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MVU OB/PEDS > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the recommended office visits for a low-risk client throughout the pregnancy?

A

-Up to 28 weeks: Every 4 weeks
-28 to 36 weeks: Every 2 weeks**
-36 weeks and on: every week or more as necessary

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2
Q

What are common discomforts for each trimester?

A

1st: breast pain/enlargement, constipation, ptyalism/bad taste in mouth, fatigue, flatulence, headache, hemorrhoids, nausea and vomiting, urinary frequency/incontinence, varicosities of vulva and legs
2nd: backache, epistaxis, leukorrhea, ligament pain, leg muscle cramps, PICA, syncope
3rd: Braxton-Hicks, dyspnea, discomfort in upper extremities, edema, heartburn, insomnia, joint or pelvic pain

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3
Q

What are the normal, non-worrisome complaints during each trimester?

A

-N/V, heartburn, constipation
-Leg cramps, lower leg swelling
-Urinary frequency
-Backache
-Dyspnea (3rd trimester)
-Leukorrhea (white, thin vaginal discharge with no odor)

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4
Q

What are complaints from the pregnant patient that would be needed to be further evaluated?

A

-Fever
-Vaginal irritation/discharge that is large amount or odorous
-Vaginal bleeding
-Palpitations
-Breathlessness at rest
-Swelling of upper extremities or face
-Oliguria
-Decreased or absent fetal movement

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5
Q

What OCP can be given to breastfeeding women?**

A

-Progesterone only pill

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6
Q

What immunizations can be given in pregnancy?

A

-TDAP, HepB, inactivated influenza vaccine- no active vaccines during pregnancy

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7
Q

S&S of mastitis

A

flu-like symptoms. malaise, fever and chills, erythema and swelling of affected breast with possible pitting edema

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8
Q

Treatment for mastitis

A

-Milk culture, bed rest, continue breastfeeding; ice packs, warm packs, increased fluids
-Meds: NSAIDS, first choice is dicloxacillin sodium 250-500 mg QID for 10-14 days, also cephalexin (if breastfeeding); if PCN allergy: erythromycin or clindamycin

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9
Q

How would you treat mastitis if you suspect MRSA?

A

-Bactrim: do not give if mom is breastfeeding and baby is under 2 months old

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10
Q

What should the fundal height be at various prenatal visits?

A

-16 weeks: halfway b/t symphysis pubis and umbilicus
-20-36 weeks: uterine fundus at umbilicus; fundal height= gestational age (give or take 2 cm)
-Term: Fundal height drops r/t fetal head engagement into pelvis

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11
Q

Describe fetal development during pregnancy

A

-Major milestones during first trimester: beginning of fetal heart movements at 6 weeks gestation, closure of the neural tube at 7 weeks gestation, rapid head and brain growth starting at week 7

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12
Q

What week can you hear fetal heart tones on a Doppler?

A

by 10-12 weeks gestation

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13
Q

What to tell patients to do about N/V during pregnancy?

A

-Often N/V is limited to first trimester
-Diclegis and vitamin B6 can help; Dramamine, benadryl, zofran are all pregnancy category B
-Adequate hydration
-Small, frequent meals to avoid stomach from being to empty or full
-Ginger is natural and effective

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14
Q

Recommended weight gain during pregnancy

A

Based off of BMI:
<18.5 = 28-40 pounds
18.5-24.9= 25-35 pounds
25-29.9= 15-25 pounds
>30 = 11-20 lbs

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15
Q

Recommended blood testing/labs for all patients during pregnancy

A

-Blood type and antibody screening
-CBC
-Rubella titer
-Syphilis screening
-Hep B surface antigen
-UA
-Chlamydia//gonorrhea
-Cervical cytology
-HIV anibody

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16
Q

How do you prevent neural tube defects?

A

Folic acid

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17
Q

How do you differentiate between Trich, BV, and Candida infections?

A

On wet mount:
Candida-hyphae/pseudohyphae
BV: clue cells**
Trich: Protozoa with tails

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18
Q

Treatment for Trich, BV, Candida infections

A

Candida- miconazole, diflucan 150 mg single dose
Trich- metronidazole BID for 7-10 dyas
BV- metronidazole

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19
Q

S&S of Trichomoniasis

A

-Grey/yellow thin, foamy discharge
-Itchy/burning

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20
Q

S&S of chlamydia

A

-Yellow discharge
-Burning/itching
-Male: itching/burning, penile discharge

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21
Q

Treatment for chlamydia

A

-CDC first line: Doxy 100 mg BID for 7 days** -or-
-azithromycin 1 gram single dose -or-
-Levofloxacin 500 mg PO for 7 days

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22
Q

What STIs are reportable to the health department?

