Dr. Sacklord lectures Flashcards
After a contraction, it is normal for the fetal HR to _____.
Increase
What is a late decel? Is it normal or bad?
When the fetal HR decreases after contraction. It is bad.
What is an early decel? Is it normal?
When fetal HR decreases before before contraction.
This can be normal due to increase in intrauterine pressure.
What is more predictive of fetal outcome? NST or BPP?
BPP. It takes into account NST plus fetal breathing, axial skeleton movements, motor tone, and amniotic fluid assessment.
What is a normal score for a BPP?
8-10 indicates no fetal asphyxia.
What should you do with a BPP score of 6?
Deliver if >36 weeks, if < 36 weeks repeat in 4-6 hours.
What should you do with a BPP score < 6?
Deliver if >36 weeks, if <26 weeks repeat in 4-6 hours for 120 minutes. If score remains <5, deliver.
What does doppler evaluation of umbilical arteries and middle cerebral arteries measure?
Velocity of blood during systole and diastole.
An increased S/D ration in doppler evaluation indicates?
Placenta is not working well.
What is macrosomia?
big ass baby
Causes for fetal macrosomia?
Constitutional (big parents)
Diabetes
Excessive maternal weight gain
What is the major concern of macrosomia?
Shoulder dystocia
What fetal weight is concerning for shoulder dystocia in diabetics? Non-diabetics?
DM - 4500g
No DM - 5000g
What are some causes for fetal growth restriction?
Trisomy 21 (downs syndrome)
Monosomy XO (turners syndrome)
Placental insufficiency
Infections
What measurements indicate oligohydramnios?
amniotic fluid index (AFI) < 5cm
Single deepest pocket <2cm
What measurements indicate polyhydramnios?
AFI >24
SDP >8
Causes of oligohydramnios?
Placental insufficiency
Renal and collecting system abnormalities
Preterm ROM
Causes of polyhydramnios?
Diabetes
GI tract/esophageal abnormalities
Fetal anemia
genetic syndromes
At how many weeks should a baby be delivered if there is polyhydramnios?
37-39 weeks
How is fetal growth delay or excess measured?
Abnormal fundal height measurements. Confirmed with fetal biometry
A fully dilated cervix is?
10cm dilation
What is labor protraction?
Rate of dilation lags from expected
What is labor arrest?
Rate of dilation has stopped or reversed.
What is the normal rate of dilation in active labor?
1cm/hour
When does stage 1 of labor start and end?
Onset of contractions to start of active labor
When does stage 2 of labor start and end?
Starts at max dilation of cervix, ends at birth of baby.
What medication can be used for induction of labor?
OXytocin
What procedure can be done for induction of labor?
Artificial ROM
What is the normal/ideal fetal presentation for vaginal birth?
Vertex/cephalic - head down
Describe the following malpresentations: Breech Transverse Compound Face or brow
Breech - butt first
Transverse - sideways
Compound - head +arm/leg
Face or brow - face or brow first
Can you vaginally deliver a face/brow presentation?
If chin(mentum) is ANTERIOR, you can deliver.
What malpresentation is amenable to external cephalic version?
Transverse back down
A patient presents at 40 weeks with SROM 30 minutes ago. The baby is found to be in transverse back down malpresentation. Can you preform a external cephalic version?
No. External cephalic version is only indicated if membranes intact.
Risks of external cephalic version?
Fetal trauma
Abruption
Cord compression
Chance for emergency C section
What is a VBAC?
Vaginal birth after caesarian
Biggest risk of VBAC?
Uterine rupture
Candidates for VBAC can only have how many previous caesarians?
1 or 2
What type of uterine scar is a contraindication to a VBAC?
Vertical
What are the first two maneuvers to preform for shoulder dystocia?
McRoberts and Suprapubic pressure
What are the two types of operative vaginal delivery?
Forceps and vaccum
When should operative vaginal delivery be used?
Maternal exhaustion
What are the two types of episiotomy’s. What are the downsides to each?
Midline -tear more
Mediolateral - bleed more
Obstetric lacerations are graded on a scale from _ to _.
1-4
Which grade obstetric lacerations tear into the anal sphincter?
3 and 4
List 3 causes of pregnancy related first trimester bleeding.
Ectopic
Spontaneous AB
sub chorionic bleed
How often should HCG be doubling in the first trimester?
every 48 hours
You should be able to see a fetus on transvag US at HCG > _____
1500-2000
You should be able to see getus on transabdominal US at HCG> ____
5000
Most common cause of spontaneous AB?
genetic
What are the 5 types of ABs?
Missed AB Threatened AB Inevitable AB Completed AB Incomplete AB
3 ways of managing AB?
Expectant (wait)
Medical (misoprostal)
Surgical
Risks of AB?
Bleeding
Infection (septic abortion)
Rarely DIC
What are some obstetric causes of 2nd and 3rd trimester bleeding?
Labor
Abruption
Placenta/Vasa previa
Painless 2nd/3rd trimester bleeding should make you think of?
Placenta previa
Painful 2nd/3rd trimester bleeding should make you think of?
Placental abruption
T/F? You can do a vaginal delivery during placental abruption.
True
Can you do a vaginal delivery during placenta previa?
No
Most common cause of postpartum hemorrhage?
ATONY!!!
What tool can be used to control postpartum hemorrhage?
Bakri balloon
What medication is used for DVT/PE in pregnancy?
Lovenox
What is the rule of thirds for autoimmune diseases in pregnancy?
1/3 get better
1/3 remain unchanged
1/3 get worse
What risks does pregnancy have for patients with cardiovascular disease?
Increased risk of morbidity and morality with stage 3 and 4 heart disease
What patients are at risk for alloimmunization?
Pregnant women with previous pregnancy or transfusion
When should antibody screening be done for pregnant women?
at first visit
If fetus is determined to be at risk, how often should antibody titers be done?
Every month
