Brainscape's Knowledge GenomeTM

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


See full index

CM III Exam III > Complicated Pregnancy > Flashcards

Complicated Pregnancy Flashcards

1
Q

Threatened Abortion

A

Bleeding w or w/o cramping. CLOSED CERVIX

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

Inevitable Abortion

A

Bleeding w or w/o cramping. CERVIX IS DILATED

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

Complete abortion

A

All POC have been expelled

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

Missed Abortion

A

Embryo or fetus dies, but POC are retained. Needs a D&C

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

Incomplete abortion

A

Some portion of POC remains in the uterus. Needs a D&C

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

Habitual Abortion

A

3 or more abortions in succession. Usually spontaneous

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

Spontaneous Abortion

A

Miscarriage. Pregnancy terminating before the 20th week

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

How many pregnancies terminate in a spontaneous abortion?

A

20%. Most of those are before 6 weeks, and before the woman even realizes she’s pregnant. These are usually due to chromosomal abnormalities that are incompatible with life.

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

What is an abortus

A

Fetus lost before 20 weeks

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

Sx of an abortion

A

Bleeding
Cramping
Abd pain
Decreased pregnancy sx

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

PE in an abortion

A

Vitals to R/O shock
Febrile illness
Pelvic exam

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

Txing an Abortion

A 
Stabilize if hypotensive
Monitor for bleeding/infection
Send POC to patho
\+/- D&C and misoprostol for dilation
Rh -? Rhogam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is an incompetent cervix? When does it usually occur?

A

Painless dilation of the cervix. Usually occurs during the second trimester.

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

RF for having an incompetent cervix

A

Cervical surgery or trauma
Uterine anomalies
Hx of DES exposure

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

Risks of an incompetent cervix

A

Spontaneous abortion
Fetal membranes being exposed to vaginal flora
Inc risk of fetal trauma (ROM)

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

When does a second trimester abortion occur

A

12-20 weeks

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

Options for removing a second tirimester abortion, and what is often the deciding factor

A

D&C, D&E (dilation and evacuation) or IOL (induction of labor)

Very few clinicians can do a D&C at >20 weeks, so if the fetus is 16-24 weeks it’s either D&C or IOL. Later is is, the more likely it will be an IOL

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

Tx for incompetent cervix

A

Cerclage

Then depends on if the fetus is previable or not

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

What is cerclage

A

Putting a suture into the cervix to keep it shut. Can be at the internal or external os. Goes with the risks of ROM, PTL or infection.

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

Previable management of an incompetent cervix

A

Expectant management (we know this is going on and expect it) and elective termination

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

Viable management of an incompetent cervix

A

Betamethasone (in case the kid delivers)
Strict bed rest
Tocolysis if preterm ctx (terbutaline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DIfference between PTL and incompetent cervix

A

PTL will have associated contractions. Sometimes it can be really hard to tell though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Three types of cerclage

A

1) Emergent- for managing a previable pregnancy
2) Elective- if there was a prev pregnancy loss and we’re suspicious it was because of an incompetent cervix.
3) Transabdominal- if both other types of cerclage have failed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If a woman gets a transabdominal cerclage, how must she deliver the baby?

A

C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is an ectopic pregnancy? What is the most common site?

A

Pregnancy that implants outside the uterus. 99% of these occurs in the fallopian tubes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What two symptoms should automatically make you get an HCG to RO ectopic?

A

Vaginal bleeding and abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

RF for an ectopic pregnancy

A

IVF, IUD, PID, tubal surgery, OCP, DES exposure, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PE of a ruptured ectopic

A

Hypotensive, unresponsive, peritoneal irritation secondary to hemoperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

HCG levels in ectopic

A

HCG does not rise appropriately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

US findings in an ectopic pregnancy

A

Adnexal mass, extrauterine pregnancy, ring of fire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Parameters for giving methotrexate

A

<4 cm without FH, reliable pt
Baseline CBC, transminases, creatinine, HCG
Repeat HCG after.

If they’re not a good methotrexate candidate, go for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of a ruptured ectopic pregnancy

A

Stabilize the patient!

