- 28 wk GA - w.i 72 hour of birth of a Rh positive fetus - if Kiehauer Betke test positive - with invasive procedure CVS amniocentesis - ectopic procedure - miscarriage or therapeutic aborption - antepartum haemorrhage

1. abnormal or atypical NST 2. post term pregnancy 3. decreased fetal movement 4. uroplacental insufficiency

1lupus anticoagulant 2. anti cardiolipin 3. anti B2 glycoprotein

OBs / Gyn Flashcards by Najala Orrell

when to give Rogham

28 wk GA
w.i 72 hour of birth of a Rh positive fetus
if Kiehauer Betke test positive
with invasive procedure CVS amniocentesis
ectopic procedure
miscarriage or therapeutic aborption
antepartum haemorrhage

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Medications termination of pregnancy

<9 week - MTX and misoprostol

>12 weeks - prostaglandin (intra or extra amniotic ally or IM) or misoprostol

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surgery to terminate pregnancy

< 12 weeks - Dilation and vacuum aspiration +/- curettage

> 12 weeks - dilation and evacuation , early induction of labour

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DDX of decreased fetal movement

DASH 
death 
amniotic fluid decreased 
Sleep cycle of fetus 
Hunger and thirst

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indications for BPP

abnormal or atypical NST
post term pregnancy
decreased fetal movement
uroplacental insufficiency

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what is looked at in BPP

AFV - 2X2
Breathing - one episode in 30 sec
Limb movement - 3 movements
fetal tone - one episode of extension followed by flexion

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score BPP

8 - good
6 - try again in 24 hours
0-4 - delivery

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adverse fetal outcomes in HTN with pregnancy

IUGR
oligohydramnios
Absent / reversed umbilical artery end diastolic flow

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if severe hypertension in pregnancy

> 160/ 110

lebatolol
nifedipine
hydrazine

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magnesium sulfate toxicity

flushing
hyporeflexia
Somnolence
Respiratory and cardiac depression
weakness

increased risk of toxicity if using CCB or renal disease

Tx - STOP MgS
GIVE calcium gluconate

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eclampsia before 20 weeks

think antiphospholipid syndrome

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blood test for APS

1lupus anticoagulant

anti cardiolipin
anti B2 glycoprotein

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threatened abortion

PVB and cramps
Cervic is soft and closed
US - viable fetus
Tx - watch and wait

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inevitable abortion

PVB and cramps 
Cervix closed until product begin to expel 
US shows nonviable fetus 
Tx - watch and wait 
2. misoprostol 
3. D and C +- oxytocin

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incomplete

PVR VERY heavy 
Cervic is open 
US - products of conception 
Tx: 
1. 2. 3. watch and wait, misoprostol or D and C

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Complete

Bleeding and passage of sac and placenta
Cervic open
US - no products of conception
Tx- expectant management - no D and C needed

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Missed abortion

No bleeding ( fetal death in utero)
Cervix closed
US - SGA with no fetal heart activity , nonviable fetus
Tx watch and wait, misoprostol, D and C

Recurrent abortiopn

> 3 consecutive spontaneous abortion

- evaluate mechanical genetic and environmental

Septic abortion

contents of uterus - infected

Treatment - DC and antiobitocs

methotextrate indication for ectopic pregnancy

< 3.5 cm unreputure extompic
no hepatic , renal or hematologic disease
B HcG < 5000
no fetal heart rate
Willing to follow up

twin twin transfusion

monochromic twins

- material blood from donor twin passes through placenta into vein of recipient twin

treatment of TTT syndrome

amniocentesis - decompress polyhydraminios of recipient town and decrease pressure in cavity on placenta
- intrauterine transfusion to donor if necessary

polyhydramnios

idiopathic 
MOM 
- Type 1 DM 
Maternal - fetal 
- multiple gestation 
- choriangiomas 
FETUS 
- chromosomal anomaly 
- malformation lung 
- anencaphly, hydrocephalus
- TEF , duodenal atresia, fascial clefts

oligohydramnios

-idiopathy 
MOM - UPI, MEDS (ACE inhibitor ) 
FETUS 
- renal agenesis 
- Demise / chronic hypoxemia ( blood shunt away from kidney to perfuse brain) 
- IUGR 
- Ruptured membrane 
- Amniotic fluid normally decrease 35K

complicated variable decelerations

< 70bpm and <60s - loss of variability or decrease in baseline after decelerations - biphasic deceleration - slow return to baseline - baseline tachycardia or bradycardia

early decelerations

benign - head compressions

later deceleration

usually a sign of uretoplacenta insufficiency - fetal hypoxia and academia maternal hypotension - uterine hypertonus

use of tocolytics

1. absence of maternal or fetal contraindications 2. preterm labour 3. cervical dilaitation <4cm

c/i tocolytics

mom - bleeding, maternal disease , preeclampsia or eclampsia Fetus - fetal demise , IUGR , severe congenital abnormalities

most common RF for preterm labour

- previous preterm labour

criteria for EVC

- < 37 weeks - singleton - unengaged presenting part - reactive NST

criteria for vaginal breach delivery

``` > 36 weeks complete or frank breech EFW 2500 - 3800 g continuous fetal monitoring 2 obstetrician ability to perform emergency C/s if necessary ```

when do you do a CS during vaginal breech delivery

fetus not descending to the perineum in the second stage of labour after 2 hours in absence of active pushing or vaginal delivery

c/i to vaginal breech delivery

cord compression clinically inadequate maternal; [e;vis detal factors affecting delivery

obstetrical causes of DIC

Abruption Gestation HTN Fetal demise PPH

risk factors for Umbilical cord prolapse

- prematurity / PROM - fetal malpositio - low lying placenta - polyhydraminos - multiple gestation

risk factor for uterine rupture

uterine scarring excessive uterine stimulation - prolonged oxytocin uterine trauma - operative equipment , ECV uterine abnormalities Multiparty

complications of uterine rupture

maternal mortality , hemorrhage fetal distress Amniotic fluid ambles hysterectomy - if excess and uncontrolled haemorrhage

risk factors for amniotic fluid embolus

- placental abruption - rapid labour - multiparty - uterine rupture - uterine manipulation

clinical Amniotic fluid embolism

- sudden onset SOB - Cardiovascular collapse (hypotension, hypoemia - Seizure - 10% - ARDS or Left ventricular dysfunction

uterine atony

- labour - uterus - placenta - maternal factors - halothane anesthesia