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3rd Year (Step 2) > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What must be present for diagnosis of Pre-term labor?

A

Contractions + Cervical Dilation from 20-36 weeks GA

Cervical incompetence = cervical dilation w/out contractions
Preterm contractions = contractions w/out cervical dilation
PROM = pt would have hx of “gush of fluid” from vagina (ROM without labor, PPROM is PROM

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2
Q

“Abortion” definition

A

Pregnancy that ends before 20 weeks gestation or a fetus less than 500 grams.

Chromosomal abnormalities account for 60-80% of these.

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3
Q

Preterm labor – when should you deliver vs. give tocolytics to prevent delivery?

A

Give tocolytics UNLESS 1 of the following:

    • > 34 or >2,500 grams
    • Maternal HTN
    • Maternal Cardiac disease
    • Cervical dilation > 4cm
    • Maternal hemorrhage (abruptio placenta, DIC)
    • Fetal death
    • Chorioamnionitis
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4
Q

Preterm labor – at what fetus age &/or weight do you stop delivery vs. deliver?

A

Tocolytics if 600-2,500 grams OR 24-33 EGA.

Deliver if >2,500 grams or 34-37 EGA.

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5
Q

Preterm labor – if you need to stop delivery, what do you give?

A

Betamethasone to mature lungs (12g IM x 2 doses 24hrs apart)
+
Tocolytics: Magnesium sulfate, CCBs, or Terbutaline

**Betamethasone effects take 24 hours to work, peak at 48 hours, & last for 7 days.

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6
Q

What do you need to check when giving Magnesium Sulfate & why?

A

Check Deep Tendon Reflexes,

  • because Mag sulfate can cause respiratory depression & cardiac arrest.
  • Other SEs include headaches, flushing, diplopia, & fatigue.
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7
Q

Workup of suspected PROM?

A

Sterile speculum examination to confirm the fluid as amniotic fluid:

    • fluid is present in posterior fornix
    • fluid turns nitrazine paper blue
    • fluid has ferning pattern when dry, under a microscope
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8
Q

PROM management

A

If + Chorioamnionitis:
– delivery now

If at term, w/out chorioamnionitis:
– wait 6-12 hrs for SVB, then induce labor if doesn’t occur

If preterm, w/out chorioamnionitis:
– Give Betamethasone + Tocolytics + ABX (ampicillin & azithromycin)

**do fewer exams to prevent chorioamnionitis

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9
Q

Placenta previa presentation?

A
    • Painless vaginal bleeding
      (vs. placental abruption, which has painFUL vaginal bleeding, usually in 3rd trimester)
  • Usually doesn’t cause bleeding until after 28 weeks
    (although may be picked up on routine U/S before 28 wks)
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10
Q

Vaginal bleeding in 3rd trimester – next step?

A

Trans-abdominal ultrasound to see if placenta is lying in the uterus.

**DVE & transvaginal exam NOT done b/c they can separate the placenta from the uterus if placenta previa is present, causing further bleeding.

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11
Q

Placental abruption – what is it & what are some risk factors?

A

Premature separation of placenta from uterus, causing tearing of blood vessels & hemorrhaging into separated space.

Risk Factors:

    • Maternal HTN
    • Prior placental abruption
    • Maternal cocaine use
    • Maternal external trauma
    • Maternal smoking during pregnancy
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12
Q

Polyhydramnios – causes?

A
    • Intestinal atresia (duodenal)
    • Tracheoesophageal fistula
    • Maternal Diabetes (fetal polyuria)
    • Anencephaly
    • Werdnig Hoffman (can’t swallow; Congenital degeneration of anterior motor horn of the spinal cord, same region destroyed by polio virus infection)
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13
Q

Oligohydramnios – causes?

A

Prune belly: lack of abdominal muscles, so unable to bear down & pee
– Treatment = serial Foley cath placements

  • Renal agenesis (incompatible w/ life; Potter Syndrome)
  • Juvenile Polycystic Kidney Disease
  • Fetal genitourinary obstruction
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14
Q

When is Prenatal antibody screening (for Rh-antibody) done for Rh-negative mothers?

A

Screened at initial visit, then it is done again @ 28 & 35 weeks

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15
Q

Management of Rh-negative mom with Rh-positive fetus?

A

Indirect antiglobulin test.

If positive for Rh-antibodies, then:
– Amniocentesis @ 16-20 weeks to evaluate fetal cells for Bilirubin levels

If low or medium, repeat amniocentesis in 2-3 wks or 1-2 wks, respectively.

If high bilirubin, to percutaneous umbilical blood sample to check fetal hematocrit & give intrauterine transfusion if low.

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16
Q

Treatment for pregnant patient w/ chronic HTN @ baseline?

A

Methyldopa, Labetalol, or Nifedipine

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17
Q

Gestational HTN definition?

A

BP over 140/90 that starts after 20 wks gestation.
There is no proteinuria & no edema.

