MTB 2 CK - Obstetrics Flashcards Preview

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Flashcards in MTB 2 CK - Obstetrics Deck (157):
1

Definition of embryo

Fertilization - 8 weeks

2

Definition of fetus

8 weeks - birth

3

Definition of infant

Birth to 1 yo

4

Developmental age

Number of days since fertilization

5

Gestational age

Number of days since LMP

6

Nagele rule

Est day of delivery by taking LMP - 3 mo + 7 d

7

First trimester def

Fert - 14 w GA

8

Second trimester def

14 w GA - 26 w GA

9

Third trimester def

26 w GA - delivery

10

Previable

Born before 24 w

11

Preterm

25-37 weeks

12

Early term

37 - 38.6

13

Full term

39 - 40.6

14

Late term

41 - 41.6

15

Postterm

42 w +

16

First sign of pregnancy on PE

Goodell sign (softening of cervix at 4 w)

17

Ladin sign

Softening of midline uterus at 6 w

18

Chadwick sign

Blue discoloration of vagina and cervix at 6-8 w

19

Chlosama

Mask of pregnancy on forehead, nose, and cheeks at 16 w

20

What makes B HCG

Placenta

21

When does BHCG peak

10 weeks

22

When should gestational sac be evident

5 w or BHCG of 1000-1500

23

Cardiology changes in pregnancy

Increased CO
Lower BP

24

What are GI changes in pregnancy

Morning sickness
GERD
Constipation

25

What are renal changes in pregnancy

Pyelo from ureter compression
Increased GFR
Decreased BUN/Cr

26

What are heme changes in pregnancy

Anemia
Hypercoagulability

27

What to do in first trimester

q4-6 week checks
US at 11-14 w (GA, nuchal trans)
FHR at end of first tri
Blood tests, Pap, GC
First tri noninvasive screen

28

How to confirm GA in first tri

US

29

What to do in second trimester

Triple or quad at 15-20
FHR
Quickening
US for fetal malformation

30

What is a triple screen

MSAFP
BHCG
Estriol

31

What is a quad screen

MSAFP
BHCG
Estriol
Inhibin A

32

High MSAFP

Dating error
Neural tube defect
Abdominal wall defect

33

What to do in third trimester

q2-3 w visits until 36 w, qweekly >36
At 37 w, examine cervix qvisit
27 w CBC
24-28 w glucose load
36 week repeat GC, do GBS

34

What is glucose load test

Give 50 g glucose and check after 1 hr

35

What is glucose tolerance test

Get fasting glucose
Give 100 g glucose
Check at 1, 2, 3 hours
(Elevation at any 2 is GDM)

36

How to interpret 3rd tri CBC

If hgb

37

When to get glucose tolerance test

If load >140 at 1 h

38

What is chorionic villus sampling

10-13 week for fetal karyotype

39

What is amnio

11-14 week for fetal karyotype

40

What is fetal blood sampling

Perc umb blood sample for Rh isoimm

41

Most common site of ectopic pregnancy

Ampulla

42

Risk factors for ectopic pregnancy

PID
IUD
Previous ectopic

43

Pres ectopic pregnancy

Unilateral pelvic pain
Vaginal bleeding
Hypotx if ruptured

44

How to dx ectopic

BHCG
US
Laparoscopy

45

Tx ectopic preg

If HDUS, IVF and immediate surgery
If stable, CBC, type and screen, LFTs, BHCG then methotrexate

46

How to follow medical treatment of ectopic pregnancy

Follow BHCG for 15% decrease in 4-7 d
If none, second dose methotrexate
If not decreasing after second dose, surgery

47

Who shouldn't get methotrexate

Immunodeficiency
Noncompliant
Liver dz
>3,5 cm ectopic
Fetal heartbeat can be heard

48

Sfx methotrexate

Hepatotox

49

Surgery in ectopic

Salpinostomy (preserves tube)
Salpingectomy (no preservation)

50

Definition of abortion

Pregnancy that ends before 20 weeks

51

Cause of abortions

Csomal abnormalities >>>
Anatomic abnormalities
STDs
Immunological factors (APL)
Endocrine factors
Malnutrition
Trauma
Rh isoimm

