OB/GYN 3 Flashcards
What are 3 physical exam findings in newborns girls that is NORMAL due to maternal inutero effect of Estrogen.
- Labial swelling
- Leukorrhea (white/yellow vaginal dc)
- Withdrawal vaginal bleed.
Adolescent Pregnancy (Age <19) is associated with these 5 fetal complications.
Mom is at increased risk of these 4 things?
- Pre-term labor
- Gastroschisis (bowel outside the body)
- Omphalocele (bowel outside body but covered in sac)
- Low birth weight
- Perinatal death.
MOM: 1. post partum depression 2 Hydatiform mole 3. Anemia 4. Pre-E
What is the definition of STAGE 2 labor ARREST (10cm -deliver)…
For without epidural?
For with epidural?
What is the most common cause?
Wha the management of arrest of Stage 2 labor?
Without epidural = >3hours
With Epidural = >4 hours
Caused usually by Cephalopelvic disproportion
Management = C section
What do you do if a baby is born to BGS positive mother who DID NOT get (PCN, Ampicillin or Cefazolin) > 4 hours prior to delivery?
IF they are >37 weeks and ROM <18 hours then just observation.
IF <37 weeks (pre-term) and ROM >18 hours then GET:
- CBC
- BLOOD CULTURE
- and observe for 48 hours.
Pregnancy induces skin changes that causes FOCAL pruritus in scalp, anus, vulva and abdomen…due to hormonal changes. It is not associated with increased risk of any obstetric complication.
INTRAHEPATIC CHOLESTASIS OF PREGNANCY causes skin itching as well, BUT is associated with obstetric complication of intrauterine fetal demise.
- What is the pathophysiology of intrahepatic cholestasis of pregnancy?
- What are the Key features of intrahepatic Cholestasis of Pregnancy that differentiates it from normal pregnancy induced skin changes?
- What is the management?
- Pathophysiology = Estrogen causes intrahepatic cholestasis.
- Key Features:
- Increase Bili
- Transaminitis
- Generalized Pruritus. - Management:
- Delivery at 37 weeks
- Symptomatic trx with Benadryl and Ursodeoxycholic Acid.
What is Pemphigoid Gestationis “Herpes Gestations”?
What trimester does it usually present?
What is the clinical presentation?
DX and TRX?
Autoimmune disease (Abs generated against BM) that occurs in pregnancy.
Usually presents 2nd/3rd trimester
Presentation = Starts with pruritus of abdomen that gives way to a periumbilical and truncal rash (urticarial papule and plaques that form tense bullae) that spread to whole body.
DX = Clinical but can verify with skin BX TRX = High potency Topical Steroids.
Anemia is present in normal pregnancy, due to increased plasma volume…but further work up is needed for what threshold values in the three trimesters?
First Trimester < 11
Second Trimester < 10.5
Third Trimester < 11
- When giving birth to TWINS, in what situation can you attempt vaginal birth for BOTH?
- What do yo do if TWIN a is vertex bit Twin B is breech?
- Both are vertex position.
2. Vaginal birth for Twin A then +/- Cesarean for Twin B
What is the recommendation for exercise in Pregnancy if you did not exercise before getting pregnant?
START - 30 min daily of mod-intensity (should be able to hold a conversation)
What are the four main benefits from exercise during pregnancy?
Decrease incidence of:
- Gestational DM
- Pre-E
- C-section
4 Faster post part REcovery
Septic Abortion usually occurs after an elective abortion when there is retained products of conception left behind…It can present with purulent vaginal dc, signs of sepsis, lower abd pain, boggy uterus, dilated cervix) …
This is a medical Emergency…What is the management ?
Broad Spec ABX
+
Suction Curettage or uterine contents
Neonatal displaced Clavicular fractures can occur during birth especially when you have a big baby with assisted deliver (forceps/vacuum)..Baby can cry with passive motion of affected arm, crepitus over clavicle and asymmetric moro reflex) …
How do you dx?
TRX?
DX = Xray
TRX = Place arm in a long sleeve shirt and pin garment at 90 degrees. Reassurance and gentle handling; NO longterm sequelae.
What are the 7 routine prenatal labs you get at initial visit?
- RH (D) type, Ab screen
- CBC
- HIV/VDR/HepBsAg
- Rubella and Varicella immunity
- Pap (if indicated)
- Chylamidia PCR
- UA/Urine culture/Urine Protein
Other than routine prenatal labs at the first visit…there are two other times when you get ROUTINE labs.
When do you get these routine labs and what labs do you get?
24-28 weeks:
- Hbg/Hct (r/o anemia)
- Ab screen (if mom is Rh(D) negative)
- Glucose Tolerance test (50 g 1hr)
35-37 weeks:
1. GBS rectovaginal swab.
As part of routine prenatal labs, one gets a Glucose Challenge Test at 24-28 weeks.
Describe the test?
What is positive result?
What do you do if you have an abnormal GCT?
Administer 50g of oral glucose and measure BG 1 hours later.
BG <140 = NORMAL
BG > 140 = ABNORMAL
IF ABNORMAL test, do Glucose Tolerance Test (GTT)
