101 102 Emergency Delivery and Vulvovaginits

Question 1

What are the two tests that confirm rupture of membranes

Answer 1

Nitrazine paper will turn dark blue and Acadia pairs of 77.4. Another test is Ferning on microscopy

Question 2

What anatomy serves as the reference point for station in childbirth

Answer 2

The internal issue with spines is station zero

Question 3

What are The four main uterotonic’s that we have

Answer 3

Oxytocin, misoprostok methylergonovine, carboprost

Question 4

Name the three stages of labor including the subdivisions of the first stage and also include theAverage dilation rate For both nulliparous and multifarious women

Answer 4

The first stage is the onset of regular contractions and ends with full cervical dilation is divided into latent and active the active phase begins at 6 cm and dilated an average rate of 1.2 cm/h in Nellie Paris woman and 1.5 cm/h in multi Paris women. Second stage deliver the infant Third stage is delivery of the placenta

Question 5

What are the first things that you should look at a patient over 20 weeks of gestation presents to the ED with signs of labor

Answer 5

Maternal vital signs such as blood pressure heart rate respiratory rate oxygen saturation temperature and the fetal heart rate

Question 6

What is the normal fetal heart rate

Answer 6

120 to 160 beats per minutes. Bradycardia is defined as less than 110 and tachycardia is greater than 160

Question 7

Describe what is happening in early decelerations variable decelerations and late decelerations

Answer 7

Early decelerations are the fetal heart rate going down due to vagal tone from Fido had a compression. Variable decelerations can also be normal and I thought to be due to cold compression. Late decelerations are a very bad sign and are usually accompanied with minimal variability. This represents uteroplacental insufficiency

Question 8

How do you estimate gestational age based on physical exam

Answer 8

Roughly, at 20 weeks the fundal height is that the umbilicus. Otherwise, add two weeks to every centimeter that the funnel height is away from the pubic symphysis.

Question 9

Describe nägeles rule

Answer 9

This means that the estimated age of delivery can be calculated by adding nine month and seven days to the first day of her last menstrual period

Question 10

What is an important consideration to keep in mind for the physical exam of a pregnant woman

Answer 10

Place the patient in left lateral position after you’re done with the physical examination because there can be compression of venous return leading to hypotension

Question 11

What is the first way that you determine ruptured membranes

Answer 11

First you should inspect with a sterile speculum examination because it digital examination increases the risk of infection and may not be helpful in preterm labor

Question 12

When should you ask OB to come to the ED rather than transport to the delivery suite

Answer 12

If the service is fully effaced and dilated or the fetal head is visible during contractions

Question 13

What does Apgar stand for and at what point should you call NICU

Answer 13

Apgar stands for appearance, pulse, grimace, activity,Respirations. Call NICU of the agar score is less than seven

Question 14

What are the feared complications of shoulder dystocia?

Answer 14

Fetal hypoxia that may lead to cerebral palsy or death, brachial plexus injury, clavicle fracture, postpartum hemorrhage, fourth-degree perineal laceration’s.

Question 15

Where should you apply downward pressure in shoulder dystocia

Answer 15

Do it right above the pubic symphysis for 1 to 2 minutes. Do not apply pressure to the uterine fundus because it can further the impact of the shoulder

Question 16

What is a consideration that you have to keep in mind for the third stage of labor in premature infants

Answer 16

Delayed cord Clamping for at least 1 to 3 minutes after birth to increase iron stores. Also be careful and pulling on the placenta, because premature Umbilical cords are likely to avulse

Question 17

Where should you clamp The umbilical cord?

Answer 17

3 cm distal to the insertion at the umbilicus

Question 18

What is the classic signs for shoulder dystocia

Answer 18

Turtle sign. Just want to head retract tightly against the perineum after delivering the head

Question 19

What percentage of shoulder dystocia’s are relieved by Mike Roberts and super pubic pressure

Answer 19

About 50%

Question 20

When are breach presentations most likely

Answer 20

About 25 to 30% of all preterm infants less than 28 weeks of gestation present in breach position

Question 21

Why is Bruce delivery such a problem?

