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MJ- Elective 1 EOR > Complicated Pregnancy > Flashcards

Complicated Pregnancy Flashcards

1
Q

What is abruptio placentae

A
  • Premature separation of the placenta from the uterine wall
  • Presents as heavy painful vaginal bleeding in the 3rd trimester
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2
Q

tx for breech presentation

A

external cephalic version

(@ or near term)

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3
Q

tx for cord prolapse

A
  • Immediate c-section
  • manual elevation of the presenting fetal part
  • repositioning of the mother to knee chest position
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4
Q

what is dystocia

A

Failure of cervical dilation and fetal descent (difficult labor)

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5
Q

3 causes of dystocia

A
  • Small pelvis
  • Poor contractions
    • Tx: IV Pitocin
  • Macrosomia
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6
Q

tx for dystocia

A

Forceps, vacuum, C-section

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7
Q

tx for shoulder dystocia

A
  • McRoberts maneuver (1’st line) – increase pelvic opening by elevating the maternal thighs against the abdomen
  • Woods corkscrew maneuver: 180 shoulder rotation; if no success then emergent C section
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8
Q

What is the turtle sign and what does it indicate

A

retraction of the delivered head against the maternal perineum

= shoulder dystocia

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9
Q

Medications used for induced abortions

A

< 9 wks: Mifepristone –> Misoprostal (1-3d later)

< 7 weeks: Methotrexate–> Misoprostal (3-7d later)

4-12wks: D&C

>12wks: dilation and evacuation

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10
Q

What is the difference b/w mild and severe pre-eclampsia?

A
  • Mild
    • BP >140/90
    • > +1 proteinuria
  • Severe
    • BP >160/110
    • > +3 proteinuria
    • thrombocytopenia
    • oliguria
    • HELLP
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11
Q

Tx for MILD pre-eclampsia

A
  • deliver at 37 wks
  • if < 34wks:
    • BP + dipstick weekly, bedrest
    • Steroids to mature lungs
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12
Q

Tx for severe pre-eclampsia

(>160/110, > 3+ protein)

A
  • PROMPT DELIVERY
  • Hospitalize–> give MAG
  • _Hydralazine*_, labetolol, Nifedipine
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13
Q

Tx for eclampsia

A

ABCDs

Mag (for seizures)

Delivery (once stabilized)

Hydralazine, labetolol

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14
Q

what is the TOC for moderate/severe pre-existing HTN

(meds if BP >150/100)

A

Methyldopa

(labetolol, hydralazine, Nifedipine)

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15
Q

PAINLESS vaginal bleeding in 3rd trimester

A

placenta previa

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16
Q

tx for placenta previa (painless vag bleed 3rd tri)

A
  • Hospitalize. bed rest
  • Mag (inhibits uterine contraction/preterm labor)
  • Steroids (if 24-34wks, lung maturity)
  • Deliver when stable (if >36w, blood loss >500mL)- Vag or CD
17
Q

PAINFUL vag bleed (dark red), continuous

A

Abruptio placentae

18
Q

Tx for Abruptio placentae

A

Hospitalize

IMMEDIATE C-SECTION

may lead to DIC

19
Q

what is a complication of Abruptio placentae

A

DIC (10%)

20
Q

MCC Abruptio placentae?

(9 causes)

A
  • MCC- Maternal HTN
  • smoking, ETOH, cocaine
  • folate deficiency
  • high parity
  • increased age
  • trauma
  • chorioamnionitis
21
Q

What is Vasa previa

tx?

A
  • fetal vessels travers the fetal membranes over the cervical os
  • ROM–> PAINLESS vag bleed
  • TX= immediate CD
22
Q

Screening for GDM: BS > ____ after 50g GTT

A

> 140

23
Q

What is a positive 3hr GTT

A

fasting >95

1hr >180

2hr >155

3hr >140

24
Q

TOC for GDM

A

insulin (doesn’t cross the placenta)- indications= fasting >105, pp>120

Glyburide, metformin

INDUCE AT 38WKS IF UNCONTROLLED/MACROSOMIA

25
Q

Difference b/w complete and partial molar pregnancies

A

complete= egg w/o DNA + 1-2 sperm= all paternal chrom, 46XX

partial= egg + 2 sperm

26
Q

“SNOWSTORM” appearance on ultrasound

A

molar preg

27
Q

tx for molar preg if METS

A

methotrexate

28
Q
A
29
Q

which Coombs test do you use to screen forRh type/alloimmunizations

A

INDIRECT coombs

30
Q

1st line tx for morning sickness and hyperemesis gravidarum

A

Pyridoxine (vitB6) + Doxylamine

31
Q

PP hemorrhage= >____ml if vaginal or >____ if CD

A

>500ml vaginal

>1000ml CD

32
Q

MCC PP hemorrhage

A

uterine atony

33
Q

tx for PP hemorrhage

A
  1. _Bimanual uterine massage***_
  2. only if uterus soft and boggy: oxytocin, Methylergonovine, Carboprost, Tromethamine, Misoprostol
34
Q

what 2 tests are used for PROM

A
  1. Nitrazine paper test (turns blue if pH >6.5= PROM)
  2. Fern test (amniotic fluid fern pattern
  3. ultrasound
35
Q

tx for preterm labor

A
  1. steroids (betamethasone)
  2. Tocolytics (prevent uterine contraction)
  • Indomethacin (24-32wks)
  • Nifedapine (32-34wks or 2nd line 24-32wks)
  • Mag sulfate (must be admitted, not used w/ nifedipine)
  • Terbutaline (2nd line 32-34wks)
36
Q

antibiotic prophylaxis for GBS?

A

Ampicillin –> PO amox + azithro

PRN allergic= Cephazolin–> PO cephalexin + azithro

37
Q

Dystocia:

What are the 3 categories of abnormal labor progression?

A
  1. Power
  2. Passenger
  3. Passage
38
Q

Two treatment options for shoulder dystocia

A

1st line= McRoberts maneuver

Wood “Corkscrew” maneuver

39
Q

How to induce labor

A
  1. unfavorable cervix= Cervidil (prostaglandin gel on cervix)
  2. Pitocin
  3. Amniotomy (rupturing membranes w/ hook)

MJ- Elective 1 EOR (8 decks)

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