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Flashcards in MTB - Obstetrics Deck (234):
1

3 things that suggest pregnancy?

amenorrhea
enlargement of uterus
+ urine B-hcg

2

when can you see a gestational sac?

4-5 weeks by transvaginal USG

3

level of B-HCG when you can see a gestational sac

1500 mIU/ml

4

fetal heart movement first seen on USG

5-6 weeks

5

fetal heart tones first heard by doppler

8-10 weeks

6

CCS TIP - when you have a newly diagnosed pregnant patient, what should you always order?

pregnancy counselling
ORDER icon: "counsel patient, pregnancy"

7

finding of anemia - first tri labs

Hb < 10 g/dL
most reliable indicator in pregnancy = MCV

8

MCC of anemia in pregnancy

iron deficiency

9

pregnant pt with LOW Hb and LOW MCV

give iron
- if anemia does not improve, test for thalassemia

10

pregnant pt with LOW Hb, high MCV, high RDW

give folate

11

when should you give RhoGAM to pregnant pts?

to RH negative mothers:
1. at 28 weeks after first rescreening
2. after any procedure (CVS, amniocentesis)
3. after delivery

12

Tx of asymptomatic bacteriuria in pregnancy

Nitrofurantoin - if before 30 weeks
Cephalosporins
Amoxicillin

13

a pregnant pt is rubella IgG ab negative - when should you vaccinate her?

after delivery
- do NOT give rubella vaccine during pregnancy

14

pregnant pt has positive HbsAg - what test should you order next?

HBeAg
- signifies highly infectious state

15

tx. of syphillis in pregnancy

IM penicillin
- if allergic, desensitize and then tx with penicillin

16

tx. pf Chlamydia/gonorrhea in pregnancy

PO azithromycin + IM ceftriaxone
alternative: PO amoxicillin

17

tx. of Bacterial Vaginitis in pregnancy

PO metronidazole or clindamycin PO

18

tx. of trichomonas vaginalis in pregnancy

PO metronidazole

19

MCC of abnormal serum MS-AFP

gestational dating error

20

first test to order if abnormal serum MS-AFP

USG

21

inhibin A

made by placenta during pregnancy, remains constant during 15-18th week
- elevated in DOWNs

22

what is the triple marker screen and when should you order it?

between 15-20 weeks gestation
MS-AFP
B-hcg
Estriol

23

causes of increased MS-AFP

neural tube defects
ventral wall defects
twin pregnancy
placental bleeding
renal disease
saccrococcygeal teratoma

24

causes of decreased MS-AFP

trisomy 21
trisomy 18

25

triple marker screen - Trisomy 21

low MS-AFP
low Estriol
high B-HCG

26

triple marker screen - Trisomy 18

all three low

27

dates are normal, MS-AFP is high - what do you order next?

amniocentesis for:
- AF-AFP level
- acetylcholinesterase activity

28

dates are normal, MS-AFP is low - what do you order next?

amniocentesis for:
- karyotyping

29

elevated levels of amniotic fluid - acetylcholinesterase activity are specific for...

open NTD

30

screen for diabetes in pregnancy

24-28 weeks: 1 hr - 50 g OGTT
abnormal result (i.e. > 140 mg/dL): f/u with 3 hr - 100 g OGTT

31

RhoGAM is not indicated in...

RH neg. women who have developed anti-D ab's
RH pos. women

32

GBS screening in pregnancy

at 35-37 weeks (Vaginal and rectal culture)

33

tx. of positive GBS result

intrapartum antibiotics
- IV penicillin G
- if allergic: IV clindamycin or erythromycin

34

abnormal 3 hr- OGTT results

1 hr = > 180 mg/dL
2 hr = > 155 mg/dL
3 hr = > 140 mg/dL

35

safe to use in pregnancy - anti-emetics

doxylamine
metoclopramide
ondansetron
promethazine
pyridoxine (vit B6)