Answer 21

It’s sucks because normally the larger head dilates the cervical canal which ensures the rest of the infants body to pass. In breech the head might get stuck and it’s very easy to have fetal hypoxia

Question 22

How to deliver a breech delivery

Answer 22

What’s the umbilicus is evident, gently place your thumbs on the sacrum and gently grasp the fetal pelvis allow each arm to deliver then With one hand grab the babies occiput and with the other grab the babies jar apply cervical flexion and while maintaining that flexion angle enough to 45° and deliver anteriorly

Question 23

Definition of postpartum hemorrhage

Answer 23

Technically there’s primary secondary postpartum hemorrhage primary within the first 24 hours secondary is after 24 hours and up to six weeks postpartum.

Question 24

Causes of primary Premier

Answer 24

Uterine atony of course, retain placental fragments, lower genital tract lacerations, uterine rupture, uterine inversion andHead repertory coagulopathy

Question 25

Causes of secondary postpartum hemorrhage

Answer 25

Failure of the uterine lining to sub envelope at the formal placental site, retain placental tissue, genital tract wounds and urogenital infection.

Question 26

What are the three most Common causes of uterine inversion

Answer 26

Connective tissue disorders, uterine structural anomalies and overzealous or excessive traction

Question 27

What device can be placed to correct a uterine inversion

Answer 27

A Rush balloon catheter

Question 28

What are the risk factors for uterine rupture

Answer 28

The biggest risk is former cesarean section, a single layer surgical closure of the uterus, fetal size greater than 3.5 kg and labor augmentation

Question 29

Describe the only treatments for an amniotic fluid embolism

Answer 29

The treatment really supported. Three hypoxia, hypotension and hypo perfusion. Placed a woman in the left lateral decubitus position to minimize vena cava compression. Give oxygen via non-rebreather mask or ETT2, resuscitate with fluid and blood, and administer pressure to support maternal fetal circulation until emergency delivery of the fetus can be performed

Question 30

What is the four minute five minute rule

Answer 30

This is the decision to do an emergency cesarean section/perimortum cesarean section. The decision to perform the procedure should be made after four minutes of CPR in the delivery should be accomplished by five minutes

Question 31

Roughly, describe how to perform an emergency cesarean section

Answer 31

Clean the skin with antiseptic, collect a scalpel scissors suction Kelly plants and umbilical cord clamps. Make a vertical incision with a scalpel that goes through the skin fat facia and peritoneum. Then carefully incise the uterus with a scalpel with an incision large enough to accommodate two fingers. Then insert two fingers through the incision and elevate the uterine wall off of the fetus use the scissors to divide the uterus and extend the incision in a vertical fashion then deliver the fetus then close

Question 32

How do you bacterial vaginosis and trichomonas affect pregnancy?

Answer 32

They are both associated with premature rupture of membranes, preterm labor and low infant birth weight.

Question 33

Which sexually transmitted infection increases the risk of HIV acquisition and transmission?

Answer 33

Trichomonas vaginitis

Question 34

What is the normal pH of the vagina, the pH of candidiasis, the pH of gardnerella vaginosis, Trichomoniasis

Answer 34

Normal vaginal pH is 44.5, candidiasis is also 44.5 BV is greater than 4.5 trichomoniasis is also greater than 4.5

Question 35

What is the pH of premenarchal and post menarchal women

Answer 35

The pH is between six and seven for both because low estrogen levels result in atrophy due to the loss of pretty protective glycogen containing superficial cells which form lactic and acetic acid

Question 36

How to sample for infectious vulvovaginitis

Answer 36

Obtain a sample from the mid portion of the vaginal sidewall. Sample from the posterior fornix may yield an accurate results because of mucus blood semen and vaginal medications can elevate the pH

Question 37

BV increases the risk of coinfection for which STI’s and how

Answer 37

Increases the risk of HIV, HSV type two, chlamydia and gonorrhea. This happens by decreasing local secretory leukocyte protease inhibitor levels

Question 38

How did diagnose BV

Answer 38

One. A thin, homogeneous Bagenal discharge on physical exam. Two. More than 20% close sales on a wet mount. Three. Positive results on the test for a mean release or with test. For. A vaginal pH level greater than 4.5

Question 39

Why are cultures not beneficial for diagnosing BV

Answer 39

Because gardnerella is a part of the normal vaginal flora

Question 40

Treatment for BV?

