comat wrongs Flashcards
how do you diagnose appendicitis in a pregnant woman?
Exploratory laparotomy; basically pretend she isn’t pregnant, bc if she dies, there will be no baby anyway.
how do you induce someone with a Bishop score less than 5?
PGE2 or PGE1M (misoprostol)
how do you induce someone with a Bishop score more than 5?
oxytocin/pitocin
what are the contraindications for using prostaglandins in labor induction?
Maternal reasons= asthma and glaucoma Obstetric reasons= prior C-section and nonreassuring fetal testing
name some non-pharma ways of easing labor pains?
lamaze/breathing and relaxation techniques
what is an absolute contraindication for Trial of Labor After Cesarean?
prior classical hysterotomy or other VERTICAL uterine incision
what is required for forceps delivery?
adequate anesthesia, full dilation of the cervix, station 2 or lower with engaged head, knowledge of fetal position
what is a contraindication for use of forceps?
evidence of cephalopelvic disproportion
when giving methotrexate therapy for ectopic pregnancy, why should you wait longer than 48 hours to get B-hCG levels?
the B-hCG level commonly rises in the first few days after methotrexate therapy with a fall to 10-15% between days 4-7 after administration. Wait to check the levels in this 4-7 day period to see if you need to add more methotrexate or not
a patient with a known uterine scar (previous c-section) is having painful contractions but is not showing signs of labor. What do you do?
she is at risk for uterine rupture. continue close observation with continuous fetal monitoring, and reevaluate in 2-4 hours
severe abdominal pains with loss of station of the fetal head on vaginal exam are classic findings of what?
uterine rupture
how do you proceed with delivery of a baby when placental abruption occurs during labor?
emergent c-section
what do you give to a pregnant woman with eclampsia and active seizure?
magnesium sulfate
Patients in 1st trimester with high risk of aneuploidy and advanced maternal age should undergo which diagnostic test?
chorionic villus sampling
Patients in 2nd trimester with high risk of aneuploidy and advanced maternal age should undergo which diagnostic test?
amniocentesis
What classifies as “fetal growth restriction”?
estimated birth weight on US is less than the 10th percentile expected for gestational age
At 20 weeks gestational age and up, how many grams does a fetus gain per day?
10 grams
what should you convey to a patient considering tubal ligation?
it is considered an irreversible form of contraception
which antiviral medication is used to treat hep B in pregnancy?
tenofovir
what is the most common cause of postpartum hemorrhage?
uterine atony
name the risk factors for uterine atony:
increased uterine distension (multiple gestation, macrosomia, or polyhydramnios), chorioamnionitis, a long induction of labor from prolonged exposure to oxytocin, magnesium sulfate for preeclampsia, uterine inversion, or retained placenta
what are the sx of congenital varicella?
infant: growth restriction, cicatrical disseminated rash/ scarred skin lesions, limb hypoplasia, chorioretinits
Mom: pruritic vesicles on trunk and extremities, fever
What are the sx of congenital parvovirus B19?
- Infant: aplastic anemia, high-output congestive heart failure, and cardiomyopathy
- hydrops fetalis=fetal anemia leading to high output cardiac failure
- Mom: fever, myalgias, arthralgias, lymphadenopathy, lacy erythematous rash
what are the sx of congenital toxoplasmosis?
infant: diffuse intracranial calcifications, chorioretinitis, hydrocephaly (large head)
what are the sx of congenital cytomegalovirus?
infant: low birth weight, ventriculomegaly, hearing impairment, periventricular calcifications
What are the sx of congenital rubella?
infant: patent ductus arteriosus, hearing impairment, ptechial purpural rash (blueberry muffin baby)
how long should you wait before doing an infertility workup on a patient below the age of 35?
12 months of trying to concieve without birth control
how long should you wait before doing an infertility workup on a patient above the age of 35?
6 months of trying to concieve without birth control
what is considered pre-term pregnancy?
<37 weeks and 0 days
What is considered early term?
37 weeks and 0 days — 38 weeks and 6 days
What is considered full term pregnancy?
3 weeks and 0 days — 40 weeks and 6 days
What is considered late term pregnancy?
41 weeks and 0 days—41 weeks and 6 days
Induce!
What is considered post-term pregnancy?
after 42 weeks and 0 days
what are fetal effects of antenatal steroids?
abnormality in fetal heart rate (usually decreased), decreased movement, and decreased breathing patterns 2-3 days after steroid administration
what are the maternal effects of antenatal steroids?
hyperglycemia and leukocytosis
decreasesed lymphocytes
how does pregnancy affect GFR?
- GFR increases, meaning that creatinine levels will decrease
- normal creatinine in a pregnant woman means renal failure
how does pregnancy affect hemoglobin?
- hemoglobin decreases (around 10)
signs and sx of HELLP syndrome
epigastric and RUQ pain with HTN, anemia, thrombocytopenia, and transaminitis, schistocytes
Turner’s syndrome
45, X
primary ameonrrhea (non-functional “streak” ovaries), low-set ears, aortic coarctation, webbed neck, wide-spaced nipples, shield chest, absent breast development
kleinfelter syndrome
male with extra “X” cromosome; 47 XXY
small firm testes, low sperm counts, low testosterone levels, tall stature
has a classic bleeding pattern of metrorrhagia or intermenstrual spotting
endometrial polyp
classical physical exam finding of tender, boggy, and enlarged uterus
adenomyosis
what are some anticholinergics that can help treat urge incontinence?
darifenacin, tolterodine, oxybutynin
