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Flashcards in OB Stepup Deck (285):
1

how is sgestational age calculated

first day of LMP + 7 days
minus 3 months+1 year

2

when can teratogens cause abnormal organ function

between 2 and 12 weeks

3

when is surfactant produced

26 weeks

4

CV changes in mom during pregnancy

CO increases 40%
systolic murmur from CO
inc O2 demand
dec BP

5

Resp changes in mom during pregnancy

decreased in RV, FRC, and ERV
O2 consumption increases 20%
tidal volum einc 40%
pCO2 decreases because of increased minute ventilation stimulated by progesterone

6

Renal changes in mom during pregnancy

increased RBF and GFR
dec DUN and Cr
Inc renal loss HCO3 to compensate for respiratory alkalosis

7

endocrine changes in mom during pregnancy

nondiabetic hyperinsulinemia with assoc mild glucose intolerance
production human placental lactogen contributes to glucose intolerance
fasting TG increase
cortisol increases
TBG and total T4 increase
TSH decreases slightly during early pregnancy

8

heme changes during pregnnacy

hypercoagulable state
increased RBC production
Hct dec from inc blood volume

9

GI changes during pregnancy

increased salivation
decreased gastric motility

10

ideal weight gain for pregnant women BMI

28-40

11

ideal weight gain for pregnant women BMI

25-35

12

ideal weight gain for pregnant women BMI >26

15-25

13

caffeine increases risk for what during pregnancy

increased risk spontaneous abortion

14

why limit fish during pregnancy

methylmercury contamination

15

daily caloric intake during pregnancy

2500 kcal

16

screening labs at first visit of pregnancy

CBC
blood Ab and Rh testing
pap smear
Gon/chalmydia testing
UA
RPR or VDRL
rubella Ab
Hep BsAg
HIV screening

17

when do you do the quad screen

16-18 weeks

18

when do you do US dating for age and fetal anomalies

18-20 weeks

19

when is the gestational DM test

24-28 weeks

20

when do you do GBS sreening

32-37 weeks

21

Why to do amniocentesis

abnormal quad screen
women >35 years
risk Rh sensitization
0.5% risk spont abortion

22

when do you perform amniocentesis (date)

16 weeks
measures amniotic AFP and can do karyotype

23

at what date do you do chorionic villus samlping

transabdominal or transcervical aspiration of tissue 9-12 weeks gestation
detects chromosomal abnormalities

24

indications for chorionic villus sampling

early detection of chromosomal abnormalities in higher risk patients

25

when is percutaneous umbilical blood sampling

blood sampling from umbilical vein after 18 weeks gestation to look for chromosomal defects, fetal infection and Rh sensitization

26

What are leopold maneuvers

external abdominal exam to determine fetal presentation

27

what do you measure for full integrated test in 1st trimester

PAPP-A and NT

28

labs in downs for full integrated test

dec PAPP-A and icnreased nucal translucency

29

labs for downs in quad screen

dec AFP
dec estriol
inc hCG
inc Inhibin A

30

labs for edwards in quad screen

dec AFP
very dec estriol
very dec hCG
normal inhibin A

31

labs for patau trisomy 13 in quad screen

normal AFP
normal estriol
normal hCG
normal inhibin A

32

labs for patau trisomy 13 on full integrated test

very dec PAPP-A and increased nuchal translucency

33

labs for edwards on full integrated test

very dec PAPP-A and increased nuchal transluceny

34

high levels maternal AFP between 16-18 weeks assoc with

neural tube defects or multiple gestations

35

low levels maternal AFP between 16-18 weeks assoc with

trisomy 21 and 18

36

risk factors gestational DM

>25 years old
obesity
prior polyhydramnios
recurrent abortions
prior stillbirth
prior macrosomia
HTN
african or pacific islander
corticosteroid use
PCOS

37

what should fasting glucose be in pregnancy

38

new onset DM in first trimester

nongestational!!!

