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OBGYN > CF: 1-5 > Flashcards

CF: 1-5 Flashcards

1: Done 2: 3: 4: 5:

1
Q

26 yo G1P0 woman at term with an adequate pelvis on clinical pelvimetry, nonimmune rubella status, is in labor. Her cervix has changed from 4 to 7 cm dilation over 2 hr w/ uterine contractions noted every 7-10 min.
Next step in management?

A

Continue to observe labor

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2
Q

Define latent phase of labor. Usually how many cm?

A

Initial part where cervix mainly effaces (thins) rather than dilates. Typically <4 cm dilation

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3
Q

Define active phase of labor. Usually how many cm?

A

Part of labor where dilation happens more rapidly. Cervix typically >4 cm (but not 10)

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4
Q

Define protraction of the active phase

A

Cervical dilation in the active phase that’s less than expected. Normals:

  • > /= 1.2 cm/hr in nulliparous
  • > /= 1.5 cm/hr in woman w/ at least 1 vag delivery
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5
Q

Define arrest of active phase

A

No progress in active phase of labor for 2 hr

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6
Q

Normal FHR?

A

110-160 bpm w/ accel and variability

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7
Q

Define FHR acceleration

A

Episodes of FHR that increase above the baseline of at least 15 bpm and for at least 15 sec

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8
Q

Normal duration of latent phase for nullipara vs multipara?

A

NP: </= 14 hr

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9
Q

Normal duration of second stage for nullipara vs multipara?

A

NP: </= 1 hr (2 w/ epidural)

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10
Q

Normal duration of third stage for nullipara vs multipara?

A

</=30 min for both

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11
Q

What are the 3 P’s?

A

Powers
Passenger
Pelvis

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12
Q

What is prolonged latent phase?

A

Latent phase >ULN

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13
Q

2 definitions of adequate uterine contractions?

A
  1. At least 200 MVU in a 10 min window

2. Contractions every 2-3 min, firm on palpation, lasting for at least 40-60 seconds

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14
Q

If powers are thought to be inadequate, what drug can you start?

A

Oxytocin

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15
Q

What are the MC type of decel and what causes them?

A

Variable

Cord compression

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16
Q

How do you handle intermittent variable decel w/ abrupt return to baseline?

A

Obs

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17
Q

What causes early decelerations? Are they benign or scary?

A

Fetal head compression

Benign

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18
Q

Which type of decel is “offset” from the uterine contraction w/ their onset after the onset of the contraction?

A

Late decel

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19
Q

What do late decels represent? What about if they’re recurrent (>50% of contractions)?

A

Uteroplacental insufficiency–> Fetal hypoxia

If recurrent, concern for fetal acidemia

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20
Q

In arrest or protraction of active phase, what’s the major indication for C/S?

A

Cephalopelvic disproportion

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21
Q

Define the 3 categories of FHR patterns

A

Category 1: reassuring: normal baseline and variability, no late or variable decels
Category 2: may have some aspect that’s concerning but not ominous
Category 3: ominous, indicates a high likelihood of severe fetal hypoxia

22
Q

What type of pelvis is defined as a pelvis w/ AP diameter > transverse diameter w/ prominant ischial spines and a narrow anterior segment?

A

Anthropod pelvis

23
Q

Define 0 station

A

When presenting part is right at the plane of the ischial spines

24
Q

How do you distinguish btwn bloody show and antepartum bleeding?

A

Bloody show will have sticky mucus admixed with blood, while antepartum bleeding won’t

25
Q

Which type of decels are mirror images of uterine contractions?

A

Early decels

26
Q

Which type of decels are abrupt in decline and abrupt in resolution?

A

Variable decels

27
Q

29 yo G2P1 woman at 20 wk gestation comes for routine prenatal care. On exam, BP is 100/60, HR 80 bpm, temp normal. Hb is 9.5 w/ elevated HbA2.
Most likely Dx?
Underlying mechanism?

