C-section, dystocia, and ToRCH Flashcards
What is a Cesarean section
delivery of fetus through incision in abdominal wall (laparotomy) and uterine wall (hysterotomy)
What are different types of C-sections
Low transverse (MC): incision in lower uterine segment Classic: vertical incision in upper contractile portion of uterus (best if premature or if baby's position demands it)
What are indications for a C-section
fetal distress Hx of breech Transverse lie Dystocia (failure to progress) Hx of C-section uterine malformation (placenta previa)
What is dystocia
During labor, cervix fails to dilate over time, and fetus fails to descend
Causes of Dystocia (3 P’s)
Pelvis: pelvis isn’t big enough to let baby pass
Power: inadequate uterine contractions
Passenger: abnormal lie, presentation, or large head
RF for dystocia include
prolonged interval between pregnancy
primigravid brith
Hx of multiple births
Complications if you dont hurry and deliver baby
fetal death
respiratory depression
hypoxic ischemis encephalopathy
brachial nerve damage
How do you manage Dystocia
oxytocin
forceps
vacuum
c-section
What is ToRCH
infection acquired in utero or during delivery that cause significant fetal or neonatal mortality
The organisms in ToRCH are
Toxoplasmosis (undercooked meat, cat poop) other (syphillis) Rubella CMV HSV
How can you prevent toxoplasmosis
Avoid undercooked meat
strict hand hygiene
avoid changing litter box
Sx of toxoplasmosis are
*chorioretinitis + hydrocephalus + intracranial calcifications
Fever, jaundice, seizure, exanthematous rash
How do you Tx toxoplasmosis
Pyrimethamine x 1 year
Sulfadiazine x 1 yr
Folinic acid x 1 yr
How do you diagnose toxoplasmosis
anti-toxoplasma IgM and IgG
What is the transmission rate of syphilis
100%!
dont fuck with treponema pallidum
Early syphilis presentation is
blood tinged nasal mucus
diffuse osteochondritis
saddle nose (2/2 rhinitis)
Late syphilis presents as
Hutchinson teeth (notched permanent incisors) anterior bowing of tibia (saber shins)
How do you diagnose syphilis
RPR/VDRL + fluorescence treponemal antigen (FTA) in MOM
How do you treat infant syphilis
Procaine Penicillin G x 10-14 d
How likely is it mom transfers Rubella to infant
80% in first trimester, 50% in second trimester
esp. if not immunized (hematogenous spread)
How does rubella present
*Hearing loss
*blueberry muffin rash
cataracts, jaundice, thrombocytopenia, hepatosplenomegaly
How do you diagnose and treat rubella
IgM rubella Ab
NO TREATMENT
CMV is a member of
herpes family
transmitted by body fluids
Diagnosed by + CMV in urine or saliva
What is the #1 cause of congenital infection
CMV
What is the #1 cause of sensorineural hearing loss in newborn
CMV
How does CMV present
Microcephaly intracranial calcifications IUGR chorioretinitis severe mental retardation
How can you prevent fetal transmisison of herpes
C section if a woman has active lesions
can only have vaginal birth if mom is on valtrex for the first trimester, and has NO current lesions
How does herpes in neonates present
seizures respiratory distress mucocutaneous vesicles meningitis encephalitis conjunctivitis
How do you treat neonatal herpes
Acyclovir for baby