39

pregnant patient failing non pharmacologic methods to control gesttational DM

insulin

40

what is normal 1 hr glucose tolerance test

give 50g glucose 1 hour later should be

41

3 hr glucose tolerance test

carbo load 3 days
fasting glucose measured
100 g given then measure at 1 2 and 3 hours

abnormal is fasting >95
1 hr >180
2 hr >150
3 hr >140
Need 2 of the above values to be considered gestational DM

42

when to check gestational DM

24-28 weeks

43

complications gestational DM

macrosomia
polyhydramnios
delayed pulmonary maturity
uteroplacental insufficiency
IUGR
delayed neurologica maturity
fetal RDS
hypoglycemia
hypoCa

44

Dx for DM I

anti insulin and anti islet cell Ab

45

in mom with DM and is pregnant do what in third trimester

give corticosteroids for fetal lung maturation

46

fetal cardiac anomalies associated with maternal DM

transposition
tetralogy
neural tube defects
sacral agenesis
renal agenesis
polyhydramnios
macrosomia
IUGR
intrauterine fetal demise

47

what is preeclampsia

pregnancy induced HTN with proteinuria and edema after 20 weeks gestation

48

risk factors preeclampsia

HTN
nulliparity
prior Hx preeclampsia
multiple gestation
vascular disease
chronici HTN or renal disease
DM
obesity
african american heritage

49

signs Sx preeclampsia

edema in hands and face
rapid weight gain
HA
epigastric pain
visual disturbances
hyperreflexia
BP >140/90

50

UA in preeclampsia

2+ proteinuria on dipstick
>300 mg protein/24 hr

51

CBC preeclampsia

dec platelets
normal or inc Cr
increased aLT AST
dec GFR

52

cure for preeclampsia

delivery

53

which BP meds do you not use in preeclampsia

ACEI or ARB

54

want to maintain what BP in preeclampsia

90

55

what meds do you use in severe preeclampsia

labetalol
IV MgSO4 for seizure proph
continue postpartum

56

Rx for preexisting HTN in pregnant women

lavetalol or methyldopa
long acting CCB as sexond agent

57

Complications preeclampsia

eclampsia, seizure, stroke, IUGR, pulmonary edema, maternal organ dysfunction, oligohydramnios, preterm delivery, hemolysis, elevated liver enzymes, low platelets, abruptio placenta, renal insufficiency, encephalopathy, DIC

58

what is eclampsia

maternal seizures that can be fatal

59

Signs Sx eclampsia

HA
scotoma visual disturbances, upper abdominal pain preceding seizures

60

Tx exlampsia

delivery
MgSO4 and IV diazepam for seizure
O2 and BP control with labetolol and hydralazine
continue MgSO4 for post 48 hours

61

anticonvulsants with pregnancy

kept on meds but supplemented with folate

62

what is associated with severe maternal asthma

preeclampsia, spontaneous abortion, intrauterine fetal demise and IUGR

63

Tx mild persistent asthma in pregnangy

short acting Beta agonist and low dose inhaled corticosteroid

64

Tx mod persistent asthma in pregnangy

med dos inhaled corticosteroid or low dose + long acting beta

65

Tx severe persistent asthma

high dose inhaled corticosteroid plus long acting beta

66

complications maternal asthma

increased risk preeclampsia, spontaneous abortion, Intrauterine fetal death
IUGR

67

Tx hyperemesis gravidarum

avoidance large meals
adequate hydration
pyridoxine and doxylamine

68

what causes morning sickness

increase hCG or imbalance P and E

69

Dx DVT in pregnancy

doppler and US studies

70

Tx DVT in pregnangy

IV heparin to maintain PTT 2x normal or LMWH to keep anti-factor Xa levels within 0.5-1.2 4 hours post infection

71

DVT in pregnancy, discharged on

LMWH
try to discontinue 24-36 hrs prior to delivery

72

why not use warfarin in pregnancy

teratogenic
but can use breast feeding

73

how long are anticoagulants continued post partum if patient had DVT during pregnancy

6 weeks
and wait at least 6 hours since delivery to prevent severe hemorrhage

74

Tx UTI in pregnancy

amox
nitrofurantoin
cephalexin x3-7 days

75

why not use fluoroquinolones in pregancy

teratogenic

76

fetal effects from maternal marijuana

IUGR and prematurity

77

fetal risks of maternal cocaine use

abruptio placentae
IUGR
prematurity
facial abnormalities
delayed intelectual development
fetal demise

78

fetal risks of ethanol use during pregnancy

fetal alcohol syndrome- mental retardation, IUGR, sensory and motor neuropathy, facial abnormalities
psontaneous abortion
Intrauterine fetal demise

