OB Stepup Flashcards
(285 cards)
1
Q
how is sgestational age calculated
A
first day of LMP + 7 days
minus 3 months+1 year
2
Q
when can teratogens cause abnormal organ function
A
between 2 and 12 weeks
3
Q
when is surfactant produced
A
26 weeks
4
Q
CV changes in mom during pregnancy
A
CO increases 40%
systolic murmur from CO
inc O2 demand
dec BP
5
Q
Resp changes in mom during pregnancy
A
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
Q
Renal changes in mom during pregnancy
A
increased RBF and GFR
dec DUN and Cr
Inc renal loss HCO3 to compensate for respiratory alkalosis
7
Q
endocrine changes in mom during pregnancy
A
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
Q
heme changes during pregnnacy
A
hypercoagulable state
increased RBC production
Hct dec from inc blood volume
9
Q
GI changes during pregnancy
A
increased salivation
decreased gastric motility
10
Q
ideal weight gain for pregnant women BMI
A
28-40
11
Q
ideal weight gain for pregnant women BMI
A
25-35
12
Q
ideal weight gain for pregnant women BMI >26
A
15-25
13
Q
caffeine increases risk for what during pregnancy
A
increased risk spontaneous abortion
14
Q
why limit fish during pregnancy
A
methylmercury contamination
15
Q
daily caloric intake during pregnancy
A
2500 kcal
16
Q
screening labs at first visit of pregnancy
A
CBC blood Ab and Rh testing pap smear Gon/chalmydia testing UA RPR or VDRL rubella Ab Hep BsAg HIV screening
17
Q
when do you do the quad screen
A
16-18 weeks
18
Q
when do you do US dating for age and fetal anomalies
A
18-20 weeks
19
Q
when is the gestational DM test
A
24-28 weeks
20
Q
when do you do GBS sreening
A
32-37 weeks
21
Q
Why to do amniocentesis
A
abnormal quad screen
women >35 years
risk Rh sensitization
0.5% risk spont abortion
22
Q
when do you perform amniocentesis (date)
A
16 weeks
measures amniotic AFP and can do karyotype
23
Q
at what date do you do chorionic villus samlping
A
transabdominal or transcervical aspiration of tissue 9-12 weeks gestation
detects chromosomal abnormalities
24
Q
indications for chorionic villus sampling
A
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
