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Flashcards in Obstetrics Deck (166):
1

primary cause third trimester bleeding

Placental abruption and placenta previa

2

Classic US and gross appearance of complete hydatidiform mole

Snowstorm on US
Cluster of grapes on gross exam

3

Chromosomal pattern of complete mole

46 XX

4

Molar pregnancy containing fetal tissue

Partial mole

5

Sx of placental abruption

Continuous painful bleeding

6

Sx of placenta previa

Self limited, painless vaginal bleeding

7

When should a vaginal exam be performed with suspected placenta pre via?

Never

8

Abx with teratogenic effect

Tetracycline
Fluoroquinolones
Aminglycosides
Sulfonamides

9

Most common cause of postpartum hemorrhage

Uterine atony

10

Tx postpartum hemorrhage

Uterine massage
If that fails - oxytocin

11

Abx prophy for GBS

IV penicillin or ampicillin

12

Meds to accelerate fetal lung maturity

Bethamethasone or dexamethasone x 48 hrs

13

Pt fails to lactate after an emergency C section with marked blood loss

Sheehan syndrome (postpartum pituitary necrosis)

14

Uterine bleeding at 18 weeks gestation, no products expelled, cervix open

Inevitable abortion

15

Uterine bleeding at 18 wks gestation, no products expelled, cervical os closed

Threatened abortion

16

Teratogens effect during which weeks

2-12 wks

17

Which is older, gestational age or embryonic/developmental age? by how much

Gestational age 2 weeks older than embryonic age because is based on LMP which is 14 d prior to fertilization which occurs at ovulation

18

Naegele rule

EDP = LMP + 7 days - 3 months + 1 year

19

CV changes in pregnancy

CO increased 40% with SV and HR increase
Systolic murmur b/c inc CO
Myocardial O2 demand increases
SP and DP decrease
Uterus push heart superiorly
Venous distension increases
PVR decreases

20

Respiratory changes in pregnancy

Uterus pushes diaphragm up and decreases RV, FRC, ERV
Total O2 consumption increases
TV increases 40% with increase in minute ventilation 2/2 progesterone stimulation
PCO2 decreases = dyspnea
VC does not change

21

Renal changes in pregnancy

Renal plasma flow and GFR increase
BUN and Cr decrease
Inc renal loss bicarb due to compensation for resp alkalosis
Blood and interstitial fluid v increases

22

Endocrine change in pregnancy

Nondiabetic hyperinsulinemia with mild glc intolerance
Production human placental lactogen inc glc intolerance by interfering with insulin activity
Fasting TG inc
Cortisol Inc
TBG and T4 inc, free T4 unchange
TSH decrease but WNL

23

Hematologic changes in pregnancy

Hypercoaguable state
Increased RBC
HCT dec bc inc blood V

24

GI changes in pregnancy

Inc salivation
Dec gastric motility
Increased gastric emptying time
Sphincter tone decreases

25

Weight gain mom

Calorie intake

BMI 26: 15-25 lbs

Calories: 2500

26

Labs at initial visit

9-14 wks
CBC
Blood ab and Rh
Pap
GC/Chlam
UA-every visit
RPR or VDRL
Rubella titer
Hep B surface antien
HIV
TSH?

27

Labs 16-18 wks

Quadruple screen - trisomies 21, 18, NTD

28

Labs 18-20 wks

US dating and anatomy

29

Labs 24-28 wks

1 hr OGTT

30

labs 32-37 wks

N\GC and chlam, HIV and RPR screen in high risk
GBS screening

31

4 things tested in Quadruple screen

AFP- maternal serum
Estriol
hCG
maternal serum inhibin A

32

Tested in full integrated test

US for nuchal translucency and serum for pregnancy associated plasma protein A - first trimester
Quadruple screen - 2nd semester

33

Amniocentesis tests
Who gets tested?

