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Flashcards in Learnin on the Job Deck (40)
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1

Normal days in a menstrual cycle

Normal is 26-35

So 14 yo/31 days/5 days is normal...

2

3 risks of oxytocin

1. tachysystole
-baby doesn't have enough time to recover btwn contractions bc uterus doesnt fully contract

2. severe hyponatremia
-2/2 oxytocin cross-reactivity w/ ADH receptors

3. neonatal hyperbilirubinemia

3

4 steps of resuscitation when you see a category 2 fetal heart tracing

3 things to increase blood flow to the baby (by increasing O2 to mother)

1. turn mother on side: decrease compression of IVC
2. IV fluid bolus (increase volume)
3. O2 face mask (controversial)
4. hold any augmentation (ex: pit)

4

What is a modified BPP?

Modified BPP = AFI + NST

Modified biophysical profile = measure amniotic fluid index and do nonfetal stress test

5

List the normal values for a OGTT

OGTT: give 100g load
fasting: under 95
1 hr: 180
2 hr: 155
3 hr: 140

6

Differentiate the two steps of induction of labor

1. Cervical ripening
-evaluate w/ Bishop score (favorable if over 6)
Agents: foley balloon, cytotec, cervidel

2. Augmentation of labor w/ Pit + AROM

7

Define a category III fetal heart tracing

Absent variability w/ repetitive variables OR repetitive late decels, or fetal bradycardia (under 110) or sinusoidal pattern

8

What is a prolonged decel?

Becomes a prolonged tracing (decel/accel) after lasting for over 2 minutes

If lasts over 10 minutes = change in baseline

9

Describe augmentation of labor
-when indicated
-2 mechanisms

Augmentation of labor: once cervix is favoriable (Bishop over 6)

1. Pit
2. AROM
-extremely effective in multips

10

Lab abnormalities seen in infants born to GDM mothers

hypoglycemia
hypocalcemia
hyperbilirubinemia (jaundice)

11

Define a fetal heart rate acceleration

15 bpm above baseline for 15+ seconds

If under 32 weeks: 10bpm above baseline for 10+ seconds

12

Key measure of fetal pH status

FHR variability in the single best indicator of fetal acidemia

13

Where is AFP produced?

Towards end of pregnancy- AFP almost primarily produced by the fetal liver

14

GDMA2 at 38 wks w/ well controlled diabetes- what is the delivery plan?

Expectant management- if GDM is well controlled, don't need to have a different than usual birth plan

15

Differentiate the 3 cervical ripening agents

1. foley balloon- mechanically dilate to 3/4 cm to cause endogenous release of prostaglandins
-only method indicated in TOLAC

2. exogenous PGE1 = Cytotec (misoprostol)
-tab placed vaginally

3. exogenous PGE2 = Cervidel (Dinoprostol)
-benefit that it is on a string

Both 2/3 are contraindcated in TOLAC pts 2/2 increased risk of uterine rupture

16

Risk of uterine rupture w. TOLAC

W. One prior c section- risk of uterine rupture is 1%

17

Risk of post-term delivery to the fetus

The placenta expires! Calcifies => increased risk of fetal demise

18

Define a category I fetal heart tracing

Normal baseline HR (110-160) w/ moderate variability (6-25)
-w/ OR w/o accels (don't need accels!)
-NO late or variable decels (but there can be earlys!!)

19

Goal blood glucose levels for GDM

Goals:
fasting under 95, 2 hr postprandial under 120

20

List the normal values for a GCT

GCT (glucose challenge test) = GDM screening test

50g load: considered positive if one hr later blood glucose is over 130-140

21

Why is methergine contraindicated in pts w/ h/o HTN?

B/c methergine is a vasoconstrictor => could cause crazy high dangerous BP

22

Name the exact criteria for diagnosis of PCO

Rotterdan's criteria: 2 of 3 = PCO
1. clinical evidence of hyperandrogenism
2. ultrasound finding of PCO (ex: pearl necklace- aka tons of follicles that haven't been ovulated)
3. abnormal menstrual cycle

23

Quad screen results associated w/ gastrochiesis

Elevated AFP, normal beta-hCG estriol and inhibin A

24

Quad screen results associated w/ increased risk of trisomy 21

(a) Another test to confirm quad screen results

Down's: low AFP, elevated beta-hCG, low estriol, high inhibin A

(a) Do nucchal thickness, thicker nuccal translucency associated w/ Downs

25

Give some etiologies of uterine size being larger than predicted for gestational age

-error in measurement (medical student measured...)
-polyhydramnios
-twins
-fibroids (often grow during pregnancy)
-fetal macrosomia
-full bladder

26

What do the different types of decelerations indicate?

Early decels = fetal head compression
-mirror image of contractions, seeing compression of ICP

Late decels = sign of uteroplacental insufficiency => most concerning

Variable decels = umbilical cord compression

27

Mother at 24 weeks p/w GBS UTI, when do you retest for colonization?

You don't, GBS UTI is considered colonization => treat as GBS+ and don't need to retest

28

When do we treat GBS? Why then?

Give penicillin for GBS+ at labor- no point in treating mother earlier, b/c mother is colonized and she'll just recolonize

29

While responding to an obstetric hemorrhage team- why is it relevant is the pt had preeclampsia?

Preeclamptics don't have nearly as large an increase in their blood volume during pregnancy => they tolerate a smaller amount of blood loss

Ex: Preeclamptic F may increase blood volume by only 10-20% (instead of the average 50%), so a EBL of 1,200L may cause much more severe consequences

30

Etiologies of AFP elevation

Elevated maternal serum AFP:
-neural tube defects
-abdominal wall defects: gastrochiesis (no sac) and omphalocele (sac)
-anything that increases fluid around baby: esophageal atresia etc