IVF, blood products, pressors if necessary
Exploratory lap to control bleeding and remove the ectopic pregnancy
RHogam if RH neg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a heterotopic pregnancy? What inc the chances of this happen?

A

Rare! Intrauterine and ectopic pregnancy at the same time.

Most common with IVF ladies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What happens to the kiddo if mom never got her rhogam and has anti-D ab?

A

Massive hemolysis, CHF, hydrops or even death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is Gestational Trophoblastic Disease?

A

(GTD). Trophoblastic=placental

Diverse group of disease, results in abnormal proliferation of trophoblastic (placental) tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Most common form of GTD

A

Molar pregnancy. Abnormal fetal tissue resulting in a maternal tumor. They’ll produce an absurd amount of HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

GTD and chemotherapy

A

Extremely sensitive. It’s the “most curable” or whatever that means

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Are molar pregnancies (hydatidiform moles) malignant?

A

No way, super benign GTD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Two types of molar pregnancies

A

1) Complete mole- 90%. Totally just molar tissue, no fetus

2) Partial- 10%. Molar tissue and some fetal tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Rf for molar pregnancy

A 
Extremes in age
Prior hx of GTD
Nullpar
Smoking
Infertility
OCP use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Sx of a molar pregnancy

A

Irregular or heavy vaginal bleeding
Insanely high HCG levels, which cause these crazy pregnancy symptoms right off the bat in the first trimester (preeclampsia, hyperemesis, hypoerthyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Pathognomonic for molar pregnancy

A

Preeclampsia in the first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Postmolar malignant sequelae

A

Post molar D&C, send the tissue down to pathology so they can determine if there’s any sequelae. Wicked rare, but these sequelae can turn your benign mole into a proper tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

US Findings of a molar pregnancy

A

Molar tissue has this mixed echogenic pattern replacing the placenta. Has these villi and intrauterine blood clots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How to manage a molar pregnancy

A

Immediate removal, suction D&C or hysterectomy. Curative, 95-100%

Also symptomatic relief

a) mole caused PEC? Give antihypertensives to prevent stroke
b) HCG caused hyperthyroidism? BB to prevent thyroid storm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Persist disease (malignant GTD) post mole DC is rare, but which type of mole is it more common in? When does it present?

A

Complete. These patients will develop malignant GTD months to years after a molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How do we FU a molar pregnancy?

A

Serial HCG titers weekly until they’re negative. If we see a plateau or a rise >6mo post DC, think persistent disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How long should you wait to get pregnant after a molar pregnancy?

A

1 yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Two types of malignant GTD (and which is more common)

A

1) Persistent/invasive moles 75% (months to years post molar pregnancy)
2) Choriocarcinoma (placental carcinoma)- 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which type of malignant GTD is more likely to occur right after a normal pregnancy, miscarriage, ectopic or abortion (something with a real fetus)?

A

Choriocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Signs of a persistent/invasive mole

A

HCG level plateau, rise.
Intrauterine masses on US, we’ll see this large swollen villi in the myometrium.
These guys rarely rupture and metastasize.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Tx of a persistent/invasive mole

A

Single agent chemo w/ MTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

FU of a persistent/invasive mole post chemo

A

Serial HCG and really really good contraceptives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is a choriocarcinoma? How bad is it?

A

It’s a malignant necrotizing tumor. Scary GTD

Invades uterine wall and vasculature, metastasizing and potentially causing severe hemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Where does choriocarcinoma usually spread

A

Brain, liver, intestines, lungs, kidneys, liver (VASCULAR HEMATOLOGIC SPREAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Presentation of a choriocarcinoma

A

Irregular uterine bleeding or signs of metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Leading causes of metastatic cancer in women in africa

A

Choriocarcinoma. .Wacky right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Choriocarinoma tx

A

chemo. The type depends on the prog

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is a placental site trophoblastic tumor (PSTT)

A

Wicked rare tumor that arises from placental implantation site.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Presentation of a PSTT

