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OBGYN > Blueprints 5,6,7,8,9,11 > Flashcards

Blueprints 5,6,7,8,9,11 Flashcards

1
Q

classic presentation of placenta previa

A

painless vaginal bleeding in the third trimester, diagnosed via ultrasound

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2
Q

placenta previa and accreta in prior C section mom

A

accounts for 20% of antepartum hemorrhage. associated with accrete in 5% of cases without prior C section and 15-67% with prior C section

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3
Q

placenta accreta, increta, percreta

A

accreta= abnormal attachment of placenta to uterus, increta= placenta invades myometrium, percreta= invades through myometrium and to the serosa

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4
Q

placental abruption epidemiology

A

30% of all trimester hemorrhages

more often in women with chronic HTN, preeclampsia, cocaine/meth use, history of abruption

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5
Q

placental abruption presentation

A

vaginal bleeding, painful contractions, firm, tender uterus. 20% of pts have no bleeding

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6
Q

placental abruption complications

A

hypovolemic shock, DIC, preterm delivery

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7
Q

uterine rupture

A

1/200 women with prior C section. increased fetal and maternal mortality. need immediate laparotomy, delivery of fetus, and repair of rupture site/laparatomy

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8
Q

fetal vessel rupture

A

rare- association with multiple gestation and/or velamentous cord insertion (exposed vessels not covered with whatnot’s jelly). perinatal mortality of up to 60%

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9
Q

sinusoidal FHR pattern

A

fetal vessel rupture-> need immediate C section delivery

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10
Q

preterm delivery rate in pregnancy

A

10% of all pregnancies

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11
Q

how to treat preterm delivery

A

tocolytics (anti contraction medications) like B agonists, magnesium, CCB, and NSAIDS

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12
Q

tocolytics effectiveness

A

they are only marginally effective at slowing down contractions but they may buy time to beta methadone to accelerate fetal lung maturity

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13
Q

preterm versus premature ROM

A

premature rupture of membranes: ROM that occurs before onset of labor. preterm rupture of membranes is ROM that occurs before 37 weeks gestation

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14
Q

latency period relationship with gestational age in PPROM

A

latency period prior to onset of labor is inversely related to gestational age in PPROM.

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15
Q

once ROM is confirmed, what does therapeutic course depend upon

A

gestational age, risk of infection, fetal lung maturity. signs of infection/fetal distress-> NEED DELIVERY

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16
Q

CPD

A

when fetal head is too large to pass through maternal pelvis- usually a trial labor is attempted first unless ultrasound and CT have been used to document a fetal head larger than the maternal pelvis

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17
Q

three types of breech

A

frank, incomplete, footling

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18
Q

how to manage breech

A

external version to vertex, C section, less frequently: trial to labor.

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19
Q

complications of L&D of breech delivery

A

cord prolpase and entrapment of fetal head

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20
Q

vertex malpresentations

A

face, brow, compound, persistent OP. often delivery vaginally but need closer monitoring and sometimes require different maneuvers

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21
Q

prolonged fetal heart rate decels

A

preuterine, uteroplacental, postplacental. variety of etiologies.

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22
Q

if no resolution of FHR declaration in 4-5 minutes, what to do

A

deliver vaginally or move to OR for c section

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23
Q

shoulder dystocia complications

A

fetal fractures, nerve damage, hypoxia

24
Q

risk factors for shoulder dystocia

A

fetal macrosomnia, diabetes, previous dystocia, maternal obesity, postterm deliveries, prolonged stage 2 of labor

25
Q

uterine rupture

A

uncommon in pts with no prior uterine scar. 0.5-1% of patients who labor with a prior C section delivery

26
Q

maternal hypotension etiologies

A

regional anesthesia, hemorrhage, vasovagal events, AFE, anaphylaxis

27
Q

first line tx for pts with seizures in pregnancy

A

IV or IM magnesium sulfate

28
Q

oligohydramnios definition

A

AFI

29
Q

polyhydramnios definition

A

AFI>20 on US. associated with diabetes, multiple gestations, hydrops, congenital abnormalities

