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MTB - Obstetrics Flashcards

1
Q

3 things that suggest pregnancy?

A

amenorrhea
enlargement of uterus
+ urine B-hcg

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2
Q

when can you see a gestational sac?

A

4-5 weeks by transvaginal USG

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3
Q

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

A

1500 mIU/ml

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4
Q

fetal heart movement first seen on USG

A

5-6 weeks

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5
Q

fetal heart tones first heard by doppler

A

8-10 weeks

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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”

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7
Q

finding of anemia - first tri labs

A

Hb < 10 g/dL

most reliable indicator in pregnancy = MCV

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8
Q

MCC of anemia in pregnancy

A

iron deficiency

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9
Q

pregnant pt with LOW Hb and LOW MCV

A

give iron

- if anemia does not improve, test for thalassemia

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10
Q

pregnant pt with LOW Hb, high MCV, high RDW

A

give folate

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11
Q

when should you give RhoGAM to pregnant pts?

A

to RH negative mothers:

  1. at 28 weeks after first rescreening
  2. after any procedure (CVS, amniocentesis)
  3. after delivery
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12
Q

Tx of asymptomatic bacteriuria in pregnancy

A

Nitrofurantoin - if before 30 weeks
Cephalosporins
Amoxicillin

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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

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14
Q

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

A

HBeAg

- signifies highly infectious state

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15
Q

tx. of syphillis in pregnancy

A

IM penicillin

- if allergic, desensitize and then tx with penicillin

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16
Q

tx. pf Chlamydia/gonorrhea in pregnancy

A

PO azithromycin + IM ceftriaxone

alternative: PO amoxicillin

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17
Q

tx. of Bacterial Vaginitis in pregnancy

A

PO metronidazole or clindamycin PO

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18
Q

tx. of trichomonas vaginalis in pregnancy

A

PO metronidazole

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19
Q

MCC of abnormal serum MS-AFP

A

gestational dating error

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20
Q

first test to order if abnormal serum MS-AFP

A

USG

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21
Q

inhibin A

A

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

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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

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23
Q

causes of increased MS-AFP

A 
neural tube defects
ventral wall defects
twin pregnancy
placental bleeding
renal disease
saccrococcygeal teratoma
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24
Q

causes of decreased MS-AFP

A

trisomy 21

trisomy 18

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25
Q

triple marker screen - Trisomy 21

A

low MS-AFP
low Estriol
high B-HCG

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26
Q

triple marker screen - Trisomy 18

A

all three low

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27
Q

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

A

amniocentesis for:

  • AF-AFP level
  • acetylcholinesterase activity
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28
Q

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

A

amniocentesis for:

- karyotyping

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29
Q

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

A

open NTD

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30
Q

screen for diabetes in pregnancy

A 
24-28 weeks: 1 hr - 50 g OGTT
abnormal result (i.e. > 140 mg/dL): f/u with 3 hr - 100 g OGTT
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31
Q

RhoGAM is not indicated in…

A

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

RH pos. women

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32
Q

GBS screening in pregnancy

A

at 35-37 weeks (Vaginal and rectal culture)

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33
Q

tx. of positive GBS result

A

intrapartum antibiotics

  • IV penicillin G
  • if allergic: IV clindamycin or erythromycin
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34
Q

abnormal 3 hr- OGTT results

A

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

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35
Q

safe to use in pregnancy - anti-emetics

A 
doxylamine
metoclopramide
ondansetron
promethazine
pyridoxine (vit B6)
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36
Q

painful late vaginal bleeding

A

abruptio placenta OR uterine rupture

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37
Q

painless late vaginal bleeding

A

placenta previa OR vasa previa

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38
Q

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

A

late decelerations and/or bradycardia

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39
Q

CCS - initial steps in management of LATE PREGNANCY BLEEDING

A
  • patient’s vitals
  • place external fetal monitor
  • start IVF with normal saline
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40
Q

CCS - what labs should you order in LATE PREGNANCY BLEEDING

A

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

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41
Q

CCS - further steps in management of late pregnancy bleeding

A
  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
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42
Q

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

A

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

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43
Q

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

A

abruptio placenta

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44
Q

RF - abruptio placenta

A

HTN
trauma - MVA
tobacco, cocaine use
uterine distension

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45
Q

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

A

placenta previa

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

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46
Q

RF for placenta previa

A

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

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47
Q

placenta accreta

A

does not penetrate entire thickness of enometrium

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48
Q

placenta increta

A

extends further into the myometrium

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49
Q

placenta percreta

A

placenta penetrates the entire myometrium and uterine serosa

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50
Q

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

A

vasa previa

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51
Q

vasa previa

A

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

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52
Q

first step in management in vasa previa

A

emergency c-section!

