Obstetrics Flashcards
(248 cards)
1
Q
What is the technical definition of parity?
A
Number of pregnancies that led to a birth beyond 20 weeks gestation, or an infant weighing over 500 g
2
Q
What is the developmental age of a fetus?
A
Time since conception–this is usually an unknown quantity
3
Q
What is the technical definition of gestational age?
A
Number of weeks and days from LMP
4
Q
When does the fundal height correspond to weeks gestation?
A
After 20 weeks
5
Q
When are fetal heart tones heard?
A
10 weeks
6
Q
When does fetal movement begin?
A
20ish weeks
7
Q
When is the crown-rump length the determining factor for dating gestational age?
A
until 12 weeks (so only the first trimester)
8
Q
What happens to hCG in the second and third trimester respectively?
A
second = decrease Third = level off
9
Q
When can a fetus be seen on US (weeks and b-hCG levels)?
A
around 5 weeks or 1500 hcg transvaginally, or 5000 transabdominally
10
Q
What is the acceptable amount of weight gain that a mother should gain if they are:
- underweight
- at weight
- overweight
- obese
A
- underweight = 15 kg
- at weight = 14 kg
- overweight = 9 kg
- obese = 7 kg
11
Q
What are the definitions of excessive and inadequate rate of weight gain in pregnancy?
A
Excessive = 1.5 kg/month Inadequate = Less than 1 kg/month
12
Q
What amount of folate should all women have? What about those with a h/o giving birth to a child with a NTD?
A
0.4 mg/day
4 mg/day for h/o it
13
Q
What is the recommended amount of Fe that a pregnant women should get per day, starting at the first prenatal visit?
A
30mg/day
14
Q
What is the recommended amount of Ca that a pregnant women should get per day, starting at the first prenatal visit?
A
1300 mg/day less than 19 years old
1000 mg/day over 19 years
15
Q
What is the recommended amount of Vitamin D that a pregnant women should get per day, starting at the first prenatal visit?
A
10 micrograms/day
16
Q
What is the recommended amount of vitamin B12 that a pregnant women should get per day, starting at the first prenatal visit?
A
2 micrograms/day
17
Q
How much exercise should pregnant women get?
A
30 minutes /day
18
Q
What happens to the following measurements in throughout the duration of pregnancy:
- Cardiac output
- Heart Rate
- BP
A
- Cardiac output = increases
- Heart Rate = increases
- BP = decreases
19
Q
What happens to the following measurements in throughout the duration of pregnancy:
- Tidal volume
- Respiratory rate
- Expiratory reserve
A
- Tidal volume = increases
- Respiratory rate = constant
- Expiratory reserve = decreases
20
Q
What happens to the following measurements in throughout the duration of pregnancy:
- blood volume
- Fibrinogen
- Electrolytes
- Hematocrit
A
- blood volume = increases
- Fibrinogen = increases
- Electrolytes = constant
- Hematocrit = decreases
21
Q
How often should pregnant women have a prenatal visit throughout their pregnancy?
A
Weeks 0 - 28 = q4 weeks
Weeks 29-35 = q2 weeks
Weeks 36+ = every week
22
Q
What are the hematological labs that should be obtained at the first prenatal visit? (3)
A
CBC
Rh
T+S
23
Q
What are the infectious diseases should be tested for at the first prenatal visit?
A
Rubella antibody titer HBsAg RPR/VDRL Gonorrhea and chlamydia PPD HIV Pap smear
24
Q
What are the prenatal tests that are offered at 9-14 weeks gestation? (3)
A
PAPP-A
nuchal translucency
beta-hCG
25
What are the prenatal tests that are offered at 15-22 weeks gestation? (4)
AFP
estriol
beta-hCG
inhibin-A
26
When is the quad screen offered in pregnancy?
second trimester
27
When is the full anatomic screen offered in pregnancy?
20 weeks
28
When is the one hour glucose challenge done in pregnancy?
26 weeks
29
When is Rhogam given in pregnancy for an Rh - woman with an Rh + fetus?
30 weeks
30
When is a GBS culture obtains in pregnancy?
35-37 weeks gestation
31
What are the quad screen results for trisomy 18?
Decreased everything (AFP, estriol, hcg, inhibin A)
32
What are the quad screen results for Down syndrome?
