Day 14 - Ob3 Flashcards
Define oligohydramnios v. polyhydramnios
OLIGO: AFI 25 cm
Tests used to confirm rupture of membranes
Pooling of amniotic fluid in vaginal vault on speculum exam; Fern test, Nitrazine blue test; Oligohydramnios helpful if
Mgt pre-term labor
Expectant mgt (no tocolytics, even in PPROM, in order to allow time for steroids); Maternal steroids (betamethasone q24 h x 2 doses, dexamethasone q 12 h x 4 doses) until fetal lung maturity - not necessary if over 34 wks; Hospitalization; SCDs; Tocolysis for 48 hrs (to give steroids); Empiric antibx - Ampicillin (primarily for GBS ppx q 4 h); No sterile vaginal exams unless signs of labor
Mgt pre-term labor 34-37 wks GA
Active management = If beyond 34 wks or shown fetal lung maturity, then can actively manage (pitocin); Steriods of no benefit; Ampicillin for GBS ppx; Limit sterile vaginal exams until Ampicillin dose 2
Tocolytic drugs
Nifedipine (more effective than Terbutaline at delaying labor 48 hr, vasodilator, tachycardia, HA, flushing, may also cause hypotension), Terbutaline (most commonly used beta agonist for labor inhibition, contraindication for cardiac disease & poorly controlled DM, can cause maternal & fetal tachycardia), Ritodrine (only FDA approved, no longer manufactured in US, also beta agonist), MgSO4 (IV, risk of Mg toxicity, contraindication: myasthenia gravis), Indomethacin (NSAID, possible premature closure of PDA if given more than 48 hrs, decreased amniotic fluid production may cause oligohydramnios)
Mg Toxicity - S/sx & Reversal agent
Bedside exam - Loss of DTRs, Respiratory paralysis (also fluid build up in lungs), Cardiac arrest; Mg levels can take 15-30 min to get back; Reverse w/ Calcium gluconate
First steps in w/u of infertile couple
(1) Semen analysis (collected after 48-72 hrs of abstinence, 40% of infertility due to male semen) (2) Eval of anovulatory cycles (in order of increasing specificity: careful menstrual hx, basal body temp monitoring, home urinary ovulation test, post ovulation serum progesterone level, endometrial bx) (3) Hysterosalpingogram (rule out anatomic, 30% cause of infertility, performed after menses cessation but prior to ovulation) (4) Post coital test (performed 2-3 days prior to ovulation 2-12 hrs after intercourse, may have anti-sperm antibodies)
Dx test used to determine anatomic cause of infertility in females
Hysterosalpingogram
Anatomic causes of infertility in females
Scarring of fallopian tubes (commonly prior STD), Endometriosis, Adhesions from prior surgery or PID, Tumors, Fibroids, Traumatic disruption of normal anatomy, Congenital anomalies (e.g., septate uterus)
1st steps in mgt non-reassuring fetal heart rate strip
Maternal O2; Turn off utero-stimulating agent (e.g., oxytocin); Left lateral decubitus; Correct uterine hyperstimulation if needed (w/ terbutaline); Correct any maternal hypotension (commonly assoc w/ epidural, often give 500 cc bolus before hand due to LE venous pooling caused); Sterile vaginal exam (e.g., check for umbilical cord prolapse); Place fetal scalp electrode; Consider interventions (e.g., amnioinfusion or c-section)
Fetal tachycardia v. bradycardia
Fetal tachycardia > 160; Bradycardia
Normal variability & DDx loss of variability in fetal HR
Normal: 6-25 beats per minute; Sleeping, IV pain meds for mother, CNS depression, Fetal acidosis
DDx fetal tachycardia
> 160 bpm; Maternal fever/infx/dehydration, Chorioamnionitis, Fetal anemia (tachy or sinusoidal), Maternal thyroxicosis, Fetal tachyarrhythmias (e.g., WPW), Fetal immaturity, Drugs/Meds (Terbutaline, Atropine), Fetal hypoxia
Fetal surveillance typical for high risk pregnancies
Biophysical profile (NST - HR accelerations, amniotic index, respiration, movement, tone)
Normal reactive nonstress test
2 15 bpm accelerations for at least 15 seconds within 20 minutes
