Endo Repro Last Flashcards

Question

Complete abortion

Answer 1

Passage of all with closed cervic With resolution of pain, bleeding and pregnancy symptoms No treatment needed

Answer 2

Fetus has expired and remains int he uterus Usually no symptoms Coagulation problems may develop, check fibrinogen levels weekly until SAB occurs or proceed with suction D and C Expectant management vs misoprostol vs D and C

Answer 3

Fever, uterine and cervical motion tenderness, purulent discharge, hemorrhage, and renal failure Retained infected products

Answer 4

IV antibiotics and D and C

Answer 5

Anembryonic gestation Gestational sac to large to not have embryo >25 mm

Answer 6

Roe v wade 1971 Suction D and C is most common in first trimester

Answer 7

Fertilized egg develops a placenta but no embryo

Answer 8

US reveals empty gestational sac

Answer 9

Expectant management Medical management -misoprostol D and C

Answer 10

Uses suction to remove products of conception Surgical D and C is a more successful primary therapy then medical or expectant management

Answer 11

Defined as three successive SAB Excluding ectopic and molar pregnancies 1% of pregnant women Often no identifiable cause can be found

Answer 12

Mycoplasma, chlamydia, listeria, or toxoplasmosis rarely identified Can be treated with antibiotics

Answer 13

Increase SABS | 4 fold increase risk. If smoke 20 cigarettes a day and consume 7 alcoholic beverages per week

Answer 14

DM, Hypothyroidism, SLE< antiphospholipid ab syndrome and hypercoagulability sources Factor V Leiden defiency, antithrombin III, protein C and S, prothrombin G20210A, ANA, anticardiolipin antibody, methylene tetrahydrofolate reductase

Answer 15

>40 lots 56% Increase with maternal age

Answer 16

Congenital anomalies (DES) Submucosal fibroids, uterine septum Intrauterine synechiae (asherman)

Answer 17

Second trimester loss Painless dilation and delivery

Answer 18

Uterine anomalies,previous trauma, and history of conization

Answer 19

Cervical circulate

Answer 20

45 XO most common Trisomy 16 most common trisomy

Answer 21

Recommended for both parents bc 3% chance that one parent is an asymptomatic carrier of a genetically balanced chromosomal translocation Detect balanced reciprocal or robertsonian translocations that could be passed on

Answer 22

Most common Has been associated with recurrent fetal loss, preeclampsia, venous and arterial thromboembolism and stroke

Answer 23

Lupus anticoagulant Anticardiolipin antibodies IggIgm Anti B2 glycoproteins 1 antibodies iggigm

Answer 24

Prophylactic dose of heparin and low dose asprin

Answer 25

Fallopian tubes, abdomen, cervix, ovary, uterine cornua

Answer 26

Trophoblastic implant into the mucosa of the Fallopian tube and rapidly erode through to underlying blood vessels -if the bleeding is extensive it can create a pressure necrosis of the overlying tubal serosa resulting in acute rupture and significant hemoperitoneum

Answer 27

Ectopic pregnancy

Answer 28

Natural-tubal Art-some tubal more ampullae and cornual Also get ovarian /abdominal (heterotopic more), more cervical But both most tubal

Answer 29

History tubal infection (G or chlamydia) Previous ectopic Previous tubal reconstructive surgery or sterilizaiotns DES IUD preg IVF or ART Smoking

Answer 30

Threatened or incomplete abortion Ruptured hemorrhagic corpus luteum cyst Acute PID Adnexal torsion Degenerating leiomyoma

Answer 31

Acute appendicitis Pyelonephritis, renal calculi Pancreatitis

Answer 32

Prior missed menses Vaginal bleeding Lower abdominal pain

Answer 33

Usually 1 visit before diagnosis -follow hcg and TVUS Ab pain, spotting, bleeding

Answer 34

Uterus soft and normal size May not feel any adnexal mass US-thickened endometrial stripe (arias Stella reaction) Rarely do you see the ectopic preg)

Answer 35

Lower ab pain vag spotting Abdominal adnexal tenderness or cervical motion tenderness US-variable amounts of fluid in cul de sac May see ectopic

Answer 36

Severe abdominal pain and dizziness from intraperitoneal preg Distended and acute tender abdomen , cervical motion tenderness, sign of hemodynamically instability US-empty uterus with free fluid

Answer 37

Indicates a normal IUP Some 66% Slowest is 53%

Answer 38

Consistent with ectopic pregnancy or nonviable IUP

Answer 39

Most likely blighted ovum, spontaneously resolving ectopic ,abnormal pregnancy

Answer 40

1500-2000 IU/L should see an intrauterine great sac

Answer 41

IUP Extrauterine preg Nondiagnostic-follows with hCG a

Answer 42

Hcg in discriminatory zone

Answer 43

Methotrexate-folic acid antagonist whihc inhibits DNA synthesis and cell replication

Answer 44

Check hCG levels day 4 and 7 -if 15% continue to follow weekly until negative If plateau or fall slow, give another dose Increase-surgical intervention

Answer 45

Folate containing vitamins

Answer 46

IUP, breastfeeding, immunodeficiency, alcoholism, liver disease, hepatic renal failure

Answer 47

Gestational sac>3.5 cm Embryonic cardiac motion HCG>6000

Answer 48

Stable and symptoms are resolving Follow hCG and give strong ectopicprecaution

Answer 49

Not rupture and resolve spontaneously

Answer 50

Preferred for hemodynamically unstable

Answer 51

Stable patient

Answer 52

Entire Fallopian tube when damage

Answer 53

Incision is made parallel to the axis of the tube over the site of implantation and incision is left open to heal by secondary intention Most studies reveal salpingostomy results in better long term tubal fcuntion

Answer 54

Incision is sutured

Answer 55

Repeat hCG 3-7 days post op

Answer 56

20% risk residual trophoblastic tissue

Answer 57

Rh negative women with RH positive fetus

Answer 58

C,D,E,c,d,e

Answer 59

Antibodies to D antigens

Answer 60

Caucasion>african American> Asian an Native American

Answer 61

IgM initially then igg that cross placenta and into fetus Bind fetal rbc and hemolysis

Answer 62

Fine bc increase erythropoietin

Answer 63

Resulting in hydrops fetalis from congestive heart failure and intrauterine fetal deat

Answer 64

Prophylactic Rh immune globulin prevent maternal production of antibodies

Answer 65

Most commonly occur during routine uncomplicated vaginal deliveries Factors that can increase the volume of fetomaternal hemorrhage -c section, placenta previa or abrupton and manual extraction of placenta

Answer 66

Abortion, abdominal trauma, ectopic preg, obstetrical procedures

Answer 67

Rhogam decrease availability to RHD to maternal immune system

Answer 68

More than 1 dose in some populations | -do kleinhauer-betke test which identifies fetal rbc in maternal blood and will determine if rhogam is necessary

Answer 69

ABO blood group, Rh D type and antibody screen

Answer 70

Test father for antigen status If he is rhd negative, no further workup or treatment is necessary bc the fetus will be rh negative If positive for rh d - homozygous, all with be rh + - heterozygous-50% will be Fetal rhd status determined by cell free fetal DNA in maternal plasma or invasively with the fetal antigen testing

Answer 71

Screening tool to estimate the severity of fetal hemolysis in rh disease

Answer 72

Usually indicate the fetus is not in serious jeopardize | Recheck titers in 4 weeks

Answer 73

Further evaluation | Detailed US to detect hydrops and Doppler studies of the idle cerebral artery

Answer 74

Ascites, pleural effusion, pericardial effusion, skin scalp edema, polyhydramnios

Answer 75

Doppler assessment of peak systolic velocity in the fetal mca most valuable Do ever 1-2 weeks from 18-35

Answer 76

Value peak systolic velocity >1.5 MOM for gestational age Predictive of moderate to severe fetal anemia Need to proceed with percutaneous umbilical blood sampling to assess true hemoglobin concentration Intrauterine transfusion if indicated

Answer 77

Before MCA Doppler Find bilirubin analysis with spectral analysts 450nm which correlated with cord blood hemoglobin of newborn at birth

Answer 78

Amniocentesis can increase the severity of fetomaternal transfusion and worsen the disease

Answer 79

HCT below 30% or 2 Sd below mean for gestational age

Answer 80

Intrauterine transfusions between 18-35 weeks Use group O Rh neg packed rbc - <20 weeks intraperitoneal transfusion - IV transfusion into umbilical vein are preferred secondary to therapeutic effects are more rapid and reliable - repeat transfusion 1-3 weeks

Answer 81

Twice weekly non stress test or biophysical profiles Serial growth scans q 3-4 weeks

Answer 82

The risk of intrauterine transfusions may be greater then that of a preterm 35 week Consider delivery and transfuse

Answer 83

Risk assessment(smoking cessation, etoh ,illicit drugs) Health promotion (nutrition, folic acid, weight) Medical intervention(DM management) Psycosocial intervention (stress reduced, 10% are abused during preg)

Answer 84

At least 1 month before

Answer 85

SAB, morbidity, fetal malformation, fetal macrosomia, IUFD

Answer 86

Given birth 1 set of twins both alive

Answer 87

One term infant, one set of preterm twins and 1 miscarriage and 1 ectopic 2 living kids

Answer 88

Normal in preg

Answer 89

Cbc, type and screen rubella immunity (cavvinate post partum if not0, syphilis, hepatitis B surface ag, HIV, cervical cytology and gonorrhea, DM, urine culture

Answer 90

Cr no chance, protein increase, cr clearance decreased

Answer 91

Number of weeks elapsed since first day of LMP and date of delivery

Answer 92

<5 no Above 25 positive 100-time of next menses

Answer 93

Doubles every 2 days

Answer 94

5 weeks, hcg 15000-2000

Answer 95

6 weeks, hcg 5200

Answer 96

7 weeks, 17500

Answer 97

LMP minus 3 months and add 7 days-but only in 28 day cycle ppl

Answer 98

Crown rump length (CRL) between 6-11 weeks can determine due date within 7 days At 12-20 weeks measuring femur length, biparietal diameter and abdominal circumference can determine due date within 10 days Third trimester due date can be off up to +/- 3 weeks

Answer 99

Size of uterus

Answer 100

Over 35 Previous child.family history of birth defects or known genetic disorder Previous birth mental retarded Previous dead baby Multiple fetal lossses Abnormal serum marker Consanguinity Maternal conditions Exposure to teratogens Abnormal US Genetic disorder

Answer 101

Meiosis nondisjucntion 47 chromosome extra 21 If have a Down’s syndrome have 1% cance of another

Answer 102

3-5% will have balanced translocation Should get counseling on having kid with an unbalanced translocation and therefore be offered prenatal diagnosis (chorionic villus sampling/amniocentesis)

Answer 103

Autosomal trisomy (16)

