decreased more and bicep refelexes waiters tip - extended elbow - pronated forearm - flexed wrist and fingers intact grasp reflex C5, C6 shoulder dystocia

claw hand - extended wrist - hyperextened metacarpophalangeal joints - flexed interphalangeal joints - absent grasp reflex horner syndrome (ptosis, miosis) C8 and T1 shoulder distocia intact more and bicep reflexes

INDICATIONS - induction or augmentation of labor - prevention and management of post partum hemorrhage ADVERSE EFFECTS - hyponatremia (water intoxication due to ADH action-- can lead to seizure) - hypotension - tachysystole

- headaches - abdominal pain - nausea - vomiting - lethargy - tonic clonic seizure treat with gradula administration of hypertonic salline

- symmetric to contraction - nadir of deceleration corresponds to peak of contraction - more than 30 seconds to nadir - caused by fetal head compression - can be normal fetal tracing

- delayed compared to contraction - nadir of deceleration occurs after peak of contraction - more than 30 seconds to nadir -caused by uteroplacental insufficiency

- can be but not necessarily associated with contraction - abrupt, takes less than 30 seconds to nadir - decrease ober 15 mins for more than 15 secs but less than 2 mins - caused by cord compression, oligohydramnios, cord prolapse - manage by first maternal repositioning, then maybe amnioinfusion

CLINICAL - abnormal vaginal bleeding - uterine enlargement greater than gestational age - abnormally high beta hcg - theca lutein ovarian cysts - hyperemisis - preeclampsia with severe features - hyperthyroidism --> hyperreflexia and clonus RISK - extremes of maternal age - history of mole DIAGNOSIS - snowstorm on US - quantititative beta hcg - histologic eval of uterine contents MANAGE - D and C - serial beta hcg after evacuation - contraception for 6 months

Special circumstances Flashcards by Lexi Mang

medroxyprogesterone acetate (DMPA)

birth control
administered every 3 months to prevent pregnancy
inhibits gnrh
suppresses ovulation

side effects

menstrual irregularities
prolonged bleeding/spotting for 6 months
amenorrhea after 1 year
less common: weight gain, fatigue, nausea, breast tenderness

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Fractured clavicle in baby

clavicular crepitus/bony irregularity
decreased more reflex due to pain on affected side
intact biceps and grasp reflex

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fractured humerus in baby

upper arm crepitus and bony irregularity

decreased moro reflex due to pain on affected side

intact biceps and grasp reflexes

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erb-duchenne palsy

decreased more and bicep refelexes

waiters tip

extended elbow
pronated forearm
flexed wrist and fingers

intact grasp reflex

C5, C6

shoulder dystocia

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Klumpke palsy

claw hand

extended wrist
hyperextened metacarpophalangeal joints
flexed interphalangeal joints
absent grasp reflex

horner syndrome (ptosis, miosis)

C8 and T1

shoulder distocia

intact more and bicep reflexes

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Normal postpartum findings and care

FINDINGS

transient rigors/chills
peripheral edema
lochia rubra
uterine contractions and involution
breast engorgement

CARE

rooming in
lactation support
serial examination for uterine bleedy or atony
perineal care
voiding trial
pain management

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post partum hormones

INCREASED OXYTOCIN

uterine contractions
protects against hemorrhage
involution with lochia

INCREASED PROLACTIN
-stimulate breast milk excretion and let down

DECREASED ESTROGEN AND PROGESTERONE

chills and shivering
mild hyperthermia or low grade fevers in first 24 hours

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Oxytocin

INDICATIONS

induction or augmentation of labor
prevention and management of post partum hemorrhage

ADVERSE EFFECTS

hyponatremia (water intoxication due to ADH action– can lead to seizure)
hypotension
tachysystole

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Hyponatremia

headaches
abdominal pain
nausea
vomiting
lethargy
tonic clonic seizure

treat with gradula administration of hypertonic salline

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rectus abdominis diastasis

DEFINITION
-weakening of linea alba

RISK

chronic abdominal stretching (pregnancy)
surgical weakening
increased abdominal pressure

CLINICAL

nontender midline mass
no associated fascial defect
no pain, no GI symptoms, no risk of strangulation or incarceration

MANAGE

observation and reassurance
typically resolves post partum

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Twin-twin transfusion syndrome

monochorionic diamniotic twins
one placenta and thin intertwin membrane that meets placenta at 90 degree angle (T sign)
donor twin: anemia, renal failure, oliogohydramnions, low output HF, fetal growth restriction
recipient twin: polycythemia, polyhydramnios, cardiomegaly, high output heart failure, hydrops fetalis
Both twins are at risk of intrauterine and neonatal death

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Early decels

symmetric to contraction
nadir of deceleration corresponds to peak of contraction
more than 30 seconds to nadir
caused by fetal head compression
can be normal fetal tracing

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late decels

delayed compared to contraction
nadir of deceleration occurs after peak of contraction
more than 30 seconds to nadir

-caused by uteroplacental insufficiency

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variable decels

can be but not necessarily associated with contraction
abrupt, takes less than 30 seconds to nadir
decrease ober 15 mins for more than 15 secs but less than 2 mins
caused by cord compression, oligohydramnios, cord prolapse
manage by first maternal repositioning, then maybe amnioinfusion

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Hydatidiform mole

CLINICAL

abnormal vaginal bleeding
uterine enlargement greater than gestational age
abnormally high beta hcg
theca lutein ovarian cysts
hyperemisis
preeclampsia with severe features
hyperthyroidism –> hyperreflexia and clonus

RISK

extremes of maternal age
history of mole

DIAGNOSIS

snowstorm on US
quantititative beta hcg
histologic eval of uterine contents

MANAGE

D and C
serial beta hcg after evacuation
contraception for 6 months

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Fetal growth restriction

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Definition
-weight less than the 10 percentile for gestational age

RISK

maternal hypertension
pregestational DM
genetic abnormalities
congenital infection

APPEARANCE

large anterior fontanel
thin umbilical cord
loose, peeling skin
minimal subcu fat

EVAL

placenta histopathology
consider karyotype, urine tox, serology

NEONATAL COMPLICATIONS

polycythemia
hypoglycemia
hypocalcemia
poor thermoregulation

Short inter pregnancy interval

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Definition
-less than 6-18 months from delivery to next pregnancy

COMPLICATIONS

maternal anemia
PPROM
preterm delivery
low birth weight

malignant hyperthermia

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EPI

genetic mutation alters control of intracellular Ca
triggered by volatile anesthetics, succinlycholine, excessive heat

MANIFESTATIONS

masseter or generalized rigidity
sinus tachy
hypercarbia resistant to minute vent
rhabdomyolysis
hyperkalemia
hyperthermia

TREATMENT

respiratory/ventilatory support
immediate cessation of causative anesthetic
dantrolene

Magnesium toxicity

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CLINICAL

mild: nausea, flushing, headache, hyporeflexia
moderate: areflexia, hypcalcemia, somnolence
severe: respiratory paralysis, cardiac arrest

TREATMENT

stop mg
give IV calcium gluconate

Post partum urinary retention

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DEF

inability to void after 6 hours post partum
overflow incontinence due to overflowing bladder

RISK

primiparity
regional neuraxial anesthesia
operative vaginal delivery
perineal injury
c section

CLINICAL

small volume voids or inability to void
incomplete bladder emptying
dribbling of urine

PATHOPHYS

prolonged second stage of labor
pudendal nerve injury
neuraxial anesthesia suppression of micturition reflex
bladder atony

MANAGE

self limited
intermittent catheterization

Postdural puncture headache

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PATHOPHYS
-unintentional dural puncture leading to CSF fluid leakage
-low pressure, slight herniation
CLINICAL
-after lumbar puncture or neuraxial anesthesia
-positional (worse when upright, improves when supine)
-photophobia, diplopia
-hearing loss, tinnitus

MANAGEMENT

typically self limited
epidural blood patch

Contraindications to breast feeding

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MATERNAL

active untreated TB
HIV ***
Herpetic breast lesions
active varicella
chemotherapy or radiation therapy
active substance use

INFANT

Galactosemia
PKU

theca lutein cysts

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PRESENTATION

multilocular
bilateral enlarged ovaries
enlarged uterus
elevated beta hCG

PATHOGEN

ovarian hyperstimulation due to
gestational trophoblastic disease
multifetal gestation
infertility treatment

CLINICAL COURSE
-resolve with decreasing beta hCG levels

Ovarian hyperstimulation syndrome

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PATHOPHYS

risk with ovulation induction
increased hCG ehances vascular permeability
acute fluid shift to extravascular space

CLINICAL

ascites
respiratory distress
hemoconcentration
hypercoagulability
electrolyte imbalances
multi organ failure
DIC
bilateral ovarian cysts

