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Cam's Cards > Dr. Sacklord lectures > Flashcards

Dr. Sacklord lectures Flashcards

1
Q

After a contraction, it is normal for the fetal HR to _____.

A

Increase

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2
Q

What is a late decel? Is it normal or bad?

A

When the fetal HR decreases after contraction. It is bad.

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3
Q

What is an early decel? Is it normal?

A

When fetal HR decreases before before contraction.

This can be normal due to increase in intrauterine pressure.

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4
Q

What is more predictive of fetal outcome? NST or BPP?

A

BPP. It takes into account NST plus fetal breathing, axial skeleton movements, motor tone, and amniotic fluid assessment.

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5
Q

What is a normal score for a BPP?

A

8-10 indicates no fetal asphyxia.

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6
Q

What should you do with a BPP score of 6?

A

Deliver if >36 weeks, if < 36 weeks repeat in 4-6 hours.

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7
Q

What should you do with a BPP score < 6?

A

Deliver if >36 weeks, if <26 weeks repeat in 4-6 hours for 120 minutes. If score remains <5, deliver.

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8
Q

What does doppler evaluation of umbilical arteries and middle cerebral arteries measure?

A

Velocity of blood during systole and diastole.

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9
Q

An increased S/D ration in doppler evaluation indicates?

A

Placenta is not working well.

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10
Q

What is macrosomia?

A

big ass baby

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11
Q

Causes for fetal macrosomia?

A

Constitutional (big parents)
Diabetes
Excessive maternal weight gain

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12
Q

What is the major concern of macrosomia?

A

Shoulder dystocia

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13
Q

What fetal weight is concerning for shoulder dystocia in diabetics? Non-diabetics?

A

DM - 4500g

No DM - 5000g

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14
Q

What are some causes for fetal growth restriction?

A

Trisomy 21 (downs syndrome)
Monosomy XO (turners syndrome)
Placental insufficiency
Infections

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15
Q

What measurements indicate oligohydramnios?

A

amniotic fluid index (AFI) < 5cm

Single deepest pocket <2cm

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16
Q

What measurements indicate polyhydramnios?

A

AFI >24

SDP >8

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17
Q

Causes of oligohydramnios?

A

Placental insufficiency
Renal and collecting system abnormalities
Preterm ROM

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18
Q

Causes of polyhydramnios?

A

Diabetes
GI tract/esophageal abnormalities
Fetal anemia
genetic syndromes

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19
Q

At how many weeks should a baby be delivered if there is polyhydramnios?

A

37-39 weeks

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20
Q

How is fetal growth delay or excess measured?

A

Abnormal fundal height measurements. Confirmed with fetal biometry

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21
Q

A fully dilated cervix is?

A

10cm dilation

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22
Q

What is labor protraction?

A

Rate of dilation lags from expected

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23
Q

What is labor arrest?

A

Rate of dilation has stopped or reversed.

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24
Q

What is the normal rate of dilation in active labor?

A

1cm/hour

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25
Q

When does stage 1 of labor start and end?

A

Onset of contractions to start of active labor

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26
Q

When does stage 2 of labor start and end?

A

Starts at max dilation of cervix, ends at birth of baby.

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27
Q

What medication can be used for induction of labor?

A

OXytocin

28
Q

What procedure can be done for induction of labor?

A

Artificial ROM

29
Q

What is the normal/ideal fetal presentation for vaginal birth?

A

Vertex/cephalic - head down

30
Q 
Describe the following malpresentations:
Breech
Transverse
Compound
Face or brow
A

Breech - butt first
Transverse - sideways
Compound - head +arm/leg
Face or brow - face or brow first

31
Q

Can you vaginally deliver a face/brow presentation?

A

If chin(mentum) is ANTERIOR, you can deliver.

32
Q

What malpresentation is amenable to external cephalic version?

A

Transverse back down

33
Q

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?

A

No. External cephalic version is only indicated if membranes intact.

34
Q

Risks of external cephalic version?

A

Fetal trauma
Abruption
Cord compression
Chance for emergency C section

35
Q

What is a VBAC?

A

Vaginal birth after caesarian

36
Q

Biggest risk of VBAC?

A

Uterine rupture

37
Q

Candidates for VBAC can only have how many previous caesarians?

A

1 or 2

38
Q

What type of uterine scar is a contraindication to a VBAC?

A

Vertical

39
Q

What are the first two maneuvers to preform for shoulder dystocia?

A

McRoberts and Suprapubic pressure

40
Q

What are the two types of operative vaginal delivery?

A

Forceps and vaccum

41
Q

When should operative vaginal delivery be used?

A

Maternal exhaustion

42
Q

What are the two types of episiotomy’s. What are the downsides to each?

A

Midline -tear more

Mediolateral - bleed more

43
Q

Obstetric lacerations are graded on a scale from _ to _.

A

1-4

44
Q

Which grade obstetric lacerations tear into the anal sphincter?

A

3 and 4

45
Q

List 3 causes of pregnancy related first trimester bleeding.

A

Ectopic
Spontaneous AB
sub chorionic bleed

46
Q

How often should HCG be doubling in the first trimester?

A

every 48 hours

47
Q

You should be able to see a fetus on transvag US at HCG > _____

A

1500-2000

48
Q

You should be able to see getus on transabdominal US at HCG> ____

A

5000

49
Q

Most common cause of spontaneous AB?

A

genetic

50
Q

What are the 5 types of ABs?

A 
Missed AB
Threatened AB
Inevitable AB
Completed AB
Incomplete AB
51
Q

3 ways of managing AB?

A

Expectant (wait)
Medical (misoprostal)
Surgical

52
Q

Risks of AB?

A

Bleeding
Infection (septic abortion)
Rarely DIC

53
Q

What are some obstetric causes of 2nd and 3rd trimester bleeding?

A

Labor
Abruption
Placenta/Vasa previa

54
Q

Painless 2nd/3rd trimester bleeding should make you think of?

A

Placenta previa

55
Q

Painful 2nd/3rd trimester bleeding should make you think of?

A

Placental abruption

56
Q

T/F? You can do a vaginal delivery during placental abruption.

A

True

57
Q

Can you do a vaginal delivery during placenta previa?

A

No

58
Q

Most common cause of postpartum hemorrhage?

A

ATONY!!!

59
Q

What tool can be used to control postpartum hemorrhage?

A

Bakri balloon

60
Q

What medication is used for DVT/PE in pregnancy?

A

Lovenox

61
Q

What is the rule of thirds for autoimmune diseases in pregnancy?

A

1/3 get better
1/3 remain unchanged
1/3 get worse

62
Q

What risks does pregnancy have for patients with cardiovascular disease?

A

Increased risk of morbidity and morality with stage 3 and 4 heart disease

63
Q

What patients are at risk for alloimmunization?

A

Pregnant women with previous pregnancy or transfusion

64
Q

When should antibody screening be done for pregnant women?

A

at first visit

65
Q

If fetus is determined to be at risk, how often should antibody titers be done?

A

Every month

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