Answer 104

Tuberous sclerosis, neurofibromatosis, achondroplasia, craniofacial synstosis, adult onset POCS, muscular dystrophy

Answer 105

Ray sachs, sickle cell, alpha and beta thalassemia, cystic fibrosis

Answer 106

1/25 ppl carry the AR tait 15% undiagnosed All preg women

Answer 107

Duchene muscular dystrophy, fragile x

Answer 108

Most common inherited mental retardation Second most common mental retardation a fter Down’s syndrome

Answer 109

No male male transmission Unaffected females carry Effect males

Answer 110

Cleft lips, heart defects, pylorus stenosus, neural tube

Answer 111

Folic acid

Answer 112

1st and 2nd

Answer 113

Maternal age, fetal nuchal translucency (NT) thickness (echo free area at back of neck between 10 and 14 weeks-high thickness chromosomal and congenital abnormalities) Hcg Pregnancy associated plasma protein a PAPPA

Answer 114

Down’s syndrome

Answer 115

Also downs

Answer 116

Bhcg, estriol, alpha fetoprotein Detect trisomy 21

Answer 117

Bhcg, estriol, afp, inhibiton a Trisomy 21

Answer 118

Report results after 2nd trimester Improve detection rate

Answer 119

9-10 weeks Tests cell free fetal dna, thought to be from apoptosis of trophoblastic cells that have entered the maternal circulation

Answer 120

Trisomy 21 Trisomy 18 Trisomy 13 Sex chromosome NOT NEURAL FETAL DEFECTS LIKE NT

Answer 121

High risk | -old, prior trisomy preg, family history chromosomal abnormalities, US abnormal, positive fist trimester screen

Answer 122

Anniocenteisis or Chorionis villi sampling

Answer 123

16-20 weeks | .3% miscarriage

Answer 124

11 weeks | 1% miscarriage

Answer 125

Study abnormal fetal development

Answer 126

Phocomelia

Answer 127

PLLR | Removed letters changed content and format for information to assist health care provides in assessing benefit vs risk

Answer 128

Pregnancy subsections 8.1-preg Pregnancy subsection 8.1 breastfeeding Females and male reproductive potential 8.3

Answer 129

Genetic make up of mom and fetus and environment Multifactorial

Answer 130

Organ malformation

Answer 131

17-56 days during organogenesis

Answer 132

Growth delay and not malformation

Answer 133

Malformation

Answer 134

Alcohol Fetal alcohol syndrome

Answer 135

Meprobamate or chlordiazepoxide Congenital anomalies

Answer 136

Aminopterin and methotrexate are both folic acid antagonists =before 40 lethal Later UIGR, craniofacial, mental retard

Answer 137

Growth restriction Facial abnormalities(low ears, smoot philitrum, thin upper lip, short palpebral tissues, flat midface) CNS dysfunction -microcephalic, mental retardation and behavior disorders

Answer 138

Iugr, fetal death, cleft lip, microphthalmia, limb reduction, poorly developed external genetalia

Answer 139

Coumadin cross placenta, heparin doesnt

Answer 140

SAB, IUGR, CNS mental retardation, stillbirth, craniofacial features, fetal warfarin syndrome

Answer 141

Usually epileptic women benefits of seizure prevention weighed against teratogenicity of the drug

Answer 142

Fetal hydantoin syndrome | -craniofacial , limb reduction, FHS, mental defiency, cardiovascular anomalies

Answer 143

Spina bifida Cardiac, skeleton, craniofacial abnormalities

Answer 144

Spina bifida, craniofacial defects, fingernail hypoplasia

Answer 145

Neonatal withdrawal and neonatal hemorrhage

Answer 146

Masculinization of female external genetalia

Answer 147

Treat threatened abortion Risk cervical and uterine issue Cancer Male-testicular abnormalities, infertility and malignancy T uterus

Answer 148

CNS CVD Craniofacial defects SAB, congenital malformations 50%

Answer 149

low birth weight IUGR SAB, fetal death, neonatal death and prematurity

Answer 150

Opiate-experience withdrawal

Answer 151

Congenital malformations, growth restriction, fetal death, mental retardation

Answer 152

Proposes, depressed nasal bridge, triangular mouth

Answer 153

Dose dependent 2-6 weeks Before 2 lethal or none Less than 5 rads of exposure no risk

Answer 154

``` Small frequent meals Avoid greasy fried food Room temp soda and saltnines Acupuncture Medes ```

Answer 155

From relaxation of esophageal sphincter by progesterone | -donut lie down after meals, elevate head of bed, small frequent meals, antacids, H2O blockers

Answer 156

Decrease in colonic activity Increase water, fiber, fruits, and vegetables, stool softened

Answer 157

Increase in venous pressure in rectum Rest, sti bath, stool softener, elevat legs, avoid cnstipation

Answer 158

Last half preg, calves at night Massage stretch

Answer 159

Avoid weight gain, exercise/stretch, comfortable shoes, pillows, heat massage

Answer 160

Every 4 weeks until 28 then ever 2 weeks tilll 36 and weekly until delivery

Answer 161

Bp, weight, urine protein, uterine size, fetal heart rate (Doppler)

Answer 162

First sensation of miovement 20 weeks

Answer 163

Evaluate fetal lie and fetal position

Answer 164

Fetal survey ultrasound

Answer 165

Gestational diabetes and repeat hemoglobin and hematocrit Rhogam injection to Rh negative patients Tdap give between 27-36 weeks

Answer 166

Screening for group b step carrier with vaginal culture-treat in labor if positive

Answer 167

Monitor how often

Answer 168

Reactive-2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes of monitoring

Answer 169

Give oxytocin to establish at least 3 contractions in a 10 min period. If late decelerations are noted with the majority of contractions the test is positive and delivery is warranted

Answer 170

Reassuring

Answer 171

Deliver if at term

Answer 172

Onreassuring consider delivery

Answer 173

Round at inlet Wide transverse diameter Wide suprapubic arch Head into the occiput anterior position Good for deliver

Answer 174

Males and 30% females Wides transverse diameter closer to scrum Prominent ischial spines Narrow pubic arch Fetal head to occiput posterior position Arrest of descent common Bar prognosis for delivery

Answer 175

Ape pelvis 20% Larger AP then transverse Creasy long narrow oval with narrow pubic arch Fetal head anterioposterior diameter Usually in OP position Good delivery

Answer 176

Flat gynecoid pelvis 3% of females Short AP and wide transverse diameter Wide bispinous diameter Wide suprapubic arch Fetal head has to engage in transverse diameter Poor prognosis for delivery

Answer 177

Inferior pubic symphysis to sacral promontory | >11.5 ok

Answer 178

Diagonal-2 cm Narrowest fixed distance through which the fetal head must pass through during a vaginal delivery

Answer 179

Sacral and iscial spine

Answer 180

Measure ischial tuberosities and pubic arch

Answer 181

8.5 cm distance ok

Answer 182

Place thumb next to each inferior pubic ramus and estimate the angle at which they meet >90 good

Answer 183

Rare only do if history or clincial indication of pelvic abnormalities or pelvic trauma

Answer 184

Review prenatal records, identify complications, confirm gestational age, review labs, history, PE

Answer 185

Frequency contractions, loss fluid, vaginal bleeding

Answer 186

Reference to maternal spine Longitudinal, transverse, oblique

Answer 187

Vertex, breech, transverse, or compound

Answer 188

1. Palpate fundus 2. Palpate or spine and fetal small parts 3. Palpate what is presenting in the pelvis with suprapubic palpation 4. Palpate for cephalic prominence

Answer 189

Check at internal os

Answer 190

Thinning cervix occurs and is reported as % change in length Normal 3-5 cm Thick 100% effaced

Answer 191

Degree of descent of the presenting part of fetus Measured in cm from presenting part to ischial spines When the bony portion of the head reaches the level of the ischial spines the station is zero -5 to 5 cm

Answer 192

Onset labor to complete cervical dilation Latent and active

Answer 193

Complete cervical dilation to delivery

Answer 194

Delivery of infant to delivery of placenta

Answer 195

Delivery of placenta to stabilization of patient

Answer 196

Latent active

Answer 197

Onset of labor and slow cervical dilation

Answer 198

Faster rate of dilation and usually begins when cervix is dilated to 4 cm Admit for labor

Answer 199

6-18 hrs 2-10 hours

Answer 200

1.5 cm per hour

Answer 201

Head engaged and reassuring monitoring is noted I in bed be left lateral recumbent

Answer 202

IV to hydrate give meds if need

Answer 203

Cbc and t ands

Answer 204

Vitals q 1-2 hours

Answer 205

Continuous Intermittent if uncomplicated or complicated differs

Answer 206

Q 30 min in active phase of first stage Q 15 min in second stage of labor

Answer 207

Q15 min in active phase Q15 min during the second stage

Answer 208

Internal monitoring

Answer 209

External tocodynamometer Internal pressure catheter Can get strength of contractions and help xyytocin augmentation

Answer 210

Active phase q2 hrs record dilation, effacement, station

Answer 211

Augment labor, allows assessment of meconium status Risk cord prolapse, prolonged rupture is associated with chorioamnionitis

Answer 212

Descent of the presenting part through the maternal pelvis and culminates in delivery Increase in bloody show and desire to bear down with contractions

Answer 213

Primiparas without epidural 2 hours With 3 hours Multiparas without epidural 1 hour Multiparas 2 hours

Answer 214

Presenting part at zero station

Answer 215

Brought about by the force of uterine contractions and maternal valsava efforts

Answer 216

OA baby’s chin to chest thus changing the presenting part from occipitofrontl to the smaller suboccipitobregmativ

Answer 217

At ischial spines Fetal head enters pelvis int ransverse diameter, rotates so the occiput turns anteriorly or posteriorly toward the pubic symphysis

Answer 218

Crowning occurs when the largest diameter of the fetal head is encircled by the vaginal introitus +5 Head is born by rapid extension

Answer 219

Delivered head now returns to its original positiona t the time fo engagement to align itself with the fetal back and shoulders

Answer 220

Anterior shoulder then delivers under the pubic symphysis, followed by the posterior shoulder and the remainder of the body

Answer 221

Avoid supine Dorsal lithotomy

Answer 222

With each contraction, the mother should hold her breath and bear down with expulsion efforts

Answer 223

Continuous Q15 with no risk factors Q5 minutes during seconds tage with risk

Answer 224

Access descent and confirm position

Answer 225

2 nurses and physician Antiseptic soap vulva Episiotomy Facilitate with modified rotten maneuver Head out bulb suction oral cavity and use index finger to assess nuchal cord -if loose can manually reduce over the infants head if tight clamp and cut

Answer 226

Anterior shoulder with gentle downward traction on fetal head Posterior shoulder by elevating the head Support head, bulb suction, dry and stimulate

Answer 227

Clamp x2 and cut | Obtain cord blood specimen

Answer 228

Third stage then inspec and repair

Answer 229

Likelihood of spontaneous laceration seems high To expedite delivery by enlarging the vaginal outlet

Answer 230

Common Risk of extension 3rd or 4th degree Less postpartum pain

Answer 231

Greater blood loss More difficult to repair More postpartum pain Increase risk of dyspareunia

Answer 232

Fingers of the right hand are used to extend the head while counterpressure is applied to the occiput by the left hand to allow for a more controlled delivery Or just support perineum

Answer 233

SUPERFICIAL LACERATION INVOLVING THE VAGINAL MUCOSA AND OR PERINEAL SKIN

Answer 234

LACERATION EXTENDING INTO THE MSUCLES OF THE PERINEAL BODY BUT DOES NOT INVOLVE THE ANAL SPHINCTER

Answer 235

LACERATION EXTENDS INTO OR COMPLETELY through the anal sphincter but not into the rectal UC osa

Answer 236

Involves the rectal mucosa

Answer 237

Interval between delivery of the infant and delivery of placenta

Answer 238

Placenta not delivered in 30 minutes

Answer 239

Gush of blood from vagina Lengthening of umbilical cord Fundus of uterus rises up Change in shape of the uterine fundus from discoid to globular

Answer 240

Apply counter pessure between symphysis and fundus Do not pull cord until classic signs noted

Answer 241

Uterine inversion

Answer 242

Monitor patient Vitals Uterine fundal checks and assess for vaginal bleeding Postpartum hemorrhage commonl occurs during this time -uterine stony, retained placenta, unprepared vaginal or cervical laceration

Answer 243

Do before labor

Answer 244

Artificial stimulation of labor which already began Vs induction of labor

Answer 245

Abruptio placenta, chorioamnionitis, fetal demise, preeclampsia, eclampsia, gestational HTN, prom, postterm pregnancy, maternal medical conditions, fetal compromise

Answer 246

