ALSO

Question 1

Mnemonic for interpretation of fetal heart rate tracings

Answer 1

DR C BRaVADO

DR: Define Risk
C: Contractions - comment on frequency
BRa: Baseline Rate 
V: Variability
A: Accelerations
D: Decelerations
O: Overall

Question 2

Shoulder Dystocia mnemonic

Answer 2

HELPERR

H: Call for Help
E: Evaluate for Episiotomy
L: Legs - McRoberts Maneuver
P: Suproapubic Pressure
E: Enter: rotational maneuvers: Robin II, Rubin II + Wood’s Screw, Reverse Wood’s Screw
R: Remove the posterior arm
R: Roll the patient to her hands and knew (Gaskin Maneuver”

Question 3

Mnemonic for vaginal breech delivery

Answer 3

CAREFUL

C: Check presentation, for full dilation, cord prolapse
A: Ask for help, Await umbilicus, sacrum Anterior
R: Rotate for arms
E: Enter for Mauriceau-Smellie-Veit maneuver - hang for 20 seconds
F: Flex head (hand on maxilla with suprapubic pressure)
U: Back Up - maintain sacrum anterior
L: Lift baby onto mother

Question 4

Dosing for Preeclampsia with Severe Features/Eclampsia

Answer 4

Magnesium 4 to 6 g IV load over 15-20 minutes

Followed by infusion of 2g/hour

Question 5

What needs to be monitored when giving magnesium in preeclampsia with severe features/eclampsia

Answer 5

Monitor serum level if Cr >0.9
Urine output <35 ml/hour
Loss of patellar reflexes (or other mag toxicities)

Question 6

When to treat for severe blood pressure during pregnancy

Answer 6

> 159 mm Hg or >109 mm Hg diastolic on two measurements 15 minutes apart

Question 7

What are the post-treatment blood pressure targets in pregnancy

Answer 7

140-150/90-100 mm Hg

Question 8

Different medications to be used in severe blood pressure in pregnancy

Answer 8

Labetalol
Hydralazine
Nifedipine

Question 9

Initial dose of Labetalol for severe blood pressure in pregnancy

Answer 9

• Initial dose:20 mg IV bolus over 2 minutes
• If BP remains >159/109 mm Hg, then repeat 10 minutes later with 40 mg IV and 10 minutes later with 80 mg IV.
• If BP remains >159/109 mm Hg, switch to hydralazine

Question 10

After initial dose, what is dose of labetalol for severe blood pressure in pregnancy

Answer 10

• Initial dose:20 mg IV bolus over 2 minutes

- If BP remains >159/109 mm Hg, then repeat 10 minutes later with 40 mg IV and 10 minutes later with 80 mg IV.

Question 11

What med to switch to if labetalol is not controlling blood pressure (continues to be above >159/109) in a pregnant woman

Answer 11

Hydralazine

Switch after initial dose plus two more escalating doses

Question 12

Maximum daily IV doe of Labetalol in sever hypertension in pregnancy

Answer 12

300 mg

Question 13

Hydralazine dosing for failed Labetalol in severe blood pressure during pregnancy

Answer 13

• Initial dose: 5-10 mg I over 2 minutes.

- After 20 minutes, if BP remains >159/109 mm Hg, may repeat with 10 mg IV

Question 14

Dosing for Nifedipine in severe blood pressure in pregnancy

Answer 14

10-20 mg PO; repeat in 30 minutes if BP remains elevated

Question 15

The Four Ts of postpartum hemorrhage (PPH)

Answer 15

Tone: Uterine Atony
Trauma: Cervix or Vagina
Tissue: Retained Placenta
Thrombin: Coagulopathy

Question 16

Medications for uterine atony

Answer 16

Oxytocin/Syntocinon
Methylergonovine
Prostaglandin F2alpha
Misoprostol

Question 17

Dosing for oxytocin in uterine atony

Answer 17

10 unite IV or IM.

10-40 units in 1000 mL saline at 250 mL/hr

Question 18

Methylergonovine dosing for uterine atony

Answer 18

0.2 mg IM

Use with caution in hypertension

Question 19

Dosing for prostaglandin F2alpha in uterine atony

Answer 19

0.25 mg IM or intramyometrial

May repeat every 15 minutes up to 8 doses but consider surgery after 2 doses

Question 20

How to confirm coagulopathy in uterine atony

Answer 20

confirm with bedside clot test