Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB/GYN > CaseFiles_1 > Flashcards

CaseFiles_1 Flashcards

1
Q

Serum screening for neural tube defects and Down’s syndrome occurs between ____ and ___ weeks of gestation.

A

16 and 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ulcers on the vulva may suggest (x3):

A

1) Herpes
2) Syphilis
3) Vulvar carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vulvar mass at the 5:00 and 7:00 regions may suggest (x2):

A

1) Bartholin cyst

2) abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is screening for gestational diabetes conducted? What does it consist of?

A

26-28 weeks. 50g oral glucose load and assessmetn of serum glucose level after 1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is uterine didelphys?

A

double uterus with double cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common cause of postpartum hemmorhage? As such, what is the first step in patient assessment and management?

A

uterine atony. First step in assessment and management is uterine massage with concurrent IV dilute oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of postpartum hemorrhage with a firm (not atonic) uterus?

A

Genital tract laceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What defines “term” in pregnancy?

A

Between 37 and 42 weeks of last menstrual period. But don’t induce delivery if less than 39 weeks gestation!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the difference between nulliparous and multiparous women with regards to the latent phase of labor (time to get to 4cm) and the lowest acceptalbe rate of cervical dilation in the active phase?

A

Nulliparous: 18-20h or less to get to 4 cm dilation; rate of at least 1.2 cm/h in active phase

Multiparous: 14h or less to get 4 cm dilation; rate of at least 1.5 cm/h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the “latent phase” of labor?

A

The initial part of labor where the cervix mainly effaces (thins) vs dilates; active phase is quicker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an “arrest of active phase” of labor? How is it different than protraction of active phase?

A

no progress in active phase for at least 2 hours. Protraction is <2h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the fetal heart rate baseline?

A

110 to 160 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the second stage of labor? How long does it take in multiparous vs. nulliparous women?

A

From complete dilation to expulsion of infant
Multiparous: takes 1h, 2h if epidural
nulliparous: takes 2 h; 3h if epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you determine if the contractions are adequate?

A

should bet at least 200 Montevideo units (mm Hg above baseline) over a 10 minute period; clinically, uterine contractions should occur every 2 to 3 minutes, last 40-60sec, and be firm on palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If the powers of contraction are deemed inadequate, then what do you do?

A

titration of oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the difference between early decelerations and late decelerations in baby? What about variable decelerations?

A

Early decelerations: caused by fetal head compression, benign. Mirror images of uterine contractions.

Late decelerations: suggest hypoxia (uteroplacental insufficiency); onset occurs after onset of contraction; gradual shape; suggests fetal hypoxia and if >50% of uterine contractions, indicates fetal acidemia

Variable decelerations are abrupt in decline and abrupt in resolution; caused by cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

An anthropoid pelvis predisposes to which fetal position?

A

Fetal occiput posterior position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does the baby being at “0 station” mean?

A

the bony part of the fetal head is at the plane of the ischial spines, not at the pelvic inlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Delivery less than 39 weeks’ gestation (by induction or schedules cesarean) is associated with:

A

increased risk of neonatal complications including increased NICU admission, respiratory difficulties, sepsis, hyperbilirubinemia, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you define anemia in a pregnant woman?

A

<10.5. Empirically treated with iron for 3-4 weeks then reassessed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patients with _______ may develop hemolytic anemia triggered by various medications such as sulfonamides, nitrofurantoin, and antimalarial agents; they will have dark-colored urine and fatigue, jaundice.

A

G6PD deficiency

22
Q

An elevated A2 hemoglobin level is suggestive of

A

B-thalassemia disorder

23
Q

What are the four signs of complete placental separation?

A

1) gush of blood; 2) cord lengthening; 3) globular and firm shape of the uterus; 4) uterus rises up to the anterior abdominal wall

24
Q

What is an abnormally retained placenta?

A

Third stage of labor that has exceeded 30 . Manual extraction must be attempted.

25
Q

What are risk factors for uterine inversion?

A

1) placenta accreta

2) grand multiparous woman (>5 births) with placenta implanted at fundus

26
Q

What is the treatment of uterine inversion?

A

1) anesthesia consult (halothane or other uterine relaxation anesthetic)
2) 2 IV lines started ASAP (hemorrhage is almost a certainty)
3) terbutaline (B-agonist) or magnesium sulfate to relax uterus
4) upon replacing uterine fundus to normal location, relaxation agents are stopped and uterotonic agents, like oxytocin, are given so uterus will bear down on itself and stop the bleeding

27
Q

Why does an inverted uterus lead to hemorrhage?

A

Uterine atony! The inverted uterus leads to inability for an adequate myometrial contraction effect, which usually has a tourniquet effect on the spiral arteries

28
Q

What are Duhressen incisions?

A

Incisions of hte cervix used to treat an entrapped fetal head of a breech vaginal delivery

29
Q

What is shoulder dystocia?