36

painful late vaginal bleeding

abruptio placenta OR uterine rupture

37

painless late vaginal bleeding

placenta previa OR vasa previa

38

signs of fetal compromise on fetal monitoring (esp. with bleeding)

late decelerations and/or bradycardia

39

CCS - initial steps in management of LATE PREGNANCY BLEEDING

- patient's vitals
- place external fetal monitor
- start IVF with normal saline

40

CCS - what labs should you order in LATE PREGNANCY BLEEDING

CBC
DIC workup - platelets, PT, PTT, fibrinogen, D-dimer
type and cross-match
obstetric ultrasound - r/o previa

41

CCS - further steps in management of late pregnancy bleeding

1. if large volume blood loss = transfusion
2. place foley catheter, measure UO
3. perform vag. exam to r/o lacerations
4. schedule delivery if fetus is in jeopardy or GA > 36 weeks

42

a patient presents with late pregnancy bleeding - what should you NEVER do?

never place a speculum or perform digital exam BEFORE getting an USG to r/o placenta previa

43

sudden onset vaginal bleeding in a pregnant patient with severe, constant pelvic pain - dx?

abruptio placenta

44

RF - abruptio placenta

HTN
trauma - MVA
tobacco, cocaine use
uterine distension

45

suddent onset painless vaginal bleeding that may occur at rest or with minimal activity; the bleeding usually stops on its own - dx.

placenta previa
- low implantation of placenta on or near the cervical os in lower uterine segment

46

RF for placenta previa

prior C/S
grand multiparities
multigravida
prior hx. of previa

47

placenta accreta

does not penetrate entire thickness of enometrium

48

placenta increta

extends further into the myometrium

49

placenta percreta

placenta penetrates the entire myometrium and uterine serosa

50

patient comes in with rupture of membranes, painless vaginal bleeding and fetal bradycardia - dx?

vasa previa

51

vasa previa

velamentous cord insertion results in umbilical cord vessels crossing the placental membranes over the cervix; if membranes rupture, fetal vessels are torn leading to blood loss from fetal circulation

52

first step in management in vasa previa

emergency c-section!

53

pregnant pt presents with sudden onset abdominal pain and vaginal bleeding; she had a prior C/S and currently, her baby has bradycardia and its head is recessed; there are no uterine contractions

uterine rupture

54

GBS meningitis

hospital acquired infection - occurs after first week of life; unrelated to vertical transmission

55

tx. of positive GBS screen at 34-38 weeks

IV intrapartum penicillin
allergic? IV cefazolin, clindamycin or erythromycin

56

who should receive GBS prophylaxis?

1. positive culture at anytime in pregnancy
2. high risk factors:
- preterm
- ROM > 18 hours
- maternal fever
- previous baby with GBS sepsis

57

who should NOT get GBS prophylaxis?

1. planned C/S w/o rupture of membranes
2. culture positive previous pregnancy, but culture negative in current pregnancy

58

classic triad of congenital toxoplasmosis

chorioretinitis
intracranial calcifications
hydrocephalus

59

tx. if mother has primary toxoplasma infection

spiramycin
- given to prevent vertical transmission

60

IgM and IgG toxoplasma are positive - what should you check?

IgG avidity
high = r/o gestational infection
low = recent exposure

61

Tx. of serologically confirmed fetal/neonatal toxoplasma infection

pyrimethamine and sulfadiazine

62

at what time is the fetus at highest risk if mother has primary varicella infection?

between 5 days antepartum and 2 days postpartum

63

neonatal varicella infection

zigzag skin lesions
limb hypoplasia
microcephaly
microphthalmia
chorioretinitis
cataracts

64

post exposure prophylaxis of varicella infection in pregnancy

VariZAG (ab) or VZIG w/in 10 days of exposure
- attentuates the clinical effects of the virus

65

Tx. maternal varicella

VariZAG to mother and neonate

66

Tx. congenital varicella

VariZAG and IV acyclovir to neonate

67

congenital rubella syndrome

congenital deafness
heart defects - PDA
cataracts
hepatosplenomegaly
thrombocytopenia
blueberry muffin rash