79

fetal risks of maternal use of opioids

prematurity, IUGR meconium aspiration, neonatal infecitons, narcotic withdrawl

80

fetal risks of maternal use of stimulants

IUGR congenital heart defects, cleft palate

81

fetal risks of maternal use of tobaccco

spont abortion
prematurity
IUGR
intrauterine fetal demise
impaired intellectual development
higher risk neonatal respiratory infections

82

maternal risk factors for using tobacco during pregnancy

abruptio placentae, placenta previa, PROM

83

fetal risks of maternal use of hallucinogens

developmental delays

84

ACEI teratogenic effects

renal abnormalities and decreased skull ossification

85

Aminoglycoside teratogenicity

CN VIII damage (hearing) skel abnormalities, renal defects

86

carbamazapine teratogenicity

facial abnrmalities, IUGR, mental retardation, CV abnormalities
neural tube defects

87

DES teratogenicity

vaginal and cervical cancer later in life

88

fluoroquinolone teratogenicity

cartilage abnormalities

89

phenobarbital teratogenicity

neonatal withdrawal

90

phenytoin teratogenicity

facial abnormalities, IUGR, mental retardation, CV abnormalities

91

retinoids teratogenicity

CNS abnormalities, CV abnormalities, facial abnormalities, spont abortion

92

sulfonamides teratogenicity

kernicterus

93

tetracycline teratogenicity

skeletal abnormalities, limb abnormalities, teeth discoloration

94

thalidomide teratogenicity

limb abnormalities

95

valproic acid teratogenicity

neural tube defects
facial abnormalites
CV abnormalities
skeletal issues

96

warfarin is assoc with what teratogenic effect

dandy walker malformation

97

TORCH

toxo
other: varicella, parvo, GBS, Chlamydia, gonn
Rubella, rubeola, RPR
Cytomegalovirus
Herpes/hepatitisB, HIV

98

congenital toxo signs

hydrocephalus, intracranial calcifications, chorioretinitis, microcephaly
seizures
spont abortion

99

Dx toxo in pregnancy

amniotic fluid PCR for toxo and srum Ab sscreening

100

Tx for toxo infection in mom

pyrimethamine, sulfadiazine, folinic acid
avoid gardening, raw meat, cat litter and unpasteurized milk

101

congenital rubella

blueberry muffin baby
IUGR, deafness, CV abrnomalities, vision isssues, CNS problems, hepatitis

102

screeningmaternal rubella

early prenatal IgG screening

103

if mom contracts rubella during pregnancy

no Tx and no benefit from Ig

104

fetal effects of rubeola (measles) infection

increased risk prematurity
IUGR
spont abortion
high risk neonatal death if transmission occurs

105

Dx rubeola or measles in pregnancy how

IgM or IgG Ab in mom after rash develops

106

Tx if mom has rubeola during pregnancy

Ig to mom
not vaccine because live attenuated

107

Fetal risks of maternal syphilis infection

neonatal anemia, deafness, HSM, pneumonia, hepatitis, osteodystophy, rash and hand foot desquamation
25% death

108

Dx maternal syphilis infection

early prenatal RPR or VDRL screen
confirm with FTA-ABS

109

Tx maternal syphilis infection

penicillin for mom and baby if needed

110

effcts of CMV infection on fetus

IUGR, chorioretinits, CNS problems
mental retardation, vision issues, deafness, hydrocephalus, seizures, HSM

111

Dx of CMS infection during pregnancy

mono like illness
IgM screening or PCR of baby in first few weeks

112

Tx for CMV infection in pregnany

no Tx
gangciclovir after once baby is born
good hygiene reduces transmission

113

fetal effects of maternal herpes infection

increased risk prematurity
IUGR and spont abortion
high risk death
CNS problems

114

Tx for herpes maternal infection

delivery by C section to avoid transmission
acyclovir maybe in infants

115

What happens with HIV during pregnancy

viral transmission, and rapid progression to AIDs

116

Tx maternal HIv infection

AZT to reduce vertical transmission
continue antiretroviral regimen
no efavirenz, didanosine, stavudine or nevirapine

