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UW3 (2020) > UW3 (14 Ob) > Flashcards

UW3 (14 Ob) Flashcards

1
Q

PreTerm Labor (management)

  • GA < 32w
  • GA 32-33w
  • GA > 34w
A
  • Betamethasone
  • Penicillin @ GBS
  • Indomethacin
  • MgSO4
  • Betamethasone
  • Penicillin @ GBS
  • Nifedipine
  • Betamethasone
  • Penicillin @ GBS
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2
Q

Appendicitis @ pregnancy

  • Complications? 2
  • Management?
A
  • Spontaneous abortion
  • Preterm labor & delivery

• Surgery (no Ob complications)

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3
Q

PylePhelebitis

  • Risks?
  • Cause / Mechanism?
A
  • Untreated Appendicitis, IA / Pelvic infections

* Portal vein thrombosis

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4
Q

Ob epidural (contraindication) 2

A
  • Plt < 70

* Rapid Plt ↓

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5
Q

Pregnancy (skin changes)

Diagnosis & Treatment?

  • Focal pruritus
  • No rash
  • Bile = n + LFT = n
  • General pruritus
  • No rash
  • Bile ↑ + LFT ↑
A

Normal change
• Oatmeal bath
• UV light
• Anti histamine

IntraHepatic Cholestasis
• Ursodeoxycholic acid
• Anti histamine

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6
Q

Start @ Periumbilical
Urticarial papule & plaque
Vesicle / Bullae

  • Diagnosis?
  • Treatment? 3
A

Pemphigoid Gestationis

  1. Steroid topical
  2. Anti histamine PO
  3. Resolve after Delivery
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7
Q

PreEclampsia (prevention)

A

Aspirin low dose @ GA 12w

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8
Q

Exercise contraindication @ pregnancy

  • Preterm Delivery risk? 3
  • Bleeding risk? 2
  • Medical conditions? 4
A
  • Cervical insufficiency
  • Preterm labor at current pregnancy
  • PPROM
  • Placenta previa
  • Persistent bleeding @ T2-3
  • Anemia
  • PIH / Pre-eclampsia
  • Restrictive lung disease
  • Heart disease
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9
Q 
Fetal Fibronectin (indication)
When does it show false positive?
A
  • GA < 34w
  • Preterm contraction / delivery

• False ⊕ @ bleeding

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10
Q

Bariatric surgery @ pregnancy

  • Indication? 2
  • Benefits? 2
  • Management?
A
  • BMI > 35 + comorbitidy
  • BMI > 40

• Reduce Ob complications (↓ Pre eclampsia & ↓ GDM)

  • Delay pregnancy 1y after surgery
  • Stabilize weight loss & nutrition
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11
Q

Seizure Medication (pregnancy)

  • Before ⊕ preg test?
  • After ⊕ preg test?
A

• Change medication > 6m

  • Keep same meds
  • Folic acid (high dose)
  • Termination counsel before Screen (AFP/US)
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12
Q

SubChorionic Hematoma

  • US findings?
  • Course?
A
  • Cresent
  • HypoEchoic
  • Normal
  • Serial US
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13
Q

Labor management

  • Prolong active labor?
  • Arrest of labor?
A
  • Dilation > 6cm + Progress < 1cm/2h
  • Oxytocin / Amniotomy
  • No fetal descent
  • > 3h normal
  • > 4h w/ epidural
  • CS
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14
Q

Septic Abortion

  • Risk? 2
  • Symptom? 2
  • Management? 4
A
  • Elective abortion
  • Spontaneous apportion
  • Purulent vaginal discharge
  • Boggy/Tender uterus

1) Culture (blood & endometrium)
2) Gentamicin + Clindamycin
3) Suction curettage
4) Hysterectomy

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15
Q

AFI (amniotic fluid index)

  • Oligo?
  • Poly?
A
  • AFI < 5
  • Pre-eclampsia
  • Placental abruption
  • UteroPlacental insufficiency
  • Renal anomaly
  • NSAID
  • AFI > 24
  • EsophageoDuodenal atresia
  • Anencephaly
  • Multiple gestation
  • Congenital infection
  • DM
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16
Q

Painless bleeding
GA > 20w

  • Diagnosis?
  • Diagnostic? Avoid?
  • Treatment?
A

• Placenta Previa

  • Speculum exam ok
  • US-TV
  • No digital vag/cerv exam
  • Avoid instrument
  • CS
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17
Q

Amniotic Fluid Embolism

Treatment?