A

Irregular bleeding, enlarged uterus, chronic low HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Tx of a PSTT

A

These guys are NOT sensitive to chemo. Hysterectomy is tx of choice, followed up by some “just in case” chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Placenta previa

A

Low lying placenta, instead of being up by the fundus it’s hanging out down low. Graded by how much of it is sitting over the cervix. ***Remember the placenta is that chunk in the back with the “tree of life” appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Complete previa

A

Placenta completely covers the internal os. Baby is probably breech

64
Q

Partial previa

A

Placenta covers a portion of the internal os

65
Q

Marginal previa

A

The edge of the placenta covers the margin of the os

66
Q

Low lying placenta

A

placenta is implanta in close proximity to the os

67
Q

Vasa previa

A

Fetal vessel lies over the cervix -really really scary. Also really rare

68
Q

Placenta accreta? Risks?

A

Abnormal invasion of the placenta into the uterine wall. Makes it so the placenta can’t separate from the uterine wall properly after delivery. Huge risk for hemorrage, shock, and maternal MM

69
Q

Placenta accreta invasion site

A

Superficial Myometrium

70
Q

Placenta Increta invasion site

A

invades into the myometrium, deeper than an accreta

71
Q

Placenta Percreta

A

Invasion through the myometrium and into the uterine serosa. Yikes

72
Q

What happens when you have a previa and an accreta (5% of them present like this!)

A

You’ve basically guarenteed yourself a hysterectomy at the time of delivery

73
Q

Sx of a placenta previa

A

Painless vaginal bleeding in pregnancy. Usually will occur after 28 weeks

74
Q

Tx of placenta previa

A

Pelvic rest (no intercourse)
Bed red
C section at 36-37 weeks, once lung maturity is confirmed

75
Q

Obstetric causes for antepartum bleeding

A

1) Placental- previa, abruption, vasa previa
2) Maternal- uterine rupture
3) Fetal- fetal vessel rupture

76
Q

Non-OB causes for antepartum bleeding

A

1) Cervical- severe cervicitis, polyps, cancer
2) Vaginal/vulvar- lacs, varices, cancer
3) Other- your classic vaginal bleeding causes. Hemorrhoids, trauma, hematuria

77
Q

What is placental abruption? What can it lead to?

A

Premature separation of the placenta (properly implanted) from the uterine wall. Causes a massive hemorrhage.

Can cause premature delivery, uterine tetany (hypercontract), DIC and hypovolemic shock

78
Q

RF for placental abruption

A 
HTN
AMA
Hydraminios
DM
COCAINE- get a tox
DM
EtOH (>14 drinks/week)
Multiple gestation
79
Q

Precipitating factors for a placental abruption

A 
Trauma
External/internal version (when we're trying to turn the baby)
MVA- inertia can cause it to shear
Delivery of 1st twin
ROM w/ polyhydraminos
PPROM
80
Q

Where does the blood go in a placental abruption?

A

80% of the time it goes outward towards the cervix, it’s an external hemorrhage and you know what you’re working with.
20% of the time it’s occult and is confined/concealed within the uterus. This is scary, but remember that when you feel a rock hard uterus

81
Q

Classic sign of a placental abruption

A

Couvelaire sign. The blood from the abruption penetrates the uterine muscle, you’ll have this rock hard uterus that is purple too. You’ll see the purple when you’re doing a c section

82
Q

Classic presentation of a placental abruption

A

3rd trimester vaginal bleeding with severe abdominal pain and frequent/strong cxn

83
Q

Vaginal delivery in a placental abruption?

A

If the baby looks good and there’s not that much blood then go for it. The blood will usually make the uterus hyperactive and you’ll have a rapid labor.

84
Q

PROM

A

Premature ROM. or, ROM before the onset of labor

85
Q

PPROM

A

Preterm Premature ROM. PROM before 37 weeks

86
Q

Prolonged ROM. What’s the risk here

A

ROM lasting >18 hours w/o deliverying the baby. Risk of chorioamnionitis. Longer the pROM lasts, greater the risk of this.