``` Unstable fetal Acute fetal distress Placenta previa or vasa previa Previous classical c section or transfundal uterin surgery HIV high viral load, active herpes ```

Answer 247

Cervical dilation, cervical effacement, station, cervical consistency cervical position

Answer 248

Unfavorable

Answer 249

Probability of vaginal delivery after labor induction is similar to that of spontaneous labor

Answer 250

E2 vaginal insert Not in previous c section

Answer 251

E1 Oral or vaginal Can’t be removed Not in previous c section

Answer 252

Foley bulb catheter Laminara japonicum

Answer 253

Synthetic oxytocin stimulate contraction IV Induction and augmentation In normal saline IV and stopped if fetal distress 1-30 mu/min

Answer 254

More than 5 contractions in 10 min | Side effect

Answer 255

Pitocin ADH has effect can lead to increase water reabsorption -convulsion and coma

Answer 256

Prolonged pitocin increase risk | -post partum hemorrhage secondary to uterine stony

Answer 257

Pain relied sage for baby

Answer 258

Blood flow to uterus may decrease To uterus with anesthesia from hypotension Need adequate hydration

Answer 259

Vasopressor

Answer 260

Visceral pain t10-t12 through l1

Answer 261

Somatic s2-4

Answer 262

Low of pain below t10 Epidural, spinal

Answer 263

Perineum, pudendal block

Answer 264

Morphine, fentanyl, meperidine nalbuphine Not for labor pain women work bc moa is sedation Opoids cross placenta

Answer 265

T8-t10 and below Local anesthesia and narcotic

Answer 266

Most effective catheter in epidural space l2-l3 , l3-l4, l4-L5 then placed over needle

Answer 267

Single shot analgesia which provide excellen pain relief for limited procedures Limited use in labor since a single shot

Answer 268

Hypotension , spinal HA, fever, spinal hematoma, abscess

Answer 269

Coagulopathy, heparin within 12 horus, bacteremia, ICP, skin infection

Answer 270

1-2% lidocaine for 20-40 min Before episiotomy or laceration repair

Answer 271

Hypotension, seizures, cardiac arrhythmias

Answer 272

Intravascular injection, hematoma infection

Answer 273

Propofol Loss of consciousness need airway management 16 fold increase maternal mortality

Answer 274

Cross placenta and associated with neonatal respiratory depression

Answer 275

Emergent cases | Regional anesthesia

Answer 276

To look for for patterns that may be frequently associated with delivery of infant with poor outcomes

Answer 277

No increase operative deliveries and c section no change in neuro damage

Answer 278

Reassurance Would have to get nurse Still goor warning of potential problems

Answer 279

Internal Rome accurate

Answer 280

Doppler US< pressure sensiiive tacodynanmometer

Answer 281

On maternal abdomen overlying fetal heart Records reflected sound waves fromt he fetal heart back to transducer

Answer 282

Detects and records contractions Useful for measuring the frequency of contractions but not the strength

Answer 283

Fetal scalp electrode Intrauterine pressure catheter

Answer 284

R wave peaks of the fetal echocardiogram Maternal and fetal movement will not alter the quality of signal Rare cases of fetal pustules Not for HIV

Answer 285

Soft plastic catheter placed transcervically Gives precsise measurement of the intensity of uterine contractions in millimeters of mercury

Answer 286

Membranes to be ruptured

Answer 287

Every contraction Can tolerate without hypoxia bc adequate oxygen exchange occurs still between contractions

Answer 288

Can’t tolerate stress of contractions and will become hypoxic

Answer 289

Chemoreceptors and baroreceptors in the peripheral arterial circulation of the fetus influence the FHR by giving rise in contraction related or periodic FHR changes Anaerobic metabolism, Peruvian and lactic acid and fetal acidosis

Answer 290

7.25-7.3 | <7.2

Answer 291

Blood flow ceases Increase or decrease Decrease

Answer 292

5 contractions or less in 10 minutes over 30 minutes

Answer 293

>5 in 10 min over 30 min Presence or absence FHR decelerations

Answer 294

Peak to peak

Answer 295

3 in 8 minutes | Occurring 2-3 mintues

Answer 296

>200 Montevideo units (sum of the contractions in a 10 minute period) for at least 2 hours