A

Supportive

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18
Q

Cyst/Mass @ pregnancy

Surgery indication? 4

A
  • Complex / Septations
  • Growing
  • Malignancy potential
  • Size > 10cm
19
Q

Epithelial Ovarian Carcinoma @ pregnancy

  • Complications? 3
  • Surgery indication? 3
  • US findings?
  • Treatment?
A
  • Torsion
  • Rupture
  • Labor obstruction
  • Complex
  • Septations
  • Size > 10cm
  • Solid
  • Complex
  • Thick Septation
  • Ascities

• Surgery @ early T2

20
Q

Painless Cervical dilation
Pelvic pressure
Vaginal discharge/bleed
Amniotic bulge/prolapse

  • Diagnosis?
  • Treatment? Contraindication?
A

• Cervical Insufficiency

  • Cerclage @ GA 12-14w
  • CI @ membrane prolapse
21
Q

Breech management

1) Before 37w
2) After 37w

A

1) rescan @ 37w

2) ECV

22
Q

ECV contraindications? 4

A
  • Herpes
  • Placenta Previa
  • Multiple gestation
  • IUGR
23
Q

Exercise @ pregnancy

  • Goal?
  • Benefits? Reduce risk of? 3
A
  • 30min
  • Mod intense aerobic
  • most days of week
  • GDM
  • PreEclampsia
  • CS
24
Q

Cervical Cancer

Symptoms & PE?

A
  • Irregular vaginal bleed
  • Post coital bleed
  • Vaginal discharge (Watery, Mucoid)
  • Cervical mass (Friable, Exophytic)
25
Q

Adolescent Pregnancy < 19y

  • Maternal complications? 4
  • Fetal complications? 4
A
  • Hydatidiform mole
  • Pre-eclampsia
  • Anemia
  • PP depression
  • Gastrochisis
  • Omphalocele
  • Preterm birth
  • SGA
26
Q

PCOS

  • Main treatment?
  • Med for menstrual regulation?
  • Med for ovulation?
A
  • Weight ↓
  • OCP (menst regulation)
  • Letrozole (ovulation)
27
Q

Uterus = tender / boggy
Vaginal discharge / bleed
PostPartum Endometritis

Treatment? 4

A

1) Clindamycin + Gentamicin
2) Unasyn
3) Cefotetan / Cefoxitin / Ceftaoxin
4) Zosyn

28
Q

Cerebral Venous Sinus Thrombosis

  • Symptoms?
  • Treatment?
A
  • Gradually Worsening headache @ Wakening / Valsalva

* Heparin

29
Q 
Contraction
high freq
low intensity
Uterus = rigid + tender
FHR = Late deceleration
  • Diagnosis?
  • Management for Rh-? 2
  • Delivery indication?
A

• Placenta Abruption

  • Kleihauer-Betke test
  • RhoGam

• Abruption ⊕ + Active bleeding

30
Q

AFP > 2.5 indication?

Management? 3

A
  • NTD
  • Ventral wall defect

1) Repeat AFP ↑
2) US
3) Amniocentesis
AFP ↑ + Acetylcholine esterase ↑

31
Q 
Vaginal bleeding
FHR deceleration
IntraAbd bleeding
BP ↓ / HR ↑
Fetal station loss

Diagnosis?

A

Uterine Rupture

32
Q

Neonatal HyperBilirubin

Exchange transfusion indication?