30
Q

obstetric management of polyhydramnios

A

careful verification of presentation, close observation for cord prolapse

31
Q

rh negative patients who are not sensitized

A

treated with antepartum RhoGAM to prevent sensitization. post partum, they should receive another dose of rhogam if the fetus is rh positive

32
Q

rh negative patients who are sensitized

A

followed closely with serial MCA Doppler velocities and ultrasound. if fetal anemia is suspected, PUBS and IUT can be performed

33
Q

genetics of monozygotic twinning

A

no genetic predisposition, but there is a genetic predispiopriton to dizygotic twinning

34
Q

preeclampsia defiinition

A

HTN>140/90 and proteinuria >300 mg/24 hours

35
Q

preeclampsia definition

A

5-6% of all live births. occurs most commonly in nulliparous women in their third trimester.

36
Q

what characterizes preeclampsia

A

multiorgan vasospasm that can lead to seizure, stroke, renal failure, liver damage, DIC, or fetal demise

37
Q

risk factors for preeclampsia

A

nulliparity, multiple gestation, chronic HTN

38
Q

how to treat preeclampsia

A

ultimately treated with delivery. seizures can be prevented with magnesium sulfate and BPS can be controlled with antihypertensive medications

39
Q

eclampsia

A

grand mal seizure in the preeclamptic patient that cannot be attributed to other causes

40
Q

when can patients present with eclamptic seizures

A

before labor (25%), during labor (50%), after delivery (25%)

41
Q

eclampsia treatment

A

seizure management and prophylaxis with magnesium sulfate, HTN management with hydrazine, and delivery after the patient has been stabilized

42
Q

chronic HTN is preg

A

HTN occurring before conception, before 20 weeks gestations, or persisting more than 6 weeks postpartum. chronic HTN leads to superimposed preeclampsia in 1/3 of patients.

43
Q

tx for chronic HTN in preg

A

nifepidine or labetalol. baseline ECG and 24 hours urine collection for protein and creatinine should be collected

44
Q

GDM occurrence

A

1-12% of pregnant women.

45
Q

screening for GDM

A

all women should be screened at 24-28 weeks. high risk women should be screened at their first prenatal visit

46
Q

fetal complications of GDM

A

macrosomnia, shoulder dystocia, neonatal hypoglycemia

47
Q

pregnancy management of GDM

A

frequent health care visits thorough patient education, ADA diet plan, glucose monitoring, fetal monitoring, and insulin or an oral hypoglycemic agent as indicated.

48
Q

labor in GDM

A

induce at 39-40 weeks. give intrapartum insulin and dextrose to maintain tight control during delivery. C section is offered if fetal weight is over 4500g.

49
Q

maternal complications of diabetes during pregnancy

A

hyperglycemia, hypoglycemia, UTI, worsening renal disease, HTN, and retinopathy

50
Q

fetal complications of GDM

A

spontaneous abortion, congenital abnormalities, macrosomnia, IUGR, neonatal hypoglycemia, respiratory distress syndrome, perinatal death

51
Q

hyperemesis gravidum problems

A

though n/v are common in pregnancy, people with HG can’t maintain adequate hydration and nutrition

52
Q

acute/chronic management of hyperemesis gravidum

A

IV hydration, electrolyte repletion, antiemetics. chronic management includes antiemetics and occupational tube feeding or parenteral nutrition

53
Q

seizures in pregnancy

A

increase ins seizure frequency- may be related to increased metabolism of AEDs, decreased pt compliance, lower seizure threshold, and/or hormonal changes in preg. pts should be moniored for monthly AED level

54
Q

congenital abnormlities in mothers with seizures

A

increased baseline for congenital anomalies. risk is increased with the use of AEDs, particularly polytherapy. all pts should have targeted US/fetal survey.

55
Q

cardiac dz in pregnancy

A

changes in cardiac physiology in pregnancy can have a big impact of cardiac dz. common aspects of management are termination of pre, medical stabilizaion, surgical or valvuloplasty repair if needed

56
Q

cardiac pt tx n L&D

A

cardiac pts are given an early epidural, careful fluid monitoring, assisted vaginal delivery to minimize maternal stress and strain. most risky time for cardiac pts is labor, delivery, and puerperium

OBGYN (2 decks)

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