A

Chlamydia, gonorrhea, syphillis

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23
Q

S&S of gonorrhea

A

-Yellow, thin discharge
-Itching/burning

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24
Q

Treatment for gonorrhea

A

-Ceftriaxone 500 mg IM injection single dose
-If weight >150kg treat with 1 gram instead

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25
Q

Symptoms of pelvic inflammatory disease

A

-Dull, continuous lower abdominal or pelvic pain
-Fever, vomiting, vaginal discharge, irregular vaginal bleeding
-Lateral motion tenderness of cervix and adnexal

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26
Q

Labs to test if suspecting PID

A

-WBC-leukocytosis
-ESR- elevated
-CRP- elevated

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27
Q

What is one of the biggest concerns of PID?

A

-Can cause infertility if travels to tubes and causes abscess

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28
Q

Causes of PID

A

-Gonnorhea, chlamydia, trichomonas
-BV or cytomegalovirus

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29
Q

Treatment for PID

A

Ceftriaxone 500 mg IM once + doxycycline 100 mg BID for 14 days + metronidazole 500 mg BID for 14 days (regiment treats multiple different causes)

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30
Q

Treatment of HPV

A

For genital warts- Cryotherapy, topical creams/lotions (imiquimod 5% cream, podofilox 0.5% solution/gel), surgery

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31
Q

Treatment for HSV during pregnancy

A

-If pregnant and at risk start suppressive therapy at or after 36 weeks gestations acyclovir 400 mg TID or valacyclovir 500 mg BID until delivery

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32
Q

Complications of syphilis

A

-Neurosyphilis- infection of CNS, this can occur AT ANY STAGE OF INFECTION

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33
Q

S&S of different phases of syphilis

A

Primary: one or more chancres that resolve after a few weeks and appear about 3 weeks after exposure
Secondary: Starts 1-2 months after primary infection; maculopapular rash on palms and soles, hypertrophic papular lesions on vulva and anus, lymphadenopathy with flu-like symptoms
Tertiary: 15-30 years after infection; aortitis or gummatous changes to skin, bone, or viscera

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34
Q

Treatment for Syphillis

A

-Treatment differs based on phase of disease
-Primary: PCN G 2.4 million units IM once, repeat dose in 1 week IF pregnant
-Secondary: Same as primary
-Tertiary: Late latent is 2.4 million units IM every week for 3 weeks; early latent the same as primary/secondary

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35
Q

What are the guidelines for PAP smears for ACOG?

A

-Start at age 21years
-Every 3 years until 65 if cytology alone
-Every 5 years for age 21-65 if cytology +HPV or HPV alone

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36
Q

What are the guidelines for PAP smears for ACS (American Cancer Society)?

A

-Start at age 25-29 years**
-HPV alone or HPV +Cytology every 5 years
-Cytology every 3 years

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37
Q

Exceptions to pap smear screening guidelines

A

-Abnormal pap: need annual till 2 normal, then follow guidelines
-Hx of cervical or uterine cancer- continue screening past 65 years until 20 years cancer free
-Hysterectomy- no screening unless cancer

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38
Q

Management for abnormal pap smear

A

-Refer for colposcopy if HPV +, guidelines are different depending on what is found but most guidelines recommend this; repeat testing in 1 year

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39
Q

What is a colposcopy and when is it indicated?

A

Procedure that can be done in office that collects biopsy of cervix; indicated if PAP is positive for certain strains of HPV that cause cervical cancer

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40
Q

What is a bimanual exam?

A

-Palpation of pelvic organs
-Examines size, controur, shape, note any masses and location
-Not recommended to be performed by AAFM
-Recommended by ACOG to continue performing

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41
Q

How to perform a bimanual exam?

A

-Use prominent hand in vaginal vault, push on cervical OS
-With nondominant hand palpate downward to locate uterus, bladder, and ovaries

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42
Q

What is the best way to palpate the ovaries and what is the purpose of this procedure?