Amniotic fluid after 16 wks for AFP and karyotype

Tested:
-Abnormal quadruple
-Rh sensitized mom to obtain fetal blood type
-Evaluate fetal lung maturity via L:S >=2.5 or detect PG
->35 yrs

34

Chorionic villous sampling tests

9-12 wks gestation for chromosome abnormalities

35

Percutaneous umbilical cord sampling tests

>18 wks: chromosome defect, fetal infection, Rh sensitization

36

Maternal serum AFP
- When valid
-If high this means?
-If low this means

Valid only 16-18 wks
High levels: NTD (ancephaly or spina bifida) or multiple gestation, abdominal wall defect (gastroschisis, omphalocele), incorrect dating, fetal death, placental abnormalities (placental abruption)
Low levels: trisomies 21 and 18, fetal demise, inaccurate dating

37

AFP low, hCG high, Inhibin A high, estriol low (Quad)
Nuchal translucency high, hCG high, PAPP-A high (full integrated)

Trisomy 21

38

AFP low, estriol low, hCG low, Inhibin A WNL/low - quad
Nuchal translucency high , hCG and PAPP-A low - full integrated

Trisomy 18

39

Quad screen WNL
Nuchal translucency inc, hCG dec, PAPPA, dec

Trisomy 13

40

AFP levels
-when are they valid
-if low/high

-Valid wks 16-18
-High: NTD or multiples
-Low: trisomyy 18 or 21

41

1 hr OGTT
-Oral glc load
-Abnormal

-50 g
->=130

42

3 hr OGTT
-test setup
-abnormal

3 days carb meals, fasting glc measured , 100 g load, measure glc 1,2,3 hrs

Abnormal with 2 of following
-FG >=95
-1 hr >=180
-2 hr > = 150
-3 hr >=140

43

Preeclampsia
Meds ok to use

HTN
Proteinuria
Edema

Labetolol, no ACEI or ARB

44

HELLP

Hemolysis
Elevated liver enzymes
Low Platelets

45

Tx seizures in pregnancy

Stay on current meds, Vit K and folate given

Diazepam can be use to break seizures

46

Warfarin

Ok breastfeeding
Not pregnancy

47

Anticoagulation during pregnancy

Stop all during active labor and until 6 hrs after delivery

48

Marijuana
-Maternal risk
-Fetal risks

Mom: minimal
Kid: IUGR, prematurity

49

Cocaine
-Maternal risk
-Fetal risks

Mom: ARRHYTHMIA, MI, SAH, seizures, stroke, abruptio placentae
Kid: ABRUPTIO PLACENTAE, IUGR, prematurity, facial abnormalities, delayed intellectual development, fetal demise, bowel atresias, congenital malformation heart, limbs, face, GU, microcephaly, cerebral infarctions

50

Ethanol
-Maternal risk
-Fetal risks

Mom: minimal
Kid: FETAL ALCOHOL SYNDROME, spontaneous abortion, intrauterine fetal demise

51

Opiods
-Maternal risk
-Fetal risks

Mom: INFECTION (needles), withdrawa, PROM
Kid: Prematurity, IUGR, meconium aspiration, neonatal infections, NARCOTIC WITHDRAWAL (may be fatal)`

52

Stimulants
-Maternal risk
-Fetal risks

Mom: lack of appetite and malnutrition, arrhythmia, withdrawal depression, HTN
Kid: IUGR, congenital heart defect, cleft palate

53

Tobacco:
-Maternal risk
-Fetal risks

Mom: ABRUPTIO PLACENTAE, PLACENTAE PREVIA, PROM
Kid: Spontaneous abortion, prematurity, IUGR, intrauterine fetal demise, impaired intellectual development, higher risk of neonatal respiratory infection

54

`Hallucinogens:
-Maternal risk
-Fetal risks

Mom: Personal enlargement (poor decisions making)
Kid: Possible developmental delays

55

Fetal alcohol syndrome

Mental retardation
IUGR
Sensory and motor neuropathy
Facial abnormalities- midfacial hypoplasia
Growth restriction
Renal and cardiac defects
Drinking >6 drinks per day

