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OB > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

what causes lactation

A
  • decreasing estrogen and progesterone

* increasing prolactin and oxytocin

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2
Q

PP lochia abnormalities

A
  • constant trickle
  • excessive w/ ctx
  • foul smelling
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3
Q

REEDA

A

•episiotomy/incision assessment

  • Redness
  • Edema
  • Ecchymosis
  • Discharge
  • Approximation
  • infection if have pain too
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4
Q

PP s/sx to report

A
  • fever > 100.4
  • unilateral breast edema w/ flu s/sx
  • abd tenderness/pressure
  • perineal pain
  • UTI
  • DVT
  • lochia change
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5
Q

early PP hemorrhage

A
  • w/in 24 hr
  • vag: > 500 cc EBL
  • C/S: > 1500 cc EBL
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6
Q

s/sx early PP hemorrhage

A
  • excessive lochia
  • soft/diff. to locate fundus
  • fundus above expected level
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7
Q

PP hemorrhage causes

A
  • uterine atony
  • placental complications/retention
  • laceration/trauma/hematoma
  • uterine inversion
  • sub-involution of uterus
  • coagulopathies (DIC)
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8
Q

uterine atony causes

A
  • overdistention
  • muliparity
  • tocolytics
  • prolonged/precipitous labor
  • C/S
  • induction
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9
Q

early PP hemorrhage tx

A
  • fundal massage
  • ABCs
  • bolus Pit
  • new large IV
  • admin meds/blood
  • elevate legs
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10
Q

meds for early PP hemorrhage

A
  • O2
  • oxytocin (Pit)
  • methergin
  • cytotec
  • Hespan
  • Hemabate
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11
Q

late PP hemorrhage

A
  • b/t 24 hr and 2 wks PP

* caused by uterine sub-involution

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12
Q

sub-involution causes

A
  • retained placental fragments

* endometritis

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13
Q

s/sx subinvolution

A
  • prolonged, foul lochia
  • hemorrhage
  • pelvic pain/heaviness
  • backache
  • malaise/fatigue
  • soft/large uterus
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14
Q

subinvolution tx

A
  • methergine
  • abx
  • D&C (last resort)
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15
Q

endometritis tx

A
  • IV abx
  • analgesics (no ASA, ibuprofen)
  • high fowlers (drain lochia)
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16
Q

meaty clots indicate…

A

•uterine atony

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17
Q

thin/shiny clots indicate

A

•trauma

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18
Q

trauma causes

A
  • macrosomia
  • operative vag. delivery
  • soft part abnormality
  • rapid delivery
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19
Q

trauma tx

A

•ice
•pressure
•treat shock
*call MD

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20
Q

early signs hypovolumetric shock

A 
•tachycardia
•thready pulse
•increased RR
•BP normal
*body trying to compensate
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21
Q

late signs hypovolumetric shock

A 
•falling BP
•cool, moist, pale skin
•bradycardia
•change in mental status
*body CANT compensate
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22
Q

hypovolumetric shock tx

A
  • trendelberg/elevate legs
  • O2
  • multiple IVs (blood, NS, etc)
  • admin Hespan
  • ABCs
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23
Q

stages of fetal response to Rh incompatibility

A
  1. fetal hemolytic anemia
  2. fetal hyperbilirubinemia
  3. erythroblastosis fetalis
  4. hydrops fetalis
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24
Q

when to admin RhoGAM

A
  • 28 wk GA Rh- mom
  • post-invasive procedure
  • post-abortion
  • w/in 72 hrs delivery if baby Rh+
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25
Q

amniocentesis

A

•measures amnt. bilirubin in amniotic fld. (urine) to determine severity of fetal hemolytic anemia

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26
Q

early abortion

A 
•before 12 wks
•r/t abnormalities of:
-chromosomes
-endocrine
-immune
-systemic
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27
Q

late abortion

A 
•b/t 12-20 wks
•r/t:
-AMA
-multiparous
-infection
-drug use
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28
Q

threatened abortion s/sx

A
  • SPOTTING
  • BACKACHE
  • cramping
  • pelvic pressure
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29
Q

threatened abortion tx

A

•pelvic rest

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30
Q

inevitable abortion

A
  • ROM
  • DILATION
  • bleeding
  • cramping
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31
Q

inevitable abortion tx

A
  • allow nature to work

* if incomplete, D&C

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32
Q

incomplete abortion s/sx

A
  • PROFUSE BLEEDING
  • DILATION
  • severe cramping
  • retained placental pressure
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33
Q

incomplete abortion tx

A
  • < 14 wk, D&C

* > 14 wk, induce

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34
Q

complete abortion s/sx

A
  • CTX STOP
  • CERVIX CLOSED
  • PG signs/test neg.
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35
Q

complete abortion tx

A

•nothing unless excessive bleeding or complications

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36
Q

missed abortion s/sx

A
  • RED/BROWN spotting
  • WEIGHT LOSS
  • PG s/sx disappear
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37
Q

miss abortion tx

A

•wait and then D&C

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38
Q

complications of missed abortion

A
  • sepsis

* DIC

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39
Q

DIC risk factors

A
  • missed Ab
  • sepsis
  • abruption
  • severe PIH
  • AFE
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40
Q

s/sx DIC

A

•bleeding from orafices
•low platelets
•prolonged bleeding time
*DONT give epidural or spinal