Answer 297

Increments of 5 bpm during 10 minute Assess between contractions

Answer 298

110-160 bpm

Answer 299

Baseline>160 bpm

Answer 300

``` Fetal hypoxia Meds-oxytocin Arrhythmias Prematurity Maternal fever Fetal infection-chorioamnionitis most common cause1 ```

Answer 301

Fetal hypoxia, obstetric anesthesia, pitocin, maternal hypotension, prolapsed or prolonged compression of the umbilical cord, heart block

Answer 302

In response to hypoxia

Answer 303

Vagus in response to changes in fetal bp

Answer 304

Amplitude undetected

Answer 305

Amplitude>25 bpm

Answer 306

Indicators of fetal stress Persistent late decelerations Hypoxia and acidemia -lack of oxygen and the build up acid in the fetus depresses the fetal heart rate and cns

Answer 307

Prematurity, sleep, maternal fever, fetal tachycardia, fetal congenital anomalies, maternal hyperthyroidism, drugs

Answer 308

Abrupt increase in the FhR and is a normal reassuring response >32 weeks HE>15 bpm above baseline for 15 sec or more <32 weeks HR>10 bpm above baseline for 10 sec or more

Answer 309

If acceleration lasts >10 min

Answer 310

Spontaneous fetal movement | Vaginal exam

Answer 311

FHR decreases in response to uterine contractions Early, variable, late

Answer 312

Head compression-fetal autonomic response to increased ICP caused by transient compression of the fetal head Not associated with fetal distress The nadir of the deceleration occurs at the same time as the peak fo the contraction and thi s. Amirror image

Answer 313

Pressure on fetal skull increase ICP->decrease cerebral blood flow->activates central vagus nerve-> produces decrase in HR->recovering occurring as pressure is relieved

Answer 314

Secondary to umbilical cord compression Abrupt decrease in FHR-can occur before, during or after contraction starts Decrease in FHR >15 bpm lasting >15 sec and <2 min in duration Onset depth and duration an vary with successive uterine contractions

Answer 315

Cord compression

Answer 316

Obstruct umbilical vein which returns re oxygenated blood to fetal heart

Answer 317

Increase in fhr to compensate for lack of blood return and the slowly diminishing oxygen supplies -

Answer 318

Slight fhr decrase followed by major drop

Answer 319

Uterine placental insuffiency Most ominous deceleration-repetitive late decelerations usually indicate fetal metabolis acidosis and low arterial pH Nadir of the deceleration occcurs after the pea of contraction

Answer 320

Excessiveuterine activity | Maternal supne hypotension

Answer 321

Decrease in FHR from baseline that is >15 bpm >2 min but <10 min Disruption of oxygen transfer from the environment to the fetus at one or more points along the oxygen pathways Maternal pushing

Answer 322

Smooth sine wave like undulating pattern in fhr Fetal anemia

Answer 323

Baseline 110-160 bpm Moderate variability no late or variable decelerations May have acccelerations and early decelerations

Answer 324

Intermittent CEFM

Answer 325

Intermittent: variable decelerations <50% of contractions Recurrent variable decelerations >50% of contractions

Answer 326

Normal outcome

Answer 327

Umbilical cord compression with acidemia impending Moderate variability and or accelerations suggest fetus is not acidemia

Answer 328

No intervention required

Answer 329

Alleviate cord comrpession repositioning amnoiinfusion Modify pushing efforts push with every other ctx

Answer 330

Instillation of normal saline can alleviate cord compression 250-1000 cc infused 15 cc/min Continuous infusion of 100-200 cc/hour

Answer 331

Transcervical IUPC

Answer 332

Minimal or absent variability Recurrent late decelerations Prolonged decelerations Tachycardia, bradycardia Variable late or prolonged decelerations occurring with maternal pushing efforts

Answer 333

Fetal sleep, meds, acidemia, UPI:hypotension, tachysystole, maternal hypoxia Rapid fetal descent , cord comrpession, tachysystole Prematurity , chorioamnionitis, epidural , cord prolapse, cord comrpession UPI

Answer 334

Promote fetal oxygenation | Decrease oxytocin

Answer 335

Spontaneous labor, induction or augmentation

Answer 336

Reduce uterine activity Lateral positioning, IV bolus, decrease oxytocin, tocolytic (tertbutaline)

Answer 337

Increased risk of fetal acidemia Increased risk of hypoxemia and acidemia

Answer 338

Prepare for delivery Fetal scalp stimulation

Answer 339

Poke it with finder | If an acceleration of 15 bpm lasting 15 seconds occurs the fetal pH value almost always is 7.33 or greater

Answer 340

When teal tracing shows reduced variability but no decelerations

Answer 341

How many minutes is standard of care to deliver this infant | Idk

Answer 342

Get consent, get team, assess transit time and location for operative deliver, ensure IV access, review labs, assemble neonatal resuscitation personnel

Answer 343

98% fetal wellbeing

Answer 344

False positive >99%

Answer 345

False positive rate is 80%

Answer 346

7% get glucose intolerance

Answer 347

24-48 weeks 50 gm on hour glucose challenge (>130-140 abnormal) May perform an earlier screen if risk

Answer 348

Follow 3 hour 100 gm oral load glucose tolerance test | -fail three hour with 2 or more abnormal values

Answer 349

Obesity, history, family history DM, glucose intolerance

Answer 350

Increase risk of gestational HTN Increase risk preeclampsia Greater risk of c delivery Increase risk Dm later in life

Answer 351

Macrosomia, neonatal hypoglycemia, hyperbilirubinemia, operate delivery, shoulder dystocia, birth trauma

Answer 352

Diabetic teaching, blood glucose monitoring, fetal testing, US for fetal weight get c section is over 4500 gm

Answer 353

Testing, growth, glycemic control are good

Answer 354

Hourly glucose monitoring Need between 80-120 Continuous fetal monitoring in labor

Answer 355

Birth defects

Answer 356

Worsening nephropathy and retinopathy, increased risk of developing preeclampsia, greater risk of diabetic ketoacidosis

Answer 357

Increase risk of spontaneous abortions, anatomic birth defects, fetal growth restriction and prematurity

Answer 358

Class a1 and a2

Answer 359

Gestational diabetes, diet controlled

Answer 360

Gestational diabetes; insulin or oral meds controlled

Answer 361

Less than 95 mg/dl

Answer 362

Less than 120

Answer 363

Half an hour

Answer 364

Renal-24 hour urine collections every trimester Cardiac ekg Ophthalmic detailed eye exam in first trimester Glycemic control (dail finger stick blood glucose and hgba1c0

Answer 365

Early dating US Detailed fetal anatomy US and echo Biochemical testing for congenital malformations in first trimester 11-13 weeks or quad screen at 16-21 weeks Fetal growth US every 2-4 weeks Fetal testing every weeks tarting 32 weeks

Answer 366

Insulin requirements drop significantly after delivery of placenta Insulin dependent patients typically require about 2/3 of pregnancy dose of insulin GDM frequently do not need further treatment With GDM-need 2 hour glucose tolerance 6 to 12 weeks postpartum to look for preexisting disease

Answer 367

Similar to preg so hard to see symtpoms

Answer 368

T4 up and TSH down

Answer 369

Radioactive iodine contraindicated PTU and methimazole in 2 or 3 (aplasia cutis in 1st) PTU-liver toxicity so only 1st

Answer 370

Meds cross placenta and fetal hypothyroid an goiter an come Risk of prematurity, IUGR, preeclampsia and stillbirth

Answer 371

Infection, labor, c secretion, noncompliance with medication

Answer 372

Hyperthermia, tachycardia, perspiration, high output cardiac failure,

Answer 373

Beta blockers-propranolol Sodium iodide PTU Dexamththasone Replace fluid Bring t down

Answer 374

Normal preg

Answer 375

Spontaneous abortion, preeclampsia, abruption, low birth weight infants, still birth, lower intelligence leees (cretinism)

Answer 376

Levothyroxine Monitor tsh and free t3/t4

Answer 377

Due to transplacental transfer of thyroid stimulating antibodies Transient Mortality 16%

Answer 378

Defiency results in generalized development retardation causes -thyroid dysgenesis Inborn error of thyroid function Drug induced

Answer 379

Mitral stenosis High risk of developing heart failure, subacute bacterial endocarditis and thromboembolic disease

Answer 380

Atrial and ventricular septal defects, primary pulmonary htn, t of fallout, transposition of great vessels -if corrected in childhood no consequences

Answer 381

Contraindications to pregnancy due to decompensation during pregnancy and a high mortality rate, epidural anesthesia is preferred and vaginal delivery ma be an option for these patients

Answer 382

Most frequently supraventricular tachycardia Benign A fib.flutter more worrisome for underlying cardiac disease

Answer 383

No underlying cardiac disease Develops typically within last weeks of pregnancy or within 6 months postpartum Women with preeclampsia, htn and poor nutrition

Answer 384

Co managed with cardiologist!!!!! | Ekg, echo, avoid na, left lateral position, no strenuous, prevent anemia, avoid infection, fetal echo

Answer 385

Vaginalis unless obstetric indications Antibiotic prophylaxis for endocarditis in high risk patients Acute cardiac decompensation with congestive heart failure is managed as a medical emergency

Answer 386

Immunoglobulins attach to maternal platelets

Answer 387

``` Begun after platelets from to 50000 Prednisone IV immunoglobulin if severe Platelet transfusion Splectomy ```

Answer 388

Neonatal thrombocytopenia can occur due to placental transfer of antiplatelet antibodies

Answer 389

1/3 improve 1/3 same , 1/3 worse

Answer 390

Prednisone

Answer 391

Preterm delivery restrictions Still birth Miscarriage

Answer 392

Presence of lupus anticoagulatn and or anticardiolipin antibody Associated with arterial or venous thrombosis

Answer 393

Increase risk of miscarriage Risk for developing preeclampsia Fetal growth restriction

Answer 394

If history of thrombosis-full anticoagulation

Answer 395

Due to rpeexisting renal disease or pregnancy induced

Answer 396

Pre renal renal post renal

Answer 397

Acute blood or fluid loss

Answer 398

Usually preexisting disease or hypercoagulable state

Answer 399

Rare, urologic obstructive lesions

Answer 400

Urine output, BUN:Cr, fractional excretion of Na, uring osmolality Cvs study-in labor need swan gang catheter Urologic-foley catheter, renal us to diagnose obstructive source

Answer 401

Retort volume Electrolytes, diuretic, flus restriction, hemodialysis

Answer 402

Mechanics to remove the obstruction Left lateral position, urethral catheter, possible surgical intervention to remove stone

Answer 403

Bad outcome | Cr>1.5-2 worsens prognosis

Answer 404

Monitor renal function with 24 hour urine collections for protein and cr clearance , manage htn, fetal surveillance with growth us and nonstress tests/biophysical profiles

Answer 405

Not recommended May lose graft function or experience rejection; best candidates are 1-2 years post transplant with stable cr and proteinuria without severe htn

Answer 406

Steroid induced adrenal and hepatic insuffiency, prematurity, intrauterine growth restriction

Answer 407

More likely to lead to cystitis and pyelonephritis in pregnant women From urinary stasis and glucosuria

Answer 408

Urine culture at initial prenatal visit

Answer 409

Antibiotic (3 or more if recurrent)

Answer 410

Fever, costovertebral tender, malaise, WBC up

Answer 411

Increase uterine activity and preterm labor Result in adult respiratory distress syndrome

Answer 412

``` IV hydration Antibiotics Antipyretic Tocolytics Suppression remainder pregnancy ```

Answer 413

8-12 weeks not known why

Answer 414

Symptomatic

Answer 415

Persistent nausea and vomiting >5% loss of pre preg weight, ketonuria, dehydration

Answer 416

Occurs more frequently in first pregnancy, multiple pregnancies, trophblastic disease

Answer 417

Outpatient management fails then may need hospitalization for IV fluids, electrolytes, glucose, vitamins and Anti-emetic Severe-may need nasogastric feeding or parental nutrition

Answer 418

Small meals, avoid lying down after meals, elevate head when sleeping, antacids, H2O blocs

Answer 419

Preg may improve Diagnose symptoms, and only endoscopy if severe or signs of gi bleeding

Answer 420

No caffeine, alchol tobacco, spicy foods Antacids, H2O blockers/proton pump Treat H pylori

Answer 421

Acid aspiration syndrome Preg women get from delayed gastric emptying and icnreased intrabadominal intra gastris pressure

Answer 422

Supplemental o2, maintain airway, treat for acute respiratory failure

Answer 423

Decrease acid ins tomach Do not feed in labor

Answer 424

Fine in pred, IC more active If bowel disease active at time of conception may increase miscarriage

Answer 425

Acute exacerbation is same as non preg

Answer 426

Cholestasis and pruritis is second half ofpregnancy

Answer 427

Can recur with each pregnancy Association with oral contraceptives and multiple gestation Benign course for maternal consequences Increase risk of meconium strained amniotic fluid and fetal demise

Answer 428

Itching without abdominal pain r rash Labs reveal elevated serum bile acids and occasionally elevated liver enzymes

Answer 429

Local treatment cold baths, bicarbonate washes Use ursodeocycholic acid Fetal surveillance and delivery at early term

Answer 430

Scary! Diffuse fatty infiltration of liver resulting in hepatic failure 1 per 14000 pregnancies

Answer 431

Ab pain, nv, jaundice , irritability, polydipsia/pseudodiabetes insipidus, HTN.proteinuria in 50% of cases

Answer 432

Increase prothrombin time and partial thrombophlebitis time, elevated bilirubin, ammonia and uric acid and elevation of liver transaminase

Answer 433

Termination pregnancy Supportive care-IV fluids with 10% glucose, FFP and cryoprecipitate

Answer 434

Yup both about 10-20%

Answer 435

Full recovery

Answer 436

Physiology decreas in hgb/hematocrit during pregnancy Hematocrit less than 30% or a HgB concentration less than 10 g/dL

Answer 437

Screened at initial prenatal visit and again 26-28 weeks Treat iron supplementation-oral or IV

Answer 438

5 fold increase in venous thrombosis and greatest risk is fist 5 weeks postpartum

Answer 439

Most common in patients with varicose gains, obesity and little physical activity Most common in calf, will not result in pulmonary emboli

Answer 440

Most common in patients with varicose veins, obesityand littlen physical activity Most common in calf, will not result in pulmonary emboli

Answer 441

Swelling, ternderness

Answer 442

Bed rest , pain medication, local heat, no need for anticoagulants, wear support hose

Answer 443

1/2000 antepartum 1/700 antepartum

Answer 444

More common in the left leg than the right Pain in the calf with dorsiflexion May also have dulla Che, tingling or pain with walking

Answer 445

50% asymptomatic compression US with Doppler MRI suspect pelvic thrombosis

Answer 446

Anticoagulation Low molecular weight or unfractioned heparin -PTT values with heparin and factor Xa values with lovenox Coumadin for 6 weeks postpartum nut not during preg

Answer 447

Maternal mortliaity -80% untreated treated 1% From dvt

Answer 448

Pleuritic chest pain, shortness of air, air hunger, palpitations, hemoptysis

Answer 449

Tachypnea, tachycardia, low grade fever, pleural friction rub, chest splinting, pulmonary rales, accentuated pulmonic valve second heart sound

Answer 450

Ekg, chest x ray, arterial blood gas, ventilation perfusion scan, helical computed tomography

Answer 451

Anticoagulation

Answer 452

Lupus anticoagulatnts, anticardiolipin antibody, factor v Leiden, protein c and s, antithrombin III, prothrombin G20210A

Answer 453

Prophylactic anticoagulant

Answer 454

Most common pregn pulmonary disease! 1.3 better 1.3 same 1/2 worse

Answer 455

Miscarriage, preeclampsia, intrauterine fetal demise, intrauterine fetal growth restriction, preterm delivery

Answer 456

