Obstetrics Flashcards Preview

Ob/Gyn Dreams > Obstetrics > Flashcards

Flashcards in Obstetrics Deck (145):
1

dx: appendicitis in preggers

graded compression u/s
if U/S not diagnostic you can MRI

2

tx: DVT in preggers

LWMH

3

when can you get sheehan syndrome

right after childbirth or even months/years later

4

tx for acute sheenhan syndrome

IV dexamethasone
(then MRI the head to r/o other crap)

5

tx: hyperthyroid for preggers

propylthiouracil 1st trimester
methimazole 2nd, 3rd

6

tx: lyme in preggers

amoxicillin

7

why do preggers get GDM?

human placental lactogen (aka chorionic somatomammotropin) increases insulin resistance

8

how much folic acid for preggers

normal: 0.4 mg
high risk: 4 mg

9

cord compression tx

corticosteroids

10

quad screen

triple screen + inhibin A
(hCG, unconjugated estriol, AFP, inhibin A)

11

quad screen results: + for Downs

decreased AFP
decreased estriol
increased inhibin
increased hCG

12

management: screening for downs

low risk can get triple screen
high risk (>35, late prenatal) get quad
if + --> genetic counseling
then offer amniocentesis

13

pregger: fever, abd pain and sausage shaped mass near umbilicus

septic pelvic pain thrombophlebitis

14

pregger/laboring: fever, tachy, tender uterus, foul smelling amniotic fluid

chorioamnionitis

15

post partum pelvic pain, foul smelling lochia

endometritis

16

vag bleeding 20+ weeks: painless vs painful

painless = placenta previa or vasa previa
painful = placental abruption

17

possible problems with babies from DM moms

resp distress syndrome
hypertrophic CM (elevated insulin)
hypoglycemia (elevated insulin)
hypocalcemia (low PTH)
polycythemia (hi EPO)
hypomagnesemia (Mg excreted by mom kidneys)
hyperbilirubinemia (increased hemolysis)

18

normal fetal HR

110 - 160

19

tx for GDM

1. lifestyle
2. + insulin or glyburide

20

most effective dating method first TM

transvaginal sonogram: crown-rump length

21

diff btwn incomplete and inevitable abortion

inevitable is before passage of tissue , incomplete has some or all tissue passed (both have open os)

22

management: placenta previa

< 36 wks: conservative, repeat U/S before delivery
> 36 wks: U/S, most --> C-section, ant-marginal --> can try vaginal

23

diff btwn gestational HTN and preeclampsia

preeclampsia has proteinuria or signs of end organ damage

24

MC breech

frank (butt presents, hips flexed, knees extended)

25

tx: low breast milk production

1. increase feedings
2. metoclopramide (D2 antag)
also make sure shes not on combined OCPs

26

latent phase of labor

effacement and dilation up to 4 cm

27

prolonged latent phase

null: > 20
multi: > 14

28

active phase of labor

eff/dil from 4 - 10 cm

29

prolonged active phase

null: < 1.2 cm/hr
multi: < 1.5 cm/hr

30

arrested active phase

no dilation in 2 hrs in active phase

31

second phase of labor

from 10 cm to delivery

32

prolonged second phase

null: 2 hrs
multi: 1 hr

33

third stage of labor

baby out to placenta out

34

prolonged third stage

> 30 min

35

shiny, peeling areola (breastfeeding)

candidiasis of nipple

36

tx: nipple candadiasis

-azole cream on nipple
oral azole for baby (thrush)

37

MCC mastitis

staph aureus

38

when can you see a gestational sac (BhCG)

transvag: > 1,500
abdominal: > 6,500

39

BhCG growth: normal vs ectopic

normal: double/48 - 72 hrs
ectopic: lower

40

dx: ectopic pregnancy

transvag U/S and serial BhCGs

41

mgmt: ectopic pregnancy

methotrexate
unstable: surgery

42

mgmt: preterm labor by dates

34 - 36.6: +/- corticosteroids (betamethasone), PCN if GBS(+)/unknown
32 - 33.6: add tocolytics (indomethacin, nifedipine)
< 32: add magnesium sulfate