Answer 40

Metronidazole 500 mg PO be ID for seven days or metronidazole intravaginal gel

Question 41

What is an alternative treatment for BV?

Answer 41

Lactobacillus intravaginal suppository and probiotics to restore the normal vaginal flora

Question 42

Name the first second and third most causes of infectious vulvovaginitis

Answer 42

One. BV two. Candida. Three. Trichomoniasis

Question 43

During what age is candida most common

Answer 43

And women of reproductive age. Incidence goes down after menopause

Question 44

Risk factors for candida

Answer 44

One. Conditions inhibit the growth of normal vaginal flora such a systemic antibiotics. To. Conditions that diminish the glycogen stores and basil epithelial cells such as diabetes, pregnancy, oral contraceptives, hormone replacement therapy or three. Increase inThe pH of vaginal secretions Such as menstrual blood or semen. Also the Wearing of thongs

Question 45

How to diagnose candida

Answer 45

Visualization of Budding yeast and pseudohyphae on slide preparation, clinically, normal vaginal pH

Question 46

What is the best treatment for candidiasis and why? When should you be careful about using it

Answer 46

The best treatment is a single dose of oral fluconazole. This is the best because it’s just one tablet PO and it’s been shown that single dose treatment is as effective as topical therapy in the treatment of uncomplicated disease. However is a class C drug in pregnancy.

Question 47

When is the candidate infection considered complicated?

Answer 47

The main one is recurrence if you have four more infections per year. Also severe symptoms or finding, suspected or proven and non-Albicans species, Or an abnormal hose such as uncontrolled diabetes debilitation or immunosuppression or pregnancy

Question 48

Treatment for complicated candidiasis

Answer 48

150 mg Fluconazole orally for three days on days one, four, and seven

Question 49

What are the classic physical exam findings for trichomoniasis?

Answer 49

Green frothy malodorous discharge and punctate hemorrhages on the cervix also known as strawberry cervix

Question 50

Treatment for trichomonas and pregnant women

Answer 50

Oral metronidazole just like normal

Question 51

Different test to diagnosediagnose trichomonas?

Answer 51

Microscopic examination of the vaginal secretions and visualization of motile trichomonads. do this really fast after collection because they become non-motile. There a new are nucleic acid amplification tests that are fast and highly sensitive and specific. The gold standard is culture of vaginal secretions but it takes forever

Question 52

Treatment for trichomoniasis with those. And how that changes with treatment failure

Answer 52

So initially gave 2 g PO and a single dose. This is the recommendation. Alternatively for treatment failures give 500 mg PO twice a day for seven days

Question 53

Difference between primary and secondary herpes IOutbreaks?

Answer 53

Primary infections are more severe and often associated with systemic symptoms

Question 54

What is an important consideration for precipitous delivery as it relates to sexually transmitted infections

Answer 54

If possible try to ask mom and treat for herpesTo prevent neonatal HSV

Question 55

How to diagnose HSV

Answer 55

PCR reaction swabs when active lesions are present

Question 56

Treatment for contact vulvovaginitis

Answer 56

After ruling out and infectious cars, try to identify and remove the offending urgent. Call sitz bath an application of wet compresses also a few days of therapy with topical corticosteroids such as hydrocortisone acetate

Question 57

Location of Bartholin glands cysts

Answer 57

They are located in the labia menorah the ducks of the glans drain to the posterior vestibule at the four and 8 positions

Question 58

Treatment of Bartholin glands cyst versus Barcelona gland abscess Versus an abscess of the labia majora

Answer 58

Bartholin glands sis I treated with broad-spectrum anabiotic’s analgesics and warm sits baths. Person gland abscess straight with incision and drainage. Labia majora abscess requires gynecologic consultation

Question 59

How to drain a bartholin Glenn abscess?

Answer 59

Local injection of 2 to 4 mL of lidocaine. Make a stab incision with a number 11 scalpel on the mucosal surface of the vestibule just lateral to the hymenal ring

Question 60

Treatment for pinworms

Answer 60

Mebendazole 100 mg time one, albendazole 400 mg times one, pyrantel pamoate 11 mg per kilogram PO times one

Question 61

Pathophysiology of bacterial vaginosis

Answer 61

Overgrowth of normal gardnerella. This is really more of a bacterial imbalance than a true infection.