```
("2 up, 2 DOWN")
Decreased AFP
Decreased estriol
Increased beta hCG
Increased inhibition A
```
33
What is elevated maternal serum AFP associated with?
NTDs
Abdominal wall defects
Multiple gestations
Fetal death
34
When is the triple screen performed?
10 weeks-ish gestation (end of first trimester)
35
What are the indications for amniocentesis? (4)
- Women over 35
- Abnormal quad screen
- Rh sensitized mother to detect fetal hemolysis
- Evaluate fetal lung maturity
36
What are the TORCHeS infections?
```
Toxo
Other
Rubella
CMV
Herpes / HIV / hepatitis
Syphilis
```
37
What is the definition of spontaneous abortion?
Loss of POC prior to 20 weeks gestation
38
What is the definition of recurrent spontaneous abortions?
Two or more consecutive SABs or three in 1 year
39
What are the likely causes of spontaneous abortions early and late in the pregnancy?
```
Early = chromosomal abnormalities
Late = Hypercoagulable states
```
40
What are the fetal effects of maternal use of: ACEIs?
fetal renal tubular dysplasia
41
What are the fetal effects of maternal use of: androgens
Virilization of female fetuses, and genital developmental defects in boys
42
What are the fetal effects of maternal use of: cocaine?
Bowel atresia
Heart or limb malformations
Microcephaly / IUGR
43
What are the fetal effects of maternal use of: carbamazepine
NTDs
| Microcephaly
44
What are the fetal effects of maternal use of: DES
Clear cell adenocarcinoma of the vagina or cerix
45
What are the fetal effects of maternal use of: lead
Increased SABs
46
What are the fetal effects of maternal use of: Li
Ebstein anomaly
47
What are the fetal effects of maternal use of: methotrexate
SABs
48
What are the fetal effects of maternal use of: organic Hg
SABs
49
What are the fetal effects of maternal use of: phenytoin
IUGR
MR
microcephaly
50
What are the fetal effects of maternal use of: radiation
microcephaly
| MR
51
What are the fetal effects of maternal use of: streptomycin and kanamycin
CN VIII damage
52
What are the fetal effects of maternal use of: tetracyclines
Yellow discoloration of teeth
53
What are the fetal effects of maternal use of: thalidomide
bilateral limb deficiencies
54
What are the fetal effects of maternal use of: valproic acid
NTDs
55
What are the fetal effects of maternal use of: vitamin A and derivatives
SABs
56
What are the symptoms of congenital infection with: toxo
Hydrocephalus
Chorioretinitis
Intracranial calcifications
57
What are the symptoms of congenital infection with: rubella
```
Blueberry muffin
cataracts
MR
Hearing loss
PDA
```
58
What are the symptoms of congenital infection with: CMV
Petechial rash and periventricular calcifications
59
What are the symptoms of congenital infection with: HSV
CNS/systemic infections
60
What are the symptoms of congenital infection with: HIV
FTT and immunodeficiency
61
What are the symptoms of congenital infection with: syphilis
Maculopapular rash
SNuffles
Saber shins
Saddle nose
62
What are the components of the Hutchinson triad of congenital syphilis infection?
Teeth
Deafness
Interstitial keratitis
63
What is the treatment for congenital infection with: toxo
Pyrimethamine
64
What is the treatment for congenital infection with: rubella
Symptomatic
65
What is the treatment for congenital infection with: CMV
Ganciclovir
66
What is the treatment for congenital infection with: HSV
Acyclovir
67
What is the treatment for congenital infection with: HIV
HAART
68
What is the treatment for congenital infection with: syphilis
PCN
69
What are the s/sx, PE findings, and treatment for complete spontaneous abortions?
- Bleeding and cramping stopped, POC expelled
- Closed OS
- no treatment
70
What are the s/sx, PE findings, and treatment for threatened spontaneous abortions?
- Uterine bleeding + abd pain
- Closed OS with *NO* POC passed
- Pelvic rest, f/u US
71
What are the s/sx, PE findings, and treatment for an Incomplete spontaneous abortions?
- Partial POC expulsion
- Open OS
- Manual uterine aspiration
72
What are the s/sx, PE findings, and treatment for inevitable spontaneous abortions?
- Uterine bleeding, No POC expulsion
| - Open OS
73
What are the s/sx, PE findings, and treatment for missed spontaneous abortions?
