101 102 Emergency Delivery and Vulvovaginits Flashcards
What are the two tests that confirm rupture of membranes
Nitrazine paper will turn dark blue and Acadia pairs of 77.4. Another test is Ferning on microscopy
What anatomy serves as the reference point for station in childbirth
The internal issue with spines is station zero
What are The four main uterotonic’s that we have
Oxytocin, misoprostok methylergonovine, carboprost
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
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
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
Maternal vital signs such as blood pressure heart rate respiratory rate oxygen saturation temperature and the fetal heart rate
What is the normal fetal heart rate
120 to 160 beats per minutes. Bradycardia is defined as less than 110 and tachycardia is greater than 160
Describe what is happening in early decelerations variable decelerations and late decelerations
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
How do you estimate gestational age based on physical exam
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.
Describe nägeles rule
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
What is an important consideration to keep in mind for the physical exam of a pregnant woman
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
What is the first way that you determine ruptured membranes
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
When should you ask OB to come to the ED rather than transport to the delivery suite
If the service is fully effaced and dilated or the fetal head is visible during contractions
What does Apgar stand for and at what point should you call NICU
Apgar stands for appearance, pulse, grimace, activity,Respirations. Call NICU of the agar score is less than seven
What are the feared complications of shoulder dystocia?
Fetal hypoxia that may lead to cerebral palsy or death, brachial plexus injury, clavicle fracture, postpartum hemorrhage, fourth-degree perineal laceration’s.
Where should you apply downward pressure in shoulder dystocia
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
What is a consideration that you have to keep in mind for the third stage of labor in premature infants
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
Where should you clamp The umbilical cord?
3 cm distal to the insertion at the umbilicus
What is the classic signs for shoulder dystocia
Turtle sign. Just want to head retract tightly against the perineum after delivering the head
What percentage of shoulder dystocia’s are relieved by Mike Roberts and super pubic pressure
About 50%
When are breach presentations most likely
About 25 to 30% of all preterm infants less than 28 weeks of gestation present in breach position
Why is Bruce delivery such a problem?
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
How to deliver a breech delivery
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
Definition of postpartum hemorrhage
Technically there’s primary secondary postpartum hemorrhage primary within the first 24 hours secondary is after 24 hours and up to six weeks postpartum.
Causes of primary Premier
Uterine atony of course, retain placental fragments, lower genital tract lacerations, uterine rupture, uterine inversion andHead repertory coagulopathy
Causes of secondary postpartum hemorrhage
Failure of the uterine lining to sub envelope at the formal placental site, retain placental tissue, genital tract wounds and urogenital infection.
What are the three most Common causes of uterine inversion
Connective tissue disorders, uterine structural anomalies and overzealous or excessive traction
What device can be placed to correct a uterine inversion
A Rush balloon catheter
What are the risk factors for uterine rupture
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
Describe the only treatments for an amniotic fluid embolism
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
What is the four minute five minute rule
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
Roughly, describe how to perform an emergency cesarean section
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
How do you bacterial vaginosis and trichomonas affect pregnancy?
They are both associated with premature rupture of membranes, preterm labor and low infant birth weight.
Which sexually transmitted infection increases the risk of HIV acquisition and transmission?
Trichomonas vaginitis
What is the normal pH of the vagina, the pH of candidiasis, the pH of gardnerella vaginosis, Trichomoniasis
Normal vaginal pH is 44.5, candidiasis is also 44.5 BV is greater than 4.5 trichomoniasis is also greater than 4.5
What is the pH of premenarchal and post menarchal women
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
How to sample for infectious vulvovaginitis
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
BV increases the risk of coinfection for which STI’s and how
Increases the risk of HIV, HSV type two, chlamydia and gonorrhea. This happens by decreasing local secretory leukocyte protease inhibitor levels
How did diagnose BV
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
Why are cultures not beneficial for diagnosing BV
Because gardnerella is a part of the normal vaginal flora
Treatment for BV?
Metronidazole 500 mg PO be ID for seven days or metronidazole intravaginal gel
What is an alternative treatment for BV?
Lactobacillus intravaginal suppository and probiotics to restore the normal vaginal flora
Name the first second and third most causes of infectious vulvovaginitis
One. BV two. Candida. Three. Trichomoniasis
During what age is candida most common
And women of reproductive age. Incidence goes down after menopause
Risk factors for candida
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
How to diagnose candida
Visualization of Budding yeast and pseudohyphae on slide preparation, clinically, normal vaginal pH
What is the best treatment for candidiasis and why? When should you be careful about using it
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.
When is the candidate infection considered complicated?
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
Treatment for complicated candidiasis
150 mg Fluconazole orally for three days on days one, four, and seven
What are the classic physical exam findings for trichomoniasis?
Green frothy malodorous discharge and punctate hemorrhages on the cervix also known as strawberry cervix
Treatment for trichomonas and pregnant women
Oral metronidazole just like normal
Different test to diagnosediagnose trichomonas?
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
Treatment for trichomoniasis with those. And how that changes with treatment failure
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
Difference between primary and secondary herpes IOutbreaks?
Primary infections are more severe and often associated with systemic symptoms
What is an important consideration for precipitous delivery as it relates to sexually transmitted infections
If possible try to ask mom and treat for herpesTo prevent neonatal HSV
How to diagnose HSV
PCR reaction swabs when active lesions are present
Treatment for contact vulvovaginitis
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
Location of Bartholin glands cysts
They are located in the labia menorah the ducks of the glans drain to the posterior vestibule at the four and 8 positions
Treatment of Bartholin glands cyst versus Barcelona gland abscess Versus an abscess of the labia majora
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
How to drain a bartholin Glenn abscess?
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
Treatment for pinworms
Mebendazole 100 mg time one, albendazole 400 mg times one, pyrantel pamoate 11 mg per kilogram PO times one
Pathophysiology of bacterial vaginosis
Overgrowth of normal gardnerella. This is really more of a bacterial imbalance than a true infection.
