Complicated Pregnancy Flashcards Preview

MJ- Womens Health EOR > Complicated Pregnancy > Flashcards

Flashcards in Complicated Pregnancy Deck (52)
Loading flashcards...
1

What is abruptio placentae

  • Premature separation of the placenta from the uterine wall
  • Presents as heavy painful vaginal bleeding in the 3rd trimester

2

tx for breech presentation

external cephalic version 

(@ or near term)

3

tx for cord prolapse

  •  Immediate c-section 
  • manual elevation of the presenting fetal part
  • repositioning of the mother to knee chest position

4

what is dystocia

Failure of cervical dilation and fetal descent (difficult labor)

5

3 causes of dystocia

  • Small pelvis
  • Poor contractions
    • Tx: IV Pitocin
  • Macrosomia

6

tx for dystocia

Forceps, vacuum, C-section

7

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

8

What is the turtle sign and what does it indicate

retraction of the delivered head against the maternal perineum

= shoulder dystocia

9

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

10

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

 

11

Tx for MILD pre-eclampsia

  • deliver at 37 wks
  • if < 34wks:
    • BP + dipstick weekly, bedrest
    • Steroids to mature lungs

12

Tx for severe pre-eclampsia

(>160/110, > 3+ protein)

  • PROMPT DELIVERY
  • Hospitalize--> give MAG
  • Hydralazine*, labetolol, Nifedipine

13

Tx for eclampsia

ABCDs

Mag (for seizures)

Delivery (once stabilized)

Hydralazine, labetolol

14

what is the TOC for moderate/severe pre-existing HTN 

(meds if BP >150/100)

Methyldopa 

(labetolol, hydralazine, Nifedipine)

15

PAINLESS vaginal bleeding in 3rd trimester

placenta previa

16

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

17

PAINFUL vag bleed (dark red), continuous

Abruptio placentae

18

Tx for Abruptio placentae

Hospitalize

IMMEDIATE C-SECTION

may lead to DIC

19

what is a complication of Abruptio placentae

DIC (10%)

20

MCC Abruptio placentae?

(9 causes)

  • MCC- Maternal HTN
  • smoking, ETOH, cocaine
  • folate deficiency
  • high parity
  • increased age
  • trauma
  • chorioamnionitis

21

What is Vasa previa

tx?

  • fetal vessels travers the fetal membranes over the cervical os
  • ROM--> PAINLESS vag bleed
  • TX= immediate CD

22

Screening for GDM: BS > ____ after 50g GTT

> 140

23

What is a positive 3hr GTT

fasting >95

1hr >180

2hr >155

3hr >140

24

TOC for GDM

insulin (doesn't cross the placenta)- indications= fasting >105, pp>120

Glyburide, metformin

 

INDUCE AT 38WKS IF UNCONTROLLED/MACROSOMIA

25

Difference b/w complete and partial molar pregnancies

complete= egg w/o DNA + 1-2 sperm= all paternal chrom, 46XX

partial= egg + 2 sperm

26

"SNOWSTORM" appearance on ultrasound

molar preg

27

tx for molar preg if METS

methotrexate

28

29

which Coombs test do you use to screen forRh type/alloimmunizations

INDIRECT coombs

30

1st line tx for morning sickness and hyperemesis gravidarum

Pyridoxine (vitB6) + Doxylamine

31

PP hemorrhage= >____ml if vaginal or >____ if CD

>500ml vaginal

>1000ml CD

32

MCC PP hemorrhage

uterine atony

33

tx for PP hemorrhage

1. Bimanual uterine massage***

2. only if uterus soft and boggy: oxytocin, Methylergonovine, Carboprost, Tromethamine, Misoprostol 

34

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

35

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)

 

36

antibiotic prophylaxis for GBS?

Ampicillin --> PO amox + azithro

PRN allergic= Cephazolin--> PO cephalexin + azithro

37

Dystocia:

What are the 3 categories of abnormal labor progression?

1. Power

2. Passenger

3. Passage

38

Two treatment options for shoulder dystocia

1st line= McRoberts maneuver

Wood "Corkscrew" maneuver

39

How to induce labor

1. unfavorable cervix= Cervidil (prostaglandin gel on cervix)

2. Pitocin

3. Amniotomy (rupturing membranes w/ hook)

40

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

41

In women with an obstetrical history of cervical insufficiency, when should cerclage be placed?

12-14 weeks

42

1st and 2nd line tocolytics for preterm labor 32-34wks

1st line= Nifedipine

2nd line= Terbutaline

43

1st and 2nd line tocolytic for preterm labor 24-32wks 

1st line= indomethacin

2nd line= Nifedipine

44

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

45

46

tx for pruritis in cholestasis of pregnancy

Ursodeoxycholic acid

(Ursodiol)

47

What is the fasting glucose goal for GDM

<95

48

Which of the following physical exam maneuver is used to help determine the position of a fetus inside the woman’s uterus?

Leopolds maneuver

49

The strongest risk factor for endometritis 

c-section

50

tx for endometritis

broad spectrum abx

clinda + gentamycin

Ampicillin-sulbactam

51

What is seen on labs in placental abruption

hypofibrinogenemia

52

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