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OB Flashcards

1
Q

What is the Pinard Maneuver

A

Used for breech deliveries.
Abduct the hip by pushing laterally on the inner aspect of the knee.
Flex the knee and sweep the foot and leg medially, maneuvering it downward to deliver.

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2
Q

Magnesium dose for preeclampsia, eclampsia, or PIH

A

6g/100ml over 30 minutes. If actively seizing administer over 15 minutes.
Maintenance: 4g/100ml NS or 10g/250ml. Infuse at 2g/hr IV. (50ml/hr)

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3
Q

Meg toxicity reversal

A

1G calcium gluconate over 3-5 minutes, redose PRN

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4
Q

Seizure management in eclampsia

A

Administer additional 2G mag over 2 minutes.
Increase infusion by 1G/hr
If seizure persists more than 2 minutes, lorazepam.

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5
Q

BP management in pre-e, eclampsia and PIH

A

SBP >160 and DBP>110
Labetalol or Hydralazine

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6
Q

Labetalol dose for BP management

A

20mg IV over 2 minutes
wait 10 minutes, then
40mg IV over 2 minutes
wait 10 minutes, then
80mg IV over 2 minutes.
Consider drip (1-2mg/min)
(max 300mg in 24 hours)

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7
Q

Hydralazine dose for BP management

A

5mg over 1 minute
wait 10 minutes, then
additional 5-10mg IV q20min.
Max cumulative dose of 20 mg
consider drip at 0.5-10mg/hr.

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8
Q

Medications for preterm labor

A

Nifedipine, magnesium sulfate, terbutaline

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9
Q

Nifedipine dose for preterm labor

A

10mg SL/PO q15min, max total dose 40.

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10
Q

Magnesium Sulfate dose for preterm labor

A

6g/100ml IV administered over 30 minutes.
Maintenance: 4G/100ml or 10G/250ML, infuse at 2G/hr.

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11
Q

Magnesium monitoring

A
  1. DTR q5m x 3, then q15m
  2. RR
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12
Q

Magnesium toxicity

A

Calcium Gluconate
1G over 3-5 minutes, redose PRN.

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13
Q

Terbutaline dose

A

0.25mg SQ q30m until tocolysis achieved.
Max 3 doses
Hold for pulse >120

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14
Q

PROM

A
  1. Document time of rupture
  2. Consult with physician regarding abx prior to transport if febrile or GBS positive
  3. Consult with physician regarding betamethasone
  4. Avoid letting patient stand or ambulate.
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15
Q

Progression threshold for transport

A

5cm dilated or 100% effaced
consult with sending provider to ensure appropriateness of transport.

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16
Q

S/S of impending delivery

A
  1. Sensation of impending defecation
  2. urge to push
  3. crowning
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17
Q

Betmethasone

A

24 0/7 – 36 6/7
12MG IM x1 per order of sending or receiving physician.

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18
Q

Assessment and management of OB transport

A
  1. Maternal vitals and O2 sats
  2. document FHR q15
  3. additional assessment per guidelines as indicated
19
Q

PPH Interventions

A

After placenta delivery:
Fundal massage
Oxytocin
Consider transfusion
Methergine

20
Q

Oxytocin for PPH

A

40 units in 1000ml
500ml over 10 minutes
50ml/hr

10 units IM if no IV available

After delivery of placenta

21
Q

Methergine for PPH

A

*If oxytocin fails to produce adequate uterine contraction
0.2MG IM q2-4hrs
Do not administer in patients SBP>140
*Consult with provider or OLMC

22
Q

Trauma in pregnancy

A
  1. determine mechanism of injury
  2. inspect abd and distinguish pain from contractions
  3. Assess for chest injury
  4. serial assessments of abd and perineum
  5. Take note of vaginal bleeding
  6. review fetal monitoring strip and get copy
  7. treat per hypotension/shock guidelines with vasopressors as last resort.
23
Q

Placental abruption

A

premature separation of placenta after 20th week.
scant, dark bleeding until delivery.
Abd/back pain
Uterine tenderness, contractions, fetal distress, labor
May or may not cause bleeding.

24
Q

Placenta previa

A

placenta over cervical os
painless vaginal bleeding in second or third trimester, “warning” hemorrhages over days/weeks.
Soft, pain free uterus.
contractions may or may not be present
fetal distress not usually present

25
Transfusion in pregnancy
Ongoing hemorrhage with loss of 1500ml or more, with tachycardia and hypotension.
26
Tocolytics in vaginal bleeding
controversial consult with sending/receiving physician prior to magnesium. Do not administer tocolytic to actively bleeding patient.
27
Uterine rupture
Possible bleeding Abd pain with n/v Diffuse abd tenderness, sudden cessation of labor
28
Oxytocin for uncomplicated delivery
20units in 1000ml Run 500ml WO then 100ml/hr
29
How long to wait for placenta to deliver
30 minutes Do not pull on cord to deliver placenta.
30
Nuchal cord
1. slip finger around infants neck and feel, slip over head if loose. 2. if wrapped tightly, clamp in two places, cut and unwind make sure anterior shoulder is delivered before cutting. **consider twins
31
Prolapsed cord
1. supplemental oxygen 2. frequent FHT checks 3. Knee/chest trendelenberg 4. elevation to presenting part with hand in vagina 5. if FHR <140 further elevation 6. prevent drying of cord 7. magnesium
32
McRoberts maneuver
Mother's hips and legs flexed suprapubic pressure gentle downward traction on infant with maternal pushing.
33
Shoulder dystocia
1. McRoberts maneuver 2. rotation of anterior shoulder forward or backward out of AP diameter of pelvis 3. delivery of posterior arm by sweeping it across the fetal chest and over perineum.
34
Shoulder presentation
Transport immediately and make facility aware of situation
35
Uterine Inversion
Manual replacement: gentle pressure and use palm of hand to push fundus upward through cervical canal -if contracted use tocolytics -replace with placenta in place -oxytocin once uterus is replaced
36
Oxytocin in uterine inversion
40 units in 1L up to 500ml over 10 minutes to contract uterus
37
Vertex delivery
1. maternal oxygen 2. support perineum 3. allow rotation without interference 4. anterior shoulder then posterior 5. ensure fetal airway 6. clamp cord after 30 seconds 7. Oxytocin 8. fundal massage
38
Placental delivery
do NOT pull cord for placental delivery 1. wait for spontaneous delivery (up to 30 minutes) 2. if retained placenta with bleeding consult with receiving provider. 3. if no bleeding, transport
39
HELLP
Hemolysis, Elevated Liver, Low Platelets 1. transport in left lateral tilt 2. treat per preeclampsia guidelines 3. consider platelet transfusion, prbcs and FFP per order of sending physician
40
Pre-Eclampsia
Triad of hypertension, edema and proteinuria
41
Eclampsia
seizures in pregnancy with no other cause
42
Mild vs severe pre-eclampsia
Mild: BP >140/90 and >300mg protein in 24 hours Moderate: High bp, proteinuria, oliguria, visual disturbances, n/v, pulmonary edema, HELLP, fetal growth restriction
43
Pre-eclampsia Assessment
1. Maternal vitals 2. DTRs 3. Absence/presence of clonus 4. FHR by doppler 5. uterine activity q15
44
Pre eclampsia fluid
<100ml/hr (total fluid and medication infusions)

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