87
Q

What do we do if ROM occurs but it’s after week 36

A

Roll with it man, let’s induce a lady.

88
Q

Gestational HTN

A

HTN w/on proteinuria. Develops after 20 wks, returns to normal PP.

> 140/90. Must have normal BP prior for it to be gestational

89
Q

Difference between preeclampsia and gestational HTN

A

Proteinuria!!

> 0.3g of protein in a 24 hour urine

90
Q

RF for PEC

A

CHTN, CKI, SLE, DM, AA

91
Q

Ultimate treatment for preeclampsia

A

Delivery

92
Q

What’s the treatment for

a) Term pregnancy w/ PEC
b) Unstable preterm w/ PEC
c) Evidence of fetal lung maturity w/PEC

A

Induction of labor! Just gotta deliver the kid if the kid’s ready or if the mom is unstable. No baby is going to grow in an unstable mom.

If mom is really unstable just run to the OR

93
Q

What’s the treatment for PEC in a stable, preterm mom

A

Bed rest
Expectant management
Betamethasone to beef up the kid’s lungs 2 doses within 24 hours

94
Q

When would MgSulfate come into play

also what’s Mg’s effect on labor

A

Seizure ppx during labor, delivery and 12-24 hours PP.

4g loading and 2g/hr for maintenance

***If mom is stable, hold off on Mg until active labor. It can make the labor drag on and you’ll be more likely to have a csection dt labor failing to progress

95
Q

Superimposed PEC

A

New onset proteinuria in a woman with CHTN
OR
Sudden increase in proteinuria (that she had prior to gestation) OR
Sudden sharp inc in HTN OR
HELLP Syndrome

96
Q

How do we tx superimposed PEC

A

just like regular PEC!

97
Q

What’s a funky way superimposed PEC might present

A

Women with CHTN who suddenly develop HA, scotoma, or epigastric pain

98
Q

Severe PEC “deliver immediately” signs

A 
>32 weeks
Signs of LF or RF
Pulmonary edema
HELLP
DIC
99
Q

Signs of severe PEC (more of a read and understand)

A

One of more of the following:

> 160/110 on two occasions 6 hrs apart when pt is in bed
Proteinuria >5g on 24 or >3g on 2 random spots
Oliguria (<500ml)
Cerebral/visual disturbances (scotoma)
Pulmonary edema- vessels get leaky. Flash E happens fast
Epigastric pain
Impaired LF
Thrombocytopenia
Fetal growth restriction

100
Q

What is fetal growth restriction considered in severe PEC

A

End organ damage. It’s a sign that the BP is affecting the baby

101
Q

Difference between Severe PEC and EC

A

Grand mal serizures!

102
Q

Giving Mg in an EC pt

A

Give mg from the time they’re diagnosed until they’re 12-24hrs PP

103
Q

Tx the mom:

Tx the baby?

A

Mom: Stop the seizures and book it to an OR
Baby: Fix mom. Decels are going on because mom is seizing. Fix mom, you fix the baby

104
Q

What does HELLP stand for?

What might HELLP patients develop

A

Hemolytic Anemia (LDH, Bili, schistocytes)
Elevated Liver enzymes (inc AST/ALT)
Low platelets. (LIKE REAL LOW, plt 9?)
They might develop DIC or hepatic rupture

105
Q

Acute Fatty Liver of Pregnancy- these patients will commonly have what two symptoms normally associated with PEC

A

HTN and proteinuria.

106
Q

How can we differentiate acute fatty liver of pregnancy from HELLP

A

Labs will show ammonia, reduced fibrinogen and antithrombin II (liver labs)

107
Q

What is true GDM caused by

A

anti-insulin agents produced by the placenta. Increases with size/function of the placenta, so we don’t usually see this until the 2nd/3rd trimester

108
Q

When do we screen for GDM

A

28 weeks, unless they’re high risk

109
Q

What makes someone high risk for GDM

A 
Not white
AMA
Obese
Fhx of DM
Biggo kiddo previously
110
Q

What is a GLT? Screening or diagnositic?

A

Glucode loading test. Screening test done at 28wks for GDM.