``` Mile-SABA Mild persistence-low dose inhaled CS Moderate persistent0saily inhaled corticosteroid combined with long acting inhaled beta agonist Severe persistent-add systemic CS Maternal monitoring ```

Answer 457

Serial growth US, NST.biophyscial profiles, deliver for fetal growth restriction or maternal deterioration

Answer 458

Stress dose of IV steroids if using daily inhaled or high potency oral for more than 3 weeks

Answer 459

Most common Give acetaminophen

Answer 460

Highes prevenalce in childbearing years Improve preg Neurology can be helpful

Answer 461

Diagnose at 30 Fewer and less severe pregnancy but may exacerbate post partum Increased risk LBW, C section

Answer 462

If seizure fre 2 years propr to conception may stop Monotherapy at lowest dose

Answer 463

Alt eratogen

Answer 464

Noooooooooooo

Answer 465

Dilatin phenobarbital

Answer 466

1-4 mg of folic acid

Answer 467

Preeclampsia, placental abruption, hyperemesis, premature labor, intrauterine fetal demise, congenital cleft lip and palate and cardiac anomalies

Answer 468

Arise and recur postpartum in 10%

Answer 469

Personal or family history depression History of abuse Drug use History of personality disorder

Answer 470

Counseling Antidepressants -not 1st trimester and if 3rd may get neonatal withdrawal

Answer 471

70-80% from hormonal fluctuations get maternal blues | 10-15 depression

Answer 472

Counseling an medication

Answer 473

Depression during pregnancy Younger women

Answer 474

Non spontaneous Vaginal forceps assisted, vacuum extracted /c section

Answer 475

Direct traction with vacuum extractor or forceps

Answer 476

Maternal exhaustion/lack of expulsion effort Inability to have expulsive effort -spinal cord injuries, neuromuscular disorders Need to avoid maternal expulsive efforts-certain cardiac conditions, cerebrovascular disease

Answer 477

Non reassuring fetal status (bradycardia, repetitive heart rate decelerations)

Answer 478

Prolonged second stage of labor Nulliparous>2 hours without regional anesthesia or>3 hours with regional anesthesia Multiparous >1 hour without regional anesthsia or> 2 hours with regional anesthesia

Answer 479

Adequate analgesia, lithotomy position, bladder empty, verbal or written consent

Answer 480

Vertex presentation, fetal head must be engaged (biparietal diameter at 0 station), position fothe fetal head must be known with certainty, station fo hte fetal head must be> 2

Answer 481

Cervix fully dilated, membranes ruptured, no placenta previa

Answer 482

Scalp visible without labia separation Fetal skull reached the pelvic floor Sagittal suture is in the anteroposterior diameter or right or left occiput anterior or posterior position Fetal AED at perineum Rotation not exceed 45 degrees

Answer 483

Leading potent of the fetal head is at +2 station or more and is not on the pelvic floor

Answer 484

Fetal skill is above +2 Not ever indicated today

Answer 485

Don’t do forceps

Answer 486

Don’t apply

Answer 487

Make sure no vaginalis tissues or the cervic are caught in the forceps Blades should dit the fetal head evenly, should lie against the fetal head so that they cover the space between the orbits and ears

Answer 488

Lacration of vagina/cervic, episiotomy extension, pelvic hematoma, urethral and bladder injuries, uterine rupture

Answer 489

Facial laceration, forcep marks, brachial plexus injur, skull fracture, intracranial hemorrhage, seizures

Answer 490

Indications requirements exactly same Advantage-little maternal analgesia

Answer 491

Gestational age less than 34 weeks Suspected fetal coagulation disorder Suspected fetal macrosomia Breech

Answer 492

Applied to fetal head with a mechanical pump Steady traction No rocking or torque on the device No rocking or torque on the device Incidence of serious complication is about 5%

Answer 493

No material tissue trapped int he cup, cup should be placed int he midline of the sagittal suture, the vacuum port of the suction cup should point toward hte occiput

Answer 494

Release suction

Answer 495

No more than 2

Answer 496

No mroe than 20 minutes

Answer 497

More failures deliveries Fewer perineal injuries Icnreased incidence of delta cephalohematoma More scalp lacerations and bruising

Answer 498

Delivery of a fetus through a surgical incision of the anterior uterine wall Rate is climbing

Answer 499

Nnonreassuring fetal heart rate Reach presentation/transverse presentation Very low birth weight Active herpes Immune theomocytopenia purpura Congenital anomalies

Answer 500

Cephalopelvic disproportion Failure to progress Placental abruption Placenta previa

Answer 501

Obstructive benign and malignant tumors Large vulvar condyloma Abdominal cervical cerclage Prior vaginal colporrhaphy Conjoined twins Maternal requires

Answer 502

Uterine artery lacerations, bladder injuries, urethral injures, GI injury, uterine atony, placenta accretion, c hysterectomy

Answer 503

Nendoyometritis Wound-infection, separation, dehiscence Urinary complications, ileus diarrhea, thromboembolic disorders (pulmonary emboli/dvt), septic pelvic thrombophlebitis

Answer 504

After 20 weeks before 37

Answer 505

Uterine contractions with cervical change or cervical dilation of 2 cm and/or 80% effaced

Answer 506

Prematurity

Answer 507

``` African Americans Decreased access prenatal care High stress Poor nutrition Genetics ```

Answer 508

``` Previous History SAB Bleeding 1st trimester UTI/genital infections Multiple gestation Polyhydramnios, Incompetent cervix ```

Answer 509

Infection Placental-vascular Psychosocial Uterine stretch

Answer 510

Bacterial vaginosis Group B strep Gonorrhea, chlamydia

Answer 511

Antibiotics,

Answer 512

Cervical length

Answer 513

Relative risk of PTL increases as cervical length decreases

Answer 514

US Fetal fibronectin (FFN)-released from the BM of the fetal membranes Released in response to disruption of the membranes as with uterine activity, cervical shortening or infection

Answer 515

Immunologic component Vascular component Low resistance connection of spiral arteries

Answer 516

Mental and physical stress increase cortisol and catecholamines

Answer 517

From adrenal | Stimulates early placental CRH known to help in labor

Answer 518

Affect blood flow an can cause uterine contractions

Answer 519

Nutrition and stress reduction

Answer 520

Polyhydramnios | Multiple gestation

Answer 521

Cramps, backache, pelvic pressure, increase in discharge/bloody discharge, uterine contractions

Answer 522

Initial-cervical exam to see dilation, effacement and fetal presentation Look for correctable prob like infection External monitoring for uterine activity and fetal HR Oral or IV hydrate Reevaluate cervic in an hour Culture for groups strep and gonorrhea and chlamydia (once diagnosis CBC, urinalysis and urine culture) US

Answer 523

Tocolysis Mg sulfate Nifedipine Prostagladin synthase inhibitors

Answer 524

Yes Competes with ca for entry into the cell at time of depolarization IV NEUROPROTECTIVE (cerebral palsy, ) If less Han 32 weeks

Answer 525

``` Feeling of warmth and flushing NV Respiratory depression -seen with serum levels 12-15 Cardiac conduction ```

Answer 526

Loss of msucle tone, drowsiness, low APGARs

Answer 527

Oral suppress preterm labor Minimal side effects Inhibits slow, inwar current of ca during the second phase of the action potential

Answer 528

Inhibits prostagladin production that induce myometrial contractions Used on a short term basis Indomethacin-oral orrectal

Answer 529

Oligohydramnios, preterm closure of fetal ductus arteriosus and cause pulmonary HTN

Answer 530

Necrotizing enterocolitis and intracranial hemorrhage

Answer 531

Can decrease uterine activity Not for primary tratment When not meet diagnosis preterm labor or after discontinuing mg to decrease prostagladin procuction

Answer 532

24-34 weeks gestation | Effects last 7 days

Answer 533

Single course of betamethasone

Answer 534

Vaginal delivery preferred | -some recommended c section for very low birt weight

Answer 535

Increased risk of cord prolapse of compression as well s head entrapment with vaginal delivery therefore most will c section

Answer 536

Progesterone IM Women with previous PTL/PPROM Smooth msucle relaxant is the thorny

Answer 537

Used in women with shortened cervix <2.5

Answer 538

Women with short cervix

Answer 539

Rupture before labor onset at any gestational age

Answer 540

Vaginal/cervical infections Abdominal membranes Incompetent cervix Nutritional defiencies

Answer 541

History! Loss of fluid and amniotic fluid in vagina

Answer 542

Sterile speculum

Answer 543

Pooling Nitrazine paper Ferning

Answer 544

Urine, semen, cervical mucous, blood, vaginitis

Answer 545

Remote PROM with no remaining fluid | Minimal leak

Answer 546

Barrier to infection preventing chirioamniotitis

Answer 547

Endomyometritis Sepsis Failed induction due to unfavorable cervix

Answer 548

Pulmonary hypoplasia and structural abnormalities from position

Answer 549

Oligohydramnios and no fluid is called anhydramnios

Answer 550

Continue preg until lung mature Assess lung maturity with vaginal poor of amniotic fluid Most deliver at 34 weeks

Answer 551

Maternal temp 100.4 Fetal maternal tachycardia Tender uterus Foul smelling amniotic fluid/purulent discharge

Answer 552

IV ampicillin and erythromycin 48 hours | Amoxicillin and erythromycin and amoxicillin 5 days

Answer 553

Reduce risk RDS up to 34 weeks

Answer 554

24 weeks start making surfactant

Answer 555

Phosphatidylinositol and phosphatidylglycerol from amniocentesis

Answer 556

Greater than 2 is mature Lecthicin increase rapidly after 35 weeks

Answer 557

Mature lungs

Answer 558

Lamellar body number density assessment 2 hours (6-12 for amniocentesis) More sensitive and predictive

Answer 559

Below the 10% for a given gestational age

Answer 560

Maternal, placental, fetal

Answer 561

``` Poor nutritional intake/maternal low body weight Smoking Drug abuse Alcoholism Cyanosis heart disease Pulmonary insuffiency Antiphospholipid syndrome Hereditary theomvophilias Collagen vascular disease ```

Answer 562

Insufficient substrate transfer through placenta as well defective trophoblast invasion

Answer 563

HTN, renal disease, placental or cord abnormalities such as velamentous cord, diabetes

