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
2
Q
Appendicitis @ pregnancy
- Complications? 2
- Management?
A
- Spontaneous abortion
- Preterm labor & delivery
• Surgery (no Ob complications)
3
Q
PylePhelebitis
- Risks?
- Cause / Mechanism?
A
- Untreated Appendicitis, IA / Pelvic infections
* Portal vein thrombosis
4
Q
Ob epidural (contraindication) 2
A
- Plt < 70
* Rapid Plt ↓
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
6
Q
Start @ Periumbilical
Urticarial papule & plaque
Vesicle / Bullae
- Diagnosis?
- Treatment? 3
A
Pemphigoid Gestationis
- Steroid topical
- Anti histamine PO
- Resolve after Delivery
7
Q
PreEclampsia (prevention)
A
Aspirin low dose @ GA 12w
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
9
Q
Fetal Fibronectin (indication) When does it show false positive?
A
- GA < 34w
- Preterm contraction / delivery
• False ⊕ @ bleeding
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
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)
12
Q
SubChorionic Hematoma
- US findings?
- Course?
A
- Cresent
- HypoEchoic
- Normal
- Serial US
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
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
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
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
17
Q
Amniotic Fluid Embolism
Treatment?
A
Supportive
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
Adolescent Pregnancy < 19y
* Maternal complications? 4
* Fetal complications? 4
* Hydatidiform mole
* Pre-eclampsia
* Anemia
* PP depression
* Gastrochisis
* Omphalocele
* Preterm birth
* SGA
26
PCOS
* Main treatment?
* Med for menstrual regulation?
* Med for ovulation?
* Weight ↓
* OCP (menst regulation)
* Letrozole (ovulation)
27
Uterus = tender / boggy
Vaginal discharge / bleed
PostPartum Endometritis
Treatment? 4
1) Clindamycin + Gentamicin
2) Unasyn
3) Cefotetan / Cefoxitin / Ceftaoxin
4) Zosyn
28
Cerebral Venous Sinus Thrombosis
* Symptoms?
* Treatment?
* Gradually Worsening headache @ Wakening / Valsalva
| * Heparin
29
```
Contraction
high freq
low intensity
Uterus = rigid + tender
FHR = Late deceleration
```
* Diagnosis?
* Management for Rh-? 2
* Delivery indication?
• Placenta Abruption
* Kleihauer-Betke test
* RhoGam
• Abruption ⊕ + Active bleeding
30
AFP > 2.5 indication?
Management? 3
* NTD
* Ventral wall defect
1) Repeat AFP ↑
2) US
3) Amniocentesis
AFP ↑ + Acetylcholine esterase ↑
31
```
Vaginal bleeding
FHR deceleration
IntraAbd bleeding
BP ↓ / HR ↑
Fetal station loss
```
Diagnosis?
Uterine Rupture
32
Neonatal HyperBilirubin
Exchange transfusion indication?
* Bilirubin > 20-25
| * Kerniecterus
33
GBS Prophylaxis (management)
* UA & UC ⊕ / GBS test ⊕ ? 4
* GBS Unknown + GA < 37w, + fever, + ROM > 18h
1) Amoxicillin / Cephalexin
2) Repeat UC 1w
3) No repeat GBS test
4) Penicillin @ delivery
Penicillin @ delivery
34
RUQ pain / Headache / Hypertension
LFT ↑ / Plt ↓ / Hb ↓ / U-protein ↑
* Diagnosis?
* Management? 3
HELLP
1) MgSO4 / Hydralazine
2) Delivery
3) Plasma exchange @ AST > 2000 or LDH > 3000
35
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
* Caput Succedaneum
* Resolve in days
* CephaloHematoma
* Weeks to resolve
* SubGaleal Bleed
* Monitor: Hb + Coag
* IVF
36
Pregnancy Contraindication (7)
* LV EF < 40%
* NYHA HF 3-4
* Peripartum cardiomyopathy
* Severe obstructive cardiac lesions
* Severe pulmonary hypertension
* (Eisenmenger)
* Aortic dilation > 4cm
37
Bipolar 1 (pregnancy)
* Treatment? 4
* Medications to avoid?
1) Haloperidol (acute)
2) Quetiapine / Risperidone / Olanzapine
3) Lithium
4) ECT
Valproate / Carbamazepine
38
```
Upper extremity
Adduction
Internal rotation
Pronated forearm
Asymmetric Moro reflex
```
* Diagnosis?
* Pathology?
* Erb Duchenne Palsy
| * Brachial plexus injury @ C5-7
39
Vaginal problems (differential & treatment)
* Discharge = think / odor
* Stippled epithelium
* Discharge = purulent
* Cervix = friable / easy bleed
• Vesicular / Ulcerative
* Discharge = thick / white
* Pruritus
* Bacterial Vaginosis
* Metronidazole
* Clindamycin
* Symptomatic tx @ preg
* Chlamydia
* Azithromycin
* Herpes Simplex
* Acyclovir
* Candida
* Fluconazole
40
GBS⊕ management after delivery for neonate
1) Abx > 4h before delivery
2) All GBS ⊕
3) Inadequate treatment + Preterm < 37w / Prolong ROM > 18h
1) No treatment if treated
2) Obs 48h (Infection symptoms / Lethargy / Poor feed)
3) CBC / BC
41
Pre-Eclampsia
* Definition?
* Severe indication? 7
* Treatment? 4
* 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
Shoulder Dystocia Maneuvers
1) McRoberts
2) Woods Screw
3) Rubin
4) Gaskin
5) Zavanelli
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
IUGR
• Definition?
Occurrence, Cause, presentation
• Symmetric?
• Asymmetric?
• Fetal weight < 10th %
* T1
* Chromosomal abnormality
* Congenital infection
* Global growth lag
* T2-3
* UteroPlacental insufficiency
* Maternal malnutrition
* Head spared growth lag
44
placental insufficiency
* Diagnosis / Monitor? 3
* Delivery indication?
1) Umbilical artery doppler US
2) BPP
3) Growth reassement
• Umbilical artery end diastolic flow = Absent/Reverse