56

ACEI teratogen effects

Renal- fetal renal tubular dysplasia and renal failure, oligohydramnios
IUGR
Decreased skull ossification

57

Aminoglycosides teratogen effects

CN VIII damange
Skeletal
Renal

58

Carbamazepine teratogen effects

Facial
IUGR
Mental retardation
CV
NTD
Fingernail hypoplasia

59

Chemo (all classes) teratogen effects

Intrauterine fetal demise
Severe IUGR
Anatomic- Palate, bones, limbs, genitals, etc
Mental retardation
Spontaneous abortion
Secondary neoplasms

60

Diazepam teratogen effects

Cleft palate
Renal
Secondary neoplasms

61

DES teratogen effects

Vaginal and cervical cancer - clear cell adenocarcinoma
Possible infertility

62

Fluoroquinolones teratogen effects

Cartilage

63

Heparain teratogen effects

Prematurity
Intrauteine fetal demise
Safer than warfarain

64

Lithium teratogen effects

Ebstein

65

OCPS teratogen effects

Spontaneous abortion
Ectopic

66

Phenobarb teratogen effects

Neonatal withdrawal

67

Phenytoin teratogen effects

Facial
IUGR
Mental retardation
CV
Microcephaly
Dysmorphic face
Fingernail hypoplasia

68

Retinoids teratogen effects

CNS
CV
Facial
Spontaneous abortion

69

Sulfonamides teratogen effects

Kernicterus

70

Tetracycline teratogen effects

Skeletal
Limb
Teeth discoloration- yellow brown
Hyoplasia enamel

71

Thalidomide teratogen effects

Limb
Anotia and micronotia
Cards and GI

72

Valproic acid teratogen effects

NTD
Facial
CV
Skeletal

73

warfarin teratogen effects

Spontaneous abortion
IUGR
CNS
Faical
Mental retardation
Dandy walker
Nasal hypoplasia and stippled bone epiphyses
Eyes

74

Hydrocephalus, intracranial calcifications, chorioretinis, microcephaly, spontaneous abortion, seizures
-Dx
-Tx

Toxoplasmosis
DX: amniotic fluid for PCR or serum Ab screening, ring enhancing lesion CT
Tx: pyrimethamine, sulfadizine, add folinic acid
Mother - no gardening, litter box, raw meat, unpastuerized milk

75

Increased risk of spontaneous abortion, skin lesion - BLUEBERRY MUFFIN
Congenital syndrome if transmission: IGUR, deafness, CV, vision, CNS, hepatitis, PDA
DX
TX

Rubella

IgG screening

Mother immunized before pregnant
No Tx if during pregnancy
No benefit from immunoglobulin

76

INcreased risk of prematurity, IUGR, spontaneous abortion, HIGH RISK NEONATAL DEATH IF TRANSMISSION
Dz
Tx

Rubeola/measles

IgM or IgG after rash develops

Immunize mom before pregnant, immune globulin during pregnancy, VACCINE CI DURING PREGNANCY b/c live

77

Neonatal anemia, deafnes, hepatosplenomegaly, pneumo, hepatitis, osteodystrophy, rash followed by hand and foot desquamation, neonatal mortality 25%
Dx
Tx

Syphilis

Early RPR or VDRL, confirm with FTA-ABS

PENICILLIN to mom or baby

78

IUGR, chorioretinitis, CNS, mental retardation ,vision, deafness, hydrocephalus, seizures, hepatosplenomegaly, petechial rash, periventricular calcifications
Dx
Tx

CMV

IgM or PCR within first few wks of life

No Tx if develops during pregnancy
Ganciclovir may decrease effects in neonates
GOOD HYGIENE TO REDUCE TRANSMISSION

79

Increased risk prematurity, IUGR< spont abortion, neonatal death or CNS probl if transmission
Dx
Tx