Answer 564

Inadequate substrate -TORCH Congenital anomalies, multiple gestations, chromosomal abnormalities

Answer 565

PE fundal height US biometry Amniocentesis, percutaneous umbilical blood sampling Doppler studies

Answer 566

Serial fundal measurement is primary screening tool

Answer 567

HTN, renal disease, diabetes, drug abuse, antiphospholipid syndrome, lupus

Answer 568

Optimize disease processes

Answer 569

Decrease modifying factors-improve nutrition, sop smoking, bed rest Deliver before fetal compromise but after fetal lung maturity monitor: Non stress test twice weekly, biophysical profile, Doppler studies of umbilical artery

Answer 570

Patient lateral tilt position, the fetal heart rate is monitored with an external transducer. The tracing is observed for fetal heart rate accelerations that peak at least 15 beats per minute above the baseline and last 15 seconds from baseline to baseline. It may be necessary to continue the tracing for 40 min

Answer 571

All four US components normal

Answer 572

One or more episodes of rhythmis fetal breathing movements of 30 seconds or more within 30 mintues

Answer 573

Three or more discrete body or limb movements within 30 minutes

Answer 574

One or more episodes of extension of a fetal extremity with return to flexion or opening or closing of a hand

Answer 575

A single vertical pocket of amniotic fluid exceeding 2 cm is considered evidence of adequate

Answer 576

Vascular impedance Umbilical flow velocity waveform of normally growing fetuses is characterized by high velocity diastolic flow, whereas with intrauterine growth restriction, there is a dimunition of umbilical artery diastolic flow

Answer 577

US-if ok no intervention | US-abnormal intervene

Answer 578

Antenatal testing normal-continue pregnancy | Antenatal testing abnormal -delivery

Answer 579

Continue preg

Answer 580

May benefit Will need continuous fetal monitor

Answer 581

Monitor neonatal blood glucose bc these neonates have less hepatic glycogen stores Monitor respiratory status as respiratory distress syndrome is more common

Answer 582

Greater risk DM, HTN, atherosclerosis as adults

Answer 583

Over 42 weeks 10% with a 2-3x high perinatal mortality

Answer 584

Related to aging and infarction of the placenta Loss of subcutaneous fat, long fingernails, dry and peeling skin and abundant hair

Answer 585

Macrosomia, abnormal labor, shoulder dystocia and c section

Answer 586

Unsure dates, fetal adrenal hypoplasia, anencephalic fetuses, placental sulfatase defiency, extra uterine pregnancy

Answer 587

Begin antenatal testing to include twice weekly NST and biophysical profile If testing abnormal or oligohydramnios induce labor (AFI lesss than 5 cm)

Answer 588

Induction of labor Induction of labor at 41 weeks preferred plan

Answer 589

Intrauterine fetal demise Fetal death after 2 weeks but before onset of labor

Answer 590

Suspect if patient complains of absence of fetal movements or if unable to Doppler fetal tones Confirm by US with lack of fetal activity and absence of fetal cardiac activity

Answer 591

Only up till 28 weeks gestation, spontaneous labor will occur in 2-3 weeks of fetal demise

Answer 592

Most will require cervical ripeningwith prostagladin/laminaria/misoprostol/oxytocin

Answer 593

Patients with IUFD are at risk of disseminated intravascular coagulopathy: need to follow complete blood count, fibrinogen level, PT/PTT/INR

Answer 594

Open up cervix

Answer 595

Look for cause TORCH, parvovirus, listeria, anticardiolipin......

Answer 596

Greater risk reoccurrence

Answer 597

MI, cardiac failure, cerebral vascular accident, renal failure, hepatic failure

Answer 598

Fetal growth restriction, preterm birth, placental abruption, stillbirth, neonatal dearth

Answer 599

Systolic 130-129 or | Diastolic between 80-89

Answer 600

Systolic at least 140 or diastolic at least 90 mmHg

Answer 601

Present before or during 1st half of preg

Answer 602

After 20 weeks

Answer 603

Occurs after 20 weeks gestation and coexists with proteinuria

Answer 604

New onset seizure activity associated with preeclampsia

Answer 605

Transposed onto chronic HTN

Answer 606

Rule out causes Look for maternal end organ damage -CBC, glucose, complete metabolic profile, 24 hour urine collection for total protein, EKG Assess fetal wellbeing -US, screening , growth US monthly after 28 weeks, antepartum fetal testing to begin 32-34 weeks gestation

Answer 607

Initiate antihypertensive if reach threshold Visit every 2-4 weeks until 34-36 weeks and then weekly Antepartum fetal monitoring Deliver 39-40 weeks

Answer 608

Methyldopa, labetalol, nifedipine

Answer 609

24 hr urine collection

Answer 610

Growth US every 3-4 weeks | Nonstress tests and or biophysical profiles

Answer 611

After 20 weeks gestation 48-72 hrs after delivery Resolves by 12 weeks

Answer 612

HTN, proteinuria, edema

Answer 613

Scoroma, blurred vision, epigastric and/or right upper quadrant pain, HA

Answer 614

``` <20 >35 Primigravid Multiple gestation DM Thyroid HTN chronic Collagen vascular disease Antiphospholipid syndrome Highest of it ```

Answer 615

Cerebral edema

Answer 616

Absence of normal intravascular volume expansion reduction in circulating blood volume

Answer 617

Noncardiogenic pulmonary edema | -changes in colloid osmotic pressure, capillary endothelial integrity, and intravascular hydrostatic vessels

Answer 618

Sinusoidal fibrin depositio in periportal areas with surrounding hemorrhage and portal capillary thrombi Subscapularis hematoma-> liver rupture Stretching of glisson’s capsule results in right upper quadrant pain

Answer 619

Swelling and enlargement of glomerular capillary endothelial cells Narrowing of capillary lumen

Answer 620

Retinal vasospasm | Retinal edema

Answer 621

Proteinuria >300 mg/24 hr uring but less than 5 gm/24 hr or single specimen uring protein: cr ration of .3 mg/dL Asymptomatic

Answer 622

Proteinuria 5gm/24 hr or 3+ protein on two random urine dips at least 4 hours apart Oliguria from renal insuffiency Symptomatic-cerebral or visual, pulmonary edema, epigastric or right upper quadrant pain, elevated liver enzymes, thrombocytopenia

Answer 623

Renal insuffiency

Answer 624

HISTORY of htn or renal disease Address HA, ab pain, n/vom vaginal bleeding, vision

Answer 625

Brisk reflexes, clonus, edema

Answer 626

Increased hematocrit, LD, ALT AST, uric acid Thrombocytopenia (low paltelet0

Answer 627

Bed rest, 1 BPP or twice NST weekly antepartum testing Fetal growth US every 3-4 weeks Office visits and laboratory evaluation Possible hospitalization

Answer 628

If favorable cervix induction If unfavorable cervix use a cervical ripening agent to begin induction

Answer 629

Immediate hospitalization, delivery if greater than 34weeks Hydralazine, labetalol, nifedipine If less than 37 weeks administer corticosteroids and work towards delivery as long as patient and fetus are stable

Answer 630

Vaginal delivery Cervical ripening agents and pitocin as necessary Mg sulfate for seizure prophylaxis Pain management as with delivery useless thrombocytopenia then may not be able to receive an epidural

Answer 631

Loading dose for preeclampsia 4 gm Maintenance dose 2 gm/hr Therapeutic value 5-9 mg/dL

Answer 632

Loss patellar reflexes, respiratory paralysis, cardiac arrest

Answer 633

Calcium glucoronate

Answer 634

Prevent overload

Answer 635

1-3 per 1000 patients Most seizures 1-2 min and 24 hours before delivery

Answer 636

Protect airway is first

Answer 637

Mg sulfate

Answer 638

Hemolysis, elevated liver , low platelets Severe preeclampsia patients and 50 % eclampsia

Answer 639

Right upper quad pain, epigastric pain, n/v , HTN, proteinuria

Answer 640

Increase cAMP

Answer 641

Increase intracellular Ca | Promote interaction of actin and myosin causing uterine contractions

Answer 642

Upper segment-actively contracts and retracts to expel the fetus the lower segment-along with cervic becomes thinner and passive

Answer 643

Soft pliable, dilateble structure -these structural changes from collagenous is, incrase in hyaluronic acid, decrease in dermatan sulfate which favors increased water content

Answer 644

Regular uterine contraction of sufficient intensity, frequency, and duration to bring about demonstratable effacement and dilation of the cervix

Answer 645

Onset of contractions to full dilation of cervix

Answer 646

Full dilation of cervix to delivery of the infant

Answer 647

Delivery of the infant to delivery of placenta

Answer 648

Cervical softening and effacement occurs with minimal dilation

Answer 649

Starts when cervix is dilated to 4 cm This phase of labor includes both cervical dilation and ultimately, descent of the presenting fetal part Acceleration phase Deceleration phase

Answer 650

Slower than normal

Answer 651

Complete cessation of progress

Answer 652

Labor has not begun

Answer 653

Rates of dilation and descent exceed times of normal labor

Answer 654

Up to 20 hrs Up to 14 hrs

Answer 655

Without substantial cervical change Excessive use of sedatives or analgesics Fetal malposition

Answer 656

Rest | Morphine

Answer 657

Nulliparous 1 cm/hr | Multiparous 2 cm/hr

Answer 658

Less then what is expected

Answer 659

Arrest has occurred

Answer 660

No increased risk

Answer 661

Inadequate uterine activity Cephalopelvc disportion Fetal malposition Anesthesia

Answer 662

Difficult labor/dysfunctional labor

Answer 663

Power, passenger, passage

Answer 664

Not be made before an adequate trial of labor has been tried

Answer 665

Refers to stimulation of uterine contraction when spontaneous contraction have failed to result in progressice cervical dilation or descent of the fetus

Answer 666

Contractions less than 3-10 minute period and or intensity is less then 25 mmHg

Answer 667

Oxytocin After look at maternal pelvis, fetal position, station, maternal and fetal status

Answer 668

Soft plastic catheter placed transcervically Gives precise measurement of the intensity of the uterine contractions in mmHg

Answer 669

Membranes to be ruptured

Answer 670

Augment labor, allows assessment of meconium status

Answer 671

Cord prolapse, prolonged rupture is associated with chorioamnionitis

Answer 672

3 contractions in a 10 minutes period averaging 25 mmHg abover baseline

Answer 673

Calculated by measuring the peaks of contractions in mmHg in a 10 min period

Answer 674

For at least2 hours

Answer 675

Document adequate contractions at least for 4 hours

Answer 676

FDA approved medicine for labor stimulation

Answer 677

Stimulates uterine contractions | Increase intracellular Ca in

Answer 678

20-40 weeks

Answer 679

Disparity between the size of the maternal pelvis and the fetal head that preculdes vaginalis delivery CPD causes a failure of descent and sometimes engagement of the head Nulliparous women who present in labor wth an unengaged head indicate an increased likelihood of CPD

Answer 680

Pubis are how>90 Ischial tuberosity>8.5 Diagonal conjugate>11.5 Prominence of ischial spines

Answer 681

Vertex occiput anterior (OA

Answer 682

Fetal head enters and engage the maternal pelvis in occipitotransverse position then rotated to OA

Answer 683

Rotate to OP or stay OT

Answer 684

Also dystocia

Answer 685

No rotate to OA Caused by CPD, android or platypelloid pelvis, relaxed pelvic flood (epidural

Answer 686

Persistent OT position with arrest of descent for a period of 1 hr or more

Answer 687

Deflection positions the occipitofrontal diameter 11 cm becomes presenting diameter +1 +2 stations

Answer 688

11 cm Head deflected Seen in OT and OP

Answer 689

Oxytocin | Rotation manuallly or keilland forceps

Answer 690

Most go to OA in labor OP labor usually normal if not may have prolonged second stage , more back discomfort

Answer 691

Prolonged labor in second stage Delivery of head often occurs spontaneously Or operative vaginal delivery -vacuum or forceps

Answer 692

Over 4500 g | Account for 1.5% of births

Answer 693

Birth weight equal to or greater then 90% for a given gestational age

Answer 694

US imprescise

Answer 695

May cause enlargement of the head that makes vaginal delivery impossible Usually see with US

Answer 696

Immune. Hydrops Rh isoimmunization is most common Nonimmune hydrops-caused by congenital infections, chromosomal abnormalities or fetal arrhythmias

Answer 697

Baby a breech, baby b vertex

Answer 698

Power passage passenger

Answer 699

Birth weight >90% for gestational age

Answer 700

>4500 grams

Answer 701

Maternal diabetes, previous history, maternal pre preg obesity, weight gain, mulitparity, male fetus, >40 weeks, maternal birth weight, maternal height, maternal age <17 years , +50 g glucose screen with a negative 3 hr

Answer 702

C section Post partum hemorrhage and significant vaginal lacerations

Answer 703

Shoulder dystocia, fracture clavicle, damage to nerves of brachial plexus (c5, c6) resulting in era duschenne , brachial plexus injuries are rare and majority resolve without any permanent injury

Answer 704

Increase 21x

Answer 705

Upper arm palsy Most common brachial plexus injury C5 c6

Answer 706

Lower arm palsy | Damage c8-t1

Answer 707

All four nerve roots

Answer 708

Delivery that requires additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders

Answer 709

Impaction of the anterior fetal shoulder behind the maternal pubic symphysis or the impaction of the post shoulder on the sacral promontory

Answer 710

Retraction of the delivered fetal head against the maternal perineum

Answer 711