**Treat only during pregnancy w/ Methyldopa, Labetalol, or Nifedipine

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18
Q

Preeclampsia – Tx?

A

If mild & at term: Induce delivery

If mild & preterm: give Betamethasone & Magnesium Sulfate as seizure proph & tocolytic

If severe (>160/110): give Mag sulfate (seizure proph) & Hydralazine (control BP), then follow above rules

19
Q

Eclampsia – Tx?

A

Seizure control – Magnesium Sulfate
BP control – Hydralazine
Deliver the baby immediately after doing these 2 things.
**Same treatment for HELLP syndrome.

20
Q

Blood sugar goals for gestational diabetes?

A

Fasting BS < 95 mg/dL

Postprandial BS < 140 mg/dL

21
Q

Macrosomia definition

A

Fetuses w/ estimated birth weight over 4500 grams

** on PE, the fundal height will be at least 3cm greater than the gestational age. In normal-sized babies, fundal height should equal gestational age in weeks.

22
Q

Macrosomia – Tx?

A

Induction of labor if lungs are mature before fetus is >4500 grams

C-section if fetus is >4500 grams

23
Q

Biophysical Profile (BPP) – components?

A
    • NST
    • Fetal chest expansions (nl >1 in 30sec)
    • Fetal movement (nl >3 in 30min)
    • Fetal muscle tone (fetus flexes an extremity)
    • Amniotic fluid index (volume of AF via U/S)
24
Q

Cause of early decels?

A

Head compression

25
Q

Cause of variable decels?

A

Umbilical cord compression

26
Q

Cuase of late decels?

A

Fetal hypoxia

27
Q

Labor Stage 1 – timeframe?

A 
Primipara = 6-18 hours
Multip = 2-10 hours
28
Q

2 phases of Stage 1 of labor?

A

Latent phase = Onset of labor - 4 cm dilation
(6-7 hours primi; 4-5 hours multip)

Active phase = 4 cm dilation - full dilation
(1-1.2 cm per hour minimum)

29
Q

Stage 2 of labor – timeframe & def?

A

Full dilation of cervix - delivery of neonate

    • 30 min - 3 hours primi
    • 5-30 min multip
30
Q

Stage 3 of labor – timeframe & def?

A

Delivery of neonate - delivery of placenta

– 30 min

31
Q

Prolonged latent stage – definition?

A

Latent phase > 20 hours (primipara)

Latent phase > 14 hours (multip)

**Tx = rest & hydration, most convert to SVD in 6-12 hours

32
Q

Protracted Cervical Dilation – def?

A

Slow dilation during active phase of stage 1 labor:
< 1 cm per hour in primipara
< 1.2 cm per hour in multip

33
Q

2 types of Arrest Disorders?

A

Cervical dilation: no cervical dilation for 2 hours

Fetal descent: no fetal descent for 1 hour

34
Q

Etiology of Arrest Disorders?

A
    • Cephalopelvic disproportion (over 50% of cases) ; tx w/ C-section
    • Malpresentation: fetus >36wks w/ presenting part anything other than head
    • Excessive sedation/anesthesia
35
Q

Causes of postpartum hemorrhage?

A
    • Uterine atony = 80% of causes
    • Laceration
    • Retained parts
    • Coagulopathy
36
Q

Sheehan Syndrome presentation?

A

Inability to breastfeed postpartum

37
Q

Difference btwn Epidural & Spinal anesthesia?

A

Epidural = IV infusion into epidural space

Spinal Anesthesia = 1-time bolus into spinal canal. More rapid onset than Epidural.

**Both provide anesthesia over similar area

38
Q

Potential complications of Hypertension during pregnancy?

A

Placental Abruption, superimposed preeclampsia, IUGR, Preterm birth & cesarean delivery

39
Q

Vaccines recommended either prepartum or immediately postpartum (if too late)?

A

MMR & Varicella

40
Q

Vaccines recommended for pregnant women who haven’t received them?

A

TDaP & Influenza

41
Q

Molar pregnancy – symptoms?

A

1st trimester bleeding ass’d w/ expulsion of vesicles

    • Excessive nausea & vomiting
    • Uterine size larger than dates
    • U/S shows “snow storm appearance”
    • β-HCG levels are higher than expected for presumed GA
42
Q

Most common cause of dysmenorrhea (heavy, painful menses) in adolescent women?

A

Primary dysmenorrhea

    • Prostaglandins release during sloughing off of endometrium, causing painful uterine contractions
    • Tx = NSAIDS (inhibit prostaglandin production); usually gets better w/ age
43
Q

What are some causes of secondary dysmenorrhea?

A
    • Adenomyosis (endometrium growth interspersed throughout myometrium)
    • Endometriosis (ectopic endometrium adhesions
    • Uterine leiomyomata (fibroids)
44
Q

PCOS – Tx

A
    • OCPs
    • Metformin (BS, lose weight, fertility)
    • Clomiphene (fertility)

3rd Year (Step 2) (44 decks)

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