A

-Rectovaginal exam
-Rule out ovarian abnormalities such as cancer
-Not often done due to discomfort

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43
Q

What is a wet prep and what is it used to test for?

A

-Testing of vaginal discharge under microscope
-Bacterial vaginitis, Candida infections (yeast) and Trichomoniasis

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44
Q

Treatment for bacterial vaginosis

A

Metronidazole 500 mg BID for 7 days ~or**
-Metrogel 0.75% for 5 nights ~or
-Clindamycin cream 2% for 7 nights

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45
Q

Recommendations for screening for HIV

A

-Annual testing with antibody or antibody/antigen testing and RNA test
-If positive- follow-up testing to confirm
-Once confirmed- Viral load, CD4 count

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46
Q

What are the guidelines for breast cancer screening?

A

-Mammography every 2 years starting at age 40 for women with low-moderate risk women
-Age >75 years- offer screening if life expectancy >10 years
-High risk: every 6 month to year; MRI also used in combination**

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47
Q

Benefits of the combination oral pill for birth control

A

-Relatively inexpensive, easy to obtain and not long-term
-Can be stopped at any point
-Regular cycles that tend to be shorter and lighter
-Help with acne

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48
Q

Use of combination birth control pills increase risk factors for what?

A

-Blood clots
-Elevated BP
-Increased risk of estrogen/progestin dependent Ca
-HAs

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49
Q

Contraindications for combination BC pills

A

-HTN
-DVT or thrombus of any kind
-CA (especially breat or endometrial)
-Smoker
-Age >35years
-Migraines
-Pregnancy
-Depression
-Caution in seizures

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50
Q

What to tell patients about missing their birth control pills

A

-Effectiveness rate drops when pills are missed
-1 pill missed = take as soon as you remember, OK to take 2 in one day
-Do not take more than 2 pills in one day
-Use backup contraceptive or abstain from sex until 7 days of no missed pills

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51
Q

Benefits and risks of the 3-mo oral pill for birth control

A

-Benefits: cycle every 3 months, good for women who have dysmenorrhea or menorrhagia
-Risk: also a combination pill and therefore same risks as other estrogen/progestin pills

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52
Q

How do you use the NuvaRing? What are the risks and contraindications?

A

-Inserted into vaginal opening and lies around the cervix; remains in place for 3 weeks and removed for 1 week
-Combination contraceptive: same side effects and contraindications as oral contraceptives

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53
Q

What are the progestin based contraceptives?

A

-Pill
-Intradermal (Nexplanon)
-Injection (Depo-provera)
-IUD

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54
Q

Pros and Cons for progestin-based contraceptives

A

-Cons: Breast tenderness, headaches, nausea, weight gain, may have more vaginal discharge

Pros: Safe for women with HTN and age over 35, lower risk of blood clots (but still a risk)

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55
Q

Instructions for patients taking progestin only pill

A

-Safe for breastfeeding
-Take at same time every day and use backup contraceptive if even 3 hours late
-Cycles are regular and lighter

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56
Q

Patient education when using nexplanon

A

-Transdermal, placed under skin between elbow and shoulder
-Lasts 3 years
-Irregular to no cycles

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57
Q

Treatment for abnormal bleeding with nexplanon or mirena

A

-Ibuprofen 600 mg q 6 hours
-Doxycycline 100 mg BID for 10 days
-Add oral combination pill for 1 cycle
-Removal

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58
Q

What is the biggest risk factor for using Depo-Provera IM injection birth control?

A

-Weight gain of 10-15 pounds or higher if African American

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59
Q

What is the best birth control method for women with a history of thromboembolism or cancer?

A

-Paragard= copper IUD

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60
Q

Education for women with Paragard

A

-Regular cycles, may have heavier than normal bleeding
-Changes cervical mucus (may have more discharge)

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61
Q

How long is Paragard good for?

A

10 years

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62
Q

How long is mirena good for?

A

5 years

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63
Q

Name and describe the forms of contraceptive that are not pharmacological

A

-Diaphragm- remove hours after sex, must be custom fit
-Sponge- remove 6 hours after sex
-Male/female condoms
-Tubal ligation

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64
Q

What are the benefits of breastfeeding for infants?