117

risks with maternal hep B infection

inc risk prematuiry, IUGR and neonatal death if they get acute disease

118

how to screen for hep B in pregnancy

prenatal surface Ag screening

119

Tx maternal hep B infection during pregnancy

vaccination
neonate gets vaccine and Ig shortly after birth

120

Tx gonorrhea or chlamydia in neonate from mom

erythromycin
can give to mom during pregnancy

121

fetal risks of maternal varicella zoster infection

prematurity, encephalitis, pneumonia IUGR
CNS problems
limb problems, blindness
high risk neonatal death with transmission

122

Dx maternal variceela zoster infection

IgG screening with no known Hx of disease prenatally
IgM and IgG in infants can confirm

123

Tx for varicella zoster infection during pregnancy

varicella Ig to nonimmune mom
and to neonate if active infection
vaccine is contraindicated during pregnancy

124

fetal risks of maternal GBS infection

respiratory distress, pneumonia, meningitis, sepsis

125

when to screen for maternal GBS

after 34 weeks gestation

126

Tx for GBS in mo during pregnancy

IV beta lactams or clinda during labor or in infected neonates

127

fetal effects of maternal parvo virus

decreased RBC produciton
hemolytic anemia
hydrops fetalis

128

screening parvo

IgM Av or PCR viral DNA in neonate

129

Tx maternal parvo B 19 infection

monitor fetal Hb by PUBS and give transfusion if severe anemia

130

where is most common place ectopic

ampulla of fallopian tube

131

risk factors for ectopic

PID or STDs
gyn surgery
prior ectopic
multiple partners
smoking

132

sign ectopic

pain, nausea, amenorrhea, scant vaginal bleeding
peritoneal signs and tachy if ruptured

133

how does bhCG increase in pregnanc

double every 48 hours

134

bhCG that is not doubling in the right amount of time

suspicious for ectopic

135

most common cause vaginal bleeding in early pregnancy

ectopic
spont abortion
physiologic bleeding
uterine-cervical pathology

136

when to do transvaginal US to look for ecotpic

when bhCG>6500 and 1500

137

Tx unruptured ectopic

MTX to abort pregnancy

138

Tx ruptured ecoptic

IV hydration and surfical excision with attempts to preserve fallopian tube

139

complications ectopic

fetal death,
severe maternal hemorrhage
increased risk for future ectopics, infertility, Rh sensitization, maternal death

140

cause of first trimester spont abortion

chromosomal abnormalities, especially trisomies

141

causes of second trimester spont abortions

infection, cervical incompetence, uterine abnormalities, hypercoagulable, poor maternal health or drug use

142

risk factors for spont abortions

increased maternal age
multiple prior births
prior spont abortion
uterine abnormalities
smoking
alcohol
NSAIDs
cocaine
excessive caffeine use
maternal inections
low folate
autoimmune- antiphospholipid!

143

signs of threatened abortion

uterine bleedingin initial 20 weeks
closed cervical os, no uterine contents expelled
US show viable fetus
need bed rest

144

signs of missed abortion

some uterine bleeding can be with pain
closed os
no expelled contents
US shows nonviable intrauterine fetus

145

Tx of missed abortion

expectant
misoprostol or D&C
give Rhogam

146

Signs inevitable abortion

uterine bleeding in inital 20 weeks with pain
open cervical os with no contents expelled
US shows viable fetus and cervix is dilated

147

Tx of inevitable abortion

expectant
misoprostol or D&C
give rhogam

148

Signs incomplete abortion

uterine bleeding in inital 20 weeks
open os and some uterine contents expelled

149

Tx incomplete abortion

misoprostol or D&C
give rhogam

150

what to give for complete abortion

rhogam

151

when is intrauterine fetal demise

fetal death after 20 weeks and before onset labor

152

what can cause intraunterine fetal demise

placental or cord abnormalities from maternal CV or heme conditions
maternal HTN
infection
poor maternal health
fetal congenital abnormalities

153

US of intrauterine fetal demise

nonviable intrauterine fetus with no heart activity

154

Tx of intrauterine fetal demise

oxytocin, misoprostol (PGE1) or PGE2
dialtion and evactuation

155

complications intrauterine fetal demise

DIC if retained for a while

156

definition of IUGR

fetal growth that lags behind gestational age

157

symmetric IUGR

overall decrease in size
likely from congenital infection, chromosomal abnormality or maternal drug use

