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obgyn > obgyn > Flashcards

obgyn Flashcards

1
Q

BP readings for diagnosis of gestational HTN?

A

BP ≥ 140/90

-2 occasions
-4 hours apart
-20+ weeks gestation
-previously normal BP

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2
Q

Severe BP readings of gestational HTN?

A

BP ≥ 160/110

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3
Q

Severe features (that can aid in the diagnosis of preeclampsia in the absence of proteinuria)?

7

A
  1. thrombocytopenia
  2. impaired liver fxn
  3. RUQ / epigastric pain
  4. renal insufficiency
  5. pulmonary edema
  6. new onset HA
  7. visual disturbances
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4
Q

Diagnosis of preeclampsia most common after how many weeks gestation?

A

20 (and frequently near term)

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5
Q

High risk factors for preeclampsia?

6

A
  1. prior hx
  2. multifetal gestation
  3. chronic HTN
  4. pregestational / gestational DM
  5. kidney disease
  6. autoimmune disease
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6
Q

Treatment if high risk factors for preeclampsia?

A

start low dose ASA between 12-16 weeks gestation

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7
Q

Moderate risk factors for preeclampsia?

5

A
  1. nulliparity
  2. pre-pregnancy BMI > 30
  3. family hx
  4. sociodemographic characteristics
  5. maternal age > 35
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8
Q

Treatment if moderate risk factors (1+) for preeclampsia?

A

consider starting low dose ASA between 12-16 weeks gestation

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9
Q

HELLP syndrome LDH levels?

A

≥ 600

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10
Q

HELLP syndrome AST / ALT elevation?

A

> 2 x ULN

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11
Q

HELLP syndrome platelet levels?

A

< 100

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12
Q

Main presenting symptoms of HELLP?

A

RUQ pain, generalized malaise, N/V

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13
Q

Convulsive manifestation of the hypertensive disorders of pregnancy?

A

eclampsia

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14
Q

Eclampsia often preceded by what symptoms?

A

severe / persistent HA’s, visual disturbances, AMS

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15
Q

Fetal consequences of HTN pregnancy disorders?

5

A
  1. fetal growth restriction
  2. oligohydraminos
  3. placental abruption
  4. nonreassuring fetal status
  5. preterm delivery
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16
Q

Maternal consequences of HTN pregnancy disorders?

7

A
  1. pulmonary edema
  2. MI
  3. stroke
  4. ARDS
  5. coagulopathy
  6. renal failure
  7. retinal injury
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17
Q

Recommendation if gestational HTN/ or preeclampsia with severe features at 34+ weeks?

A

Delivery

(after maternal stabilization, with labor / PROM)

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18
Q

Loading dose of magnesium if eclampsia or gestational HTN / preeclampsia with severe features?

A

4-6 g IV over 20-30 min

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19
Q

Maintenance dose of magnesium if eclampsia or gestational HTN / preeclampsia with severe features?

A

1-2 g IV / hour

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20
Q

Timing of magnesium admin if c-section?

A

Begin before, continue during + 24 hours following delivery

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21
Q

Correction for elevated magnesium levels and risk of impending respiratory depression?

A

calcium gluconate 10% solution, 10 mL IV over 3 min + IV lasix

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22
Q

Acute BP management (initiate within 30-60 min) with labetalol?

A

10-20 mg IV then 20-80 mg q 10-30 min to max cumulative dose of 300 mg

OR

constant infusion of 1-2 mg / min

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23
Q

Acute BP management (initiate within 30-60 min) with hydralazine?

A

5 mg IV or IM then 5-10 mg IV q 20-40 min to max dose of 20 mg

OR

constant infusion of 0.5-10 mg / hr

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24
Q

Acute BP management (initiate within 30-60 min) with nifedipine?

A

10-20 mg orally, repeat in 20 min if needed, then 10-20 mg q 2-6 hours, max daily dose of 180 mg

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25
Q

Expectant BP management (initiate within 30-60 min) with labetalol?

A

200 mg q 12 hours, increase to 800 mg q 8-12 hours as needed

(max 2400 mg daily)
(+ short acting nifedipine added gradually if needed)

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26
Q

Contraindications for labetalol admin?

5

A
  1. asthma
  2. preexisting myocardial disease
  3. decompensated cardiac function
  4. heart block
  5. bradycardia
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27
Q

Consequences of eclamptic seizures?

3

A

prolonged fetal HR decels, fetal bradycardia, increase in uterine contractility / baseline tone

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28
Q

Weeks of gestation considered preterm birth?