A

-1st few days of infants life- mom is producing colostrum which is HIGH IN CALORIES and baby would only need a few drops (good because they have a small stomach)
-Maternal antibodies
-Decreased incidence of diarrhea, respiratory infections, otitis media, meningitis, botulism, UTI, necrotizing entercholitis, obesity, SIDS, Type I DM, Crohn’s, leukemia
-Breastfeeding is BEST choice for preterm infants

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65
Q

Benefits of breastfeeding for mothers

A

-Assists in involution- quicker recovery
-Decreases risk of ovarian, uterine, and breast cancer
-Weight control
-Lower cost, convenient, fewer clinic visits
-Increased bonding with the infant
-Helps with postpartum depression due to hormones that are released

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66
Q

Name some contraindications for breastfeeding

A

-HIV- only MAJOR contraindications
-Precautions: breast reconstruction/reduction, certain medications, tobacco and alcohol use

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67
Q

What are the benefits of bottle feeding?

A

-Iron fortified
-Ready to feed
-No additional fluids or vitamins needed

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68
Q

Describe the concept of supply and demand in regard to breastfeeding

A

-The more mom stimulates with feeding baby or pumping, the more milk she will produce and vice versa

69
Q

Differentiate between: Goodell’s sign, Chadwick’s sign, Hegar’s sign, Braxton Hicks

A

Goodell’s: a probable sign of pregnancy characterized by a softening of the cervix
Chadwick’s: bluish appearance of the vaginal part of the cervix**
Hegar’s: compressibility and softening of the cervical isthmus
Braxton-Hicks: sporadic contractions and relaxation of the uterine muscles; also known as “false labor” pains; begin around 6 weeks gestation but are not felt until 2nd or 3rd trimester

70
Q

Describe Naegele’s rule to estimate date of delivery**

A

-Assumes 28-day cycle
-Subtract 3 months from first day of last menstrual period, add 7 days, and add a year depending on month of LMP

71
Q

What to tell patients about missing their birth control pills

A

-Effectiveness rate drops when pills are missed
-1 pill missed = take as soon as you remember, OK to take 2 in one day
-Do not take more than 2 pills in one day
-Use backup contraceptive or abstain from sex until 7 days of no missed pills

72
Q

What is the best birth control method for women with a history of thromboembolism or cancer?

A

-Paragard= copper IUD

73
Q

How are TSH levels affected during pregnancy?

A

Often TSH levels are lower

74
Q

What cardiac changes can be expected during pregnancy?

A

-Increase in plasma and RBC volume, HGB drop due to dilution
-Cardiac output increases
-Peripheral resistance decreases, decreasing diastolic BP in 1st and 2nd trimesters by 10-20 mmHg
-Varicose veins= increased pressure

75
Q

What are the respiratory changes that can be expected during pregnancy?

A

-Tidal volume and RR increases
-Oxygen consumption increases
-All of this can cause dyspnea
-Fetus can push against diaphragm

76
Q

Timing of each trimester in pregnancy

A

1st: 1-13 weeks
2nd: 14-27 weeks
3rd: 28th week-delivery

77
Q

What labs should be drawn at the initial prenatal visit?

A

-Pap smear
-Blood type and antibody screen
-Rubella/Hep B titer
-STIs: GC, syphilis, HIV, Hep C
-CBC
-UA (if concern present)
-UDS (if concern present)

78
Q

What would you check at every subsequent prenatal visit?

A

-Weight
-BP
-Fetal movement/quickening
-Urine: blood, ketones, protein, glucose
-Fundal height: after 17 weeks
-Fetal heart tones: after 12 weeks

79
Q

What are some concerning symptoms during pregnancy?**

A

-Fever
-Vaginal discharge that is a large amount or odorous with itching
-Vaginal bleeding
-Palpitations
-Dyspnea at rest
-Swelling of arms or face
-Oliguria
-Decreased or absent fetal movement

80
Q

What could sudden weight gain in the third trimester indicate?

A

impending Pre-eclampsia

81
Q

What vitamins and supplements should be given during pregnancy?

A

-Folic acid: 400 micrograms per day**
-Iron: dosage based on patient’s anemic status:
non-anemic: 30 mg/day
anemic: 120 mg/day for at least 6 weeks and then recheck

82
Q

When is sexual intercourse NOT ok during pregnancy?**

A

-If patient has vaginal bleeding: nothing in vagina for 2 weeks after bleeding stops
-Symptoms of preterm labor or placenta previa

83
Q

Which immunizations are not safe during pregnancy?**

A

Live vaccines such as MMR and Varicella

84
Q

What is the Quad screen?