158

asymmetric IUGR

majority
decreased abdominal size with preserved head and extremities
happens late in pregnancy
caused from multiple gestation or poor maternal health or placental insufficiency

159

fundal height in IUGR

160

when does fundal height equal gestational age

20 weeks and on

161

Tx IUGR

follow with US
nutritional supp and mom O2 therapy
maybe bedrest
delivery should be induced if fetal growth slows further
give corticosteroids to increase lung maturation

162

some causes of oligohydramnios

IUGR, fetal stress, fetal renal abnormalities, poor fetal health

163

second trimester oligohydramnios

renal problems
maternal cause like preeclampsia, renal disease, HTN
or placental thormbosis

164

third trimester oligohydramnios

assoc with PROM, preeclampsia, abruptio placentae or idiopathic cause

165

US of oligohydramnios Dx

amniotic fluid index

166

Tx oligohydramnios

expectant. may need to induce
hydraiton and bed rest

167

complications oligohydramnios

spon abortion
intrauterine fetal demise
abnomral limb, facies of lungs
abnormal abdominal development all from compression

168

polyhydramnios Dx criteria

>25 cm amniotic fluid index

169

causes of polyhydramnios

insufficient swallowing of fluid(esophageal atresia)
infecreased fetal urination from maternal DM
multiple gestation
fetal anemia, chrom abnormalities

170

Tx polyhydramnios

32 weeks amnioreduction only

171

complications polyhydramnios

preterm labor
PROM
fetal malpresentation
maternal respiratory compromise

172

what is PROM

spontaneous rupture of amniotic sac with spillage of fluid before onset of labor

173

risk factors for PROM

vaginal or cervical infection, cervical incompetence, poor maternal nurtrion, prior PROM

174

labs to Dx PROM

microscopic exam of vaginal fluid will show ferning
vaginal fluid will turn nitrazine paper blue
Need to send for culture to Dx possible infection

175

imaging for PROM

US to assess volume and fetal position

176

why not do bimanual if patient has PROM

risk of infection

177

Tx for PROM

178

Tx for PROM 32-34 weeks

amniotic analysis for lung maturation
if mature induce labor
corticosteroids and antibiotics if not mature yet

179

Tx PROM >34 weeks

antibiotics and delivery is induced

180

how to assess fetal lung maturity

Lecithin and sphingomyelin levels L:S should be >2 in presence of phophatidylglycerol which suggests maturation

181

what is preterm labor

labor before 37 weeks

182

risk factors preterm labor

multiple gestation, PROM, infection, placenta previa, abruptio placentae, previous preterm labor, polydydramnios, cervical imcompetence, poor nutrition, stressful environment, smoking, substance abuse, lower socioeconomic statu

183

signs Sx preterm labor

constant low back pain and conractions

184

what to order in preterm labor

UA vaginal and cervical cultures to check for infection
do US to assess amniotic fluid and fetal well being and confirm gestational age

185

Tx preterm labor

hospitalization, hydration and acitivy restriction
tocolytics for 48 hours -- with MgSO4, terbutaline, indomethacin or nifedipine
glucocorticoids for 48 hours
empiric ampicillin if delivery is immenent of suspect infection

186

Tx preterm labor >34 weeks

active management if indication for delivery
empiric ampicillin

187

what cervical length by US has greater risk preterm birth

188

What is placenta previa

implantation of placenta near cervical os assoc with vaginal bleeding

189

what is low implantation placenta previa

in lower uterus but does not affect cervical os until dilation

190

what is partial placental previa

placenta partially covers os

191

what is complete placental previa

placenta completely covers os

192

risk factors placenta previa

muliparity, increased maternal age, prior previa, prior cesarean section!!!!
multiple gestation, fibroids, Hx ablation and smoking

193

painless vaginal bleeding in third trimester

placenta previa

194

Dx placenta previa

US

195

Tx placenta previa

bed rest
rhogram for Rh- moms with any bleeding
tocolytics can be used
do C section

196

most common causes of vaginal bleeding after 20 weeks gestation

placenta previa and placenta abruption

197

complications plcaenta previa

severe hemorrhage, IUGR, malpresentation, PROM, vasa previa(fetal exsanguination)
maternal death in 1%

