Obstetrics Flashcards
(41 cards)
Methotrexate is indicated for ectopic pregnancy if she can satisfy ALL the following criteria
Not in significant pain
Hemodynamically stable
Adnexal mass <35mm with no fetal heart visible
No intrauterine pregnancy
Serum hCG < 5000 IU/L (ideally < 1500 IU/L)
Able to return for follow-up
Emergency contraception of choice within 72 hours of unprotected sex
Levonelle Pill
Emergency contraception within 120 hours of unprotected sex
IUCS or ellaOne pill
Pregnant exposed to chickenpox
Check women’s immunity (previous infection, varicella antibodies)
Pregnant exposed to chicken pox and not immune
Administer VZIG (unless more than 20 weeks, in which case pick aciclovir)
IF we suspect that the fetus may have Rhesus hemolytic disease, what investigation should we perform on the pregnant patient? Why?
Assess fetal MCA via UTZ
To estimate fetal Hgb concentration -> estimate fetal anemia
Less than 24 weeks AOG
With pain or bleeding or pain and bleeding
UTZ - fetus has fine heartbeat
Threatened Miscarriage
- less than 24 weeks AOG
- bleeding
- open cervix
INEVITABLE MISCARRIAGE
What PE findings would you appreciate in a patient with missed miscarriage?
Less than 24 weeks AOG
Presents with pain, bleeding or pain + bleeding
UTZ does not show fetal heartbeat
- less than 24 weeks AOG
- with bleeding
- history of passing products of conception
- cervix may be open
- no fetal heart
- heterogeneous tissue seen on UTZ
Incomplete Miscarriage
A patient presents less than 24 weeks AOG with bleeding and a history of passing products of conception. Ultrasound revealed an empty uterus.
COMPLETE MISCARRIAGE
A woman in labor presents with SEVERE ABDOMINAL PAIN and VAGINAL BLEEDING. She is HYPOTENSIVE. Her history is POSITIV FOR A PREVIOUS CS.
UTERINE. RUPTURE
What are the features of ectopic pregnancy?
Lower abdominal pain Missed period Vaginal bleeding Shoulder tip pain + Peritonism Cervical excitation
What is the initial investigation if you are presented a woman of a childbearing age presenting with abdominal pain?
Urine pregnancy test
If you are suspecting ectopic pregnancy and patient had a positive urinary pregnancy test, what is the next step?
Ultrasound to look for intrauterine pregnancy
What is the value that is needed to consider in a hemodynamically stable patient who tested negative for urinary pregnancy test but no intrauterine pregnancy by ultrasound?
Beta hCG of 1400
<1400 - wait and observe
> 1400 - laparoscopy
What is the next most appropriate action for a hemodynamically unstable patient with ectopic pregnancy diagnosed by ultrasound (presenting with severe lower abdominal pain, cervical excitation, shoulder tip pain with peritonism, and missed period)?
URGENT LAPAROTOMY
39 wks AOG passed clear viscous fluid per vagina 4 days ago.
Now, she is feverish, sweaty and with suprapubic tenderness.
SFH: 35cm
Fetal tachycardia at 175
WBC and PCT both elevated
Chorioamnionitis
What are the 4T’s of postpartum hemorrhage?
Tone - atony
Tissue - retained placenta or clots
Trauma - laceration
Thrombin - DIC
Values needed to know in categorizing PPH as to its severity
Mild - 500-1000
Moderate 1000-2000
Severe 2000
Management for secondary PPH?
What is secondary PPH?
Secondary PPH is excessive vaginal bleeding 24 hours after delivery until 12 weeks postpartum
A woman at 4 weeks postpartum, did not breastfeed, presents with postpartum hemorrhage. What to do?
REASSURE
At 4 weeks postpartum, an exclusively breastfeeding woman was arranged for a high vaginal or endocervical swab. What was significant in her history?
Risk factor for infection
At 4 weeks postpartum, an exclusively breastfeeding woman was arranged for a pelvic ultrasound. What was significant in her history? What is being ruled out in the ultrasound?
SIgnificant is a risk factor for a retained product of conception
Pelvic UTZ to rule out POC