A

-A screening test offered between 12-24 weeks during pregnancy that tests for birth defects

85
Q

When is the postpartum visit for mom?

A

-6 weeks for vaginal birth
-1 week for C-sections to check incision

86
Q

How long should a woman abstain from sex after delivery?

A

6 weeks

87
Q

What are the problems mothers encounter that cause them to stop breastfeeding?

A

-Problems latching
-Milk supply issues
-Pain and lack of support
-Lack of training/education/experience
-Limited time

88
Q

What are the recommendations for breastfeeding from Healthy People and American Academy of Pediatrics?

A

-Exclusive breastfeeding till 6 months of life

89
Q

What are some recommendations for nipple care for the breastfeeding mother?

A

-Proper latch technique
-Ensure nipples are clean and dry after feeding
-Moisturize - lanolin or breast milk
-Avoid heat
-Watch for cracking, peeling, bleeding, and yeast
-Treat mom if baby has thrush and mom is breastfeeding

90
Q

What are some concerning signs in the infant if mom is breastfeeding?

A

-Poor weight gain
-Lack of voids and stools (3-4 wet diapers, stool every few days at least)
-Infant fussy after feedings (sign they are still hungry)
-Lack of milk (soft breast, unable to express milk)
-Sore nipples (thrush, latch is wrong)

91
Q

Different positioning for breast feeding

A

-Cradle hold: good for full term infants, may be uncomfortable if C-section
-Cross cradle: good for small infants or who have a hard time latching
-Football: good for C-section, small infants or those who have a hard time latching, mom with large breasts, twins
-Reclining: good for C-section or difficult delivery, be careful NOT to fall asleep in this position

92
Q

Recommendations for pumping

A

-Best to exclusively breastfeed during first 2 weeks
-Slowly introduce pumping
-Stimulate breast every 3 hours (8-12 times a day)
-Clean equipment after each pumping in warm soapy water

93
Q

Recommendations for storage of milk

A

-Good for 4 hours at room temperature
-Good in fridge for 7 days
-Good in freezer for 3 months
-Good in deep freezer for 1 year (once thawed good for 24 hours)

94
Q

Medications considerations for breastfeeding moms

A

-Quinolones are always contraindicated
-<1% of drug taken by mom is delivered to infant
-Best meds are those that can be given to the infant

95
Q

Describe the lactation risk categories for medications

A

L1- safest: tylenol, PCN, depo-provera
L2- safer- macrolides, cephalosporins, SSRIs, antihistamines, prednisone
L3- moderately safe: bactrim, 1st generation antihistamines, doxycycline
L4- hazardous: lithium, corticosteroids

96
Q

What is the usual amount of bottle feeding for an infant at first?

A

15 mLs and steadily increase

97
Q

Education for bottle feeding moms

A

-Feed every 3-4 hours
-Hold infant, don’t prop bottle, burp after each feeding
-Clean equipment with warm, soapy water
-Do not warm bottle in microwave
-Mix per formula, usually 1 scoop per 2 oz of water

98
Q

Risks/things to consider with formula feeding

A

-More problems with allergies
-Requires clean water (check rural wells)

99
Q

What are the leading causes of death for women in pregnancy?

A

-HTN
-PE
-Hemorrhage
-Infection
-Mental health (according to the CDC this is the primary cause of deaths)

100
Q

What factors increase a pregnant woman’s risk of death or complications?

A

-Age: over 35/under 20 years
-Poverty
-Single
-Nonwhite (specifically AA)
-No prenatal care

101
Q

Why do you get a UA on pregnant women on every prenatal visit?

A

-Due to the risk of UTI with atypical symptoms or no symptoms
-UA would show positive leukocytes and MAY or MAY NOT positive nitrites
-ALWAYS culture if positive leukocytes
-Also good to check for proteinuria (sign of preeclampsia) or glucosuria (sign of GDM)

102
Q

Which antibiotic would we not want to prescribe during the first and third trimesters for women?

A

Bactrim

103
Q

What are the effects of pre-existing DM on mom and baby?