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53
Q

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

A

uterine rupture

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54
Q

GBS meningitis

A

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

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55
Q

tx. of positive GBS screen at 34-38 weeks

A

IV intrapartum penicillin

allergic? IV cefazolin, clindamycin or erythromycin

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56
Q

who should receive GBS prophylaxis?

A
  1. positive culture at anytime in pregnancy
  2. high risk factors:
    - preterm
    - ROM > 18 hours
    - maternal fever
    - previous baby with GBS sepsis
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57
Q

who should NOT get GBS prophylaxis?

A
  1. planned C/S w/o rupture of membranes

2. culture positive previous pregnancy, but culture negative in current pregnancy

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58
Q

classic triad of congenital toxoplasmosis

A

chorioretinitis
intracranial calcifications
hydrocephalus

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59
Q

tx. if mother has primary toxoplasma infection

A

spiramycin

- given to prevent vertical transmission

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60
Q

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

A

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

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61
Q

Tx. of serologically confirmed fetal/neonatal toxoplasma infection

A

pyrimethamine and sulfadiazine

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62
Q

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

A

between 5 days antepartum and 2 days postpartum

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63
Q

neonatal varicella infection

A 
zigzag skin lesions
limb hypoplasia
microcephaly
microphthalmia
chorioretinitis
cataracts
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64
Q

post exposure prophylaxis of varicella infection in pregnancy

A

VariZAG (ab) or VZIG w/in 10 days of exposure

- attentuates the clinical effects of the virus

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65
Q

Tx. maternal varicella

A

VariZAG to mother and neonate

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66
Q

Tx. congenital varicella

A

VariZAG and IV acyclovir to neonate

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67
Q

congenital rubella syndrome

A 
congenital deafness
heart defects - PDA
cataracts
hepatosplenomegaly
thrombocytopenia
blueberry muffin rash
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68
Q

MC congenital viral syndrome

A

congenital CMV

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69
Q

MCC of sensorineural deafness in children

A

CMV

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70
Q

Manifestations of congenital CMV infection

A 
IUGR, prematurity
microcephaly
jaundice
petechiae
hepatosplenomegaly
periventricular calcifications
chorioretinitis
pneumonitis
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71
Q

Tx. congenital CMV infection

A

antiviral therapy - ganciclovir

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

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72
Q

precautions for active HSV infection in woman in labour

A
  1. scheduled C/S

2. do not use fetal scalp electrodes for monitoring (increased risk of HSV transmission)

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73
Q

Tx. of primary HSV infection in pregnancy

A

acyclovir

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74
Q

drug therapy in HIV positive pregnant woman

A
  • triple therapy for mom
  • IV intrapartum ZDV
  • combination ZDV-based ART for 6 weeks after delivery for baby
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75
Q

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

A

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

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76
Q

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

A

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

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77
Q

CF: early acquired congenital syphillis

A

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

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78
Q

late acquired congenital syphillis

A

diagnosed after age 2

  • Hutchinson teeth
  • mulberry molars
  • saber shins
  • deafness (CN 8 palsy)
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79
Q

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

A

darkfield microscopy

- VDRL or RPR will be falsely negative

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80
Q

which maternal infections are contra-indications to breast feeding?

A

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

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81
Q

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

A

galactosemia

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82
Q

if mom is found to be HBsAb negative….

A

give active immunization in pregnancy

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83
Q

post exposure prophylaxis of HBV

A

HBIG - passive immunization

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84
Q

chronic gestational HTN

A

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

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85
Q

gestational HTN

A

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

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86
Q

mild pre-eclampsia

A
  1. sustained BP > 140/90

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

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87
Q

severe pre-eclampsia

A
  1. sustained BP > 160/110
  2. proteinuria of 3-4+ (dipstick) and > 5 g/24 hr
  3. presence of warning signs
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88
Q

warning signs in pre-eclampsia

A

headache
epigastric pain
changes in vision
pulmonary edema

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89
Q

RF: severe pre-eclampsia

A 
primiparas - most at risk
multiple gestation
hydatidiform mole
diabetes mellitus
age extremes
chronic HTN
chronic renal disease
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90
Q

chronic HTN with superimposed pre-eclampsia

A

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

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91
Q

eclampsia

A

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

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92
Q

HELLP syndrome

A

hemolysis
elevated liver enzymes
low platelets

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93
Q

what tests should you order in suspected Eclampsia

A

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

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94
Q

Tx. of acutely elevated BP in preeclampsia/eclampsia

A

IV hydralazine or labetalol

95
Q

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

A

thiazide diuretics
ACE inhibitors
aldosterone antagonists

96
Q

first line therapy for maintenance of HTN in pre-eclampsia

A

methyldopa

2nd = BB (labetalol, atenolol)