``` Fetal macrosomia Maternal diabetes Obesity Post term gestation Short stature Previous history macrosomia Previous history of shoulder dystocia ```

Answer 712

Labor induction Epidural analgesia Prolonged labor Operative vaginal deliveries

Answer 713

Erbs most common, klumpke, fractured clavicle or humerus, hypoxic, death

Answer 714

Hyperflexion and abduction of the maternal hips

Answer 715

May dislodge the impacted anterior shoulder Do not apply fundal pressure

Answer 716

Cephalic replacement, last resort, poor prognosis significant risk of fetal morbidity and mortality

Answer 717

Place pressure on an accessible shoulder to push it toward the anterior chest wall fo the fetus to decrease the bisacrominal diameter and free the impacted shoulder

Answer 718

Apply pressure behind the posterior to rotate the infant and dislodge he anterior shoulder

Answer 719

Last resort Fetal head manually returned to its prostitution position Slowly replaced int he vagina by steady upward pressure Delivery is by emergent c section

Answer 720

Obstetric emergency Call for help, team Can NOT be predicted or prevented and most accurate in absence of macrosomia

Answer 721

Mcroberts and suprapubic

Answer 722

Two separate ova are fertilized by two separate sperm Distinct pregnancies coexisting in same uterus Each have own amnion, chorion and placenta

Answer 723

Arise from cleavage of a single fertilized ovum at various stages during embryogenesis Arrangement of fetal membranes and placentas will depend on the time at which hte embryo divides

Answer 724

``` Scab 0-3 dichorionic dimniotic 4-8 days monochorionic diamniotic 9-12 monochorionic, monoamniotic >13 days conjoined twins ```

Answer 725

Monochorionic diamniotic

Answer 726

Monochorionic monoamniotic Not separating amnions Cord entanglement , mortality 50-80%

Answer 727

Joined at the cranium

Answer 728

Joined chest wall most common

Answer 729

Joined at the coccyx and sacrum

Answer 730

2x more likely after 35 Familyhistory Most spontaneous twins dizygotic

Answer 731

HCG higher than normal Uterus palpated larger Pregnancy has occured after ovulation induction or in vitro fertilization Confirmwith US

Answer 732

``` Congenital anomalies Weight discordance Twin twin transfusion syndrome Neurologic sequelae Preterm delivery Fetal demise ```

Answer 733

Diagnosing

Answer 734

Different fetal gender Visualization of a thick amnion chorion septum Peak or inverted V sign at the bae of the septum

Answer 735

Dividing membrane is fairly thin

Answer 736

Inspect placenta after delivery DNA analysis

Answer 737

Cleavage occurs 13-15 days 1 in 70,000 deliveries (ratio of females to males is 3:10 Mortality rates 50% C section Advancement of imaging allows mapping of shared organs and more successful surgical separation procedures Elective termination if cardiac or cerebral fusion is identified

Answer 738

90% occur in monochorionic twins Most common type is arterial arterial followed by arterial-venous and then venous venous Vascular communications between the 2 fetuses through the placenta can cause several problems -abortion polyhydramnios, TTTS, fetal malformations

Answer 739

Results secondary to uncompensated arterial-venous anastomoses in a monochorionic placenta -which leads to a net transfer of blood flow going from one twin to the other

Answer 740

Hypovolemia, hypotension, anemia, oligohydramnios, growth restriction

Answer 741

Hyperbole is, polyhydramnios rhomboids, HTN, polycythemia, edema, and cardiomegaly , congestive heart failure

Answer 742

Both twins are at risk of demise bc of heart failure

Answer 743

Smaller stuck appearance | Oligohydramnios

Answer 744

Larger Polyhydramnios Ascites

Answer 745

Serial amniocentesis with amniotic fluid reduction Laser photocoagulation of the anastomoses vessels on the placenta

Answer 746

Recipient twin being perfused in a reverse direction with poorly oxygenated blood fails to develop normally. It is known as acardiac twin (ACARDIAC)

Answer 747

Fully formed lower extremities | No anatomic structures cephalic of the abdomen

Answer 748

Primarily associated with monochorionic twins Absence of umbilical artery Velamentous umbilical cord insertions occur more frequently

Answer 749

Associated with renal agenesis

Answer 750

Incidence of single fetal death in utero up to 5% If gestation is 20 weeks or greater retained dead fetus syndrome can develop - disseminated intravascular coagulopathy in the mother - check platelets and fibrinogen levels weekly

Answer 751

Vanishing twin syndrome if gestation is <12 weeks and dead fetus reabsorbed

Answer 752

Polyhydramnios anemia, HTN, preeclampsia, gestational diabetes, preterm labro, c section, postpartum hemorrhage, uterine atony

Answer 753

Prematurity, malpresentaiton, placental previa, placental abruption, PROM, umbilical cord prolapse, IUGR, congenital, incrase perinatal morbidity and mortality

Answer 754

2 week office visits | US cervical length assessments

Answer 755

Cervical length of less than 25 mm at 24-28 weeks doubled the risk for premature birth in twins Serial US to check for intrauterine growth q 4-6 weeks begin at 24 weeks. Looking for discordant fetal growth —defined by a 20% reduction in fetal weight of the smallest fetus compared with the largest Antepartum testing testing (NSTs or weekly BPPs) Often patients will be placed on bed rest

Answer 756

Secondary to increase risk for lethal cord entanglement Hospitalization at 26 weeks, antenatal steroids, and fetal heart rate monitoring several times daily

Answer 757

35-36 weeks

Answer 758

Delivery room equipped for c section Large IV bore needle, blood products Capability to monitor fetal heart rates Anesthesiology US to determine precise presentations of the twins Two pediatricians/NICU personnel one for each Abby Nurses

Answer 759

Presenting twin is designated twin a and secondtwin b After delivery 1st cord clamped and cut Vaginal exam to assess station of second -second twin is at increased risk of cor prolapse, placental abruption and malpresentation Careful attention to fetal monitoring is necessary After seen twin delivers obtain cord samples and deliver placenta Be prepared for hemorrhage

Answer 760

Secondary to prematurity and congenital anomalies RDS, intracranial hemorrhage Birth asphyxia-second twin 2 x the perinatal mortality then the first born twin and are 4x more likely then first to die from birth trauma complications

Answer 761

2x more frequently then in singletones

Answer 762

Most in twins

Answer 763

Shorter and lighter until 4 years old

Answer 764

As number of fetus grow

Answer 765

Fetal butt or lower extremities presents into the maternal pelvis

Answer 766

Prematurity

Answer 767

US, Leopoldo, pelvic exam

Answer 768

Most common presentation Thighs flexed Lower extremities are extended at knees

Answer 769

Thighs are flexed | Lower extremities are flexed

Answer 770

1 or both thighs are extended | 1 or both feet are below the bout

Answer 771

Applying pressure to moms abdomen to turn the fetus in either a forward or backward somersault to achieve a vertex presentation

Answer 772

Placental previa Non reassuring fetal monitoring Oligohydramnios Previous uterine surgery that is contraindication for vaginal delivery

Answer 773

Hospital equipped for c section

Answer 774

``` NPO 7 hrs IV access Continuous monitor NST BPP Confirmbreech with US Consider tocolytics ```

Answer 775

``` Frank or complete >37 weeks 2500-4000 grams Fetal head flexed Adequate maternal pelvis No maternal or fetal contraindications for vag Anesthesia ```

Answer 776

All c section

Answer 777

NO aggressive traction can cause deflection of the fetal vertex and increase risk of head entrapment or nuchal arm entrapment

Answer 778

YES external rotation of each thigh combined with opposite rotation of the fetal pelvis restyles in flexion of the knee and delivery on the leg

Answer 779

When scapula appears under the symphysis. | The operator reache over the left shoudler , sweeps the arm across the chest and delivers the arm

Answer 780

Gentle traction maintain cephalic flexion by applying pressure on fetal maxilla NOT fetal mandible

Answer 781

Piper forceps

Answer 782

C section preferred esp pre term | Don’t want fetal asphyxia

Answer 783

Perinatal mortality higher than forvertex fetuses | Lethal congenital anomalies, prematurity, birth trauma and asphyxia are common