A

-Mom: PIH, cystitis, DKA, spontaneous abortion
-Infant: NTD’s, cardiac defects, macrosomia (larger/increased weight), IUGR (decreased nutrients/blood supply- intrauterine growth restriction), hyperbilirubinemia

104
Q

What is the main causative factor of delayed lung maturation in infants?

A

-Hyperglycemia

105
Q

Normal metabolic changes during pregnancy

A

-Hormones stimulate insulin production in 1st trimester
-Hormones cause insulin resistance in 2nd and 3rd trimester
-Postpartum- return to pre-pregnancy glucose sensitivity 7-10 days after delivery

106
Q

When should you refer a pregnant woman with pre-existing DM to a specialist?

A

-Immediately refer to high-risk OB
-Would need to follow up with endocrine

107
Q

What are the risks of developing gestational diabetes?

A

-Age 35+
-Overweight
-Previous FBS 110-125
-Previous GD
-Infant >9lbs
-Unexplained stillbirth
-FH of DM

108
Q

Describe the glucose tolerance test

A

-Done at 24-28 weeks of pregnancy
-Mom drinks 50g glucose: if 1 hour BS is > 130 than do a 3 hour GTT
-Screening test, not diagnostic

109
Q

Describe the 3-hour glucose tolerance test (GGT)***

A

Have patient be NPO after midnight:
—> FBS prior to test, drink 100g glucose, check BS hourly for 3 hours
-GB diagnosed if FBS is >95 or if 1 hour glucose >180, 2 hour is > 155, or 3 hour is >140
-Diagnostic

110
Q

What is PIH?

A

-Pregnancy induced hypertension or gestational hypertension
-Occurs after 20 weeks
-Resolves within 48 hours after delivery
-Risk factors: DM, HTN, renal disease, multiple gestation, primigravida

111
Q

Tx for PIH

A

-Prevention: exercise, increased protein, 8 glasses of water per day, rest
-Tx: labetalol, nifedipine, methyldopa (only if severe= SBP > 160 or DBP >110**), weekly OB visits, kick counts (best way to mntr fetal well being), refer to high-risk OB

112
Q

Triad of symptoms for preeclampsia

A

-HTN
-Edema
-Proteinuria

113
Q

S&S of preeclampsia

A

-Rapid weight gain
-Hyperreflexic DTRs
-HA, visual disturbances
-Epigastric pain (late sx, concern for HELLP)

114
Q

Sx of mild versus severe preeclampsia

A

Mild: SBP >140, DBP <90, 1+ proteinuria, no HA
Severe: SBP >160, DBP >110, 3+ proteinuria, decreased UOP, HA, visual disturbance, thrombocytopenia

115
Q

Tx for mild versus severe preeclampsia

A

Mild: increase protein in diet, document fetal activity, weekly NST
Severe: rest, decreased stimuli, meds- apresoline for severe HTN, MgSO4 (antivonvulsant & antihypertensive), delivery

116
Q

S&S of eclampsia versus HELLP

A

Eclampsia: facial twitching, tonic-clonic seizures, pulmonary edema, renal/circular failure
HELLP**: RUQ pain, N/V, edema, decreasing H&H, decreased PLT, increased liver enzymes

117
Q

Tx for eclampsia/HELLP

A

-Bedrest in hospital
-Meds: MgSO4, valium or phenobarb (if mag not effective, not within 2 hours of delivery), hydralazine, steroids to increase fetal lung maturity in prep of delivery

118
Q

Labs to draw when evaluating for PIH/eclampsias/HELLP

A

-CBC- increase H&H and low PLT
-Uric acid- increased
-Protein to creatinine ratio- increased
-Urine 1+ to 4+ proteins

119
Q

What is hyperemesis gravidarum?

A

Excessive vomiting with dehydration, ketoacidosis, electrolyte imbalance

120
Q

Tx for hyperemesis gravidarum

A

-Avoid zofran if possible due to risk of cardiac abnormalities**
-B-complex vitamins if mild
-High protein/carb, low fat, advance as tolerated; slow, frequent meals
-Natural remedies: ginger, pressure point bracelets
-Oral hygiene

121
Q

What can early bleeding in pregnancy signify?