- Cramping, loss of early pregnancy s/sx
| - Closed OS, w/o fetal cardiac activity
74
What are the s/sx, PE findings, and treatment for septic spontaneous abortions?
- Fever, foul smelling d/c
- Fever, hypotension
- D+C and Abx
75
What is the defintion and treatment for intrauterine demise?
Absence of fetal cardiac activity over 20 weeks gestation
76
When in the pregnancy can methotrexate be used to end a pregnancy?
49 days
77
When in the pregnancy can mifepristone and misoprostol be used to end a pregnancy?
49 days
78
When in the pregnancy can vaginal or SL misoprostol (high dose, repeated) be used to end a pregnancy?
59 days
79
When in the pregnancy can manual D+C (w/wo suction) be used to end a pregnancy?
up to 13 weeks
80
When in the pregnancy can induction of labor through prostaglandins / oxytocin be used to end a pregnancy?
13-24 weeks GA
81
When in the pregnancy can D+E be used to end a pregnancy?
Up to 24 weeks GA
82
What are the leopold maneuvers used for?
Determine fetal lie and presentation to determine if the pregnancy will be complicated
83
If ROM is suspected in a women, what exam should be performed?
Sterile speculum examination
84
What are the aspects of the cervix that are evaluated just prior to Labor? (4)
Dilation
Effacement
Station
Cervical station/consistency
85
What are the stages of labor?
```
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
```
86
How often should FHR be obtained in the first and second stages of labor assuming there are no complications?
```
First = q30 minutes
Second = q15 minutes
```
87
What defines the latent and active parts of the first stage of labor?
```
Latent = Onset to 4 cm dilation
Active = 4 cm dilation to full (10cm) dilation
```
88
What is the average time for the latent and active phases of labor for primiparous and multiparous women respectively?
```
Primiparous = 9 hours, 6 hours
Multiparous = 5 hours, 2.5 hours
```
89
What is the average time for the second phase of labor for primiparous and multiparous women respectively?
0.5 - 3 hours for primiparous
| 5 - 30 mins for multiparous
90
What is the average time for the third phase of labor for primiparous and multiparous women respectively?
0 - 0.5 hours for both
91
How often should FHR be obtained in the first and second stages of labor if there are complications?
First stage = q15 minutes
| Second stage - q5 minutes
92
What is the normal fetal heart rate range?
110-160 bpm
93
What does absent variability of the fetal HR mean?
Indicates severe fetal distress
94
What does minimal variability of the fetal HR mean?
Less than 6 bpm change, indicates fetal hypoxia Mg, or sleep cycle
95
What does normal variability of the fetal HR mean?
6-25 bpm
96
What does marked variability of the fetal HR mean?
Over 25 bpm variations
| Indicates fetal hypoxia
97
What does sinusoidal variability of the fetal HR mean?
Points to serious fetal anemia
98
What are accelerations in fetal HR? What are the significance of these?
Onset of an increase in FHR over 15 bpm to a peak in less than 30 seconds
Reassuring because the indicate fetal ability to appropriately respond to the environment
99
When is antepartum fetal surveillance indicated (indications, timeframe)?
IN pregnancies in which the risk of antepartum fetal demise is increased, usually at 32-34 weeks
100
What is assessed in the antepartum fetal surveillance?
- Number of fetal movements over 1 hour (avg is 10/ 2 hours)
| - Less than this is an indication for further workup
101
What are early decelerations, and what causes them?
Gradual onset of deceleration in FHR, with the nadir occurring less than 30 seconds after the contraction.
Indicates fetal head compression, and is a normal finding
102
What are late decelerations, and what causes them?
Gradual onset of FHR deceleration with the onset to the nadir over 30 seconds with gradual return to baseline
Indicates placental insufficiency and fetal hypoxemia
103
What are variable decelerations, and what causes them?
Abrupt decrease in FHR with onset to nadir less than 30 seconds after contraction, with quick return to baseline.
Indicates cord compression, and should be followed with infusion of NS
104
What is the fetal non-stress test?
Mother resting on left lateral tilt position, and FHR assessed as well as a tocometer. Acoustic stimulation may be used
105
What characterizes a "reactive" fetal nonstress test?
Normal response--Two accelerations over 15 bpm above baseline lasting for at least 15 seconds, over a 20 minute period
106
What characterizes a "non-reactive" fetal nonstress test?
