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MJ- Womens Health 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
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17
Q

PAINFUL vag bleed (dark red), continuous

A

Abruptio placentae

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18
Q

Tx for Abruptio placentae

A

Hospitalize

IMMEDIATE C-SECTION

may lead to DIC

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19
Q

what is a complication of Abruptio placentae

A

DIC (10%)

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20
Q

MCC Abruptio placentae?

(9 causes)

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

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
Difference b/w complete and partial molar pregnancies
complete= egg w/o DNA + 1-2 sperm= all paternal chrom, 46XX partial= egg + 2 sperm
26
"SNOWSTORM" appearance on ultrasound
molar preg
27
tx for molar preg if METS
methotrexate
28
29
which Coombs test do you use to screen forRh type/alloimmunizations
INDIRECT coombs
30
1st line tx for morning sickness and hyperemesis gravidarum
Pyridoxine (vitB6) + Doxylamine
31
PP hemorrhage= \>\_\_\_\_ml if vaginal or \>\_\_\_\_ if CD
\>500ml vaginal \>1000ml CD
32
MCC PP hemorrhage
uterine atony
33
tx for PP hemorrhage
1. _**Bimanual uterine massage\*\*\***_ 2. only if uterus soft and boggy: **_oxytocin, Methylergonovine, Carboprost, Tromethamine, Misoprostol_**
34
what 2 tests are used for PROM
1. **_Nitrazine paper test_** (turns **blue** if pH \>6.5= PROM) 2. **_Fern test_** (amniotic fluid fern pattern 3. ultrasound
35
tx for preterm labor
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
antibiotic prophylaxis for GBS?
Ampicillin --\> PO amox + azithro PRN allergic= Cephazolin--\> PO cephalexin + azithro
37
Dystocia: What are the 3 categories of abnormal labor progression?
1. Power 2. Passenger 3. Passage
38
Two treatment options for shoulder dystocia
1st line= McRoberts maneuver Wood "Corkscrew" maneuver
39
How to induce labor
1. unfavorable cervix= **_Cervidil_** (prostaglandin gel on cervix) 2. **_Pitocin_** 3. **_Amniotomy_** (rupturing membranes w/ hook)
40
What conditions must be met in order to treat ectopic with Methotrexate
ectopic **_mass size \< 4 cm_**, hemodynamically stable **_HCG ≤ 5000_** IU/L no fetal cardiac activity
41
In women with an obstetrical history of cervical insufficiency, when should cerclage be placed?
12-14 weeks
42
1st and 2nd line tocolytics for preterm labor 32-34wks
1st line= Nifedipine 2nd line= Terbutaline
43
1st and 2nd line tocolytic for preterm labor 24-32wks
1st line= indomethacin 2nd line= Nifedipine
44
What are the 9 teratogenic drugs
1. Ethanol 2. Isotretinoin 3. Phenytoin 4. Warfarin 5. Valproate/ Carbamazepine 6. DES 7. Tetracycline 8. Lithium 9. ACE
45
46
tx for pruritis in cholestasis of pregnancy
Ursodeoxycholic acid | (Ursodiol)
47
What is the fasting glucose goal for GDM
\<95
48
Which of the following physical exam maneuver is used to help determine the position of a fetus inside the woman’s uterus?
Leopolds maneuver
49
The strongest risk factor for endometritis
c-section
50
tx for endometritis
broad spectrum abx clinda + gentamycin Ampicillin-sulbactam
51
What is seen on labs in placental abruption
hypofibrinogenemia
52
what 4 things tabulate to a higher **_Bishop score_** and greater likelihood of vaginal delivery following induction.
Greater cervical dilation and effacement, softer cervix, more anterior cervical position, and great fetal station

MJ- Womens Health EOR (4 decks)

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