bishop score = higher likelihood of cesarean section

36
Q

NMDAR encephalitis

A

autoimmune encephalitis caused by anti-NMDA receptor IgG antibodies

psychiatric symptoms including hallucinations, anxiety, agitation, and disorganized thinking

Associated with ovarian teratoma. The ovarian teratoma should be evaluated with a pelvic ultrasound or CT of the abdomen and pelvis.

37
Q

Complications of Urinary Tract Infections in Pregnancy

A

Maternal Complications:

  • Increased risk of pre eclampsia
  • Maternal anemia
  • Amnionitis

Neonatal Complications:

  • Preterm birth
  • Neonatal respiratory distress
  • Low birth weight
  • Perinatal mortality
38
Q

How to use amniotic fluid index (AFI) for rupture of membranes

A

(AFI) less than 5cm would be concerning for leakage of fluids

39
Q

Treatment for postpartum endometritis

A

Broad-spectrum intravenous antibiotics including clindamycin and gentamicin. Ampicillin may be added for Group B strep

40
Q

Which drugs induce cytochrome P450 enzymes?

A 
Rifampin
Phenytoin
Barbiturates
Carbamazepine
St. John's wort
41
Q

How do P450 enzyme inducers decrease drug affects?

A

St. John’s induces P450 enzymes which increases metabolism of drugs (OCPs) being metabolized by these enzymes and gets OCP out of the body faster

42
Q

Drugs affected by cytochrome P450 enzyme induction

A

OCPs, antiretrovirals, and anticoagulants.

These drugs will be metabolized and eliminated from the body quicker and have less affects

43
Q

Cytochrome enzyme inhibitors can cause a buildup or toxicity of medications

A

For example, when taking grapefruit juice (inhibitor of cytochrome P450) with the anticoagulant warfarin, patients can experience an increased risk of bleeding

44
Q

Late decelerations

A

Sign of uteroplacental insufficiency and is a decrease and return to baseline of the fetal heart rate (FHR) associated with a uterine contraction.

The deceleration (FHR) is delayed in timing, with the nadir (lowest pt) of the deceleration occurring after the peak of the contraction.

45
Q

Early deceleration

A

Benign- head compression, Vagus nerve stimulation
Symmetrical gradual

Decrease and return of the FHR is associated with a uterine contraction

46
Q

Variable decelerations

A

umbilical cord compression

47
Q

Normal fetal status/ Category I tracing

A
  • Baseline rate 110-160 beats per minute
  • Baseline FHR variability: moderate
  • No late or variable decelerations
  • Early deceration present or absent
  • Accelerations present or absent

OME Cards (20 decks)

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