A
  • Bilirubin > 20-25

* Kerniecterus

33
Q

GBS Prophylaxis (management)

  • UA & UC ⊕ / GBS test ⊕ ? 4
  • GBS Unknown + GA < 37w, + fever, + ROM > 18h
A

1) Amoxicillin / Cephalexin
2) Repeat UC 1w
3) No repeat GBS test
4) Penicillin @ delivery

Penicillin @ delivery

34
Q

RUQ pain / Headache / Hypertension
LFT ↑ / Plt ↓ / Hb ↓ / U-protein ↑

  • Diagnosis?
  • Management? 3
A

HELLP

1) MgSO4 / Hydralazine
2) Delivery
3) Plasma exchange @ AST > 2000 or LDH > 3000

35
Q

Neonatal head finding (types)

  • Boggy / Pitting edema / Poorly defined
  • Present at birth
  • Across suture line
  • Not cross suture line
  • Transient Bili ↑
  • Vacuum delivery
  • Hb ↓ / Shock
A
  • Caput Succedaneum
  • Resolve in days
  • CephaloHematoma
  • Weeks to resolve
  • SubGaleal Bleed
  • Monitor: Hb + Coag
  • IVF
36
Q

Pregnancy Contraindication (7)

A
  • LV EF < 40%
  • NYHA HF 3-4
  • Peripartum cardiomyopathy
  • Severe obstructive cardiac lesions
  • Severe pulmonary hypertension
  • (Eisenmenger)
  • Aortic dilation > 4cm
37
Q

Bipolar 1 (pregnancy)

  • Treatment? 4
  • Medications to avoid?
A

1) Haloperidol (acute)
2) Quetiapine / Risperidone / Olanzapine
3) Lithium
4) ECT

Valproate / Carbamazepine

38
Q 
Upper extremity
Adduction
Internal rotation
Pronated forearm
Asymmetric Moro reflex
  • Diagnosis?
  • Pathology?
A
  • Erb Duchenne Palsy

* Brachial plexus injury @ C5-7

39
Q

Vaginal problems (differential & treatment)

  • Discharge = think / odor
  • Stippled epithelium
  • Discharge = purulent
  • Cervix = friable / easy bleed

• Vesicular / Ulcerative

  • Discharge = thick / white
  • Pruritus
A
  • Bacterial Vaginosis
  • Metronidazole
  • Clindamycin
  • Symptomatic tx @ preg
  • Chlamydia
  • Azithromycin
  • Herpes Simplex
  • Acyclovir
  • Candida
  • Fluconazole
40
Q

GBS⊕ management after delivery for neonate

1) Abx > 4h before delivery
2) All GBS ⊕
3) Inadequate treatment + Preterm < 37w / Prolong ROM > 18h

A

1) No treatment if treated
2) Obs 48h (Infection symptoms / Lethargy / Poor feed)
3) CBC / BC

41
Q

Pre-Eclampsia

  • Definition?
  • Severe indication? 7
  • Treatment? 4
A
  • BP 140/70 after 20w
  • Proteinuria / Organ damage
  • BP > 160/110 x2 q4h
  • Plt ↓ / Cr ↑ / LFT ↑
  • Pulmonary edema
  • Visual symptoms
  • Neuro symptoms

1) MgSO4
2) BP meds
3) No severe = delivery @ 37w
Severe = delivery > 34w

42
Q

Shoulder Dystocia Maneuvers

1) McRoberts
2) Woods Screw
3) Rubin
4) Gaskin
5) Zavanelli

A

1) Leg elevation & Hip HyperFlexion
2) Posterior shoulder rotation
3) Posterior shoulder adduction
4) Mother on hands & knees
5) Push head back then CS

43
Q

IUGR
• Definition?

Occurrence, Cause, presentation
• Symmetric?
• Asymmetric?

A

• Fetal weight < 10th %

  • T1
  • Chromosomal abnormality
  • Congenital infection
  • Global growth lag
  • T2-3
  • UteroPlacental insufficiency
  • Maternal malnutrition
  • Head spared growth lag
44
Q

placental insufficiency

  • Diagnosis / Monitor? 3
  • Delivery indication?
A

1) Umbilical artery doppler US
2) BPP
3) Growth reassement

• Umbilical artery end diastolic flow = Absent/Reverse

UW3 (2020) (19 decks)

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