A

-Could be benign
-Miscarriage
-Ectopic pregnancy
-Incompetent cervix

122
Q

Spontaneous abortion management

A

-Threatened: Check fetus by U/S; not much to do to prevent it; bedrest, no sexual activity and nothing in vagina for 2 weeks after bleeding stops, support & education
-Inevitable: Check with U/S for complete vs. incomplete, analgesics for D&C, RhoGAM

123
Q

Incomplete or missed abortion management

A

-Hospitalization
-Before 14 weeks: D&C + IV pitocin
-After 14 weeks: Pitocin or Prostaglandins
-Monitor for DIC

124
Q

Post-abortion education

A

-Bleeding & cramping for 1-2 weeks
-Vaginal rest for 1 week
-Check temp BID
-F/U 2 weeks

125
Q

S&S of incompetent cervix

A

-advanced cervical dilation
-lower abdominal pressure
-bloody show
-urinary frequency

126
Q

Tx of incompetent cervix

A

-Cerclage placed in-hospital under anesthesia; cerclage kept in until term

127
Q

What are the risk factors for ectopic pregnancy?

A

-History of salpingitis
-Prior ectopic pregnancy
-Assisted reproduction
-IUD
-Cigarette smoking

128
Q

S&S of ectopic pregnancy

A

-Missed period
-Abdominal pain- severe if rupture
-Vaginal spotting
-Lower HCG/progesterone level than normal pregnancy

129
Q

Tx of ectopic pregnancy

A

-Salpingectomy- surgical
-Methotrexate if unruptured and early on

130
Q

What can late pregnancy bleeding be indicative of?

A

Placenta previa and abruptio placenta

131
Q

What is placenta previa and what are the risk factors?

A

-Placenta covers cervix
-Rx factors: HTN, tobacco use, cocaine use, previous C-section, multifetal pregnancy, Asian or AA

132
Q

S&S of placenta previa

A

-bleeding after 24 weeks
-Abdomen is soft, nontender, relaxed
-Diagnosed by US

133
Q

Management of placenta previa

A

-Avoid pelvic exam unless done in OR
-Bed rest until 36 weeks
-Antenatal testing: US, NST,
-L/S ratio prior to early delivery (lung maturity)
-C-section

134
Q

What is abruptio placenta and risk factors?

A

-Premature separation of placenta
-Rx factors: HTN, DM, poor nutrition, cocaine or tobacco use, blunt trauma

135
Q

S&S of abruptio placenta

A

-Sudden onset of intense pain with or without bleeding
-Hard abdomen
-Decreased fetal HR and movement
-Shock

136
Q

How do you assess fetal well-being during pregnancy?

A

-Kick counts: about 3x per hour
-Can be used in all pregnancies in 3rd trimester
-Left lying position- more blood going to fetus = more movement
-US- abdominal or transvaginal

137
Q

What would an elevated S/D (systolic/diastolic) ratio on doppler flow study indicate?

A

poorly perfused placenta

138
Q

What would a low amniotic fluid volume indicate?

A

Anomalies, IUGR, fetal distress, post-term pregnancy

139
Q

What would a high AFI indicate?

A

Anomalies (primarily kidney), DM

140
Q

What is the normal AFI?

A

5-19 cm

141
Q

What are we looking for in a non-stress test?

A

-2 or more episodes of accelertation (>15 BPM) in 20 minutes, at least 15 seconds long–> indicator of fetal movement
-Usually do this weekly or twice weekly on moms that have DM or HTN

142
Q

What is a biophysical profile (BPP)?

A

-Real-time ultrasound/physical of the fetus
-Looks at: fetal breathing, gross body movements, fetal tone, reactive fetal heart rate, quality of amniotic fluid volume
-Each receives a score of 0 or 2: Normal score is 8-10, Abnormal is <4

143
Q

What is completed at the 28-34 week prenatal visits?

A

-RhogGam administration if indicated
-STI testing if indicated
-Continued feeding discussions
-Administer Tdap
-preterm labor assessment/education

144
Q

When should mom begin performing fetal movement counts (FMCs)

A

-Daily starting at 28 weeks gestation

145
Q

Name some positive signs of pregnancy

A

-Auscultation of fetal heart sounds
-Palpation of fetal movements
-Radiological and/or ultrasonic verification of gestation

146
Q

What is leopold’s maneuver?

A

-Used to determine the baby’s positioning and can also be used to help determine where to find the fetal heart rate

147
Q

Where do you find fetal heart tones?