HSV

Clinical + viral culture/immunoassay

C-section to avoid transmission if active lesion or primary outbreak
Acyclovir in neonates

80

Increased risk prematurity, IUGR< increased risk of neonatal death if acute disease develops
Dx
Tx

Hep B

Prenatal surface antigen

Maternal vaccination, vaccination of neonate and immunoglobulin after birth

81

Viral transmission in utero, RAPID DISEASE PROGRESSION
Dx
Tx

HIV
Early prenatal maternal blood screening

AZT to decrease vertical transmission
COntinue antivirals - NO efavirenz, didanosine, stavudine, nevirapine

82

Increased risk spontaneous abortion, neonatal sepsis, conjunctivitis
Dx
Tx

GC/chlam

Cervical culture + immunoassay

Erythromycin to mom or neonate

83

Prematurity, ENCEPHALITIS< PNEUMO, IUGR, CNS, limb, blindness, high risk neonatal death if birth during active infection
Dx
Tx

VZV

IgG titier if no known history of disease
IgM and IgG to confirm Dx in neonates

Varicella immunoglobulin to nonimmune mom within 96 hr of exposure and to neonate if born during active infection
Vaccine CI during pregnancy b/c live attenuated

84

Respiratory, pneumo, meningitis, sepsis
Dx
Tx

GBS

Antigen screening after 34 wks

IV beta lacatams or clindamycin during labor or in infected neonates

85

Decreased RBC production, hemolytic anemia, hydrops fetalis
Dx
Tx

Parvovirus B19

IgM or PCR

Monitor fetal Hg by PUBS (umbilical blood), give transfusion if severe anemia

86

TORCH

Toxoplasmosis
Other (VZV, Parvovirus B 19, GBS, chlam/GC)
Rubella/rubeola/RPR (syphilis)
CMV
HSV/Hep B/HIV

87

Abortion type: uterine bleeding + closed cervical os + no uterine contents expelled
US viable fetus

Threatened

Bed rest and limit activity

88

Abortion type: uterine bleeding with pain, os closed, no uterine contents expelled, US shows nonviable fetus
Tx

Missed

Misoprostol or DandC

89

Abortion type: uterine bleeding and pain, os open, no uterine contents expelled
Tx

Incomplete

Tx: Misoprostal and DandC

90

Abortion type: uterine bleeding, open/closed os, all contents expelled

Complete

91

Spontaneous abortion/miscarriage - when
1st trimester cause
2nd trimester cause

<20 wks, non selective

1st: chromosome
2nd: infection, cervical incompetence, uterine abnormalities, hypercoaguable, poor maternal health, drug use

92

Major risk factor for miscarriage

>35 yrs

93

When: intrauterine fetal demise

>20wks

94

Most common causes vaginal bleeding early pregnancy

Ectopic
Threatened or inevitable abortion
Physiologic bleeding (implantation)
Uterine cervical pathology

95

Tx UTI pregnant

Amoxicillin
Nitrofurantoin
Cephalexin

96

Beta hCG level for transabdominal vs transvaginal US

Transabdominal: 6500
Transvaginal: 1000

97

Most common location ectopic pregnancy

Ampulla

98

2 types IUGR

Symmetric: overall decrease in body size, early pregnancy
Asymmetric: decrease abdominal
Size only, late in pregnancy

99

Oligohydramnios 1st vs 2nd vs
3rd trimester

1: spontaneous abortion
2: fetal renal, maternal cause, placental thrombosis
3: PROM, preeclampsia, abruptio placentae, idiopathic causes

100

Oligohydramnios AFI

<5cm

101

Polyhydramnios AFI

>25cm

102

Tests show PROM

Not razing paper blue
Ferning

103

Fetal lung maturity: lecithin vs sphingomyelin

L:S >2 with presence PG in amniotic fluid suggests fetal lung maturity

104

Preterm labor wks

<37wks

105

Cervical length low vs high risk

Low: >35mm
High:<15mm

106

Most common causes vaginal bleeding >20wks: painful vs painless

Placenta previa: painless
Abruptio placentae: painful

107

Placenta previa: low implantation vs partial vs complete

Placenta near cervical os
Low: placenta in lower uterus but does not infringe on cervical os until
Dilation
Partial: partially covers os
Complete: completely covers os

108

Premature separation of placenta from uterine wall leading to lots of hemorrhage

Abruptio placenta

109

Only time conjoined twins occur

Monozygotic twinning

110

Umbilical cord for multiple fetuses fused, what happens?

