maternal fever and 1+: - uterine tenderness - maternal or fetal tachy - malodorous amniotic fluid - purulent vaginal discharge

OB Uworld Flashcards by Amanda Beach

causes of asymmetric fetal growth restrictions

vascular disease like HTN and preeclampsia and DM
antiphospholipids Ab
autoimmune
cyanotic cardiac disease
substance abuse

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causes of symmetric fetal growth restrictions

genetic
congenital heart disease
intrauterine infections: malaria CMV, rubella, toxo, varicella)

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causes of variable heart decelerations

cord compression
oligohydramnios
cord prolapse

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Tx variable decelerations

maternal repositioning to left lateral then if fail to improve do amnioinfusion

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PPROM and fetus has bilateral renal agenesis

next step

allow spontaneous vaginal delivery because baby wont survive anyway

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when to do C section no matter what

prior classic cesarean (vertical)

myomectomies

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postpartum endometritis

fever greater than 100.4 outside first 24 hours postpartum

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risk factors postpartum endometritis

prolonged rupture of membranes
prolonged labor >12 hours
C section
use of intrauterine pressure catheters or fetal scalp electrodes

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signs Sx of endometritis postpratum

fever, uterine tenderness foul smelling lochia and leukocytosis

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pathogens in postpartum enodmetritis

polymicrobial

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Antibiotics for postpartum endometritis

clinda and genta IV

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low grade fever and leukocytosis in first 24 hours postpartum

normal

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management of missed spontaneous abortion

D and C

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indication for induction labor for fetal demise

when coagulation studies are low normal range

impending DIC

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chorioamninitis

prolonged rupture of membranes

>18 hours

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Dx chorioamnionitis

maternal fever and 1+:

uterine tenderness
maternal or fetal tachy
malodorous amniotic fluid
purulent vaginal discharge

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risk factor for chorioamnionitis

prolonged rupture of membranes

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management chorioamnionitis

broad spec antibiotics and delivery

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Dx intrauterine fetal demise

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patient has confirmed intrauterine fetal demise and passes baby. next step to address?

autopsy to determine cause and if can prevent for future pregnancies

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when is serial bhCG monitoring required post delivery

for molar pregnancies

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what can you give patient if want to pass their spontaneous abortion at home

misoprostol

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when to give anti D Ig or rhogam

28-32 weeks in Rh negative patient
within 72 hours of delivery
ectopic
molar
CSV or amniocentesis
abdominal trauma
2nd and 3rd trimester bleeding
external cephalic version

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management for preterm labor

tocolytics, NSAIDs

corticosteroids and MgSO4 for neuroprotection

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risk for fetus if mom has Hx of anorexia nervosa

higher risk for baby small for gestational age

common findings in anorexic patients

``` osteoporosis elevated cholesterol and carotene cardiac arrythmias like long QT euthyroid sick syndrome HPA dysfunction hyponatremia from drinking excess water ```

very high AFP is associated with what

open NT defects ventral wall defects multiple gestation

placenta previa with bleeding at 37 weeks | hemodynamically stable

C section

greatest risk placental abruption

DIC

risk factors for placental abruption

tobacco use and preeclampsia

tonic clonic seziure in pregnancy and now has arm adducted and internally rotated normal DTR and strength

posterior shoulder dislocation

contraindications to external cephalic version

``` indications for c sextion placental abnormalities oligohydramnios ruptured membranes hyperextended fetal head fetal or uterine anomaly multiple gestation ```

what vaccines can be given during pregnancy

Tdap and inactivated influenza

avoid conception for how long after live attentuated vaccines

4 weeks

severe features preeclampsia

``` proteinuria or end organ damage BP >160 ?110 on 2 occasions more than 4 hours apart thrombocytopenia Cr >1.1 inc LFTs Pulmonary edema new onset visual or cerebral Sx ```

Tx preeclampsia

delivery if term | MgSO4 and hydralazine or labetolol or nifedipine PO

most comon cause postpartum hemorrhage

uterine atony

Tx uterine atony

bimanual uterine massage IV fluids, oxygen Uterotonic medications (oxytocin, methylergonovine, carboprost, misoprostol)

risk factors uterine rupture

prior uterine surgery induction labor or prolonged congenital uterine anomalies fetal macrosomia

presentation uterine rupture

``` vaginal bleeding intra abdominal bleeding (hypotension) fetal deceleartions loss of fetal station loss of intrauterine pressure ```

suspect ectopic, and transabominal US shows no implant in uterus next step

transvaginal US

when do majority breech presentation self correct by

37 weeks

risk factors placental abruption

cocaine and HTN

is there pain with problems with vasa previa

management threatened abortion

reassurance and US one week later | bed rest and no sex

lumpke palsy presentation

extended wrist hyperextened MCP join with flexed ICP joints absent grasp reflex can also get ptosis and miosis injury to C8 and T1

erb duchenne

decreased moro and biceps reflexes waiters tip intact grasp

risk for chorioamnionitis

protracted labor and prolonged membrane rupture

pain RUQ with HELPP

distention liver capsule

hard to breath with preeclampsia is from what

pulmonary edema from increased pulmonary capillary pressure from increased afterlod from generalized arterial vasoaspasms

screen all women at first visit for what

syphilis Hep B and HIV

when to screen for Hep C in pregnant women

HIV patients and those at high risk

risk for uterine inversion

nulliparity, fetal macrosomia | placenta acreta and rapid labor and delivery

management uterine inversion

aggressive fluid replacement manual replacement uterus placental removala nd uterotonic durgs after replacement

greates risk for pregnancy in someone with primary HTN

preterm labor

US of placental abruption can show what

retroperitoneal hemorrhage

first step placental abruption

aggressive fluid resuscitation with crystalloids and put in L lateral decubitus

old patient with vulvar atrophy and urinary Sx | cause of urinary problems

estrogen deficiency

if patient quad screen shows low AFP and estriol with high bhCG and inhibin A at 18 weeks next step

US to look for endocardial cushion defects, duodenal atresia, cystic hygroma

PPROM with unknown GBS status

give penicillin

Tx septic abortion

suction curretage

preterm labor and many late declerations | next step

C section

problem with dribbling urinary Sx post partum

urinary retention because of epidural

risk uterine rupture

previous C section | scar!!

loss of fetal station, fetus retracts

uterine rupture

contraindication to breastfeeding

``` active substance abuse unTx active TB maternal HIB herpetic lesions varicella infection ```

lab findings in hyperemesis gravidarum

severe persistent vomiting fluid and electrolyte abnormalities ketones!!! in urine >5% body weight loss