A

20 0/7 - 36 6/7

plus contractions and cervical dilation / effacement

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29
Q

Upper limit for the use of tocolytic agents?

A

34 weeks

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30
Q

Contraindications to tocolysis?

8

A
  1. intrauterine fetal demise
  2. lethal fetal anomaly
  3. nonreassuring fetal status
  4. severe preeclampsia or eclampsia
  5. maternal bleeding with hemodynamic instability
  6. chorioamnionitis
  7. PPROM
  8. maternal contraindications to tocolysis
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31
Q

Corticosteroids used in the antenatal period for fetal organ maturation?

A

betamethasone & dexamethasone

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32
Q

Preterm labor at risk of delivery within 7 days +/- ruptured membranes or multiple gestations should be given?

A

single course of corticosteroids between 24-34 weeks gestation

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33
Q

Dose of corticosteroids in the antenatal period?

A

12 mg IM q 24 hours x 2 doses

OR

6 mg IM q 12 hours x 4 doses

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34
Q

Common tocolytic agents?

A

CCB’s, NSAID’s, beta-adrenergic receptor agonists

(use for up to 48 hours for steroid admin)

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35
Q

definition of PPH

A

cumulative blood loss ≥ 1000 mL

+/- signs / sxs hypovolemia within 24 hours after birth process

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36
Q

primary PPH is what time frame

A

within first 24 hours of birth

37
Q

secondary PPH is what time frame

A

from 24 hours after delivery and up to 12 weeks PP

38
Q

4 T’s of PPH

A

tone, trauma, tissue, thrombin

39
Q

what should be suspected as first etiology of PPH

A

uterine atony

40
Q

first line treatment for PPH due to uterine atony

A

uterotonic agents

oxytocin, methylergonovine, 15-methyl prostaglandin, misoprostol

41
Q

most common causes of secondary PPH

4

A
  1. subinvolution of placental site
  2. retained POC
  3. infection
  4. inherited coagulation defects
42
Q

medium risk factors for PPH

7

A
  1. prior c-section / uterine surgery
  2. > 4 previous deliveries
  3. multiple gestaion
  4. large uterine fibroids
  5. chorioamnionitis
  6. magnesium sulfate use
  7. prolonged use of oxytocin / prolonged labor
43
Q

high risk factors for PPH

6

A
  1. previa / accreta / increta / precreta
  2. HCT < 30
  3. bleeding at admission
  4. known coagulation defect
  5. history of PPH
  6. abnormal vital signs
44
Q

placenta covers cervical opening

A

previa

45
Q

placenta invasion into uterine wall and fails to separate during 3rd stage of labor

A

accreta / increta

46
Q

most severe form of accreta, invasion through entirety of myometrium +/- extrauterine tissue

A

precreta

47
Q

active management of third stage of labor

A

oxytocin admin, uterine massage, umbilical cord traction

48
Q

dose of oxytocin during third stage of labor

A

bolus dose of 10 units IV vs IM

49
Q

US finding highly suspicious for retained placental tissue

A

echogenic mass

50
Q

classic contraction pattern for placental abruption

A

high frequency, low amplitude

51
Q

triad for amniotic fluid embolism

A

hemodynamic compromise
respiratory compromise
DIC

52
Q

dose of oxytocin for uterine atony

A

10-40 units per 500-1000 mL as continuous infusion ot 10 units IM

53
Q

dose of methylergonovine for uterine atony

A

0.2 mg IM q 2-4 hours

54
Q

dose of 15-methyl PGF for uterine atony

A

0.25 mg IM or intramyometrial 0.25 mg q 15-90 min (max 8 doses)

55
Q

dose of misoprostol for uterine atony

A

600-1000 micrograms oral, sublingual, or rectal (once)

56
Q

when the uterine corpus descends to, and sometimes completely through, the uterine cervix

A

uterine inversion

57
Q

treatment of anemia found on routine PP labs

A

transfusion of PRBCs, oral iron, IV iron

58
Q

early pregnancy loss definition

A

nonviable, IU pregnancy w/ either an empty GS or GS + embryo / fetus without fetal heart rate activity

59
Q

time frame of early pregnancy loss

A

within the first 12 6/7 weeks

60
Q

~50% of all early pregnancy losses are due to?