Give 50g of glucose as a loading dose and check serum glucose 1 hr later. If >140, go ahead and do the GTT

111
Q

What is the GTT? Screening or diagnostic?

A

Diagnostic test for GDM. We take a fasting serum glu, then give 100g of PO glucose as a loading dose. Then we take a serum glucose 1,2 and 3 hours after that loading dose. If two or more of these values are elevated, that’s diagnostic for GDM

112
Q

GTT Glucose levels

A

Fasting >95
1hr >180
2hr> 155
3 hr>140

113
Q

Mainstay of tx for GDM

A

Diet! True GDM is an issue of CHO digestion. Limit calories, carbs to 220g a day. Promote walking and exercise

114
Q

When to consider insulin for GDM

A

When >25-30% of BG are elevated.

115
Q

Hard to ask this in a question. “True” GDM will have _ fasting glucose and _ PP glucode

A

Normal fasting and elevated PP, since the issue is with glucose digestion

116
Q

White classification for GDM

A

It’s how we classify GDM.

Class A is when you just have GDM, and you’re in category 1 or 2 depending on whether or not you’re medicated. The other classes are all based on if you have preexisting DM, looks at things like age of onset, end organ damage, stuff like that

117
Q

When do we US GDM mom’s for macrosomia

A

Weeks 34-37. We might base the delivery plan around this

118
Q

What do we do if a GDMA1 mom comes in for delivery?

A

Take a random BG. If it’s normal, we just deliver the babe as per usual

119
Q

How do we manage GDMA2 when mom comes in for IOL

A

Laboring women don’t exactly eat regular meals, so we keep them on a dextrose/insulin drip to keep the BS <120

120
Q

GDM, baby weighs >4,000g

A

Inc risk of shoulder dystocia. Avoid forceps/vacuum, be quicker to go for a cesarean

121
Q

GDM, baby weights >4,500g

A

Offer elective cesarean. This weight is a guarenteed birth injury

122
Q

Why is diet education so important for PP GDM mom;s

A

Because they have SUCH a high risk of developing DM later on in life/in future pregnancies

123
Q

RF for shoulder dystocia

A

Macrosomia, diabetes of all kinds, maternal obesity, postterm pregnancy (biggo kiddo), prolonged 2nd stage of labor

124
Q

Fetal complications of shoulder dystocia

A 
Fx of humerus or clavicle
Brachial plexus nerve injuries dt hyperflexion of the neck (Erb's palsy)
Other palsies
Brain injury (hypoxia)
Death
125
Q

Hallmark sign for shoulder dystocia

A

Turtle sign. Incomplete delivery of head, or the chin tucking up against maternal perineum. Kid will bob in and out

126
Q

Why might we do an episiotomy for a shoulder dystocia

A

If we can’t fit our hands in there to rotate the baby. This is a bone issue, an episiotomy will not get the baby out on its own

127
Q

How much time do you have to deliver the kid in a shoulder dystocia

A

5 min before brain death

128
Q

Is a shoulder dystocia an emergency

A

Heck yeah it is

129
Q

Three main maneuvers for shoulder dystocia

A

1) McRoberts- sharp flexion of maternal hips to decrease pelvis inclincation and just max out the diameter. Always done w/ #2 as the primary maneuver.
2) Suprapubic pressure- Pressure directed at an oblique angle to dislodge that anterior shoulder out from the pubic symphysis
3 )If the two above fail, we do the Rubin maneuver where we stick our hands all the way in and push the shoulder towards the anterior chest wall to dislodge it.

130
Q

What are some other things we can do for a shoulder!

A

1) Wood’s corkscrew- apply pressure to the posterior shoulder and try and rotate the infant
2) Deliver the posterior arm/shoulder, free up space
3) Fx fetal clavicle
4) Cut maternal pubic symphysis
5) ZavanellI!

131
Q

ml of blood loss to define a PPH

A

> 500ml for vag and >1,000 for c section

132
Q

Early vs late PPH

A

<24 hours after delivery =early

>24 hours after delivery = late

133
Q

> ___L we get worried about DIC. What do we give?