43

why do you give mg sulfate for preterm labor

fetal neuroprotection (eg cerebral palsy)

44

when to cervical cerclage

cervix < 2.5 cm

45

mgmt: uterine inversion

immediate manual replacement
if can't replace, try uterotonics
uterotonics once it's replaced
(remove placenta after it's replaced if still attached)
if nothing works -- laparotomy

46

baby complications of DM mom (1st TM)

congenital heart dz
NTD
small L colon
spontaneous abortion

47

baby complications of DM mom (2/3 TM)

hyperinsulinemia
polycythemia (up met demand --> hypoxia)
organomegaly
hypoglycemia
brachial plexopathy, clavicle frx, perinatal asphyxia (macrosomia, shoulder dystocia)

48

preeclampsia: baby risks

chronic uteroplacental insuff --> growth restriction/LBW
(not hypoxia, which is due to acute UPI)

49

preeclampsia: mom risks

placental abruption
DIC
eclampsia

50

fetal non-stress test: what is a reactive result?

110 - 160 bpm
mod variability (6 - 25/min)
2+ accelerations in 20 min (each 15+ high and 15+ s long)

51

causes of non-reactive non-stress test

fetal sleep (MC)
fetal hypoxia (from UPI)
fetal cardiac abnormalities
fetal neuro abnormalities

52

mgmt: nonstress test

reactive? great, 20 min is good
nonreactive? extend to 40 - 120 min (feti only sleep 40 min at a time)
all nonreactive need follow up biophysical profile or contraction stress test

53

causes of fetal tachycardia

maternal fever
maternal hyperTh
meds (terbutaline)
placental abruption

54

definition of fetal growth restriction

U/S estimated weight < 10th percentile for gestational age

55

symmetric vs asymmetric fetal growth restriction

symmetric: see it 1st TM; global growth lag
asymmetric: see in 2nd/3rd; head-sparing growth lag

56

causes of fetal growth restriction

symmetric: chromosome abnorm, congenital infection
asymmetric: UPI, maternal malnutrition

57

normal preg physio: kidneys

up renal blood flow, GFR, BM permeability -->
down serum BUN, Cr
up renal protein excretion

58

normal preg physio: heart

fill

59

normal preg physio: lungs

fill

60

normal preg physio: blood

fill

61

normal preg physio: endo

fill

62

recommended preggo vaccines

Tdap
inactivated flu
Rho(D)

63

preggo vaccines (for high risk pts)

Hep A/B
pneumococcus
H flu
Meningococcal
Varicella-zoster Ig

64

RFs for uterine atony

prolonged labor
induction of labor
operative delivery
fetal weight > 4000 g

65

spontaneous abortions with closed os

missed
threatened
complete

66

empty sac = which spontaneous abortion

missed

67

Tx: asx bacteriuria in pregnancy

cephalexin
amox-clav
nitrofurantoin
NO cipro/TMP-SMX

68

when can you quad screen

15 - 22 wks

69

what preg screening can you do @ 10 wks

cell-free fetal DNA
CVS
PaPP, beta HCG, nuchal translucency

70

when do you give rhogam

28 - 32 wks
< 72 hrs after delivery
< 72 hrs after abortion
2nd/3rd TM bleeding
CVS/amnio

71

biggest RF for preterm birth

previous preterm birth

72

cervix things that increase risk of preterm birth

short cervix
cold knife conization
LEEP (maybe)
laser ablation DOES NOT

73

mgmt: short cervix (with no previous preterm)

vaginal progesterone

74

mgmt: short cervix (with previous preterm)

