Ectopic pregnancy lab values (2)
QhCG should rise at least 53% over 48H
progesterone less than 5
ectopic pregnancy medical over surgical tx? (4)
if less than 3.5 cm
QhCG less than 5000
no cardiac activity
unruptured
normal pregnancy TVUS findings (2)
gestational sac “double ring” at 5 wks.
fetal pole w/ heart activity at 5.5-6 weeks
Hydatidiform Mole imaging findings (2)
chorionic villi are a mass of clear vesicles
snowstorm on U/S
abn bleeding, enlarged uterus, absent heart tones, elevated QhCG, pre-eclampsia before 20 weeks
and these plus pulm/CNS findings?
hydatidiform mole
choriocarcinoma
parts of hyperemesis gravidarum (3)
and when do you see it
dehydration, ketonuria, wt loss
begins 1st trimester, usu. resolves before 20 weeks
when to screen for Rh
first visit & 26-28 weeks
who gets RhoGAM
Rh- mom
HELLP?
Hemolysis
Elevated Liver enzymes
Low Platelets
mild preeclampsia? severe preeclampsia?
> 140/90 & >300 mg/24h urine
> 160/100, >5 g/24h urine
most accurate IUGR screening
MCA doppler flow on US
components of BPP w/ UA doppler (5)
fetal tone movement breathing NST amniotic vol.
test w/ negative predictive value for acidosis in IUGR
nonstress test
1 hr OGTT result indicating a 3h OGTT?
> 130-140
high values on 3h OGTT (4)
1 hr: 180
2 hr: 155
3h: 140
any over 200
when to screen for gestational diabetes (2)
24-28 weeks w/ 1h OGTT
6 weeks postpartum w/ 2h OGTT
most common site of ectopic pregnancy
ampullary portion of fallopian tube
hallmark of gestational diabetes
insulin resistance
when does preterm labor occur
after 20 weeks but before 37 weeks
preterm labor lab?
fetal fibronectin: present at term but not at 22-35 weeks
if present: risk of preterm L&D
if not present: no labor for 2 weeks
preterm labor prevention (2)
smoking cessation
progesterone IM for pts w/ hx preterm labor. Start at 16-20 weeks and continue until 36 weeks
leading cause of 3rd trimester bleeding
placenta previa
acute painless bleeding in 2nd/3rd trimester
placenta previa
placenta previa diagnostics
abd US followed by confirmation w/ TVUS
bleeding and internal/external hemorrhage
abruptio placentae
vaginal bleeding on ROM w/ changes in fetal HR
vasa previa
vasa previa diagnostics (2)
U/S using color doppler Apt test (after the fact)
vasa previa treatment
corticosteroids
possible 3rd trimester hospitalization
Cesarian delivery at 35 weeks
risks assoc. w/ PPROM before 26 weeks (2)
fetal pulm. hypoplasia
limb positioning defects
PROM diagnostics (2)p
Nitrazine paper
Fern test
when does the quickening occur
18-20 weeks
16-18 weeks in multiple births
methods of dating the pregnancy (4)
uterus size
quickening- when does it occur
uterine fundus position at 20 weeks
first trimester US- most accurate
protraction disorder (3)
cervical dilation rate at less than 1 cm/hr or less than 1.2-1.5 cm/hr (nulli/multi)
latent phase longer than 20 or 14h (nulli/multiparous)
second stage longer than 3h w/ anesthesia or 2h w/o anesthesia
arrest disorder (2)
no cervical dilation in the active phase of labor for > 2 h
no descent after 1 hour pushing
breech treatment
external cephalic version at 36 weeks w/ tocolytics to relax the uterus
most common cause of cephalopelvic disproportion
contraction of the mid-pelvis
diagnosis of funic cord prolapse
palpitation of pulsatile mass
diagnosis of occult prolapse
fetal HR changes
how to relieve shoulder dystocia
McRobert’s manuever
early decelerations indicate
head compression
variable decelerations indicate
cord compression
late decelerations indicate
uteroplacental insufficiency
sign of fetal intolerance to labor
decelerations in fetal HR
risk factors that incr. risk of uterine rupture in VBAC (4)
vertical incision in uterus
> 2 prior cesarian deliveries
induction of labor (don’t use ptocin)
previous uterine rupture
definition of postpartum hemorrhage (2)
> 500 mL blood loss, vaginal birth
> 1000 mL blood loss, cesarian
most common cause of postpartum hemorrhage
uterine atony
how to diagnose postpartum hemorrhage (3)
10% decr. in HCT
need for transfusion
S&S of blood loss
diagnosing ovulatory function (2)
serum progesterone: > 3 ng/mL is evidence of recent ovulation. Measure 1 week prior to menses (day 21)
ultrasound: follows dominant follicle, most accurate
ovarian reserve diagnostics (2)
Anti-mullerian hormone: how many eggs are left. measured any time. less than 1 ng/mL indicates poor embryo quality, poor response to ovarian stimulation
FSH: measure on day 3 of cycle. greater than 20 indicates poor response
hysteroscopy use (2)
evaluate uterine cavity
diagnostic & therapeutic- can remove polyp
semen analysis values (3)
volume: below 1.5 mL is low
concentration: should be above 15 million
motility: at least 40% should be motile
low volume of sperm sample w/ few sperm indicates (2)
androgen deficiency
GU obstruction/absence of vas deferens
vaginal bleeding with a closed cervix
Threatened abortion
incomplete abortion is signified by?
persistent bleeding & cramping following passage
vaginal bleeding with an open cervix before 20 weeks
inevitable abortion
recurrent SAB is?
> 3 consecutive pregnancy losses
mifepristone use? (3)
not given after 9 weeks
PO, then buccal admin. 24-48h later
follow up US in 7 days
absent fetal heart tones, no cardiac activity on US, retained pregnancy
missed abortion
tx postabortive syndrome (2)
Methergine
D&C
lambda sign on US
dichorionic twins
T sign on US
monochorionic twins