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41
Q

risks r/t bicornuate uterus

A
  • poor baby perfusion

* labor issues b/c head doesn’t push on cervix effectively

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42
Q

methotrexate

A 
•antineoplastic ectopic PG tx
•N/V
•no etoh/sex until no hCG 
•must be < 8 wks and < 4 cm
*preferred tx b/c less scarring risk
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43
Q

placental previa s/sx

A
  • painless bright red bleeding
  • uterus soft/nontender
  • FHT distress
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44
Q

normal bloody show

A
  • mucous mixed w/ blood
  • pink
  • small amnt.
45
Q

pathological bloody show

A
  • dark red

* copious

46
Q

DONT do vag. exam if bleeding until…

A
  • know where placenta is

* MUST assess for placental previa first

47
Q

placental abruption

A 
•premature separation of normally implanted placenta
•r/t
-HTN***
-trauma
-nicotine/cocaine
48
Q

placental abruption s/sx

A
  • abd. pain
  • board-like abd
  • pathological bloody show
  • uterine irritability
  • poor rlxn b/t ctx
  • FHT distress/absence
49
Q

grade I abruption

A
  • 10-20% detached

* mom and fetus NOT in distress

50
Q

grade II abruption

A
  • 20-50% detached
  • mom in shock
  • fetus in distress
51
Q

grade III abruption

A
  • > 50% detached
  • mom in shock and has DIC
  • fetus dead
52
Q

gestational HTN

A
  • dx after 20 wks
  • BP > 140/90
  • no proteinuria
53
Q

mild preeclampsia

A
  • BP > 140/90
  • proteinuria 1+
  • irritable, edema, abd pain
54
Q

severe preeclampsia

A
  • BP > 160/110
  • proteinuria 3+
  • HA, visual distrubances, hyperreflexia, oliguria
55
Q

severe preeclampsia tx

A
  • MgSO4
  • hospitalized bed rest
  • induce labor w/ pit
  • fld. restriction
56
Q

MgSO4 uses

A
  • smooth muscle relaxant for SEIZURE PRECAUTIONS
  • S/E is lower BP
  • given to non HTN mom when baby on steroids to prevent baby cerebral hemorrhage
57
Q

therapeutic MgSO4 range

A

•4-8 mg/dL

58
Q

loss of patellar reflex MgSO4

A

•9-10 mg/dL

59
Q

respiratory distress MgSO4

A

•12-17 mg/dL

60
Q

cardiac arrest MgSO4

A

•30-35 mg/dL

61
Q

signs of MgSO4 toxicity

A
  • absent DTR
  • fluid in lungs (dec. RR)
  • decreased UOP
62
Q

r/o uterus rupture

A

•macrosomia/hydrops
•hx of C/S or uterine surgery
•D&C
*hypervascularized so MAJOR bleeding risk

63
Q

anemia in PG

A
  • Hgb < 11 g/dl in 1st/3rd trimester
  • Hgb < 10.5 g/dl in 2nd trimester
  • Hct < 33%
64
Q

main consequences of anemia

A

•PREECLAMPSIA and HF b/c less O2 capacity means CO increase

65
Q

thalassemia

A
  • genetic disorder causing production of short-life span RBC

* DONT give Fe supp. b/c they store Fe in excess

66
Q

pre-existing diabetes increases r/o…

A
  • abortion
  • congenital anomalies (heart)
  • macrosomia
  • shoulder distocia
  • PIH
  • C/S
  • over distention of uterus
  • IUGR
  • UPI (perif. vasc. site)
67
Q

influence of diabetes on newborn

A
  • cardiac anomalies
  • rebound hypoglycemia
  • RDS b/c late surfactant development
  • birth trauma r/t macrosomia
  • hypocalcemia
  • hyperbilirubinemia (r/t trauma)
68
Q

why fetus of diabetic mom at risk for macrosomia

A
  • hyperinsulinemia

* lots of sugar from hyperglycemic mom

69
Q

hyperemesis gravidarum effect on fetus

A
  • IUGR

* preterm birth

70
Q

toxoplasmosis

A 
•protozoan transmitted thru undercooked meat and cat feces
•can cause:
-LBW
-enlarged spleen/liver
-jaundice
-anemia
71
Q

congenital varicella syndrome

A
  • fetal infected by varicella before 20 wks GA
  • lib hypoplasia
  • cutaneous scars
  • microcephaly
72
Q

zidovudine

A
  • PO med given to HIV+ mom @ 14 to prevent transmission
  • IV during labor
  • elixir for baby up to 6 wks
73
Q