IM progesterone @ 2nd TM
serial TVUS to check for short
short --> cerclage

75

whats on the biophysical profile (+norm)

continuous observation for 30 min
non stress test (reactive)
amniotic fluid vol (> 2 x 1 cm)
fetal mvmts (> 3)
fetal tone (> 1 flex/ext)
fetal breathing mvmts (> 1 for > 30 s)

76

when do you deliver based on biophysical profile

4 or less

77

fetal demise with limb fractures, hypoplastic thoracic cavity

osteogenesis imperfecta (II)

78

when can you turn a breech baby

37 weeks to onset of labor

79

who can't breastfeed

active TB
HIV
HSV breast lesions
varicella
meds/chemo/drugs

80

preterm labor definition

contractions (making cervical change!) before 37 wks

81

chorioamnionitis aka

intraamniotic infection

82

criteria for chorioamnionitis

maternal fever plus 1:
- uterine tenderness
- maternal or fetal tachycardia
- malodorous amniotic fluid
- purulent vaginal discharge

83

tx: chorioamnionitis

broad spectrum Abx
deliver (accelerate w/ oxytocin)
antipyretics

84

lactation suppression

avoid nipple stimulation
ice packs
NSAIDs
no binding (mastitis) no bromocriptine

85

prenatal care: when do you type and screen

initial visit

86

prenatal care: when do you do the 1 hr GTTT

24 - 28 wks

87

prenatal care: when do you do HIV/HBsAg/RPR/Chlamydia

initial visit

88

prenatal care: when do you get the GBS culture

35 - 37 wks

89

prenatal care: when do you get the Ab screen if shes Rh negative

24 - 29 wks

90

prenatal care: when do you check her rubella/varicella immunity

initial visit

91

prenatal care: when do you do a UA

initial visit

92

pregnancy liver d/os

intrahepatic cholestasis of pregnancy
HELLP
acute fatty liver of pregnancy

93

3rd TM: itchy papular rash around umbilicus

pruritic urticarial papules and plaques of pregnancy

94

pregnancy: general pruritus, worse at night, worse on palms/soles

intrahepatic cholestasis of pregnancy

95

definition of preeclampsia

new onset HTN (>140/+/- >90) @ > 20wks +/-
proteinuria (> 0.3 g in 24 hr or protein/Cr ratio >0.3 or dipstick >/= 1+)
plt < 100,000
Cr > 1.1 or doubling Cr
LFT 2x ULN
Pulm edema
Cerebral/visual sx

96

McRoberts maneuver complication

mom femoral nerve damage

97

where is 0 station

midway btwn ischial spines

98

quick loss of fetal station

think uterine rupture

99

painless vaginal bleeding upon rupture of membranes

think vasa previa

100

contraindications for exercise in preg

amniotic fluid leak
cervical incompetence
multis
placenta abruption/previa
preeclampsia/gest HTN
severe heart/lung dz
also no hot yoga

101

mgmt: eclampsia

mg sulfate
anti-HTN (hydralazine, labetalol...)
deliver

102

when do you treat moms for GBS

+ test: during labor
unknown and < 37 wks: during labor

103

mgmt: inevitable abortion

hemo stable: misoprostol, nothing or D+C
hemo unstable: D+C

104

why can't you use oxytocin for 1 TM/2 TM abortions

there aren't many oxytocin receptors on uterus yet

105

pregnancy: thyroid changes

TG up
thyroxine up --> total thyroid hormone up
free T4 only up a little or none
TSH down (suppressed by hcg and increased T4)

106

tx: hypothyroidism in preg

up levo 30% when find out pregnant
adjust q month

107

path: HELLP syndrome

abnormal placentation --> systemic inflammation --> activate coags and complement --> platelet consumption and microangio hemolytic anemia --> liver problems

108

tx: HELLP

delivery
magnesium (seizure prophylaxis)
anti-HTN

109

when do you do amnioinfusion

variable decels from cord compression in labor

110

things that cause up AFP in maternal serum

NTDs
abdominal wall defects (omphalocele, gastroschisis)
multiple gestations
rare: congenital nephrosis or obstructive uropathy