97
Q

s/e of using BB in pregnancy

A

IUGR

98
Q

Tx. of HELLP syndrome

A

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

99
Q

MC time that peripartum cardiomyopathy occurs

A

last month of pregnancy to 5 months post-partum

100
Q

RF for peripartum cardiomyopathy

A

multiparity
age> 30
multiple gestations
preeclampsia

101
Q

management of arrhythmias in pregnancy

A

continue rate control

do NOT give amiodarone or warfarin

102
Q

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

A

stenotic lesions

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

103
Q

mitral stenosis in pregnancy has an increased risk of…

A

pulmonary edema

atrial fibrillation

104
Q

leading cause of maternal death in USA

A

pulmonary embolus

105
Q

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

A
  • DVT or PE
  • A. fib with underlying heart disease
  • antiphospholipid syndrome
  • severe HF (EF < 30)
  • Eisenmenger syndrome
106
Q

anticoagulant of choice in pregnancy

A

LMWH

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

107
Q

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

A

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

108
Q

effects of hyperthyroidism on fetus

A

fetal growth restriction and still birth

109
Q

effects of hypothyroidism on fetus

A

intellectual defects in offspring

miscarriage

110
Q

DOC for hypothyroidism in pregnancy

A

levothyroxine

- increase dose by 25-30% in pregnant pts

111
Q

DOC for sx. hyperthyroidism in pregnancy

A

Beta blockers

112
Q

DOC for Grave’s disease in pregnancy

A

PTU

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

113
Q

routine monitoring for diabetic pregnant patients

A 
HbA1c
triple marker screen at 16-18 weeks
monthly sonograms
monthly BPP
weekly NST and AFI at 32 weeks
114
Q

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

A
  • targeted USG at 18-20 weeks (structural anomalies)

- fetal ECHO at 22-24 weeks (congenital heart disease)

115
Q

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

A
  • presence of small vessel disease

- poor glycemic control

116
Q

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

A

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

117
Q

what HbA1c level correlated with congenital malformations?

A

levels > 8.5% in first trimester

- impossible to get with gestational DM

118
Q

blood glucose control in diabetic pt during labour

A

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
Q

neonatal complications of DM

A
  • hypoglycemia
  • hypocalcemia (PTH synthesis failure)
  • polycythemia (hypoxia)
  • hyperbilirubinemia (excessive neonatal RBC breakdown)
  • RDS (delayed surfactant production)
120
Q

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

A

intrahepatic cholestasis of pregnancy

121
Q

RF: intrahepatic cholestasis of pregnancy

A

European descent - genetics

multiple pregnancies

122
Q

Dx. intrahepatic cholestasis of pregnancy

A

10-100 fold increase in serum bile acids

123
Q

Tx. intrahepatic cholestasis of pregnancy

A

ursodeoxycholic acid

124
Q

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?

A

acute fatty liver of pregnancy

125
Q

tx. acute fatty liver of pregnancy

A

ICU admission for aggressive IVF and prompt delivery

126
Q

Tx. asymptomatic bacteriuria and acute cystitis in pregnancy

A

Nitrofurantoin

alt. cephalexin, amoxicillin

127
Q

Tx. pyelonephritis in pregnancy

A

admission, IVF
IV cephalosporins or gentamycin
tocolysis

128
Q

complications of pyelonephritis in pregnancy

A

preterm labour/delivery
sepsis
anemia
pulmonary dysfunction

129
Q

definition: SAB

A

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

130
Q

fetal demise

A

in utero death of a fetus > 20 weeks gestation

131
Q

threatened abortion

A

mild bleeding and cramps
closed cervix
no POC expelled

132
Q

first step in management of early pregnancy bleeding

A

speculum exam

133
Q

tx. threatened abortion

A

avoid heavy activity

pelvic and bed rest

134
Q

inevitable abortion

A

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

135
Q

tx. inevitable abortion

A

emergency suction D&C

136
Q

missed abortion

A

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

137
Q

tx. missed abortion

A

allow up to 4 weeks for POC to pass

offer: misoprostol, D&C

138
Q

incomplete abortion

A

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

139
Q

tx. incomplete abortion

A

emergency suction D&C

140
Q

tx. complete abortion

A

no D&C needed

- serial B-hcg until negative to make sure ectopic pregnancy has not been missed

141
Q

MCC of SAB

A

chromosomal abnormalities

142
Q

RF for fetal demise

A 
antiphospholipid syndrome
overt maternal DM
maternal trauma
severe maternal isoimmunization
fetal infection
143
Q