52

Pres abortion

Crampy pain
Vaginal bleeding

53

How to dx abortion

CBC
Blood type and Rh screen
US

54

Complete abortion

No products of conception
Office f/u

55

Incomplete abortion

Some products of conception
D&C, medical

56

Inevitable abortion

Products of conception intact but IU bleeding and cervical diln
D&C, medical

57

Threatened abortion

Products of conception intact but IU bleeding
Bed rest

58

Missed abortion

Death of fetus with products in uterus
D&C, medical

59

Septic abortion

Infection of uterus and surrounding area
D&C and IV Abx

60

Medical treatment of abortion

Misoprostol

61

Who should receive Rhogam

Rh negative moms that have trauma

62

First clue for multiple gestations

High BHCG and MSAFP

63

Complications of multiple gestations

Spontaneous abortion of one
Premature L&D
Placenta previa
Anemia

64

Risk factors for premature labor

PROM
Multiple gestations
Previous preterm labor
Placental abruption
Uterine abnls
Infx
PreE
Intrabdominal surgery

65

When should premature labor not be stopped with tocolysis

Severe HTN
Cardiac dz
Diln >4 cm
Maternal hemorrhage
Fetal death
Chorio

66

What are some tocolytics

Mag sulfate
CCB
Terbutaline

67

Sfx mag

Flushing
HA
Diplopia
Fatigue

68

Sfx CCB

HA
Flushing
Dizzy

69

Sfx terb

Palps
Hypotx

70

Monitor mag

DTRs frequently

71

How to confirm amniotic fluid

Pool
Nitrazine paper = blue
Fern

72

WHat is PPROM

Early and >24 h

73

Complications of PROM

Preterm labor
Cord prolapse
Abruption
Chorio

74

Manage PROM

Chorio = deliver
No chorio, at term = wait 6-12 h for spont delivery, then induce
Preterm = steroids, tocolytics, ampicillin and azithro x 1 (cefazolin or clinda if allergic)

75

What increases the risk of placenta previa

Previous C sections
Previous uterine surgery
Multiple gest
Previous previa

76

First step in third tri bleeding

TRANSABDOMINAL US (DO NOT DO DIGITAL VAGINAL EXAM OR TRANSVAGINAL US)

77

Pres of placenta previa

Painless vaginal bldg

78

When to tx previa

Large volume bldg
Drop hct

79

How to tx previa

Strict pelvic rest

80

When to deliver in previa

>4 cm diln
Severe hemorrhage
Fetal distress

81

Risk factors for abruption

HTN
Prior abruption
Cocaine
External trauma
Smoking

82

Pres of abruption

Third tri bleeding
Severe pain
Ctx
Possible fetal distress

83

Complications of concealed abruption

DIC
Uterine tetany
Fetal hypoxia, death
Sheehan

84

Do C section in abruption with

Uncontrolled hemorrhage
Rapidly expanding concealed hem
Fetal distress
Rapid separation

85

Do vaginal delivery in abruption with

Limited separation
Reassuring FHR
Extensive separation with dead fetus

86

Risk factors for uterine rupture

C section
Trauma
Myomectomy
Polyhydramnios
Multiple gestations
Placenta percreta

87

Pres of uterine rupture

Extreme abdominal pain
Abnl bump in abdomen
No ctx
Regression of fetus (moving away from vagina)

88

Tx uterine rupture

Immediate LAPAROTOMY

89

Cause of Rh incompatibility

Rh negative mom with Rh positive baby

90

How to screen for Rh incompatibility

If Rh negative, check antibody titer for sensitization

91

What does Rh incompatibility cause

Hemolytic dz of newborn

92

What is hemolytic dz of newborn

Fetal anemia
Extramedullary prodn of RBCs (HSM)
High hgb and bilirubin
Erythroblastosis fetalis (CHF)

93

How to manage Rh incomp

If unsensitized, give Rhogam at 28 weeks and at delivery if baby is positive
If sensitized, get titer, if >1:16, serial amnio for bili
If high bili, do IU transfusion

94

Chronic HTN in preg

>140/90 before 20 week GA

95

How to tx chronic HTN in preg

Methyldopa
Labetalol
Nifedipine

96

Gest HTN in preg

>140/90 after 20 week GA with no proteinuria or edema

97

Risk factors for preE

Chronic HTN
Renal dz

98

Difference btwn mild and severe preE

140/90 vs 160/110
1-2+ (300mg) vs 3-4+ (5g)
Facial, hand, feet edema vs generalized
Normal mental status vs changes
No vision changes vs yes
No LFT changes vs yes

99

What is eclampsia

TC seizure in preE

100

Manage mild preE

Deliver if at term
BMZ and Mag if preterm

101

Manage severe preE

Deliver if at term
Mag and hydralazine if preterm to stabilize, BMZ and mag if can't stabilize