68

MC congenital viral syndrome

congenital CMV

69

MCC of sensorineural deafness in children

CMV

70

Manifestations of congenital CMV infection

IUGR, prematurity
microcephaly
jaundice
petechiae
hepatosplenomegaly
periventricular calcifications
chorioretinitis
pneumonitis

71

Tx. congenital CMV infection

antiviral therapy - ganciclovir
- prevents viral shedding and prevents hearing loss but does not cure infection

72

precautions for active HSV infection in woman in labour

1. scheduled C/S
2. do not use fetal scalp electrodes for monitoring (increased risk of HSV transmission)

73

Tx. of primary HSV infection in pregnancy

acyclovir

74

drug therapy in HIV positive pregnant woman

- triple therapy for mom
- IV intrapartum ZDV
- combination ZDV-based ART for 6 weeks after delivery for baby

75

what other prophylactic treatment should an infant born to an HIV positive mother be given?

TMP-SMX prophylaxis of pneumocystic pneumoniae (continue for 6 weeks after ART therapy has completed)

76

when should an HIV positive pregnant woman have a C-section?

at < 38 weeks unless her viral load is < 1000 copies/ml

77

CF: early acquired congenital syphillis

non-immune hydrops fetalis
maculopapular/vesicular peripheral rash
anemia, thrombocytopenia, hepatosplenomegaly
large, edematous placenta

78

late acquired congenital syphillis

diagnosed after age 2
- Hutchinson teeth
- mulberry molars
- saber shins
- deafness (CN 8 palsy)

79

case describes a woman with painless genital ulcer - what test should you order?

darkfield microscopy
- VDRL or RPR will be falsely negative

80

which maternal infections are contra-indications to breast feeding?

HIV
active tuberculosis
HTLV-1
HSV - if there is a lesion on breast

81

which disease present in infant is a C/I to breast feeding?

galactosemia

82

if mom is found to be HBsAb negative....

give active immunization in pregnancy

83

post exposure prophylaxis of HBV

HBIG - passive immunization

84

chronic gestational HTN

history of elevated BP before pregnancy or diagnosis before 20 weeks gestation

85

gestational HTN

BP develops > 20 weeks gestation and returns to normal baseline by 6 weeks post partum
- MC in multifetal pregnancy

86

mild pre-eclampsia

1. sustained BP > 140/90
2. proteinuria of 1-2+ (dipstick) or > 300 mg/24 hr

87

severe pre-eclampsia

1. sustained BP > 160/110
2. proteinuria of 3-4+ (dipstick) and > 5 g/24 hr
3. presence of warning signs

88

warning signs in pre-eclampsia

headache
epigastric pain
changes in vision
pulmonary edema

89

RF: severe pre-eclampsia

primiparas - most at risk
multiple gestation
hydatidiform mole
diabetes mellitus
age extremes
chronic HTN
chronic renal disease

90

chronic HTN with superimposed pre-eclampsia

chronic HTN with increasingly severe HTN, proteinuria and/or warning signs

91

eclampsia

unexplained grand mal seizures in a hypertensive and/or proteinuric pregnant patient in last half of pregnancy

92

HELLP syndrome

hemolysis
elevated liver enzymes
low platelets

93

what tests should you order in suspected Eclampsia

CBC, Chem 12, coagulation, LFTs, urinalysis with urinary protein, DIC panel

94

Tx. of acutely elevated BP in preeclampsia/eclampsia

IV hydralazine or labetalol

95

which HTN/ heart failure drugs should be avoided in pregnancy?

thiazide diuretics
ACE inhibitors
aldosterone antagonists

96

first line therapy for maintenance of HTN in pre-eclampsia

methyldopa
2nd = BB (labetalol, atenolol)

97

s/e of using BB in pregnancy

IUGR

98

Tx. of HELLP syndrome

delivery
IV steroids if platelets < 100,000
transfusion if platelets < 20,000 (50,000 and c/s)
IV Mg sulfate

99

MC time that peripartum cardiomyopathy occurs

last month of pregnancy to 5 months post-partum

100

RF for peripartum cardiomyopathy

multiparity
age> 30
multiple gestations
preeclampsia

101

management of arrhythmias in pregnancy

continue rate control
do NOT give amiodarone or warfarin

102

which type of valvular diseases have an increased risk of maternal/fetal morbidity and mortality

stenotic lesions
- regurgitant lesions are usually well tolerated, no tx. required

103

mitral stenosis in pregnancy has an increased risk of...

pulmonary edema
atrial fibrillation

104

leading cause of maternal death in USA

pulmonary embolus

105

when should you give anticoagulation to a pregnant woman on the usmle?