A

-1st trimester: lower pelvic region
-2nd trimester: upwards toward umbilicus (easier to find)

148
Q

What are the presumptive signs of pregnancy?**

A

-Amenorrhea
-N/V
-Fatigue
-Urinary frequency
-Breast changes
-Quickening

149
Q

What are the probable signs of pregnancy?

A

-Positive urine pregnancy
-Enlarged abdomen
-Hegar’s sign
-Chadwick’s sign
-Goodell’s sign
-Ballotement
-Fetal outline

150
Q

Treatment for nausea in pregnancy

A

-Small, frequent meals
-Low fat meals
-Bland foods
-Unisom/B6
-Acupuncure
-Getting away from using Zofran in first trimester due to fetal anomalies

151
Q

What to tell patients that are experiencing back pain during pregnancy- management & education

A

-Exercise- at least walking
-Massage
-Physical therapy
-Pregnancy belt- sits below uterus and helps relieve weight off of pelvis

152
Q

36-wk pregnant woman presents to clinic. BP is 150/92. UA shows proteinuria. Weight gain 6 pounds since last visit. She also has edema in LE. What are you most concerned for and what would you do for management?

A

-Preeclampsia
-Assess DTRs, HA
-Instruct to closely monitor kick counts
-US for placental blood flow
-Diet high in protein
-Weekly NSTs
-Bedrest
-Hydralazine/nifedipine
-Delivery if severe

153
Q

Screening in 2nd trimester

A

-1 hour glucose tolerance test
-Quad test
-Anatomy US

154
Q

Patient presents 2-weeks post-partum with c/o lochia becoming brighter red with clots. What do you suspect?

A

-Subinvolution

155
Q

How would you diagnose subinvolution?

A

-Emergency
-VS for signs of sepsis
-Pelvic exam
-Fundus: soft, larger than expected
-Diagnostics: US for retained placental parts

156
Q

How to treat subinvolution?

A

Methergine for 2-3 days and antibiotics

157
Q

How do you perform a fundal height measurement?

A

-Make sure patient’s bladder is empty
-Mother should be lying supine with pillow under head/shoulder
-Locate highest point of the fundus (may or may not be midline)
-Measure down to the symphysis pubis

158
Q

How do you perform leopold’s maneuvers?

A

-1st: palpate upper abdomen using both hands: head is firm and round, buttox is symmetric and soft
-2nd: Identify the fetus’s back by palpating deeply with palms of hands using one hand to support the uterus while palpating the other side with the other hand
-3rd: Identify the part of the fetus that is above the inlet by using fingers and thumb of hand to grasp the lower abdomen
-4th: Examiner faces patients feet to locate the fetus’ brow: move both hands toward the pubis by sliding the hands of the sides of the uterus

159
Q

What is the leading cause of morbidity and mortality for moms during the postpartum period?

A

Hemorrhage

160
Q

What are some common causes of late hemorrhage in postpartum women?

A

-Subinvolution
-Uterine atony- uterus remains flaccid
-Lacerations- firm uterus with lacerations
-Hematoma

161
Q

When to suspect a postpartum hematoma?

A

Patient complains of persistent perineal or rectal pain and pressure with a palpable mass OR may present in shock with little pain due to hidden bleed

162
Q

What puts a patient at risk for uterine atony?

A

-High parity
-Multifetal pregnancy
-Hydramnios
-Large fetus
-Oxytocin use during delivery
-Mag sulfate use
-Long labor

163
Q

Treatment for uterine atony

A

Uterine massage or Hemabate (prostaglandins)

164
Q

What are some common postpartum thromboembolic problems?

A

DVTs and PEs

165
Q

Treatment for DVT vs PE

A

DVT: IV heparin, bed rest 5-7 days and then ambulate with TED hose
PE: IV heparin, bed rest initially; Later: Coumadin or lovenox for 3-6 months (coumadin is contraindicated in pregnancy)

166
Q

What is the most common form of postpartum infection?

A

Endomyometritis

167
Q

What are some S&S of endomyometritis?

A

Fever, chills, anorexia, nausea, fatigue, pelvic pain, and foul-smelling lochia

168
Q

Diagnostic workup for endomyometritis

A

-CBC- elevated WBC
-Sed rate
-Blood and cervical cultures

169
Q

Management of endomyometritis

A

-Triple ABX therapy IV
-Hydration, rest, nutrition

MVU OB/PEDS (4 decks)

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