111

EMB: complex endometrial hyperplasia

think about unopposed estrogen

112

best emergency contraceptive

copper IUD

113

which emergency contraceptives can be given > 72 hrs after

copper IUD
ulipristal - less effective than IUD
both up to 120 hrs after

114

tx: essential HTN during pregnancy

labetalol or methyldopa (1st line)
nifedipine and hydralazine good alternatives

115

mgmt: prego pt on lithium

taper lithium

116

tx: recurrent variable decels

maternal repositioning (L lat)
amnioinfusion if doesnt work

117

infertility by age

< 35 you get a year to try
> 35, 6 months

118

what does hCG do

preserves corpus luteum so that progesterone stays up

119

mgmt: PPROM

34 - 37 wks: abx, +/- corticosteroids, delivery

< 34 wks, no fetal compromise: abx, corticosteroids, fetal surveillance

< 34 wks, fetal compromise: abx, corticosteroids, delivery

< 32 wks, fetal compromise: above + Mg

120

time frame: post partum blues

2 wks

121

late term vs postterm pregnancies

late term: 41 wks
post term: 42+ wks

122

fetal risks a/w late/post term pregnancies

oligohydramnios
meconium aspiration
stillbirth
macrosomia
convulsions

123

maternal risks a/w late/post term pregnancies

c-section
infection
postpartum hemorrhage
perineal trauma

124

what to do when you can't find fetal HR w/ doppler

need absence of fetal cardiac activity on abdominal U/S to confirm fetal demise

125

what has to be done after a fetal demise

fetal: autopsy; examine placenta/membranes/cord; karyotype/genetics

maternal: Kleihauer-Betke test for fetomaternal hemorrhage; antiphospholipid abs; coag studies

126

c-section: how long after can you give anti-coags if need

6 - 12 hrs

127

arrest of active labor

no cervical change for > 4 hrs w/ adequate contractions
no cervical change for > 6 w/o adequate contractions

128

tocolytics

< 32 wks: indomethacin
32 - 34 wks: nifedipine

129

why do women get hTN post epidural (+ppx)

block sympathetic nerves --> vasodilation (give IVF before)

130

fetal malposition vs malpresentation

malposition: relation of presenting part to pelvis
malpresentation: presenting part

131

optimal fetal position

occiput anterior

132

optimal fetal presentation

vertex

133

MCC of arrested 2nd stage

fetal malposition

134

possible nerve stuff with preeclampsia with severe features

hyperreflexia

135

RFs shoulder dystocia

macrosomia
maternal obesity/excess weight gained in pregnancy
GDM
post-term

136

Hep C preggo

give hep A/B vaccines if hasn't had them
don't treat (teratogens)
breastfeeding is fine
c-section won't help

137

RFs for vertical hep C transmission

HIV co-infection
high viral load

138

oxytocin toxicity

similar to ADH --> hNa, hTN, tachysystole
hNa --> HA, n/v, seizures

139

amphetamines in pregnancy risks

FGR, fetal demise
preterm labor
placental abruption
preeclampsia

140

GDM sugar goals

fasting < 95
1 hr postprandial < 140
2 hr postprandial < 120

141

mgmt: shoulder dystocia

BE CALM
1. Breathe, don't push
2. Elevate hips against abdomen (McRoberts)
3. Call for help
4. Apply suprpubic pressure
5. enLarge vaginal opening (episiotomy)
6. Maneuvers

142

shoulder dystocia maneuvers

deliver posterior arm
rotate 180 (Wood's corkscrew)
collapse ant shoulder (Rubin)
replace fetal head for c-section (Zavanelli)

143

wtf is pseudocyesis

psych pregnancy
pregnancy sx, thinks test is +
usually following loss or infertility

144

contraindications to amnioinfusion

hx of uterine surgery

145

birth plan with hx of vertical c section or open myomectomy

planned c section @ 36 - 37 wks
laparotomy + hysterotomy if labor earlier