Insufficient accelerations over a 40 minute period
This indicates the need for further evaluation with biophysical profile
107
What is the contraction stress test?
Performed in the lateral recumbent position, with FHR monitored during spontaneous or induced contractions.
Reactivity is determined from FHR monitoring, as in the NST
108
What conditions are contraindications to the contraction stress test?
Placenta previa
| PPROM
109
What defines a "positive" contraction stress test? What is the significance of this?
Late decelerations following 50% or more of contraction in a 10 minute period
Raises concerns about fetal compromise
110
What defines a "negative" contraction stress test? What is the significance of this?
NO late or significant variable decelerations within 10 minutes, and at least 3 contractions
Highly predictive of fetal wellbeing in conjunction with a normal NST
111
What defines an "equivocal" contraction stress test? What is the significance of this?
Intermittent late decelerations or significant variable decelerations
112
What is a biophysical profile? What are the 5 components of this?
Real time US to assign a score of 2 (normal) or 0 (abnormal) to five parameters:
- Fetal tone
- breathing
- movement
- amniotic fluid volume
- NST
113
What is an amniotic fluid index?
Sum of the measurements of the deepest cord-free amniotic fluid measured in each of the 4 abdominal quadrants
114
What are the scores of the Biophysical profile that are:
- Reassuring
- Equivocal
- Worrisome
- Reassuring = 8+
- Equivocal = 6
- Worrisome 0-4
115
What is the only major indication to perform umbilical artery doppler velocimetry?
IUGR suspected
116
What level of amniotic fluid is diagnostic of oligohydramnios?
Less than 5 cm
117
Uterine contractions and cervical dilation result in visceral pain at what spinal levels?
T10-L1
118
Descent of the fetal head and pressure on the vagina and perineum results in somatic pain at what spinal levels?
S2-S4 (pudendal nerve)
119
What are the absolute contraindications to regional anesthesia (epidural, spinal, or combo) for pregnant women? (6)
- Refractory hypotension
- Coagulopathy
- Use of once daily dose of LMWH with 12 hours
- Untreated bacteremia
- Skin infx at site of placement
- Increased ICP 2/2 mass lesion
120
How long does morning sickness usually last?
first trimester
121
What are the diagnostic criteria for hyperemesis gravidarum?
- Ketonuria/ketonemia
- hyponatremia/hypokalemia
- Hypochloremic metabolic alkalosis
122
What is the treatment for hyperemesis gravidarum?
- Vit b6
- Doxylamine (antihistamine)
- Diphenhydramine PO
- IVFs PRN
123
What needs to be r/o in cases of suspected hyperemesis gravidarum?
Molar pregnancy
124
What is the suspected cause of hyperemesis gravidarum?
Increased hCG and estradiol causes it, maybe
125
When is the screening for gestational DM done? What is done?
25 weeks-ish
| 1 hour 50g glucose challenge
126
How many measurements of abnormal BG are needed to diagnose G-DM?
2 or more
127
What are the fasting, 1 hour, 2 hour, and 3 hour BG cutoff values for the 50g glucose tolerance test?
Fasting = less than 95
1 hour = over 180
2 hours = over 155
3 hours = over 140
128
What is the diet that is recommended that mothers with G-DM be started on?
ADA diet
129
What are the tests that should be performed on the fetus in cases of maternal G-DM?
Periodic US and NST
130
In mothers who had G-DM, when should f/u testing be done to assess for DM-II?
6-12 weeks postpartum
131
What level of HbA1c indicates a risk for congenital malformations?
Greater than 8, investigate!
132
What are the fasting and postprandial goals of G-DM?
Fasting goal under 95 mg/dL
| Postprandial under 120 mg/dL
133
True or false: glucosuria on a UA in a woman before 20 weeks gestation is an indication of G-DM
False-indicates pregestational DM
134
What are the three major tests that are performed on a fetus at 16-24 weeks in a mother who has G-DM?
- Quad screen
- US
- Fetal echo
135
What are the three major tests that are performed on a fetus at 32-34 weeks in a mother who has G-DM?
- close fetal surveillance
- Admit if poorly controlled
- Serial US
136
True or false: maternal BG levels should be tightly regulated during delivery
True
137
When is pregnancy does *gestational* HTN develop?
