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U World Step 2 > Pregnancy, Childbirth, & Puerperium > Flashcards

Pregnancy, Childbirth, & Puerperium Flashcards

(77 cards)

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1
Q

First stage of labor

Definition

Phases

A

Latent: Gradual cervical change from 0 cm to 6 cm dilation

Active: Rapid cervical change from 6 cm to 10 cm dilation

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2
Q

Disorders of the active phase of labor

  1. Diagnosis
  2. Clinical features
  3. Treatment
A
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3
Q

Neural tube detects

  1. Types
  2. Risk factors
  3. Prenatal screening
  4. Prevention
A
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4
Q

Infants of diabetic mothers – general risks

A

Respiratory distress syndrome

Preterm delivery

Fetal macrosomia

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5
Q

Infant of diabetic mother – complications

  1. 1st trimester
  2. 2nd and 3rd trimester
A
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6
Q

Placenta previa

  1. Risk factors
  2. Clinical features
  3. Diagnosis/management
A
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7
Q

Fetal fibronectin

A

Found on the choriodecidual interface

Presence in vaginal secretions at 24-34 gestation is predictive of preterm delivery

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8
Q

Kleihauer-Betke test

A

Determines the necessary dose of Rh(D) anti-D immunoglobulin after delivery of an Rh-positive fetus to an Rh-negative mother

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9
Q

Tocolytics

  1. Drug
  2. Mechanism
  3. Indication
  4. Side effects
A
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10
Q

Preterm labor (<37 weeks)

  1. Gestational age
  2. Management
A
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11
Q

Eclampsia

  1. Clinical features
  2. Management
A
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12
Q

Types of abortion (pregnancy loss at <20 weeks of pregnancy)

  1. Missed
  2. Threatened
  3. Inevitable
  4. Incomplete
  5. Complete
A
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13
Q

Antepartum fetal surveillance

Purpose

Frequency

A

Evaluates for fetal hypoxia in pregnancies with a high risk of fetal demise due to maternal or fetal factors.

Maternal factors: Hypertension, diabetes mellitus

Fetal factors: post-term pregnancy, growth-restriction

Weekly testing starting at 32 weeks

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14
Q

Normal non-stress test (NST)

A

>=2 heart rate accelerations that are >= 15 beats/min above baseline and >=15 seconds long within a 20 minute period

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15
Q

Antepartum fetal surveillance (Description, normal result, abnormal result)

  1. Nonstress test
  2. Biophysical profile
  3. Contracction stress test
  4. Doppler sonography of the umbilical artery
A
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16
Q

Placenta accreta

Risk factors

A

Occurs when uterine villi attach directly to the myometrium instead of the decidua.

Risk factors:

Prior cesarean delivery

History of D&C

Maternal age > 35

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17
Q
A

Placental abruption

Premature detachment of the placenta from the uterus

Vaginal bleeding

Abdominal pain

Tense and distended uterus

Fetal heart rate abnormalities

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18
Q
A

Placenta previa

Occurs when the placenta implants over the internal cervical os

Contractions and cervical dilation typically cause antepartum hemorrhage

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19
Q
A

Vasa previa

Fetal vessels traverse the amniotic membranes over the cervical os

Painless antepartum bleeding and fetal heart rate abnormalities just after the rupture of membranes

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20
Q

Breastfeeding contraindications

  1. Maternal
  2. Infant
A
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21
Q

Biophysical profile (Component, normal finding)

A
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22
Q

Nuchal cord

A

Associated with variable decelerations

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23
Q

Intrauterine fetal demise

  1. Definition
  2. Diagnosis
  3. Management
  4. Complication
A

Risk factors for intrauterine fetal demise: nulliparity, obesity, hypertension, and diabetes mellitus

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24
Q

Kleihauer-Betke test

A

Confirm or rule out fetomaternal hemorrhage

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25
Evaluation of fetal demise 1. Fetal 2. Maternal
26
Postpartum urinary retention 1. Risk factors 2. Clinical features 3. Management
27
Preeclampsia 1. Definition 2. Severe Features 3. Management 4. Fetal complications
4. Fetal complications: Oligoydramnios and fetal growth restriction/small for gestational age infants due to chronic uteroplacental insufficiency
28
Management of patients \>=37 weeks gestation with breech presentation
External cephalic version
29
Internal podalic version
Used for breech extraction of a malpresenting second twin Breech delivery of a second twin has a lower risk of asphyxia than Cesarean and is not contraindicated
30
Pubic symphysis diastasis 1. Risk factors 2. Presentation 3. Management
31
Femoral nerve damage
Can occur during delivery as a result of hyperfelxion of the thigh Numbness over anterior and medial thigh, inability to extend the leg or flex the thigh, and diminished patellar reflexes
32
Risk factors for fetal macroscomia (Weight \> 4 kg) 1. Maternal 2. Fetal
33
Low back pain during pregnancy 1. Etiology 2. Risk factors 3. Imaging 4. Mangement
34
Intrapartum fetal heart rate monitoring 1. Early decelerations 2. Late decelerations 3. Variable decelerations
35
Chorioamnionitis
Maternal fever Fetal tachycardia (baseline FHR \> 160 bpm)
36
Fetal anemia
Sinusoidal fetal heart rate tracing
37
Recurrent variable decelerations
Occur with \>50% of contractions Require treatment to prevent fetal acidosis 1. Maternal repositioning (to left lateral) - 1st line 2. Amnioinfusion - 2nd line
38
Normal physiological changes during pregnancy (system, clinical finding, mechanism) 1. Renal/urinary 2. Heme 3. Cardiovascular 4. Pulmonary
39
Syphilis in pregnancy 1. Screening 2. Serologic tests 3. Treatment 4. Pregnancy effects 5. Fetal efects
40
Timing of screening for Group B strep
35-37 weeks
41
Causes of hyperandrogenism in pregnancy 1. Diagnosis 2. Maternal clinical features 3. Fetal virilization
42
Neonatal clavicular fracture No intervention needed Heals rapidly without intervention
43
Neonatal displaced clavicular fracture 1. Risk factors 2. Clinical features 3. Diagnosis 4. Treatment
44
Treatment of preeclampsia 1. Drug 2. Indication
45
Maternal cardiopulmonary adaptations to pregnancy 1. Maternal adaptations 2. Clinical manifestations
46
Ectopic pregnancy locations
47
Managment of a hemodynamically unstable patient with hemoperitoneum (bloiod in pelvis)
Emergency surgical exploration
48
Gestational diabetes mellitus 1. Target blood glucose levels 2. Treatment
49
Brachial plexus injuries
50
Management of shoulder dystocia (BE CALM)
51
Chorioamnionitis (intraamniotic infection) 1. Risk factors 2. Diagnosis
52
Late-term and postterm pregnancy complications 1. Fetal 2. Maternal
53
Uterine rupture Presents with severe pain, antepartum bleeding, and loss of fetal status. Uterine rupture rarely occurs in patients who have no had uterine surgery.
54
Uterine inversion 1. Etiology 2. Presentation **3. Management**
If the placenta is still attached to the uterus, it should not be removed until after the uterus is replaced due to risk of massive hemorrhage.
55
Routine prenatal laboratory tests 1. Initial prenatal visit 2. 24-28 weeks 3. 35-37 weeks
56
Montevedo units
Measure adequacy of contractions of uterine contactions in 10 min x contraction strength Adequate labor: **200 Montevideo units**
57
Treatment of pyelonephritis in pregnancy
Ceftriaxone
58
Treatment of acute cervicitis
Ceftriaxone + azithromycin | (Covers gonorrhea and chlamydia)
59
Treatment of lactational mastitis
Dicloxacillin Narrow spectrum penicillin that coers the two most frequent pathogens: MSSA and Group A Strep
60
Treatment of breast abscesses
Vancomycin
61
Postpartum endometritis 1. Risk factors 2. Clinical features 3. Etiology **4. Treatment**
62
Fetal position
Relatinship of the fetal presenting part to the maternal pelvis Optimal feal position: occiput anterior (facilitates the cardinal movements of labor) Deviations: Occiput transverse, occiput posterior
63
Fetal presentation
Lowest part of the fetus in the maternal pelvis Most common: Vertex Nonvertex presentations: breech, face
64
Fetal station
Measures the descent of the presenting part through the pelvis
65
Second stage arrest of labor 1. Definition 2. Risk factors 3. Etiology 4. Management
Second stage begins when the cervix is 10 cm dilated and ends with delivery
66
Fetal growth restriction (Symmetric versus Asymmetric) 1. Definition 2. Onset 3. Etiology 4. Clinical features 5. Managment
67
Vaccines during pregnancy 1. Recommended 2. Indicated for high-risk patients 3. Contraindicated
68
Management of pregnant patients exposed to varicella
If a patient lacks evidence of immunity (negative IgG serologic testing, no history of childhood infection), she is treated with postexposure prophylaxis. **Varicella-zoster immunoglobulin administration**. Varicella vaccine is contraindicated in pregnancy.
69
Magnesium toxicity 1. Clinical features 2. Treatment 3. Common risk factor
3. Common risk factor: Renal insufficiency, because magnesium is excreted solely by the kidneys
70
Preventing neonatal group B Streptococcus infection 1. Universal screening 2. Indications 3. Prophylaxis
71
Preterm birth prevention
72
Risks associated with being Small for Gestational Age (SGA)
Hypoxia **Polycythemia** Hypoglycemia Hypothermia Hypocalcemia
73
Hydatidiform mole Anechoic, cystic spaces ("snowstorm" on ultrasound)
74
Hydatidiform mole 1. Clinical presentation 2. Risk factors 3. Diagnosis 4. Management
Preeclampsia with severe features at \<20 weeks gestation
75
Ectopic pregnancy 1. RIsk factors 2. Clinical features 3. Diagnosis 4. Management
76
Indications for prophylactic anti-D immune globulin administration for Rh(D)-negative patients
Anti-D immune globulin (RhoGAM) is indicate in unsensitized, Rh-negative women at 28 weeks gestation or within 72 hours of any procedure or incident in which there is any possibility of feto-maternal blood mixing.
77
Antiphospholipid antibody syndrome
False positive VDRL (FTA-ABS negative) Prolonged PTT Thrombocytopenia Prophylaxis with low dose aspirin and LMWH

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