198

painless vaginal bleeding in 3rd trimester
do NOT do what

steril vaginal examination
need to rule out placenta previa

199

risk factors abruptio placentae

HTN
prior abruption
trauma
tobacco use
cocaine
PROM
mutiple gestation
multiparity

200

signs of abruptio placentae

painful vaginal bleeding in 3rd trimester, back pain, abdominal pain, pelvic tenderness, increased uterine tone, hypotension

201

US of abruptio placentae

inconsistently shows separation of placenta from uterus

202

Tx abruptio placentae

bed rest
C section for hemodynamic instability
transfusion usually required

203

complications abruptio placentae

DIC, severe hemorrhage that increases risk maternal death, fetal demise and increased abruption in future pregnancies

204

monozygotic twins

division zygote resulting in identical fetuses
may or maynot share same amnion or chorion

205

dizygotic twins

fertilization of more than one egg by different sperm
fraternal twins
separate amnions

206

twins create increased risk for what during pregnancy

HTN DM preeclampsia and preterm
fetal malpresenationa, previa, abruptiom PROM, IUGR, birth trauma, CO and RDS

207

what is twin twin transfusion syndrome

umbilical cords are fused and one twin is inadequately perfused causing more complications

208

average delivery time for twin

36 weeks

209

pregnancy visits for twins

biweekly or weekly starting at 24 weeks

210

when do you start fetal non stress tests for twins

36 weeks

211

twins and having preterm labor

tocolytics

212

when can you attempt vaginal delivery of twins

Vertex vertex
or vertex-breech sometimes

213

normal fetal HR

120-160

214

position for fetal non stress test

L lateral decubitus

215

normal reactive NST for fetal wellbeing

2+ 15 bpm accelerations lasting at least 15 seconds each within 20 minutes

216

what to do if nonreactive NST

biophysical profile

217

what is a biophysical profile to assess fetal well being

NST repeat with US
US measures amniotic fluid index
fetal breathing rate
fetal mvoement
fetal tone

218

total points for biophysical profile

10. 8-10 is normal

219

what is used to assess uteroplacental dysfunction

contractions tress test
fetal HR monitored with fetal scalp electrode

220

reassuring signs of fetal HR

beat to beat variability
long term HR variability
occasional HR acclerations

221

decelerations

fetal head compression, umbilical cord compression of fetal hypoxia

222

when do you perform fetal scalp blood sampling

consistentlyabnormal fetal heart rate tracing
dec pH and hypoxemia and inc lactate indicate fetal distress

223

braxton hicks contractions

false contractions

224

early decelerations

begin and end with uterine contractions
head compression

225

late decelerations

begin after initiation of uterine contraction and end after contraction finishes

226

cause of late decelerations

uteroplacental insufficiency, maternal venous compression
maternal hypotension
abruptio placentae
fetal hypoxia

227

Tx for late decelerations

test fetal blood for hypoxia or acidosis
recurrent late declerations promt delivery

228

variable decelerations

inconsistent onset duration and degree

229

cause of variable decelerations

umbilical cord compression

230

Tx for variable decelerations

change in mother position

231

Stage 1 labor begins and ends with what

latent is the start of uterine contractions until 6 cm dilated and complete effacement
active phase is 6 cm to 10 cm dilation
deceleration phase is transition into 2nd stage

232

Stage 2 labor what happens

full dilation until delivery

233

Stage 3 labor what happens

delivery of neonate until placental delivery

234

Stage 4 labor is what

initial postpartum hour

235

progression of cervical dilation in active phase 1 for nulliparous

1.2 cm/hr

236

progression of cervical dilation in active phase 1 for multiparous

1.5cm/hr

237

management stage 1 labor

monitor fetal heart rate and uterine contractions
assess progressions of cervical change periodically

238

how long is stage 1 labor in nulliparous

239

how long is stage 1 labor in multiparous

240

management of stage 2 labor

monitor fetal heart rate and movenet through birth canal

241

how long is stage 2 labor in nulliparous

242

how long is stage 2 labor in multiparous

243

management of stage 3 labor

uterine massage and examination of placenta to confirm no intrauterine remnatns

244

how long is stage 3 labor for nulli and multiparous

0-30 minutes

245

managemnet stage 4 labor

monitor maternal pulse and BP
look for signs of hemorrhage

246

how long is stage 4 labor for nulliparous and multiparous

1 hr

247

what can you induce labor with

oxytocin or misoprostol

248

indicatoins to induce labor

maternal preeclampsia, DM, stalled stage of labor, chorioamnionitis
fetal: prolonged pregnancy, IUGR, PROM, congenital defects