102

What is HELLP

Hemolysis
Elevated liver enzymes
Low platelets

103

Comps of pregestational DM

PreE
Spont abt
Increased infx
Increased postpartum hem
More congenital problems
Macrosomia/dystocia
Preterm labor

104

Addl tests to do in pregest DM

EKG
24 h Cr
A1C
Optho exam

105

Fetal testing needed in pregest DM

32-36 w: Weekly NST and US
>36 w: Weekly NST, BPP
37 w: L/S ratio

106

What is the definition of IUGR

Weight in the bottom 10%

107

What does symmetric IUGR baby look like

Brain in proportion with rest of body

108

When does symmetric IUGR occur

Before 20 w

109

What does asymmetric IUGR baby look like

Brain weight is not decreased (big head)

110

When does asymmetric IUGR occur

After 20 w

111

What are causes of IUGR

Chromosomal abnormalities
Neural tube
Infx
Multiple gestation
Renal dz

112

Complications of IUGR

Premature labor
Stillbirth
Fetal hypoxia
Low IQ
Seizures
MR

113

What is the definition of macrosomia

4500 g

114

Risk factors for macrosomia

Maternal DM
Maternal obesity
Postterm pregnancy

115

When to do an US for larger than expected fundal height

>3 cm

116

Complications of macrosomia

Dystocia
Birth injuries
Low Apgars
Hypoglycemia

117

How to manage macrosomia

If lungs are mature, IOL before 4500g
If >4500g, C section

118

What is a reactive NST

2 fetal movements
Acceleration >15 bpm lasting 15-20 seconds within 20 mins

119

What to do if NST is nonreactive

VIbroacoustic stimulation

120

What is BPP

NS
Fetal chest expansion (1x in 30 min)
Fetal movement (>3 in 30 mins)
Flexion of an extremity
AFI

121

What is normal BPP

>8

122

What is normal fetal HR

110-160

123

What is fetal bradycardia

124

What is fetal tachycardia

>160

125

Cause of early decels

Head compressions

126

Cause of variables

Cord compression

127

Cause of late decels

Hypoxia

128

What is lightening

Fetal descent to pelvic brim

129

What is bloody show

Bloody mucus released with cervical effacement

130

How long should phase 1 last

Primip: 6-18
Multip: 2-10

131

How long should latent phase last

6-7, 4-5

132

How long should active phase last

1 cm/h
1.2 cm/h

133

How long should stage 2 last

30 min - 3 h
5-30 min

134

How long should stage 3 last

30 min

135

Signs of placenta separation

Fresh vaginal bleeding
Umb cord lengthening
Uterine fundus rising
Uterus becoming firm

136

Meds for IOL

Prostaglandin E2 for cervical ripening
Oxytocin

137

Who to avoid prostaglandin E2 in

Asthma

138

What defines arrest of cervical dilation

No dilation for >2 h

139

What defines a prolonged latent stage

>20 h for primip
>14 h for multip

140

What causes prolonged latent stage

Sedn
Unfavorable cervix
Uterine dysfx with irreg/weak ctx

141

Tx prolonged latent stage

Rest and hydration

142

What defines protracted cervical dilation

143

Causes of protracted cervical diln

Power
Passenger
Passage

144

Tx protracted cervical diln

C section or oxytocin

145

What is arrest of fetal descent

No descent for 1 h

146

What causes arrest disorders

Cephalopelvic disproportion
Malpresentation
Excessive sedn/anesthesia

147

First step in presumed breech

US

148

What are Leopold manuevers

Estimate fetal wt and presenting parts

149

What is frank breech

Hips are flexed with extended kneew

150

What is complete breech

Hips and knees are flexed

151

What is footling breech

Feet first

152

When can you perform cephalic version

After 36 weeks

153

Steps of tx shoulder dystocia

McRoberts (flexion of knees, suprapubic pressure)
Rubin (push posterior shoulder toward fetal head)
Woods (push posterior shoulder toward fetal back)
Deliver posterior arm
Fracture clavicle
Zavanelli (push head back in)

154

What defines PPH

>500 ml

155

What defines early vs late PPH

24 h

156

Risk factors for atony

Anesthesia
Uterine overdistension
Prolonged labor
Lac
Retained placenta
Coagulopathy

157

Tx PPH

Bimanual exam for rupture, retained placental
If normal, bimanual compression and massage
Oxytocin