A

fetal chromosomal abnormalities

61
Q

most significant risk factors for early pregnancy loss

A

advanced maternal age, prior early pregnancy loss

62
Q

common sxs of early pregnancy loss

A

vaginal bleeding, uterine cramping

63
Q

findings diagnostic of pregnancy failure

CRL of __ mm + __

A

CRL of ≥ 7mm + no heartbeat

64
Q

findings diagnostic of pregnancy failure

Mean sac diameter of __ mm + __

A

Mean sac diameter of ≥ 25 mm + no embryo

65
Q

findings diagnostic of pregnancy failure

Absence of __ ≥ __ after a scan that showed a gestational sac without a yolk sac

A

Absence of embryo with heartbeat ≥ 2 weeks after a scan that showed a gestational sac without a yolk sac

66
Q

findings diagnostic of pregnancy failure

Absence of __ ≥ __ after a scan that showed a gestational sac with a yolk sac

A

Absence of embryo with heartbeat ≥ 11 days after a scan that showed a gestational sac with a yolk sac

67
Q

common criteria for complete expulsion of pregnancy tissue (on US)

A

absence of GS and endometrial thickness < 30 mm

68
Q

when can medical management for early pregnancy loss be considered

A

without infection, hemorrhage, severe anemia, or bleeding disorders

69
Q

medical management for early pregnancy loss (dosing)

A

Misoprostol 800 micrograms, intravaginally + mifepristone 200 mg orally 24 hours prior

with repeat dose as needed
(no earlier than 3 hours after first dose and typically within 7 days if there is no response to the first dose)

70
Q

Administration of Rh(D)-immune globulin should be considered, especially if ?

A

later in the first trimester & Rh(D) negative and unsensitized

(prophylaxis if surgical management)

71
Q

dose of Rh(D)-immune globulin

A

50 micrograms

72
Q

timing of Rh(D)-immune globulin if medical management

A

within 72 hours of the first misoprostol administration

73
Q

“too much bleeding” with early pregnancy loss

A

soaking of 2 maxi pads per hour for 2 consecutive hours

74
Q

surgical uterine evacuation if ?

A

retained tissue, hemorrhage, hemodynamic instability, signs of infection

75
Q

dose of abx with surgical intervention of early pregnancy loss

A

single dose of doxycycline 200 mg 1 hour prior

76
Q

most common site of ectopic pregnancy

A

fallopian tube

77
Q

heterotopic pregnancy

A

co-occurence of ectopic pregnancy with IU pregnancy

78
Q

risk factors for ectopic pregnancy

5

A
  1. prior ectopic pregnancy
  2. previous damage to fallopian tubes
  3. ascending pelvic infection
  4. prior pelvic / fallopian tube surgery
  5. assisted reproductive technology
79
Q

US findings of ectopic pregnancy?

A

mass +/- hypoechoic area separate from ovary

80
Q

collection of fluid or blood in the uterine cavity, sometimes visualized with ectopic pregnancy

A

pseudogestational sac

81
Q

an IU gestational sac with yolk sac should be visible when ?

A

between 5-6 weeks gestation

82
Q

chorionic villi found on uterine aspiration confirms what?

A

failed IU pregnancy

83
Q

absolute contraindications to methotrexate in ectopic pregnancy

8

A
  1. IU pregnancy
  2. immunodeficiency
  3. anemia / leukopenia / thrombocytopenia
  4. pulmonary disease
  5. PUD
  6. hepatic dysfunction
  7. renal dysfunction
  8. breastfeeding
84
Q

single dose regimen of methotrexate for ectopic pregnancy

A

-day 1: 50 mg/m2 IM
-day 4 & 7: measure hCG
-if decrease > 15%, measure until non-pregnant level
-if decrease < 15%, re-administer methotrexate 50 mg/m2 IM

85
Q

two dose regimen of methotrexate for ectopic pregnancy

A
  • day 1 & day 4: 50 mg/m2 IM
    -day 4 & &: measure hCG
    -if decrease > 15%, measure until non-pregnant level
    -if decrease < 15%, re-administer methotrexate 50 mg/m2 IM on day 7
    -day 11: re-check hCG
    -can repeat again on day 14 if needed
86
Q

most common adverse effects of multiple doses of methotrexate

A

GI problems

87
Q

what to avoid on methotrexate

A

folic acid supplements, foods that contain folic acid, NSAIDs

(all decrease efficacy)

88
Q

avoid pregnancy during treatment and for how long after methotrexate therapy

A

one ovulatory cycle

89
Q

surgical options for ectopic pregnancy

A

laparoscopic salpingostomy vs laparoscopic salpingectomy

-removal of the ectopic pregnancy while leaving the affected fallopian tube in situ
-removal of part or all of the affected fallopian tube

obgyn (3 decks)

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