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Ob/Gyn Dreams > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

dx: appendicitis in preggers

A

graded compression u/s

if U/S not diagnostic you can MRI

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2
Q

tx: DVT in preggers

A

LWMH

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3
Q

when can you get sheehan syndrome

A

right after childbirth or even months/years later

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4
Q

tx for acute sheenhan syndrome

A

IV dexamethasone

then MRI the head to r/o other crap

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5
Q

tx: hyperthyroid for preggers

A

propylthiouracil 1st trimester

methimazole 2nd, 3rd

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6
Q

tx: lyme in preggers

A

amoxicillin

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7
Q

why do preggers get GDM?

A

human placental lactogen (aka chorionic somatomammotropin) increases insulin resistance

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8
Q

how much folic acid for preggers

A

normal: 0.4 mg

high risk: 4 mg

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9
Q

cord compression tx

A

corticosteroids

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10
Q

quad screen

A

triple screen + inhibin A

hCG, unconjugated estriol, AFP, inhibin A

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11
Q

quad screen results: + for Downs

A

decreased AFP
decreased estriol
increased inhibin
increased hCG

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12
Q

management: screening for downs

A

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

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13
Q

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

A

septic pelvic pain thrombophlebitis

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14
Q

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

A

chorioamnionitis

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15
Q

post partum pelvic pain, foul smelling lochia

A

endometritis

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16
Q

vag bleeding 20+ weeks: painless vs painful

A 
painless = placenta previa or vasa previa
painful = placental abruption
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17
Q

possible problems with babies from DM moms

A 
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)
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18
Q

normal fetal HR

A

110 - 160

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19
Q

tx for GDM

A
  1. lifestyle

2. + insulin or glyburide

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20
Q

most effective dating method first TM

A

transvaginal sonogram: crown-rump length

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21
Q

diff btwn incomplete and inevitable abortion

A

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

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22
Q

management: placenta previa

A

< 36 wks: conservative, repeat U/S before delivery

> 36 wks: U/S, most –> C-section, ant-marginal –> can try vaginal

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23
Q

diff btwn gestational HTN and preeclampsia

A

preeclampsia has proteinuria or signs of end organ damage

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24
Q

MC breech

A

frank (butt presents, hips flexed, knees extended)

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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

Ob/Gyn Dreams (2 decks)

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