What is abruptio placentae
- Premature separation of the placenta from the uterine wall
- Presents as heavy painful vaginal bleeding in the 3rd trimester
tx for breech presentation
external cephalic version
(@ or near term)
tx for cord prolapse
-
Immediate c-section
- manual elevation of the presenting fetal part
- repositioning of the mother to knee chest position
what is dystocia
Failure of cervical dilation and fetal descent (difficult labor)
3 causes of dystocia
- Small pelvis
- Poor contractions
- Tx: IV Pitocin
- Macrosomia
- Tx: IV Pitocin
tx for dystocia
Forceps, vacuum, C-section
tx for shoulder dystocia
- McRoberts maneuver (1'st line) – increase pelvic opening by elevating the maternal thighs against the abdomen
- Woods corkscrew maneuver: 180 shoulder rotation; if no success then emergent C section
What is the turtle sign and what does it indicate
retraction of the delivered head against the maternal perineum
= shoulder dystocia
Medications used for induced abortions
< 9 wks: Mifepristone --> Misoprostal (1-3d later)
< 7 weeks: Methotrexate--> Misoprostal (3-7d later)
4-12wks: D&C
>12wks: dilation and evacuation
What is the difference b/w mild and severe pre-eclampsia?
- Mild
- BP >140/90
- > +1 proteinuria
- Severe
- BP >160/110
- > +3 proteinuria
- thrombocytopenia
- oliguria
- HELLP
- BP >140/90
- > +1 proteinuria
- BP >160/110
- > +3 proteinuria
- thrombocytopenia
- oliguria
- HELLP
Tx for MILD pre-eclampsia
- deliver at 37 wks
- if < 34wks:
- BP + dipstick weekly, bedrest
-
Steroids to mature lungs
- BP + dipstick weekly, bedrest
- Steroids to mature lungs
Tx for severe pre-eclampsia
(>160/110, > 3+ protein)
- PROMPT DELIVERY
- Hospitalize--> give MAG
-
Hydralazine*, labetolol, Nifedipine
Tx for eclampsia
ABCDs
Mag (for seizures)
Delivery (once stabilized)
Hydralazine, labetolol
what is the TOC for moderate/severe pre-existing HTN
(meds if BP >150/100)
Methyldopa
(labetolol, hydralazine, Nifedipine)
PAINLESS vaginal bleeding in 3rd trimester
placenta previa
tx for placenta previa (painless vag bleed 3rd tri)
-
Hospitalize. bed rest
-
Mag (inhibits uterine contraction/preterm labor)
-
Steroids (if 24-34wks, lung maturity)
-
Deliver when stable (if >36w, blood loss >500mL)- Vag or CD
PAINFUL vag bleed (dark red), continuous
Abruptio placentae
Tx for Abruptio placentae
Hospitalize
IMMEDIATE C-SECTION
may lead to DIC
what is a complication of Abruptio placentae
DIC (10%)
MCC Abruptio placentae?
(9 causes)
- MCC- Maternal HTN
- smoking, ETOH, cocaine
- folate deficiency
- high parity
- increased age
- trauma
- chorioamnionitis
What is Vasa previa
tx?
- fetal vessels travers the fetal membranes over the cervical os
- ROM--> PAINLESS vag bleed
- TX= immediate CD
Screening for GDM: BS > ____ after 50g GTT
> 140
What is a positive 3hr GTT
fasting >95
1hr >180
2hr >155
3hr >140
TOC for GDM
insulin (doesn't cross the placenta)- indications= fasting >105, pp>120
Glyburide, metformin
INDUCE AT 38WKS IF UNCONTROLLED/MACROSOMIA
Difference b/w complete and partial molar pregnancies
complete= egg w/o DNA + 1-2 sperm= all paternal chrom, 46XX
partial= egg + 2 sperm
"SNOWSTORM" appearance on ultrasound
molar preg
tx for molar preg if METS
methotrexate
which Coombs test do you use to screen forRh type/alloimmunizations
INDIRECT coombs
1st line tx for morning sickness and hyperemesis gravidarum
Pyridoxine (vitB6) + Doxylamine
PP hemorrhage= >____ml if vaginal or >____ if CD
>500ml vaginal
>1000ml CD
MCC PP hemorrhage
uterine atony
tx for PP hemorrhage
1. Bimanual uterine massage***
2. only if uterus soft and boggy: oxytocin, Methylergonovine, Carboprost, Tromethamine, Misoprostol
what 2 tests are used for PROM
1. Nitrazine paper test (turns blue if pH >6.5= PROM)
2. Fern test (amniotic fluid fern pattern
3. ultrasound
tx for preterm labor
1. steroids (betamethasone)
2. Tocolytics (prevent uterine contraction)
- Indomethacin (24-32wks)
- Nifedapine (32-34wks or 2nd line 24-32wks)
- Mag sulfate (must be admitted, not used w/ nifedipine)
- Terbutaline (2nd line 32-34wks)
antibiotic prophylaxis for GBS?
Ampicillin --> PO amox + azithro
PRN allergic= Cephazolin--> PO cephalexin + azithro
Dystocia:
What are the 3 categories of abnormal labor progression?
1. Power
2. Passenger
3. Passage
Two treatment options for shoulder dystocia
1st line= McRoberts maneuver
Wood "Corkscrew" maneuver
How to induce labor
1. unfavorable cervix= Cervidil (prostaglandin gel on cervix)
2. Pitocin
3. Amniotomy (rupturing membranes w/ hook)
What conditions must be met in order to treat ectopic with Methotrexate
ectopic mass size ,
hemodynamically stable
HCG ≤ 5000 IU/L
no fetal cardiac activity
In women with an obstetrical history of cervical insufficiency, when should cerclage be placed?
12-14 weeks
1st and 2nd line tocolytics for preterm labor 32-34wks
1st line= Nifedipine
2nd line= Terbutaline
1st and 2nd line tocolytic for preterm labor 24-32wks
1st line= indomethacin
2nd line= Nifedipine
What are the 9 teratogenic drugs
1. Ethanol
2. Isotretinoin
3. Phenytoin
4. Warfarin
5. Valproate/ Carbamazepine
6. DES
7. Tetracycline
8. Lithium
9. ACE
tx for pruritis in cholestasis of pregnancy
Ursodeoxycholic acid
(Ursodiol)
What is the fasting glucose goal for GDM
<95
Which of the following physical exam maneuver is used to help determine the position of a fetus inside the woman’s uterus?
Leopolds maneuver
The strongest risk factor for endometritis
c-section
tx for endometritis
broad spectrum abx
clinda + gentamycin
Ampicillin-sulbactam
What is seen on labs in placental abruption
hypofibrinogenemia
what 4 things tabulate to a higher Bishop score and greater likelihood of vaginal delivery following induction.
Greater cervical dilation and effacement, softer cervix, more anterior cervical position, and great fetal station
