C-section, dystocia, and ToRCH

Question 1

What is a Cesarean section

Answer 1

delivery of fetus through incision in abdominal wall (laparotomy) and uterine wall (hysterotomy)

Question 2

What are different types of C-sections

Answer 2

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)

Question 3

What are indications for a C-section

Answer 3

fetal distress 
Hx of breech 
Transverse lie 
Dystocia (failure to progress) 
Hx of C-section 
uterine malformation (placenta previa)

Question 4

What is dystocia

Answer 4

During labor, cervix fails to dilate over time, and fetus fails to descend

Question 5

Causes of Dystocia (3 P’s)

Answer 5

Pelvis: pelvis isn’t big enough to let baby pass
Power: inadequate uterine contractions
Passenger: abnormal lie, presentation, or large head

Question 6

RF for dystocia include

Answer 6

prolonged interval between pregnancy
primigravid brith
Hx of multiple births

Question 7

Complications if you dont hurry and deliver baby

Answer 7

fetal death
respiratory depression
hypoxic ischemis encephalopathy
brachial nerve damage

Question 8

How do you manage Dystocia

Answer 8

oxytocin
forceps
vacuum
c-section

Question 9

What is ToRCH

Answer 9

infection acquired in utero or during delivery that cause significant fetal or neonatal mortality

Question 10

The organisms in ToRCH are

Answer 10

Toxoplasmosis (undercooked meat, cat poop)
other (syphillis) 
Rubella 
CMV 
HSV

Question 11

How can you prevent toxoplasmosis

Answer 11

Avoid undercooked meat
strict hand hygiene
avoid changing litter box

Question 12

Sx of toxoplasmosis are

Answer 12

*chorioretinitis + hydrocephalus + intracranial calcifications
Fever, jaundice, seizure, exanthematous rash

Question 13

How do you Tx toxoplasmosis

Answer 13

Pyrimethamine x 1 year
Sulfadiazine x 1 yr
Folinic acid x 1 yr

Question 14

How do you diagnose toxoplasmosis

Answer 14

anti-toxoplasma IgM and IgG

Question 15

What is the transmission rate of syphilis

Answer 15

100%!

dont fuck with treponema pallidum

Question 16

Early syphilis presentation is

Answer 16

blood tinged nasal mucus
diffuse osteochondritis
saddle nose (2/2 rhinitis)

Question 17

Late syphilis presents as

Answer 17

Hutchinson teeth (notched permanent incisors) 
anterior bowing of tibia (saber shins)

Question 18

How do you diagnose syphilis

Answer 18

RPR/VDRL + fluorescence treponemal antigen (FTA) in MOM

Question 19

How do you treat infant syphilis

Answer 19

Procaine Penicillin G x 10-14 d

Question 20

How likely is it mom transfers Rubella to infant

Answer 20

80% in first trimester, 50% in second trimester

esp. if not immunized (hematogenous spread)

Question 21

How does rubella present

Answer 21

*Hearing loss
*blueberry muffin rash
cataracts, jaundice, thrombocytopenia, hepatosplenomegaly

Question 22

How do you diagnose and treat rubella

Answer 22

IgM rubella Ab

NO TREATMENT

Question 23

CMV is a member of

Answer 23

herpes family
transmitted by body fluids
Diagnosed by + CMV in urine or saliva

Question 24

What is the #1 cause of congenital infection

Answer 24

CMV

Question 25

What is the #1 cause of sensorineural hearing loss in newborn

Answer 25

CMV

Question 26

How does CMV present

Answer 26

Microcephaly 
intracranial calcifications 
IUGR 
chorioretinitis 
severe mental retardation

Question 27

How can you prevent fetal transmisison of herpes

Answer 27

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

Question 28

How does herpes in neonates present

Answer 28

seizures 
respiratory distress 
mucocutaneous vesicles 
meningitis 
encephalitis 
conjunctivitis

Question 29

How do you treat neonatal herpes

Answer 29

Acyclovir for baby