A

Inability of the fetal shoulders to deliver spontaneously, due to impaction of the anterior shoulder behind the maternal symphysis pubis

30
Q

What are four risk factors for shoulder dystocia?

A

1) fetal macrosomia
2) maternal obesity
3) prolonged second stage of labor
4) gestational diabetes (can lead to shoulders and abdomen of baby being much bigger than head; opposite of hydrocephalus)
* *note, 50% of cases occur in babies less than 4000g!

31
Q

What is the McRoberts maneuver?

A

hyperflexion of the maternal thighs causing anterior rotation of pubic symphysis; maneuver for treatment of shoulder dystocia

32
Q

What are the maneuvers for treating shoulder dystocia?

A

1) McRoberts (hyperflex maternal thighs)
2) suprapubic pressure
TRY THOSE FIRST! and then…
3) Wood’s corkscrew maneuver (anterior arm to chest, posterior to back, baby head to face rectum)
4) delivery of posterior arm
5) Zavanelli maneuver (cephalic replacement and cesarean)

33
Q

What is the first step in the evaluation of fetal bradycardia in the face of rupture of membranes?

A

rule out umbilical cord prolapse! Usually the fetal head fills the pelvis preventing this, which is why rupture of the membranes should be avoided with an unengaged fetal part

34
Q

What is fetal bradycardia and what are the steps that should be taken should it occur?

A

fetal heart rate <110 for 10 minutes
First make sure no umbilical cord prolapse! And then assess maternal pulse to distinguish maternal and fetal bradycardia
1) place mom on side to move uterus from the great vessels, improving blood return to heart
2) IV fluid bolus or pressors
3) administration of 100% oxygen by face mask
4) stopping oxytocin if it is being given (hyperstimulation of uterus can be counteracted with a B-agonist like terbutaline)

35
Q

What are predisposing conditions to umbilical cord prolapse?

A

1) rupture of membranes with unengaged fetal part
2) footling breech presentation
3) transverse fetal lie

36
Q

What is the most common finding in uterine rupture?

A

Fetal heart rate abnormality, like fetal bradycardia

37
Q

How is uterine hyperstimulation defined?

A

> 5 uterine contractions in a 10 minute window

38
Q

What is misoprostol?

A

Prostaglandin E1 analogue used to induce labor/abortion. Low cost, but associated with uterine hyperstimulation (>5 uterine contractions in a 10 minute window)
**note, can be used with NSAIDs to treat gastric ulcers

39
Q

What is the best therapy for umbilical cord prolapse?

A

Elevation of the presenting part and emergency C section

40
Q

What is the best treatment for suspected uterine rupture?

A

Immediate C section

41
Q

What is the definition of postpartum hemorrhage?

A

Passage of >500 cc of blood after vaginal delivery or >1000 after C section

42
Q

What is the most common etiology of postpartum hemorrhage? What is the treatment?

A

Uterine atony, in which the myometrium has not contracted to cut off the uterine spiral arteries that are supplying the placental bed.

Treatment is uterine massage concurrently with IV dilute oxytocin, followed by prostaglandin F2-alpha or rectal misoprostol or methergine (ergot alkaloid)

Last ditch: intrauterine balloon, exploratory laparotomy with ligation of blood supply or hysterectomy

43
Q

Why is preeclampsia a risk factor for uterine atony?

A

Likely to have been treated with magnesium sulfate (uterine relaxant)

44
Q

What is methylergonovine maleate (methergine) and when is it contraindicated?

A

AN ergot alkaloid that induces myometrial contraction as a treatment of uterine atony, contraindicated in hypertension (risk of stroke)

45
Q

What is prostaglandin F2-alpha and when is it contraindicated?

A

prostaglandin that causes smooth muscle contraction, contraindicated in asthmatic patients (risk of bronchoconstriction)

46
Q

What are risk factors for uterine atony (x7)?

A

1) magnesium sulfate
2) oxytocin use during labor
3) rapid labor and/or delivery
4) overdistention of the uterus (macrosomia, multifetal pregnancy, hydramnios)
5) intraamniotic infection (chorioamnionitis)
6) prolonged labor
7) high parity

47
Q

What defines late postpartum hemorrhage and what is a potential cause?

A

PPH occurring after the first 24 hours
caused by subinvolution of the placental site (usually occurs 10-14 days after delivery)

Retained products of conception is another cause (uterine cramping, bleeding, fever, foul-smelling lochia)

48
Q

What are the surgical interventions for postpartum hemorrhage?

A

1) ligation of blood supply to uterus (suture ligation of ascending branch of uterine artery,or internal iliac artery=hypogastric); or
2) the B-lynch stitch to compress the uterus with external suture “netting.”
3) hysterectomy

49
Q

Coagulopathy, retained products of conception, or atypical uterine atony can result in (infra/supra)cervical bleeding.

A

Supracervical bleeding

50
Q

What is a cervical cerclage?

A

A procedure performed to prevent preterm labor and delivery in a pregnant woman with cervical insufficiency

OB/GYN (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions