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Ob/Gyn > Differential And Steps > Flashcards

Differential And Steps Flashcards

0
Q

Management of placenta previa?

A
  1. Bedrest
  2. C-section if unstoppable labor, fetal distress, life-threatening hemorrhage
  3. If bleeding, venous access, HCT, type and screen, PT/PTT, Kleinhauer-Betke,
  4. tocolysis and steroids if under 34 weeks
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1
Q

Patient with antepartum bleeding – differential?

A

OBSTETRIC causes

  1. Placental – previa, abruption, vasa previa
  2. Maternal – uterine rupture
  3. Fetal – fetal vessels rupture

NON-OBSTETRIC causes

  1. Cervical – cervicitis, polyps, cancer
  2. Vaginal – lacerations, varices, cancer
  3. Other – bleeding disorder, trauma
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2
Q

Placental abruption - management?

A
  1. IV access, type and screen, CBC, PT/PTT, fibrin split products, RhoGAM
  2. Prepare for preterm deliver
  3. C-section if life-threatening bleed, and non-reassuring tracing
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3
Q

Uterine rupture - management?

A
  1. Laparotomy and delivery of the fetus
  2. Hysterectomy if repair not possible
  3. Discourage future pregnancies, at minimum no trial of labor in future
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4
Q

ruptured fetal vessel - management?

A

emergent c-section

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5
Q

Suspect Preterm rupture of membranes - diagnosis?

A
  1. Pooling, nitrazine, and ferning
  2. if evoquivical, use ultrasound for AFI
  3. If still unconfirmed, inject dye into amnionic sac and examine vaginal for leakage
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6
Q

Preterm rupture of membranes - management?

A
  1. If under 32, prolong with ampicillin, give steroids (tocolysis has little benefit)
  2. If 32-36, physician decision
  3. If over 36, deliver (longer wait increase risk for Chorioamnionitis)
  4. If signs of infection or fetal distress, deliver
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7
Q

Labor fails to progress - Ddx?

A
  1. Pelvis - too small?
  2. Power - IUPC and ptosin
  3. Passenger - macrosomia?
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8
Q

Cephalopelvic Disproportion - management?

A
  1. Trial of labor unless US has documented fetal head larger than pelvis
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9
Q

Breech presentation - management?

A
  1. External version if after 37 weeks (earlier and it will revert back)
  2. Trial of breech vaginal delivery (if favorable pelvis, weight 2000-3800, and not foot/compound breech)
  3. If compound breech, watch for umbilical cord prolapse
  4. C-section
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10
Q

Vasa previa - management?

A
  1. Do NOT artificially rupture membranes

2. If vasa previa, can undergo a trial of labor if they wish

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11
Q

Fetal bradycardia - tx?

A
  1. Move pt to side (may be due to IVC compression)
  2. O2 to mother
  3. Vaginal exam (for blood, uterine tetany, rapid descent)
  4. If hypotensive, hydration and ephedrine
  5. For tetany, give nitroglycerin and terbutaline
  6. If umbilical cord prolapse, c-section
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12
Q

Shoulder dystocia - management?

A
  1. McRoberts
  2. Wood’s corkscrew
  3. Delivery of posterior arm
  4. Suprapubic pressure
  5. Zavanelli
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13
Q

Pregnant with seizure - management?

A
  1. ABCs
  2. Assess fetal status
  3. Mag sulfate
    4 lorazepam
    5 phenytoin
  4. If no response, phenobarbital
    7.
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14
Q

SGA - Ddx?

A
  1. Decreased growth potential - trisomies, congenital infections, teratogens
  2. IUGR with symmetric restriction - insults <20 weeks gestation (malnutrition, maternal anemia, renal disease, hypertension, SLE, twins)
  3. IUGR with asymmetric restriction - insults over 20 weeks
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15
Q

Risk factors for SGA vs LGA

A
  1. Trisomies vs other chromosomal (Beckwith-Wiedemann)
  2. Large vs small maternal stature
  3. Substance abuse vs food abuse (obesity/diabetes)
  4. IDDM vs gestational diabetes
  5. Females vs males
    6 intrauterine infections vs old, multips
16
Q

LGA fetus - management?