Twin-twin transfusion syndrome: one twin inadequately transfused

111

Normal FHR

120-180

112

False contractions

Braxton Hicks

113

Early decel
Cause
Tx

Decelerations begin and end with uterine contractions
Cause: head compression
Tx: not sign of fetal distress

114

Late decel
Cause
Tx

Begin after contraction starts and end after contraction finished
Cause: uteroplacental insuff, maternal venous compression,maternal hypotension, abruptio placenta
FETAL HYPOXIA
Tx: determine hypoxia or acidosis; recurrent late decels - prompt delivery

115

Variable decel
Cause
Tx

Inconsistent onset, duration, degree
Cause: umbilical cord progression
Tx: change moms position

116

Most common causes uterine atony

Multiple gestational
Prolonged labor
Chorioamnionitis
Atony most common

117

High beta hCG

Hydatidiform mole and multiple gestation

118

Preeclampsia in first half of pregnancy

Suspect molar pregnancy

119

Complete vs incomplete hydatidiform mole

Complete 46 XX or XY - all from father with empty egg
Incomplete: 69 XXY or XXX or XYY - 2 sperm

120

Complications hydatidiform mole

Malignant gestational trophoblastic neoplasm
Choriocarcinoma

121

GP: Parity means

Number of pregnancies led to birth beyond 20 wks or infant >500 g

122

Fundal height at 20 wks

Umbilicus

123

When can you hear fetal heart tones on doppler

10-12 wks

124

Fetal movements- when

17-18 wks

125

When does beta hCG peak, at what number?

10 wks, 100,000
Doubles every 48 hrs during early pregnancy

126

When to give RhoGAM

If Rh- mom
give 28-30 wks

127

When should moms visit doc's?

Wks 0-28: every 4 wks
Wks 29-35: every 2 wks
Wks: 36-birth: every 1 wks

128

CVS vs amniocentesis

CVS: 10-12 wks, placental tissue, earlier than amniocentesis; cannot detect open NTD

Amnio: 15-20 wks, amniotic fluid

129

Lead fetal defects

Inc spont abortion rate
Stillbirth

130

Methotrexate fetal defects

Inc spont abortion rate

131

Organic mercury fetal defects

Cerebral atrophy
Microcephaly
Dysmorphic craniofacial features
Cardiac defects
Fingernail hypoplasia

132

Radiation fetal defects

Microcephaly
Mental retardation
Medical diagnostic radiation delivering <0.05 Gy to the fetus has NO risk

133

Streptomycin and kanamycin fetal defects

Hearing loss
CN VIII damage

134

Trimethadione and paramethadione fetal defects

Cleft lip or palate
Cardiac defects
Microcepaly
Mental retardation

135

Vitamin A fetal defects

Inc spont abortion
Microtia
Thymic agenesis
CV
Craniofacial
Microphthalmia
Cleft lip or palate
Mental retardation

136

Endometritis leading to septicemia, result sin hypotension, hypothermia, inc WBC

Septic

137

Station fetal head position

Above ischial spines -
Below ischial spines +

138

Visceral pain from uterine contractions and cervical dilation - levels

T10-L1

139

Somatic pain from descent of fetal head and P on vagina and perineum - levels

Pudendal n, S2-S4

140

Pneumonic BPP

Test the Baby MAN
Fetal Tone
fetal Breathing
Amniotic fluid V
Nonstress test

141

Gestational HTN develops which wks

>20 wks

142

Rh neg mom, Rh + baby = risk

Erythroblastosis fetalis
Hydrops fetalis if Hg <7
Fetal hypoxia and acidosis, kernicterus