Answer 784

Presenting part of the fetus is between the facial orbits and anterior fontanelle - presenting diameter is the supraoccipitomental diameter - frontal bones are te point of designation

Answer 785

Usually to a face presentation through extension or vertex presentation throug flexion

Answer 786

Vaginal delivery impossible CSECTION

Answer 787

13. 5 | 9. 5

Answer 788

Fulle xtension of the fetal head and neck with occiput against upper back

Answer 789

1.500 Can be seen in frequently with fetal malformations -anencephaly is seenin 1/3 of face presentation

Answer 790

Most present mentum anterior and can deliver vaginally Can NOT deliver vaginally menum posterior presentation -will need to proceed with c section

Answer 791

12.6 cm | 9,5 cm

Answer 792

Fetal extremity found prolapsed alongside the presenting fetal part (head) Premature

Answer 793

Knowledgeable team for hemodynamically stability and correct cause 2 large bore IV Access vitals, bleeding, mental status

Answer 794

Known bleeding disorders, liver disease, anatomic abnormalities, and abnormal placentation

Answer 795

CBC and coagulation profile Serial H and H Type and crosmatch

Answer 796

Avoid until placenta previa has been ruled out by US

Answer 797

Genital lacerations or cervical lesions

Answer 798

Cervical dilation

Answer 799

US-placenta location, rsetnation of fetus | Amount of bleeding, maternal status, gestational age, continuous electronic fetal monitoring

Answer 800

Abortion ectopic clot

Answer 801

Placental abruption Placenta previa Uterine rupture Vasa previa

Answer 802

``` Bloody show labor Cervical polyps Infection Trauma Cancer vulvar varicosities Blood dyscrasia ```

Answer 803

Implantation of placenta over cervical os | Most common placental prob

Answer 804

Painless vaginal bleeding

Answer 805

Maternal age >35 Multiparity geation Cocaine smoking Prior previa, previous c section

Answer 806

Edge of the placenta extending to the margin of cervical os But does not cover the os

Answer 807

Partial occlusion of the cervical os by the placenta

Answer 808

Cervical os completely covered by the placenta Most serious type and is associated with greater blood loss

Answer 809

Painless bleeding at 30 weeks

Answer 810

Repeat US at 30 weeks

Answer 811

90% by 32-25 weeks by placental migration

Answer 812

Third trimester

Answer 813

Fetal maturation is goal Manage in hospital and bed rest and if bleeding stops cn go home but 70% recur bleed

Answer 814

C section if fetal lung maturity

Answer 815

C section immediately regardless of gestational age

Answer 816

Hospitalize, IV access 2 large bore needles if bleeding profuse H/H type and cross PT PTT fibrinogen RH neg-kleihauer-betke test, give rhogam if need

Answer 817

Serial blood draws , NPO statins, type and cross 4 units

Answer 818

Prior to 34 weeks give antenatal steroids (betamethasone) tocolysis can be used in stable

Answer 819

Abnormal firm attachment to the superficial lining of the myometrium Most common

Answer 820

Invades myometrium

Answer 821

Through the myometrium into the uterin serosa Least common

Answer 822

Previous c section C hysterectomy

Answer 823

Premature separation of the normally implanted placenta Most common third trimester bldeeding Painful bleeding, uterine tenderness, uterine hyperactivity, and fetal distress and/or death

Answer 824

Painful bleeding, uterine tenderness, uterine hyperactivity, fetal distress and /or death

Answer 825

Maternal HTN* Cocain Blunt trauma Polyhydramnios and multiparity Previous abruption

Answer 826

Painful vaginal bleeding, uterine tenderness and uterine hyperactivity and fetal distress or death US can detect, but better for previa

Answer 827

Monitor fetal and maternal condition s

Answer 828

Vaginal delivery—rapid delivery often ensues after abruption If remote from vaginal delivery with signs of fetal distress or uncontrolled bleeding proceed with c section

Answer 829

HostpiatIV access 2 large bore 16 guage if bleeding profusely H/H type and cross PT PTT fibrinogen, platelets RH neg consider kleihauer Bette test, give rhogam if indicated

Answer 830

Serial blood draws NPO status Type and cross 4 units

Answer 831

Prior to 34 weeks give antenatal steroids | Tocolysis can be used to stabilize

Answer 832

Extravasation of blood into the uterus | Causing red and purpl discoloration of the serosa

Answer 833

Complete separation of the uterine musculature through all layers

Answer 834

Spontaneous, traumatic ,associated ith previous uterine scar

Answer 835

Fetal mortality or permanent neurologic sequelae

Answer 836

Prior uterine incision Injudicious use of oxytocin Trauma External cehoali version Multiparity

Answer 837

Rupture associated with sudden onset of intense abdominal pain vaginal bleeding Abnormal fetal heart rate pattern of cessation of fetal heart tones Regression Fetal parts may be easily palpable on abdominal exam

Answer 838

Immediate laparotomy and delivery of fetus If feasible repair ruptured site If large rupture may have to do c section

Answer 839

C section Recurrence rate! Upper segment recurrent more common than lower though

Answer 840

Rupture fetal vessel secondary to velamentous insertion of umbilical cord

Answer 841

Rupture of fetal vessel

Answer 842

At a distance away from the placenta and its vessels must transverse between the chorion and amnion without the protective Wharton’s jelly

Answer 843

Unprotected vessels pass over the cervical os

Answer 844

Acute vaginal bleeding with a change in fetal heart rate .

Answer 845

Diagnose rapidly and proceed to delivery

Answer 846

>500 cc following vaginal birth | >1000 cc following a c section

Answer 847

In first 24 horus | Secondary to uterine atony

Answer 848

24 hours to 12 weeks | Can occur with subinvolution of the uterus, sloughing of the Escher or retained products

Answer 849

Postpartum hemorrhage

Answer 850

Uterine atony Retained placenta espicially accreta Defects in coagulation Uterine inversion

Answer 851

Subinvolution of placental site Retained products of conception Infection Inherited coagulation defects

Answer 852

``` Prolonged labor Augmented labor Precipitous laborhistory of postpartum hemorrhages Placental abruption Placental previa Vag delivery ```

Answer 853

Immediately preceding or after delivery of placenta Most PPH are due to it Excessive blood loss most commonly result when the uterus fails to contract after delivery of placenta. Palpation-boggy uterus

Answer 854

Enlargement of the uterus Abnormal labor Conditions which interfere with contraction of the uterus -leiomyoma and mg sulfate

Answer 855

The myometrium to comrpession the severed vessels(spiral arterioles and decidua veins)

Answer 856

Bimanual massage uterus Oxytocin, methylergovinins, hemabate, dinoprostone, misoprostol Uterine packing or large volume balloon catheter Interventional radiology Surgical measure/hysterectomy

Answer 857

Confirms diagnosis Boggy! Massage of the uterine corpus can dismiss bleeding, expel blood clots and allow time for other measured to be implemented

Answer 858

4 inch gauze layer back and forth from one course to other using sponge stick Large volume balloon

Answer 859

Patient has stable vitals and persistent bleeding may be a candidate for arterial embolization

Answer 860

Is last resort, if patient desires future fertility may try to lighten uterine arteries If unstable proceed with total abdominal hysterectomy

Answer 861

Trauma during delivery

Answer 862

Inspect for vaginal, perineal, periurethral and cervical lacerations Repair surgical

Answer 863

Most of secondary PPH have it -bleeding is secondary to inability of uterus to maintain a contraction and involuted normally around the placental tissue

Answer 864

Previous c section, leiomyoma, prior d and c, and accessory placenta lobe

Answer 865

Manual removal if bleeding is profuse +/- uterine curettage with or without US guidance be careful not to perforate

Answer 866

Top of fundus descends into the vagina and sometimes through the cervix -if occurs before placenta is delivered DO NOT remove placenta until inversion is corrected

Answer 867

Improper management of third stage

Answer 868

Copiousbleeding and hypovolemia shock

Answer 869

Anesthesiologist Manually replace the uterus Once replaced start oxytocin to cause the uterus to contract Rarely paratotomy

Answer 870

80% mortality rare | Caused by infusion of amniotic fluid into maternal circulation

Answer 871

Respiratory distress, intense bronchospasm, cyanosis, cardiovascular collapse, hemorrhage, coma

Answer 872

Respiratory support, correct the hypovolemia shock and replace coagulation factors

Answer 873

Inherited coagulopathy with prolonged bleeding times | Factor VIII defiency

Answer 874

Factor VIII concentrate or cryoprecipitate

Answer 875

Platelets function abnormally and have a shortened life span Causes thrombocytopenia an tendency to bleed Circulating antiplatelet antibodies of igg type can occasionally cross placenta resulting in fetal and neonatal thrombocytopenia

Answer 876

Require platelet concentration infusions

Answer 877

Following delivery women can develop a febrile morbidity

Answer 878

Temps100.4 or higher that occurs for more than 2 consequetive days during first 10 postpartum das

Answer 879

Endometriosis

Answer 880

Neutralizing effects of amniotic fluid, blood, and decreased population of lactobacilli -

Answer 881

Favors growth of aerobic organisms About 48 hours after delivery the endometrial and placental remnants produce a favorable intrauterine environment for the production of anaerobic bacteria

Answer 882

Anaerobic organisms Cocci, (peprostrep, peptococcus, streptococcus) Mixed with abcteriodes fragilis Aerobic-e coli

Answer 883

Poor nutrition and hygiene Anemia PROM Prolonged rupture of membranes Prolonged labor

Answer 884

Postpartum fever and increasing uterine tenderness on postpartum day 2 OT 3 are the key clinical findings -purulent lochia, child, malaise, anorexia

Answer 885

Careful history and physical | Extreapelvic causes of fever should be excluded

Answer 886

Antibiotic treatment Anaerobic coverage since more scommon Ampicillin and gentamicin Major pathogen resistant to this is bacteriodes fragilis, which is sensitive to clindamycin

Answer 887

Physiologic conditions for the pathogesis of thrombosis Endothelial damage, venous stasis, hypercoagulable state of preg

Answer 888

Fever and ab pain within 1 week after delivery or surgery

Answer 889

Fever, abdominal pain, localized to the side of the affected vein

Answer 890

Ovarian vein on radiography

Answer 891

Unlocalized fever int he first few days that is non responsive to antibiotcs

Answer 892

So not appear CLINCIALLY ill

Answer 893

No radiographically evidence of thrombosis | Diagnosis of exclusion

Answer 894

Anticoagulation is though to prevent further thrombosis Unfractioned heparin or low molecular weight heparin Discontinue after resolution of fever x 48 hrs

Answer 895

Anticoagulatnts 6 weeks | Repeat imaging to evaluate for persistence

Endo Repro Last Flashcards

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