- DVT or PE
- A. fib with underlying heart disease
- antiphospholipid syndrome
- severe HF (EF < 30)
- Eisenmenger syndrome

106

anticoagulant of choice in pregnancy

LMWH
- does not cross placenta and does not cause osteopenia like unfractionated heparin

107

management scheme for pregnant pts with either DVT/PE in previous pregnancy or known thrombophillic condition...

LMWH prophylaxis during pregnancy
unfractionated heparin during labour
warfarin 6 weeks post partum

108

effects of hyperthyroidism on fetus

fetal growth restriction and still birth

109

effects of hypothyroidism on fetus

intellectual defects in offspring
miscarriage

110

DOC for hypothyroidism in pregnancy

levothyroxine
- increase dose by 25-30% in pregnant pts

111

DOC for sx. hyperthyroidism in pregnancy

Beta blockers

112

DOC for Grave's disease in pregnancy

PTU
- crosses the placenta and may cause goiter and hypothyroidism in fetus

113

routine monitoring for diabetic pregnant patients

HbA1c
triple marker screen at 16-18 weeks
monthly sonograms
monthly BPP
weekly NST and AFI at 32 weeks

114

what do you need to order if HbA1c is elevated in first trimester?

- targeted USG at 18-20 weeks (structural anomalies)
- fetal ECHO at 22-24 weeks (congenital heart disease)

115

when should NSTs and AFIs start at 26 weeks in a diabetic mother?

- presence of small vessel disease
- poor glycemic control

116

in gestational DM - when and what test do you order to see if it has resolved?

2 hour 75g OGTT, 6-12 weeks post-partum

117

what HbA1c level correlated with congenital malformations?

levels > 8.5% in first trimester
- impossible to get with gestational DM

118

blood glucose control in diabetic pt during labour

maintain between 80-100 mg/dL on an insulin drip and 5% dextrose infusion; turn off any insulin after delivery (insulin resistance decreases rapidly as the placenta is delivered)

119

neonatal complications of DM

- hypoglycemia
- hypocalcemia (PTH synthesis failure)
- polycythemia (hypoxia)
- hyperbilirubinemia (excessive neonatal RBC breakdown)
- RDS (delayed surfactant production)

120

CF: intractable nocturnal pruritus on palms and soles of feet with no skin findings in a pregnant women

intrahepatic cholestasis of pregnancy

121

RF: intrahepatic cholestasis of pregnancy

European descent - genetics
multiple pregnancies

122

Dx. intrahepatic cholestasis of pregnancy

10-100 fold increase in serum bile acids

123

Tx. intrahepatic cholestasis of pregnancy

ursodeoxycholic acid

124

Pregnant woman presents with HTN, proteinuria and edema; she has N/V and anorexia. Labs show elevated LFTs, hyperbiliruibinemia, DIC, hypoglycemia and increased serum ammonia - diagnosis?