A

Anemia 2/2 beta thal minor

Decreased beta globin chain production

28
Q

31 yo G4P3 woman has normal SVD of baby and after slight lengthening of the cord, a reddish shaggy mass is noted bulging in the introitus.
Most likely Dx?
Most likely Cpx?

A

Uterine inversion

Postpartum hemorrhage

29
Q

25 yo obese G2P1 woman is delivering at 42 wk gestation. The fetus appears clinically to be 3700 g (average weight). After a 4 hr 1st stage of labor and a 2 hr second stage of labor, the head delivers, but the shoulders don’t easily deliver.
Next step in management?
Likely complication (1 maternal and 1 neonatal)?
Predisposing maternal condition?

A
  • McRoberts maneuver: hyperflexion of the maternal hips onto the maternal abdomen +/- subrapubic pressure
  • Postpartum hemorrhage
  • Brachial plexus injury
  • GDM
30
Q

22 yo G3P2 woman at term is in labor w/ a cervical dilation of 5 cm. Vertex is at -3 station. Upon AROM, persistent fetal bradycardia to 70-80 bpm range is noted for 3 min.
Next step?

A

Vaginal exam to assess for umbilical cord prolapse

31
Q

Treatment of mild microcytic anemia in pregnant woman w/o RF for thalassemia?

A

Trial of iron + recheck h/h in 3 wk

32
Q

Next step for mild microcytic anemia in pregnant woman who didn’t respond to iron trial?

A

Iron studies + HFE

33
Q

Hb less than ____ qualifies as anemia in pregnancy?

-Define mild vs severe

A

<7

34
Q

Why can babies with beta thal appear healthy at birth?

A

HbF is present

35
Q

Pregnant women with sickle cell disease will have worsening and/or incr freq of what 4 complications?

A
  1. Anemia
  2. Pain crisis
  3. Infections
  4. Pulm Cpx
36
Q

Name two fetal complications with incr risk in pregnant women with sickle cell disease. How do you monitor for these?

A
  1. IUGR
  2. Perinatal mortality
    Serial US
37
Q

Major cause of megaloblastic anemia in pregnancy?

A

Folate deficiency

38
Q

Which two meds commonly used for UTIs in pregnancy could cause hemolysis in G6PD deficient women?

A
  1. Nitrofurantoin

2. TMP-SMX

39
Q

Anemia w/ elevated A2 suggests?

A

beta thal

40
Q

Anemia w/ elevated HbF suggests?

A

alpha thal

41
Q

4 signs of placental separation?

A
  1. Gush of blood
  2. Lengthening of the cord
  3. Firm, globular uterus
  4. Uterus rises up to anterior abdominal wall
42
Q

In uterine inversion, what’s the reddish bulging shaggy mass seen adjacent to the placenta?

A

Endometrial surface (shaggy= big clue)

43
Q

MCC of uterine inversion?

A

Undue traction on the cord before complete placental separation

44
Q

What defines an abnormally retained placenta?

A

3rd stage of labor >30 min

45
Q

Name 4 RFs for uterine inverion

A
  1. Undue traction on the cord before complete placental separation
  2. Grand multiparosity
  3. Placenta accreta
  4. Placenta implantation in uterine fundus
46
Q

1st step in treating uterine inversion?

A

Secure 2 large bore IV lines! Remember that even with proper tx, profuse hemorrhage is almost certain.

47
Q

After securing your IVs, name the 3 major steps in treating uterine inversion

A
  1. Uterine relaxants
  2. Replace uterus (with hand)
  3. Stop relaxants and start uterotonics
48
Q

Name 3 major uterine relaxants used in uterine inversion

A

Halothane
MgSO4
Terbutaline

49
Q

How do you treat an abnormally retained placenta?

A

Attempt manual extraction

50
Q

Mechanism of hemorrhage in uterine inversion?

A

Inverted uterus–> uterus can’t establish normal tone and contract–> myometrial fibers can’t exert tourniquet effect on spiral arteries–> placental bed pours out blood

OBGYN (7 decks)

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