After 20 weeks
138
What level of proteinuria is diagnostic of eclampsia?
Over 300 mg/L
139
What is the treatment for gestational HTN? What is NOT?
Monitor closely, and give methyldopa, labetalol PRN.
NOT ACEIs
140
What is the classic triad of preeclampsia?
HTN
Proteinuria
Edema
141
What are the components of HELLP syndrome?
```
Hemolysis
Elevated
LFTs
Low
Platelets
```
142
What BP defines mild preeclampsia? Severe?
```
Mild = 140/90 or more
Severe = 160/110
```
143
What are the features of severe preeclampsia?
- 160/110
- Proteinuria
- Cerebral changes
- Visual changes
- RUQ pain (and other HELLP syndrome s/sx)
144
What level of proteinuria is diagnostic of severe preeclampsia?
Over 5g/day, oor 3-4 + urien dipsticks
145
What is the treatment for eclampsia that is far from term?
Modified bed rest and expectant management
146
What are the three major treatments that are done with eclamptic women?
- IV Mg
- Labetalol or hydralazine
- Delivery if possible
147
What is the treatment for Mg toxicity?
Calcium gluconate
148
How long should seizure prophylaxis (Mg) be continued in eclamptic women postpartum?
24 hours
149
What is the treatment for an uncomplicated UTI and pyelonephritis respectively in pregnancy?
```
UTI = Macrobid
Pyelo = 3rd gen cephalosporins
```
150
What are the two most common causes of antepartum hemorrhage?
Placental abruption
| Placenta previa
151
What are the four major causes of bleeding in the third trimester?
- Vagina-bloody show, trauma
- Cervical lesions/CA
- Placental bleeding
- Fetal bleeding
152
What is placental abruption?
Premature separation of normally implanted uterus
153
What is a "low lying" placenta previa?
Placenta is in close proximity to the OS
154
What is vasa previa?
Velamentous umbilical cord insertion and/or bilobed placenta causing vessels to pass over the internal os.
155
What are the major risk factors for placental abruption? (3)
HTN
Abdominal/pelvic trauma
Tobacco/cocaine abuse
156
What are the major risk factors for placenta previa? (3)
Prior C-sections
Multiparity
Advanced maternal age
157
What are the major risk factors for vasa previa (3)?
Multiple gestations
IVF
Single umbilical artery
158
What are the s/sx of placental abruption?
Painful, dark vaginal bleeding that does not spontaneously cease
159
What are the s/sx of placenta previa?
Painless bright red bleeding that often ceases in 1-2 hours w/wo uterine contractions
160
How do you diagnose:
- Placental abruption
- Placenta previa
- Vasa previa
- Placental abruption = Clinical
- Placenta previa = TV / TA US
- Vasa previa = TVUS
161
What are the s/sx of vasa previa?
Painless bleeding at rupture of membranes with fetal bradycardia
162
How do you manage placental abruption?
Expectant/stabilize if mild
| Immediate delivery if severe and expected delivery soon
163
How do you manage placenta previa?
Do NOT perform vaginal exam
Serial US to see if resolves
Deliver by C-section if not resolved by
164
How do you manage vasa previa?
- Acute bleeding = emergency C-section
| - Before labor = Steroids at 30 weeks, and scheduled c-section
165
What is the classic triad for an ectopic pregnancy?
Pain
Amenorrhea
Vaginal bleeding
166
What does the workup of a suspected ectopic pregnancy involve?
```
bhCG measurements (will not double appropriately)
US w/o intrauterine pregnancy
+ prego test
```
167
What is the medical treatment for an ectopic pregnancy?
Methotrexate
168
What is the technical definition of IUGR?
EFW less than 10th percentile
169
What are the risk factors for IUGR?
■ Maternal systemic disease leading to uteroplacental insufficiency (intrauterine infection, hypertension, anemia).
■ Maternal substance abuse.
■ Placenta previa.
■ Multiple gestations.
170
What is the treatment for IUGR that is near delivery date?
Administer steroids to accelerate fetal lung maturity (48 hours)
171
What is the technical definition of fetal macrosomia?
Birth weight over the 95th percentile
172
What is the treatment for fetal macrosomia?
-Planned c-section if over 5000g
173
What is the technical defintion of polyhydramnios?
AFI over 25 on US
174
How do you diagnose polyhydramnios?
Fundal height greater than expected.
| US
175
What are the complications associated with polyhydramnios?
Preterm labor
Fetal malpresentation
Cord prolapse
176
What is the technical definition of oligohydramnios?
AFI less than 5
177
What must always be r/o prior to diagnosing oligohydramnios?
Inaccurate dating
178
What is erythroblastosis fetalis?
Rh problems
179
What are the two major malignant types of gestational trophoblastic disease?
Invasive moles
| Choriocarcinoma
180
What are the usual s/sx of gestational trophoblastic disease?
Uterine bleeding and uterine sizes greater than expected for dates
181
What is the mechanism behind complete and incomplete moles?
```
Complete = sperm fertilization of an empty ovum
Incomplete = normal ovum fertilized by two sperm
```
182
What are the karyotypes of complete and incomplete hydatidiform moles?
Complete =46, XX or YY
| Incomplete = 69 XXY or XYY
183
Which contains fetal tissue: complete or incomplete moles?
Incomplete
184
What are the dietary deficiencies that have been associated with the development of moles?
Low in folate or beta-carotene
185
What are the gross exam findings of a mole?
Grapelike molar clusters
186
What are the beta-hCG findings of a mole?
Markedly increased hCG
187
What is the treatment for a mole?
D+C and trend b-hCG downward to ensure resolution
188
What is the chemotherapy of choriocarcinomas?
Methotrexate and dactinomycin
189
True or false: beta-hCG is elevated with multiple gestations
True
190
What must multiple gestations be monitored for throughout the course of the pregnancy?
IUGR (twin-twin transfusion syndrome)
191
What is the treatment for potential shoulder dystocia during delivery of a large infant?
```
Help reposition
Episiotomy
Leg elevated
Pressure (suprapubic)
Enter the vagina and attempt to rotate
Reach for fetal arm
```
("HELPER")
192
What is first stage protraction/arrest?
Labor that fails to produce adequate rates of progressive cervical change.
193
What is prolonged second-stage arrest?
Arrest of fetal descent
194
What are the complications associated with failure to progress?
Chorioamnionitis
| Postpartum hemorrhage
195
What is the definition of PROM?
ROM that occurs more than 1 hour before the onset of labor.
196
What is the defintion of failure to progress in the latent stage of labor for primiparous and multiparous women respectively?
```
Prima = over 20 hours
Multi = over 14 hours
```
197
What is the defintion of failure to progress in the active stage of labor for primiparous and multiparous women respectively?
```
Prima = over 2 hours
multi = over 1 hour
```
(add an hour to either if epidural present)
198
What is the defintion of failure to progress in the second stage of labor for primiparous and multiparous women respectively?
```
Prima = over 2 hours
Multi = over 1 hour
```
199
What is the treatment for arrest in the latent phase of labor? Active? Second stage?
```
Latent = therapeutic rest and analgesia
Active = Amniotomy, oxytocin
Second = C section or assisted vaginal
```
200
What is the definition of PPROM?
ROM occurring at less than 37 weeks gestation
201
What is the defintion of prolonged ROM?
ROM occurring ver 18 hours prior to delivery
202
What is the basis of the nitrazine paper test in diagnosing ROM?
If amniotic fluid present, then the paper will turn blue to indicate alkaline fluid
203
What is the Fern test used to diagnose ROM?
A ferning pattern is seen under a microscope after amniotic fluids dries on a glass slide
204
What are the unequivocal tests that can be performed to definitively diagnose ROM?
US guided transabdominal installation of indigo carmine dye to check for leakage
205
What is the treatment for PPROM if less than 32 weeks?
Expectant management with bed rest and pelvic rest
206
What is the treatment for PPROM if between 34-36 weeks?
Labor induction
207
What should be given to preterm fetuses less than 32 weeks gestation prior to inducing delivery?
Betamethasone or dexamethasone x48 hours
208
What should be done if PPROM is complicated by infection?
Delivery
209
What is the technical definition of preterm labor?
Preterm labor = regular uterine contractions + concurrent cervical change at < 37 weeks’ gestation.
210
True or false: most patient who go into preterm labor have identifiable risk factors
False
211
What are the diagnostic criteria for preterm labor?
- Regular uterine contractions- (three or more contractions of 30 seconds each over a 30-minute period)
- Concurrent cervical changes at less than 37 weeks
212
What should be done with a suspected preterm labor?
- R/o contraindications for tocolysis
- Sterile speculum exam to r/o ROM
- US to r/o uterine anomalies
213
What is the treatment for Preterm labor?
Tocolytic therapy
Steroids to accelerate fetal lungs
PCN for GBS prophylaxis
214
What are the drugs that are used for tocolysis?
- MgSO4
- Beta-mimetics
- CCBs
- Prostaglandin inhibitors
215
What is the major complication associated with preterm labor for the fetus?
PDA
216
What is the common malpresentation of a fetus?
Breech
217
What is the major risk factor for the development of fetal malpresentation?
Prematurity
218
What are:
- Frank breech
- Footling breech
- Complete breech
- Frank breech = The thighs are flexed and the knees are extended.
- Footling breech = One or both legs are extended below the buttocks.
- Complete breech = The thighs and knees are flexed.
219
What is the treatment for breech presentation? (4)
- Follow, since most resolve by 38 weeks
- External version
- Trial of breech vaginal delivery (if imminent)
- Elective c-section
220
What type of uterine incision predisposes to uterine rupture with vaginal delivery?
Vertical
221
What maternal infection is an indication for a c-section?
Herpes
222
What is the most common cause of primary c-section?
Cephalopelvic disproportion
223
What is puerperium?
the period of about six weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition.
224
What amount of blood is classified as postpartum hemorrhage?
More than 500 mL if vaginal delivery
| More than 1 L if C-section
225
What are the three key features of postpartum endometritis?
- Fever over 38 C within 36 hours
- Uterine TTP
- Malodorous lochia
226
What is the treatment for severe postpartum hemorrhage?
Uterine artery embolization
227
What are the causes of uterine atony?
- Uterine overdistention
- Exhausted myometrium
- Uterine infx
- Conditions interfering with contractions
228
What are the four T's of postpartum hemorrhage?
- Tone
- Trauma
- Thrombin
- Tissue (retained)
229
What are the causes of retained placental tissue?
- Placenta accreta/increta/percreta
- placenta previa
- Uterine leiomyomas
230
How do you diagnose retained placental tissue?
Manual and visual inspection of the placenta and uterine cavity for missing cotyledons. Ultrasound may also be used to inspect the uterus.
231
What is the treatment for uterine atony? (4)
- Bimanual uterine massage (usually successful).
- Oxytocin infusion
- Methergine (methylergonovine) if not hypertensive.
- PGF2a.
232
What is the treatment for retained placental tissue?
Manual removal or Curettage
233
What timeframe is needed for a fever to diagnose postpartum infection?
Over 38 C for at least 2 of the first 10 postpartum days, not including the first 24 hours
234
What are the 7 W's of post op fever?
```
Womb
Wind
Water
Wound
Weaning (breast abscess or mastitis)
Wonder drugs
```
235
How long should broad spectrum abx be used for in treating postpartum fever?
So that pt has been afebrile for at least 48 hours
236
What causes septic pelvic thrombophlebitis?
Pelvic infection leads to infection of the vein wall and intimal damage, leading in turn to thrombogenesis. The clot is then invaded by microorganisms.
237
What are the classic s/sx of septic pelvic thrombophlebitis?
Presents with abdominal and back pain and a “picket-fence” fever curve (“hectic” fevers) with wide swings from normal to as high as 41°C (105.8°F).
238
What is the treatment for septic pelvic thrombophlebitis?
Abx and anticoagulation
239
What is the most common presenting symptom of SHeehan syndrome?
Inability to lactate
240
How do you dx sheehan syndrome?
Provocative hormonal testing and MRI of pituitary
241
What is the treatment for sheehan syndrome?
Replace all lost hormones
242
What happens after delivery to stimulate milk production?
Loss of placenta leads to increased prolactin levels
243
What is the immune component of colostrum?
IgA
244
What are the contraindications to breastfeeding?
- HIV infx
- HSV/varicella infx
- Certain meds
245
What is the most common causative organism of mastitis?
Staph aureus
246
True or false: mastitis is usually bilateral
False-unilateral
247
When does mastitis typically present?
2-4 weeks postpartum
248
Why continue breastfeeding with mastitis?
to prevent the accumulation of infected material