A

2-3L

Give coag factors and platelets. Which is a normal part of a massive transfusion protocol

134
Q

What is Sheehan syndrome? When would we see it? Manifestations?

A

Sheehan syndrome is a pit infarct that can happen during a PPH because of the hypotensive/hypovolemic state.

Manifests as a lack of lactation dt lack of prolactin or amenorrhea dt lack of GnRH. Bc the pit is totally blown out

135
Q

RF for PPH

A

abnormal placenta
trauma during LD
Uterine atony
Coagulation defects

136
Q

Causes of a PPH-vag

A 
Vaginal lacs
Cervical lacs
Uterine atony
Placenta accreta
Retained POC
Uterine inversion
Uterine rupture (yikes)
137
Q

Causes of a PPH- csection

A

Uterine atony
Surgical blood loss
Placenta accreta
Uterine rupture (also yikes)

138
Q

Four T’s of a PPH

A

1) Tone- Give uterotonic agents if the contractions are crummy
2) Trauma- suture any lacs. General or inversion of uterus
3) Tissue: Is the placenta retained? D&C?
4) Thrombin- are they clotting? Do they need plt/cofactor?

139
Q

Prolonged Decel

A

FHR <110 for >2min

140
Q

Fetal brachycardia

A

prolonged decel for >10min

141
Q

3 Etiologies of FHR decel

A

1) Preuterine- Any event that leads to maternal hypotension or hypoxia
2) Uteroplacental- Abruption, infarction, hemorrhaging previa
3) Postplacental- cord prolapse, compression, rupture of fetal vessel

142
Q

Managing FHR decel

A

Conservative at first!

  • Move position
  • Nasal O2 for mom
  • Did mom get an epidural and this is probably caused by a drop in BP? Consider giving a pressor
  • Stop pitocin drip if baby is deceling
143
Q

Most common reason for a c-section

A

Labor failing to progress. 2 hrs in active phase of labor without cervical change. This is when the uterine cxn are more than adequate

144
Q

3 P’s of failure to progress

A

Power: Strength of contractions
Passenger: Is the baby okay
Passage: if the pelvis/vagina big enough to support this kiddo

145
Q

Maternal indications for a CS

A

Maternal dx (genital herpes, HIV, cervical cancer)
Prior uterine surgery
Prior uterine rupture
Obstruction of birth canal (fibroids, ovarian tumor)

146
Q

Fetal indications for a CS

A 
Nonreassuring FHT (brady, asbsence of variability, acidodic)
Cord prolapse
Malpresentation (breech, brow)
Multiple gestations
Fetal anomalies (hydrocephalus)
147
Q

What direction should the incisions go in?

A

Horizontal if you can! OK to do vertical on the skin, but never on the uterus

148
Q

When would we do a single layer uterine closure?

A

If we’re going to go back and do a tubal ligation. Otherwise do a double

149
Q

Monozygotic twins

A

1 Fertilized ovum divides into two separate ova

150
Q

Dizygotic twins

A

Ovulation produces two eggs which are both fertilized

151
Q

TTS- Twin to Twin Transfusion Syndrome

A

One twin “eats” the other. Most common with Monochorionic (one placenta), diamnionic twins (two sacs)

152
Q

Mono/di-chorionic

A

of placenta

153
Q

Mono/di-amnionic

A

of amniotic saccs

154
Q

Monochorionic/monoamnionic twins MM

A

Crazy high due to risk of entangling cords

155
Q

What determines amnionicity/chorionicity?

A 
When the monozygotic twin cleaves! 
Cleavage between...
 1-3 days? Di/Di
4-8 days? Mono/Di
8-13? Mono/Mono
13-15? Conjoined
156
Q

What is mastitis? What causes it?

A

Regional infection of the breast. Caused by pts skin flora or infants mouth flora

157
Q

Tx for mastitis

A

Dicloxacillin. Keep pumping. If unresponsive to PO abx give IV abx until 48hrs afebrile

CM III Exam III (8 decks)

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