143

What to do with shoulder dystocia

HELPER

Help reposition
Episiotomy
Leg elevated- McRoberts maneuver
Pressure (suprapubic)
Enter vagina and try to rotate (Wood's screw)
Reach for fetal arm

144

Postpartum endometritis

Fever >38C within 36 hrs
Uterine tenderness
Malodorous lochia

145

Pelvic infection leads to infection of vein wall and intimal damage --> thrombogenesis-->clot invaded with microbes
Suppuration w/ liquefaction --> fragmentation -->septic embolization

Picket fence fever curve, abdominal and back pain

Tx: abx, anticoag w/ hepatin 7-10d

Septic pelvic thrombophlebitis

146

7 W postpartum fever

Womb - endomyometritis
Wind - atelectasis, pneumo
Water- UT
Wound
Weaning- breast abscess, mastitis
Wonder drug

147

Failure to lactate due to dec prolactin levels

Sheehan syndrome- ant pituitary

Tx: replace hormones, may recover

148

Breastfeeding CI

HIV
Active hepatitis
Meds- BDZ, barbs, opiates, alcohol, caffeine, tobacco

149

Tx mastitis

Continue breastfeeding
Abx: dicloxacillin, cephalexin, amxicillin/clauvulanate, azithromycin, clindamycin

150

Normal lab tests in pregnancy

ESR elevated
TBG increased, free T4 normal
V inc dec H and H
BUN and Cr dec
GFR inc
WBC inc
ALP inc
Mild proteinuria and glucosuria normalx

151

Weeks pregnant when fundus at pubic symphysis

12 wks

152

Tx bacteriuia

Always Tx even if ASx

Penicillin, cephalosporin, nitrofurantoin

153

Antiphospholipid Ab with previous pregnancies - what may help with subsequent pregnancies

NSAID- acetaminophen best (not use ASA or other NSAID)

154

Safe in pregnancy

Acetaminophen, NOT NSAID OR ASA
Penicillin
Cephalosporin
Erythromycin
Nitrofurantoin
H2 blockers
Antacids
Heparin
Hydralazine
Methyldopa
Labetalol
Insulin
Docusate

155

Itching of palms and soles
Abnormal LFT
Jaundice

Cholestasis

Tx: delivery, can use ursodeoxycholic acid or cholestyramine

156

Acute fatty liver of pregnancy

3rd trimester or after delivery
Usually progresses to hepatic coma
Tx: IVF, IV glc, FFP
Cannot use Vit K - because liver is in temporary failure

157

Toxic effects Mg

Hyporeflexia - first sign
Resp depression
CNS depression
Coma death

158

Prolonged rupture of membranes

> 18 hrs
Inc risk infection: GBS, E coli, Listeria

159

When is fetal fibronectin most useful

Wks 22-34, if test negative indicates very low likelihood of delivery in next 2 weeks

160

If check Rh ab in RH - mom and is positive

Dont bother giving RhoGAM, already positive

If test is negative, RhoGAM at 28 wks and after delivery also with any surgery, bleeding, etc.

161

Hemolytic disease of newborn

Rh incompatibility
ABO incompatibility- do not need prior sensitization because already have Ab (O mom with A, AB, B kid)

162

Test that quantifies fetal blood in maternal circulation, can be used to determine amt of RhoGAM

Kleihauer Betke

163

Cardinal movements of labor

Engagement
Flexion
Descent
IR
Extension
ER/restitution
Expulsion

164

Scalp pH below what indicates immediate C section

7.2

165

SOB
Tachypnea
CP
Hypotension
DIC

AF PE

166

Tx chorioamnionitis

Ampicillin plus gentamicin while awaiting culture