acute fatty liver of pregnancy

125

tx. acute fatty liver of pregnancy

ICU admission for aggressive IVF and prompt delivery

126

Tx. asymptomatic bacteriuria and acute cystitis in pregnancy

Nitrofurantoin
alt. cephalexin, amoxicillin

127

Tx. pyelonephritis in pregnancy

admission, IVF
IV cephalosporins or gentamycin
tocolysis

128

complications of pyelonephritis in pregnancy

preterm labour/delivery
sepsis
anemia
pulmonary dysfunction

129

definition: SAB

non-elective expulsion of an embryo/fetus < 500 g or < 20 weeks gestation

130

fetal demise

in utero death of a fetus > 20 weeks gestation

131

threatened abortion

mild bleeding and cramps
closed cervix
no POC expelled

132

first step in management of early pregnancy bleeding

speculum exam

133

tx. threatened abortion

avoid heavy activity
pelvic and bed rest

134

inevitable abortion

painful cramps, continued bleeding
open cervical os
no POC expelled yet

135

tx. inevitable abortion

emergency suction D&C

136

missed abortion

loss of early pregnancy sx
closed cervical os
no fetal cardiac activity
retained POC

137

tx. missed abortion

allow up to 4 weeks for POC to pass
offer: misoprostol, D&C

138

incomplete abortion

bleeding, cramping
open cervical os
some POC expelled, some retained (intrauterine debris on USG)

139

tx. incomplete abortion

emergency suction D&C

140

tx. complete abortion

no D&C needed
- serial B-hcg until negative to make sure ectopic pregnancy has not been missed

141

MCC of SAB

chromosomal abnormalities

142

RF for fetal demise

antiphospholipid syndrome
overt maternal DM
maternal trauma
severe maternal isoimmunization
fetal infection

143

CCS TIP: what should you always order in pt presenting with intrauterine fetal demise

coag studies -->platelet count, D-dimers, fibrinogen, PT and PTT (look for signs of DIC)

144

MC first trimester abortion

D&C
- performed by 13 weeks of gestation

145

complications of first trimester abortion

endometritis (outpatient abx) and/or retained POC (repeat curretage)

146

medical abortion

oral mifepristone (P4 antagonist) or
oral misoprostol (PGE1 analog)
- only first 63 days of amenorrhea

147

what type of sepsis can occur in medical abortions?

Clostridium sordellii

148

MC 2nd trimester abortion

D&E

149

complications of D&E

retained placenta or tissue
uterine perforation
hemorrhage
infection
DIC

150

delayed complications of therapeutic abortions i.e. D&E

cervical trauma
cervical insufficiency

151

girl presents with amenorrhea, vaginal bleeding and unilateral pelvic pain

ectopic pregnancy!

152

amenorrhea, vaginal bleeding, abdominal guarding/rigidity, hypotension and tachycardia

ruptured ectopic pregnancy

153

RF: ectopic pregnancy

hx. of PID
prior ectopic pregnancy
tubal/pelvic surgery
DES exposure in utero
IUD use

154

when can u first see a normal intrauterine pregnancy on transvaginal USG

5 weeks gestation
serum B-hcg approx. > 1500

155

when can you first see a normal intrauterine pregnancy on transabdominal USG

6 weeks gestation
serum B-hcg approx. > 6500

156

indications for MTX treatment of ectopic pregnancy

size < 3.5 cm
not ruptured
B-HCG < 6000
No hx of folic acid supplementation
absence of fetal heart motion

157

RF: cervical insufficiency

2nd trimester abortion
cervical laceration during delivery
deep cervical conization
DES exposure in utero

158

prior to putting in a cerclage - what should you do?

R/O chorioamnionitis and labour

159

elective cerclage placement?

can be done at 13-16 weeks gestation in pts with > 3 unexplained midtrimester pregnancy losses

160

when can you suspect IUGR clinically?

when difference between fundal height and GA is > 4 cm

161

symmetric IUGR with decrease in all measurements on USG - cause? etiology?

cause = fetal
etiology: aneuploidy, infections, structural anomalies

162

asymmetric IUGR with decreased abdominal size but normal head measurements

can be maternal or placental causes
- all result in decreased placental perfusion

163

maternal causes of asymmetric IUGR

HTN
small vessel disease
malnutrition
tobacco, alcohol, drugs

164

placental causes of asymmetric IUGR

infarction
abruption
twin-twin transfusion
velamentous cord insertion

165

definition: IUGR

estimated fetal weight < 5-10% for GA
- must have accurate early pregnancy dating