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

A

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

144
Q

MC first trimester abortion

A

D&C

- performed by 13 weeks of gestation

145
Q

complications of first trimester abortion

A

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

146
Q

medical abortion

A 
oral mifepristone (P4 antagonist) or 
oral misoprostol (PGE1 analog)
- only first 63 days of amenorrhea
147
Q

what type of sepsis can occur in medical abortions?

A

Clostridium sordellii

148
Q

MC 2nd trimester abortion

A

D&E

149
Q

complications of D&E

A 
retained placenta or tissue
uterine perforation
hemorrhage
infection
DIC
150
Q

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

A

cervical trauma

cervical insufficiency

151
Q

girl presents with amenorrhea, vaginal bleeding and unilateral pelvic pain

A

ectopic pregnancy!

152
Q

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

A

ruptured ectopic pregnancy

153
Q

RF: ectopic pregnancy

A 
hx. of PID
prior ectopic pregnancy
tubal/pelvic surgery
DES exposure in utero
IUD use
154
Q

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

A

5 weeks gestation

serum B-hcg approx. > 1500

155
Q

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

A

6 weeks gestation

serum B-hcg approx. > 6500

156
Q

indications for MTX treatment of ectopic pregnancy

A 
size < 3.5 cm
not ruptured
B-HCG < 6000
No hx of folic acid supplementation
absence of fetal heart motion
157
Q

RF: cervical insufficiency

A

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

158
Q

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

A

R/O chorioamnionitis and labour

159
Q

elective cerclage placement?

A

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

160
Q

when can you suspect IUGR clinically?

A

when difference between fundal height and GA is > 4 cm

161
Q

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

A

cause = fetal

etiology: aneuploidy, infections, structural anomalies

162
Q

asymmetric IUGR with decreased abdominal size but normal head measurements

A

can be maternal or placental causes

- all result in decreased placental perfusion

163
Q

maternal causes of asymmetric IUGR

A

HTN
small vessel disease
malnutrition
tobacco, alcohol, drugs

164
Q

placental causes of asymmetric IUGR

A

infarction
abruption
twin-twin transfusion
velamentous cord insertion

165
Q

definition: IUGR

A

estimated fetal weight < 5-10% for GA

- must have accurate early pregnancy dating

166
Q

definition: macrosomia

A

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

167
Q

RF for macrosomia

A 
GDM/overt DM
prolonged gestation
obesity
multiparity
male fetus
168
Q

sterile speculum exam in PROM

A

posterior fornix pooling
nitrazine test positive (blue)
ferning

169
Q

diagnosis of chorioamnionitis

A
  1. maternal fever and uterine tenderness
  2. fetal tachycardia
  3. foul smelling amniotic fluid - confirmed PROM
  4. absence of URI or UTI
170
Q

tx of PROM if chorio is present

A

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

171
Q

tx of PROM, no infection, < 24 weeks

A

bed rest at home

172
Q

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

A

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

173
Q

tx of PROM, no infection, > 34 weeks

A

admit, manage expectantly (initiate delivery)

174
Q

definition: stage 1 (latent phase) labour

A

onset of regular contractions until acceleration of cervical dilation

175
Q

duration: stage 1 (latent phase) labour

A

primi: < 20 hours
multipara: < 14 hours

176
Q

definition: adequate uterine contraction

A

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

177
Q

prolonged latent (Stage 1) labour

A

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

caused by analgesia

178
Q

definition: stage 1 (active phase) labour

A

acceleration of cervical dilation to 10 cm dilated

> 1.2 cm/hour (primi) or > 1.5 cm/hour (multi)

179
Q

prolongation of active phase of labour

A

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

180
Q

arrest of active phase of labour

A

no cervical change in > 2 hours

181
Q

causes of prolonged/arrested active phase of labour

A

abnormalities in:

  1. passenger (fetal size/presentation)
  2. pelvis
  3. power (dysfxnal contractions)
182
Q

tx of hypotonic contractions

A

IV oxytocin

183
Q

tx of hypertonic contractions

A

morphine sedation

184
Q

arrest of active phase but adequare contractions - tx.

