MTB - Obstetrics Flashcards
(234 cards)
1
Q
3 things that suggest pregnancy?
A
amenorrhea
enlargement of uterus
+ urine B-hcg
2
Q
when can you see a gestational sac?
A
4-5 weeks by transvaginal USG
3
Q
level of B-HCG when you can see a gestational sac
A
1500 mIU/ml
4
Q
fetal heart movement first seen on USG
A
5-6 weeks
5
Q
fetal heart tones first heard by doppler
A
8-10 weeks
6
Q
CCS TIP - when you have a newly diagnosed pregnant patient, what should you always order?
A
pregnancy counselling
ORDER icon: “counsel patient, pregnancy”
7
Q
finding of anemia - first tri labs
A
Hb < 10 g/dL
most reliable indicator in pregnancy = MCV
8
Q
MCC of anemia in pregnancy
A
iron deficiency
9
Q
pregnant pt with LOW Hb and LOW MCV
A
give iron
- if anemia does not improve, test for thalassemia
10
Q
pregnant pt with LOW Hb, high MCV, high RDW
A
give folate
11
Q
when should you give RhoGAM to pregnant pts?
A
to RH negative mothers:
- at 28 weeks after first rescreening
- after any procedure (CVS, amniocentesis)
- after delivery
12
Q
Tx of asymptomatic bacteriuria in pregnancy
A
Nitrofurantoin - if before 30 weeks
Cephalosporins
Amoxicillin
13
Q
a pregnant pt is rubella IgG ab negative - when should you vaccinate her?
A
after delivery
- do NOT give rubella vaccine during pregnancy
14
Q
pregnant pt has positive HbsAg - what test should you order next?
A
HBeAg
- signifies highly infectious state
15
Q
tx. of syphillis in pregnancy
A
IM penicillin
- if allergic, desensitize and then tx with penicillin
16
Q
tx. pf Chlamydia/gonorrhea in pregnancy
A
PO azithromycin + IM ceftriaxone
alternative: PO amoxicillin
17
Q
tx. of Bacterial Vaginitis in pregnancy
A
PO metronidazole or clindamycin PO
18
Q
tx. of trichomonas vaginalis in pregnancy
A
PO metronidazole
19
Q
MCC of abnormal serum MS-AFP
A
gestational dating error
20
Q
first test to order if abnormal serum MS-AFP
A
USG
21
Q
inhibin A
A
made by placenta during pregnancy, remains constant during 15-18th week
- elevated in DOWNs
22
Q
what is the triple marker screen and when should you order it?
A
between 15-20 weeks gestation
MS-AFP
B-hcg
Estriol
23
Q
causes of increased MS-AFP
A
neural tube defects ventral wall defects twin pregnancy placental bleeding renal disease saccrococcygeal teratoma
24
Q
causes of decreased MS-AFP
A
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