EVALUATION

fluid balance monitoring
serial CBC, electrolytes
serum hCG
pelvic U/S
CXR
Echo

MANAGEMENT

correct electrolyte imbalances
paracentesis and thoracentesis
thromboembolism prophylaxis

Causes of hyperandrogenism in pregnancy

placental aromatase deficiency luteoma theca lutein cyst sertoli-leydig tumor

placental aromatase def

no ovarian mass high maternal and fetal virilization risk resolution of maternal symptoms after deliver

luteoma

solid, unilateral/bilateral ovarian masses moderate maternal virilization risk high fetal virilization risk spontaneous regression of masses after delivery

sertoli-leydig tumor

solid unilateral ovarian mass high maternal and fetal virilization surgery required (2nd trimester or postpartum)

physiologic hydronephrosis of pregnancy

- urinary frequency, nocturia, back pain, round ligament pain - bilateral enlarged kidneys, enlargement and dilation of renal pelvices and proximal ureters - right is usually more pronounced - no additional management needed

Delivery planning for a non viable fetus

DIAGNOSIS - acardia - anecephaly - bilateral renal agenesis - holoprosencephaly - intrauterine fetal demise - pulmonary hypoplasia - thanatophoric dwarfism Obstetric management - vaginal delivery - no fetal monitoring Neonatal management -palliative care if not stillborn

Sheehan syndrome

PATHOGEN - obstetric hemorrhage complicated by hypotension - post partum pituitary infarction CLINICAL - lactation failure (low prolactin) - amenorrhea, hot flashes, vaginal atrophy (low FSH and LH) - fatigue, bradycardia (low TSH) - anorexia, weight loss, hypotension (low ACTH) - decreased lean body mass (low growth hormone)

Management of shoulder dystocia

- Breath do not push - elevate legs and flex hips and thighs against abdomen (mcroberts) - call for help - apply suprapubic pressure - enlarge vaginal opening with episiotomy MANEUVERS - deliver posterior arm - rotate posterior shoulder (wood screw) - adduct posterior fetal shoulder (Rubin) - mother on hands and knees (Gaskin) - replace fetal head into pelvic for C section (Zavanelli)

Type II osteogenesis imperfecta

PATHOPHYS - AD - Type I collagen defect US findings - multiple fractures - short femur - hypoplastic thoracic cavity - fetal growth restriction - intrauterine demise PROGNOSIS -lethal

post partum thyroiditis

- occurs in 7-8% of women - usually in first 6 months post partum - brief hyper followed by hypo thyroid - anxiety, palpatations - fatigue, weight gain, constipation EXAM - nontender goiter - bradycardia - diastolic HTN - LE edema LAB - hypercholesterolemia - hyponatremia

melasma

PATHO - acquired hyperpigmentation - occurs on sun exposed areas of the face - uv light radiation triggers melanocyte production RISK - reproductive age - pregnancy: estrogen and progesterone stimulate melanocyte proliferation - thyroid dysfunction CLINICAL - irregularly shaped, hyperpigmented macules of varying color - malar distribution MANAGE - no further evaluation - minimize sun exposure - typically resolves post partum

ABO hemolytic disease

RISK -infants with blood types A or B born to a mother with O CLINICAL - jaundice within 24 hours of birth - anemia - increased reticulocyte count - hyperbili - positive combs MANAGE - serial bili levels, oral hydration and phototherapy - exchange transfusion for sever anemia/hyperbili

Indications for prophylactic administration of anti-D immune globulin for RH negative patients?

- at 28-32 weeks gestation - less than 72 hours after delivering a positive infant - less than 72 hours after a SAB - ectopic pregnancy - threatened abortion - hydatididifiom mole - chorionic villus sampling, amniocentesis - abdominal trauma - second and third trimester bleeding - external cephalic version

twin pregnancy

MATERNAL COMPLICATIONS - hyperemesis - preeclampsia - gestation DM - iron deficiency anemia - uterine crowding - uterine overdistension --> increased prostaglandins and oxytocin receptors and contractility within uterus FETAL COMPLICATIONS - congenital anomalies - fetal growth restriction - preterm delivery - malpresentation - monochorionic twins: TTTS - monoamniotic twins: conjoined, cord entanglement

pseudocyesis

PATHO - somatization of stress - affects HPO axis CLINICAL - amenorrhea - breast fullness - morning sickness - abdominal distention - believes self to be pregnant - negative pregnancy test RISK - history of infertility - prior pregnancy loss MANAGE -psych eval and treatment

Special circumstances Flashcards

(39 cards)