166

definition: macrosomia

EFW > 90-95% percentile for GA or birth weight of 4000-4500g

167

RF for macrosomia

GDM/overt DM
prolonged gestation
obesity
multiparity
male fetus

168

sterile speculum exam in PROM

posterior fornix pooling
nitrazine test positive (blue)
ferning

169

diagnosis of chorioamnionitis

1. maternal fever and uterine tenderness
2. fetal tachycardia
3. foul smelling amniotic fluid - confirmed PROM
4. absence of URI or UTI

170

tx of PROM if chorio is present

get cultures
IV abx: ampicillin +/- erythromycin
schedule delivery regardless of GA

171

tx of PROM, no infection, < 24 weeks

bed rest at home

172

tx. of PROM, no infection, 24-33 weeks

hospitalize
IM betamethasone - lung maturation (< 32 weeks)
cervical cultures
prophylactic ampicillin and erythromycin for 7 days
tocolysis - ritodrine, terbutaline, Mg2+

173

tx of PROM, no infection, > 34 weeks

admit, manage expectantly (initiate delivery)

174

definition: stage 1 (latent phase) labour

onset of regular contractions until acceleration of cervical dilation

175

duration: stage 1 (latent phase) labour

primi: < 20 hours
multipara: < 14 hours

176

definition: adequate uterine contraction

every 2-3 minutes, lasts 45-60s and has 50 mmHg intensity

177

prolonged latent (Stage 1) labour

no cervical change in 20h/14h or cervix dilated < 3 cm
caused by analgesia

178

definition: stage 1 (active phase) labour

acceleration of cervical dilation to 10 cm dilated
> 1.2 cm/hour (primi) or > 1.5 cm/hour (multi)

179

prolongation of active phase of labour

cervical dilation of < 1.2 cm/hour or < 1.5cm/hour in multipara

180

arrest of active phase of labour

no cervical change in > 2 hours

181

causes of prolonged/arrested active phase of labour

abnormalities in:
1. passenger (fetal size/presentation)
2. pelvis
3. power (dysfxnal contractions)

182

tx of hypotonic contractions

IV oxytocin

183

tx of hypertonic contractions

morphine sedation

184

arrest of active phase but adequare contractions - tx.

emergency C/S

185

stage 2 labour (descent)

10 cm dilation until delivery of baby
< 2hours primi
< 1 hour multi
+ 1 hour if epidural given

186

management of second stage labour arrest

fetal head engaged --> trial of forceps or vaccuum
fetal head not engaged --> emergency C/S

187

stage 3 labour (expulsion)

from delivery of baby to delivery of placenta
< 30 min

188

umbilical cord prolapse - mngmt

NEVER replace the cord
knee-chest position, elevate presenting part
IV terbutaline
immediate C/S

189

baseline fetal HR

110-160 bpm

190

fetal tachycardia

> 160 bpm
- B-agonist medications: terbutaline, ritodrine

191

fetal bradycardia

< 110 bpm
- B-blockers, local anesthetics

192

FHR accelerations

abrupt increases in FHR < 2 min long, unrelated to contractions --> response to fetal movement and are reassuring

193

FHR early decelerations

gradual decreases in FHR that begin and end simultaneously with contractions
cause: fetal head compression

194

FHR variable decelerations

abrupt decreases in FHR unrelated to contractions
cause: umbilical cord compression
- indicate fetal acidosis if severe

195

FHR late decelerations

gradual decreases in FHR and delayed in relation to contractions
cause: uteroplacental insufficiency
all late decels are non-reassuring

196

normal FHR variability

6-25 bpm
absence of variability is non-reassuring sign

197

first steps in response to non-reassuring fetal tracings

1. discontinue medications
2. follow w/ IV saline and high flow O2
3. change position - left lateral

198

when do you obtain a fetal scalp pH

when EFM tracing is non-reassuring and does not improve with initial steps

199

when is forceps/vacuum assissted delivery the option?