249

contraindications to induce labor

prior uterine surgery, fetal lung immaturity, malpresentation, acute fetal distress, active genital herpes, vasa previa

250

what is bishop score measuring

likelihood of vaginal delivery following induction

251

face presentation of fetus

full hyperextension of neck

252

brow presentation of fetus

partial hyperextenion

253

frank breech

hips flexed and knees extended- 75%

254

complete breech

hips and knees flexed

255

footling breech

one or both legs extended

256

risk factors for malpresentation

prematurity, multiple gestation,polyhydramnios, uterine anomaly placenta previa

257

complications malpresentation

cord prolapse, head entrapment, fetal hypoxia, abruptio placentae, birth trauma

258

vertical C section

vertical incision through anterior muscle protion
"classic"
when fetus is in transverese position or adhesions and fibroids prevent acess
do it if hysterectomy after delivery
if cervical cancer
or if postmorten delivery

259

low transverse C section

transverse incision in lower uterine segment
decreased risk uterine rupture, bleeding, bowel adhesions, and infection
more common

260

when can you do VBAC, what type of C section did they have

transverse
cannot do with vertical

261

what is colostrum

early breast milk rich in proteins, fat and minerals
has IgA

262

components of apgar

color
heart rate
response to stimulation
muscle tone
respirations

263

when does the red lochia discharge after birth stop in mom

by 10th day

264

when does mensturation return in non nursing moms

6-8 weeks

265

what causes the most substantial volume of postpartum bleeding

retaiend placental tissue

266

what blood loss in delivery is abnormal

>500 mL in 24 hours if vaginal
>1000 in 24 hours if c sextion

267

major cause of postpartume bleeding

uterine atony

268

workup for postpartum bleeding

US to look for retained tissue

269

Tx for postpartum bleeding

uterine massage and oxytocin administration
dec hemorrhage
surgical repair of lacerations
D&C if retained tissue
hysterectomy for refractory cases

270

What is hydatidiform mole

benign neoplasm of trophoblastic cells that become malignant

271

complete mole

46 XX or 46 XY
derived from father
empty egg with 2 sperm

272

what is incomplete mole

69 XXY or 69XYY
fertilization of egg by 2 sperm
assoc with abnormal fetus

273

risk factors for hydatidiform mole

low socioeconomic status, extremes of age, Hx prior molar pregnancy, asian, smoking

274

signs of molar pregnancy

heavy or irregular painless bleedingi n 1st and 2nd trimester
hyperemesis gravidarum
dizziness
anxiety
large fundal height for gestational age
grape like vesicles in vagina and no heart tones

275

preeclampsia in first half of pregnancy

suspect molar pregnancy

276

labs in molar pregnancy

bhCG is very high

277

US in molar pregnancy

snowstorm pattern without presence of gestational sac

278

Tx molar pregnancy

D&C to remove neoplasm
follow bchCG for 1 year
avoid pregnancy 6 mo-1 year

279

complications molar pregnancy

malignant gestational trophoblastic neoplasm
choriocarcinoma

280

choriocarcinoma

malignant trophoblastic neoplasm that arises from hydatidiform moles or following abortion, ectopic or normal pregnancy

281

signs choriocarcinoma

vaginal bleeding, possible hemoptysis, dyspnea, HA, dizziness or rectal bleeding, enlarged uterus with bleeding from cervical os

282

labs in choriocarcinoma

increase bhCG

283

US in choriocarcinoma

uterine mass with mix hemorrhagic and necrotic areas, possible parametrial invasion
CT detects mets

284

treatment choriocarcinoma

hysterectomy if limited to uterus
chemo
if want to maintain fetility do chemo alone
follow bhCG
avoid pregnancy 1 year after therapy

285

complications choriocarcinoma

mets to lungs, brain, liver, kidneys and GI tract
good prognosis unless brain or liver mets