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First Aid Step 2 > Obstetrics > Flashcards

Obstetrics Flashcards

(166 cards)

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1
Q

primary cause third trimester bleeding

A

Placental abruption and placenta previa

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2
Q

Classic US and gross appearance of complete hydatidiform mole

A

Snowstorm on US

Cluster of grapes on gross exam

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3
Q

Chromosomal pattern of complete mole

A

46 XX

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4
Q

Molar pregnancy containing fetal tissue

A

Partial mole

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5
Q

Sx of placental abruption

A

Continuous painful bleeding

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6
Q

Sx of placenta previa

A

Self limited, painless vaginal bleeding

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7
Q

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

A

Never

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8
Q

Abx with teratogenic effect

A

Tetracycline
Fluoroquinolones
Aminglycosides
Sulfonamides

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9
Q

Most common cause of postpartum hemorrhage

A

Uterine atony

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10
Q

Tx postpartum hemorrhage

A

Uterine massage

If that fails - oxytocin

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11
Q

Abx prophy for GBS

A

IV penicillin or ampicillin

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12
Q

Meds to accelerate fetal lung maturity

A

Bethamethasone or dexamethasone x 48 hrs

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13
Q

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

A

Sheehan syndrome (postpartum pituitary necrosis)

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14
Q

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

A

Inevitable abortion

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15
Q

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

A

Threatened abortion

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16
Q

Teratogens effect during which weeks

A

2-12 wks

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17
Q

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

A

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

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18
Q

Naegele rule

A

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

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19
Q

CV changes in pregnancy

A 
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
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20
Q

Respiratory changes in pregnancy

A

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

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21
Q

Renal changes in pregnancy

A

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

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22
Q

Endocrine change in pregnancy

A

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

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23
Q

Hematologic changes in pregnancy

A

Hypercoaguable state
Increased RBC
HCT dec bc inc blood V

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24
Q

GI changes in pregnancy

A

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

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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

First Aid Step 2 (22 decks)

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