preventing HIV transmission to neonate

A
  • zidovudine
  • elective C/S @ 38 wks
  • DONT allow ROM
  • DONT BF
74
Q

GBS neonate effects

A

•sepsis
•pneumonia
•meningitis
*crucial to vag. screen mom @ 36 wks

75
Q

GBS abx tx if…

A
  • hx of infant w/ GBS
  • GBS during current PG
  • preterm birth
  • maternal fever during labor
  • ROM longer than 18 hrs
76
Q

what conditions can cause IUGR

A

•diabetes
•hyperemesis gravidarum
*baby thin, pale, loose, dry skin

77
Q

molar PG basics

A
  • partial- 2 sperm, 1 egg
  • complete- 1 sperm, one egg w/o nucleus
  • key s/sx hyperemesis gravidarum; grape-like clusters, fundus wrong for GA; scant dark discharge
78
Q

L/S ratio

A
  • determines fetal pulmonary maturity
  • 2+: mature
  • 1.5-: r/o RDS
79
Q

neonate thermoregulations

A
  • flexed position
  • constriction of peripheral vessels (acrocyanosis)
  • brown fat metabolism
  • crying/restless
80
Q

cold stress

A

•ineffective thermoregulation leading to hypoxia, acidosis, and hypoglycemia

81
Q

cold stress s/sx

A
  • drop in temp
  • RR increase
  • tachy then brady
  • mottle skin; acrocyanosis
  • if RD, decreased activity
  • no RD, increased activity
82
Q

newborn sucking coordination

A
  • 32-34 wks

* 1500 g

83
Q

neonate hepatic system fxn

A
  • carb metabolism
  • Fe storage
  • bilirubin conjugation
  • coagulation
84
Q

hyperbilirubinemia risks

A
  • prematurity
  • blood incompatibilities
  • cephalhematoma/bruising
  • cold stress
  • poor intake/BF
  • sepsis
85
Q

physiologic jaundice

A 
•hyperbilirubinemia that appears after 1st 24 hrs
•benign 
•resolves by day 4
•bili < 12
*normal
86
Q

pathologic jaundice

A

•hyperbilirubinemia w/in first 24 hrs
•r/t excessive RBC destruction
•bili remains high
*abnormal

87
Q

kernicterus

A
  • bilirubin encephalopathy
  • severe jaundice
  • neurological damage and death
  • bili > 25
88
Q

HR apgar scores

A
  • 0: none
  • 1: < 100
  • 2: > 100
89
Q

RR apgar scores

A
  • 0: apnea
  • 1: irregular/shallow
  • 2: crying
90
Q

muscle tone apgar scores

A
  • 0: flaccid
  • 1: some flexion
  • 2: well flexed
91
Q

reflex irritability apgar scores

A
  • 0: none
  • 1: grimace/withdraw
  • 2: crying
92
Q

color apgar score

A
  • 0: central cyanosis
  • 1: peripheral cyanosis
  • 2: pink
93
Q

classification of gestational age

A
  • preterm: before 37 wks
  • term: 38-42 wks
  • possterm: after 42 wks
94
Q

post-mature

A
  • > 3 wks past EDD
  • placenta failiing -> less O2/nutrients
  • must induce
  • LBW, dry, long hair/nails
  • r/o meconium aspiration
95
Q

expected newborn measurements

A
  • length: 45-55 cm
  • head: 32-37 cm
  • chest: 30-33 cm
96
Q

expected newborn VS

A
  • 97.7-98.9
  • HR: 110-160
  • RR: 30-60
  • BP: 60-80/40-50
97
Q

RR indicating RDS

A

•apnea > 15-20 sec

98
Q

infant caloric intake

A

•110 kcal/kg/day

*milk 20 kcal/oz

99
Q

how to know if neonate receiving enough to eat

A
  • content b/t feeding
  • 6-8 wet diapers/day
  • gains weight
100
Q

how should bottle-feeding mom relieve breast engorgement

A
  • wear snug, supportive bra

* DONT pump

101
Q

healthy neonate blood glucose

A

•50-60

102
Q

when are neonate lungs mature?

A
  • 37 wks

* amniocentesis to determine maturity if < 37 wks

103
Q

avg. cord separation

A

•10-14 days

104
Q

pre-eclampsia impact on organs

A
  • decreased fxn of placenta, kidney, liver, brain

* d/t vasospasms that diminish diameter of vessels, impeding flow

105
Q

most prevalent symptom of abruptio placentae

A

•intense abdominal pain

  • what differentiates it from placenta previa
  • both have bleeding, uterine activity, and cramping
106
Q

s/sx rupture of uterus

A
  • hypotonic activity
  • hypovolemia
  • no pain
107
Q

most important factor affecting pregnancy outcome of pre-GDM mom

A
  • glucose control

* no vessel dz

108
Q

most important cause of perinatal loss in diabetic pregnancy

A

•congenital malformations, esp. heart

OB (17 decks)

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