1. prolonged 2nd stage
2. non-reassuring EFM in absence of C/I
3. avoid maternal pushing if mom has cardiac or pulmonary conditions

200

indications for C/S

1. cephalopelvic disproportion (failure to progress/arrest)
2. fetal malpresentation
3. non-reassuring EFM strip
4. placenta previa
5. infection - maternal HIV or active HSV
6. uterine scar (myomectomy or classical C/S)

201

external cephalic version

if baby is in transverse or breech lie; best time to try is 37 weeks

202

MCC of postpartum hemorrhage

uterine atony

203

causes of uterine atony

rapid/protracted labour
chorioamnionitis
medications - MgSO4, halothane
overdistended uterus

204

diagnosis of uterine atony

palpation of large, boggy uterus

205

management of uterine atony

uterine massage
uterotonic agents --> oxytocin, methylergonovine (if not hypertensive), carboprost (if not asthmatic)

206

retained placenta

assoc. with accessory placental lobe or abnormal uterine invasion [placenta accreta/increta/percreta] (suspect if any missing cotyledons), placenta previa, prior C/S

207

management of retained placenta

manual removal or uterine curretage under USG guidance

208

DIC post partum is most commonly assoc. with

abruptio placenta
severe preeclampsia
amniotic fluid embolism
prolonged retention of dead fetus

209

when should you suspect DIC post partum

generalized oozing/bleeding from IV or lac. sites in presence of contracted uterus

210

uterine inversion

beefy-appearing bleeding mass in vagina w/ failure to palpate uterus --> replace manually followed by IV Oxytocin

211

postpartum urinary retention

is RV > 250 ml, give bethenachol; if this fails, catheterize

212

what is the only contraception that can be started right after delivery?

progestin only contraception i.e. mini-pill, depo, implanon
- it is also safe to use in breastfeeding

213

when can you give combined OCP to women post-partum?

min. 3 weeks after delivery (increased risk of DVT etc
not used in breastfeeding women - decrease lactation

214

when can a diaphragm or IUD be placed post-partum?

at 6 week post-partum visit

215

maternal factors for C/S

any prior C/S
maternal infection - HSV
cervical carcinoma
maternal trauma/demise

216

fetal and maternal factors for C/S

cephalopelvic disproportion
placenta previa
placental abruption
failed operative vaginal delivery

217

fetal factors for C/S

fetal malposition
fetal distress
cord prolapse
RH incompatability

218

postpartum fever - day 0

atelectasis
- mild fever, mild rales
- pt is unable to take deep breaths

219

management of postpartum atelectasis

incentive spirometry
ambulation

220

postpartum fever - day 1

UTI
- high fever, CVA tenderness, positive urinalysis and culture

221

management of postpartum UTI

single agent antibiotics

222

postpartum fever day 2-3

endometritis
- uterine tenderness, no peritoneal signs

223

tx. postpartum endometritis

multiple agent IV antibiotics ex. gentamycin + clindamycin

224

post-partum fever day 4-5

wound infection
- persistent spiking fever despite antibiotics
- wound erythema, fluctuance or drainage

225

tx. postpartum wound infection

IV antibiotics
wet-to-dry wound packing

226

postpartum fever day 5-6

septic thrombophlebitis
- persistent wide fever swings despite antibiotics

227

tx. postpartum septic thrombophlebitis

IV heparin for 7 days

228

postpartum fever days 7-21

mastitis
- unilateral breast tenderness, erythema and edema

229

tx. mastitis

PO cloxacillin
continue breast feeding or expressing milk
incision and drainage if abscess

230

papular uriticarial papules and plaques of pregnancy

pruritic erythematous papules within striae gravidarum; may involve extremities

231

herpes gestationis

urticarial plaques, papules and vesicles surrounding the umbilicus; not caused by herpes (thought to be autoimmune)

232

Tx. herpes gestationis

topical corticosteroids
may give oral antihistamines to alleviate pruritic symptoms

233

main complication of CVS

tranverse limb anomaly
- greatest risk > 9 weeks GA, lowest > 11 weeks GA

234

management of superior sagittal thrombosis in pregnancy

heparin
- even if area of hemorrhagic infarction is seen on CT