A
  1. Get good dating or assess lung maturity from amniocentesis
  2. Induced before fetus becomes macrosomic (over 4500g)
17
Q

Oligohydramnios - causes?

A
  1. Uteroplacental insufficiency
  2. Renal agenesis/ GU obstruction
  3. Rupture of membranes/leakage
18
Q

Oligohydramnios - management?

A
  1. Plan for Labor at term or post date or with rupture of membranes
  2. Frequent antenatal testing
  3. Amnioinfusion if meconium or cord compression
19
Q

Polyhydramnios - Management?

A
  1. Expect Malrotation and Risk of cord prolapse so be careful after ROM
  2. RhoGAM to prevent Isoimmunization
20
Q

Fetal demise - management?

A
  1. Delivery to prevent DIC (prostaglandins/oxytocin after 20 weeks)
  2. Test mother of CVD, hypercoagulable state, TORCH
21
Q

Postterm pregnancy - management?

A
  1. Week 41 - NST
  2. Week 42 - BPP and NST
  3. After 42nd week, induce
22
Q

Mild preeclampsia - management?

A
  1. If over 34 weeks, induce with ptosin, prostaglandins, amniotomy
  2. If stable preterm, steroids and bedrest
    3 Mag sulfate during L&D
23
Q

Severe preeclampsia – management?

A
  1. Magnesium sulfate for seizure prophylaxis (Continue 24 hours postpartum)
  2. Hydralazine for blood-pressure control
  3. If less than 32 weeks, steroids
  4. Beyond 32 weeks, delivery
24
Q

Eclampsia – management?

A
  1. Seizure management with magnesium
  2. Blood pressure control with hydralazine
  3. Calcium chloride or calcium gluconate if magnesium toxicity
  4. No cesarean section unless obstetrics indications (nonreassuring fetal tracing, hemodynamic instability)
25
Q

Patient with chronic hypertension in pregnancy – management?

A
  1. Labetalol
  2. Nifedipine
  3. Methyldopa less effective
26
Q

PMS tx?

A
  1. Exercise and vitamin A, E, B6
  2. OCP
  3. SSRIs
27
Q

Diabetes during pregnancy - evaluation?

A
  1. 50g 1 hour glucose tolerance at 24-28 weeks (positive if over 140)
  2. If positive 3 hour GTT (gestational diabetes if 2+ values are elevated)
28
Q

Gestational diabetes - pregnancy management?

A
  1. Diabetic diet A1
  2. Insulin (short acting since fasting values usually normal while postprandial elevated) A2
  3. If A2, NST or BPP between 32-36 weeks
  4. US for macrosomia at 34-37 weeks
29
Q

Gestational diabetes - delivery management?

A
  1. Induction at 39-40 weeks (if poor sugar control, at 37-39 weeks)
  2. C-section if over 4000-4500
30
Q

Pt with diabetes - obstetric complications?

A 
Polyhydramnios
Preeclampsia (4x)
Miscarriage (2x)
Infection
Postpartum hemorrhage
31
Q

Regular diabetes during pregnancy - management?

A
  1. ECG, 24 urine analysis, HbA1c, TSH
  2. Tight Glucose control
  3. 4mg frolic acid daily (neural tube)
  4. After week 32, weekly NST. After week 36, biweekly
  5. After pregnancy, insulin requirements decrease due to removal of placenta (fewer insulin antagonists)
32
Q

Ddx postpartum hemorrhage with vaginal delivery?

A

Vaginal - hematoma/lacerations
Cervical - lacerations
Uterus - atony, inversion, rupture
Placental - accreta, retained POCs

33
Q

Ddx postpartum hemorrhage with c-section delivery

A

Placenta - accreta

Uterus - atony, rupture

34
Q

Uterine atony - management?

A
  1. Oxyoxin with uterine massage
  2. If fails, methergine (unless HTN)
  3. If fails, prostaglandin F2a (unless asthmatic)
  4. If fails, D&C to r/o retained POC
  5. If fails, uterine artery embolization
  6. I fails, hysterectomy
35
Q

Accreta management?

A

Laparoscopy

Ob/Gyn (64 decks)

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