A

emergency C/S

185
Q

stage 2 labour (descent)

A

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

186
Q

management of second stage labour arrest

A

fetal head engaged –> trial of forceps or vaccuum

fetal head not engaged –> emergency C/S

187
Q

stage 3 labour (expulsion)

A

from delivery of baby to delivery of placenta

< 30 min

188
Q

umbilical cord prolapse - mngmt

A

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

189
Q

baseline fetal HR

A

110-160 bpm

190
Q

fetal tachycardia

A

> 160 bpm

- B-agonist medications: terbutaline, ritodrine

191
Q

fetal bradycardia

A

< 110 bpm

- B-blockers, local anesthetics

192
Q

FHR accelerations

A

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

193
Q

FHR early decelerations

A

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

194
Q

FHR variable decelerations

A

abrupt decreases in FHR unrelated to contractions

cause: umbilical cord compression
- indicate fetal acidosis if severe

195
Q

FHR late decelerations

A

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

196
Q

normal FHR variability

A

6-25 bpm

absence of variability is non-reassuring sign

197
Q

first steps in response to non-reassuring fetal tracings

A
  1. discontinue medications
  2. follow w/ IV saline and high flow O2
  3. change position - left lateral
198
Q

when do you obtain a fetal scalp pH

A

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

199
Q

when is forceps/vacuum assissted delivery the option?

A
  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
Q

indications for C/S

A
  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
Q

external cephalic version

A

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

202
Q

MCC of postpartum hemorrhage

A

uterine atony

203
Q

causes of uterine atony

A

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

204
Q

diagnosis of uterine atony

A

palpation of large, boggy uterus

205
Q

management of uterine atony

A

uterine massage

uterotonic agents –> oxytocin, methylergonovine (if not hypertensive), carboprost (if not asthmatic)

206
Q

retained placenta

A

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

207
Q

management of retained placenta

A

manual removal or uterine curretage under USG guidance

208
Q

DIC post partum is most commonly assoc. with

A

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

209
Q

when should you suspect DIC post partum

A

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

210
Q

uterine inversion

A

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

211
Q

postpartum urinary retention

A

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

212
Q

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

A

progestin only contraception i.e. mini-pill, depo, implanon

- it is also safe to use in breastfeeding

213
Q

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

A

min. 3 weeks after delivery (increased risk of DVT etc

not used in breastfeeding women - decrease lactation

214
Q

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

A

at 6 week post-partum visit

215
Q

maternal factors for C/S

A

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

216
Q

fetal and maternal factors for C/S

A

cephalopelvic disproportion
placenta previa
placental abruption
failed operative vaginal delivery

217
Q

fetal factors for C/S

A

fetal malposition
fetal distress
cord prolapse
RH incompatability

218
Q

postpartum fever - day 0

A

atelectasis

  • mild fever, mild rales
  • pt is unable to take deep breaths
219
Q

management of postpartum atelectasis

A

incentive spirometry

ambulation

220
Q

postpartum fever - day 1

A

UTI

- high fever, CVA tenderness, positive urinalysis and culture

221
Q

management of postpartum UTI

A

single agent antibiotics

222
Q

postpartum fever day 2-3

A

endometritis

- uterine tenderness, no peritoneal signs

223
Q

tx. postpartum endometritis

A

multiple agent IV antibiotics ex. gentamycin + clindamycin

224
Q

post-partum fever day 4-5

A

wound infection

  • persistent spiking fever despite antibiotics
  • wound erythema, fluctuance or drainage
225
Q

tx. postpartum wound infection

A

IV antibiotics

wet-to-dry wound packing

226
Q

postpartum fever day 5-6

A

septic thrombophlebitis

- persistent wide fever swings despite antibiotics

227
Q

tx. postpartum septic thrombophlebitis

A

IV heparin for 7 days

228
Q

postpartum fever days 7-21

A

mastitis

- unilateral breast tenderness, erythema and edema

229
Q

tx. mastitis

A

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

230
Q

papular uriticarial papules and plaques of pregnancy

A

pruritic erythematous papules within striae gravidarum; may involve extremities

231
Q

herpes gestationis

A

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

232
Q

Tx. herpes gestationis

A

topical corticosteroids

may give oral antihistamines to alleviate pruritic symptoms

233
Q

main complication of CVS

A

tranverse limb anomaly

- greatest risk > 9 weeks GA, lowest > 11 weeks GA

234
Q

management of superior sagittal thrombosis in pregnancy

A

heparin

- even if area of hemorrhagic infarction is seen on CT

Step 3 COPY (20 decks)

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