Kaplan High Yield Ob Flashcards

1
Q

pre-viable vs preterm vs term fetus

A

<24 weeks vs 25-37 weeks vs 38-42 weeks

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2
Q

Goodell sign
Ladin sign
Chadwick sign

A
  • softening of cervix; 4 weeks
  • softening of midline of uterus; 6 weeks
  • blue discoloration of cervix/ vagina; 6-8 weeks
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3
Q

what is the cause of morning sickness?

A

inc progesterone, estrogen, beta-HCG

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4
Q

physiologic changes during pregnancy

  • cardiac
  • GI
  • renal
  • hematology
A
  • cardiac: inc CO, dec BP (progesterone-mediated vasodilation)
  • GI: morning sickness, GERD, constipation
  • renal: inc GFR (from inc plasma volume); inc size of kidney/ ureter (= physiologic hydronephrosis from compression of ureters)
  • heme: anemia (from inc plasma volume); hyper-coagulable state
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5
Q

triple vs quad screen? when are they done? what is it used for?

A
  • MSAFP + beta-HCG + estriol
  • MSAFP + beta-HCG + estriol + inhibin A
  • performed during 2nd tri
  • used to screen for chromosomal abnormalities
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6
Q

Braxton-Hicks contractions vs preterm labor

A
  • B-H = sporadic contractions withOUT cervical changes

- preterm labor = regular contractions with cervical changes before 37 weeks

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7
Q

3rd tri tests?

A
  • CBC –> for anemia
  • glucose load test
  • cervical and rectovaginal cultures –> for chlamydia/ gonorrhea and GBS
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8
Q

chorionic villus sampling: when? what does it dx? how?

A
  • when: 10-13 weeks
  • dx: obtains fetal karyotype
  • how: aspirate chorionic villi from placenta via inserting a catheter to the intrauterine cavity (trans-abdominally vs -vaginally)
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9
Q

amniocentesis: when? what does it dx? how?

A
  • when: after 14 weeks
  • dx: obtains fetal karyotype
  • how: withdraws amniotic fluid via inserting a needle trans-abdominally
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10
Q

fetal blood sampling: when? what does it dx? how?

A
  • when: in mom’s with Rh isoimmunization or when fetal CBC is needed
  • dx: anemia of the fetus
  • how: withdraw blood from the umbilical cord via a needle trans-abdominally
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11
Q

risk factors for ectopic pregnancy?

A
  • PID
  • IUD
  • previous ectopic
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12
Q

ectopic pregnancy px

A

-px: unilateral lower abdominal or pelvic pain + vaginal bleeding + hypotensive (if ruptured)

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13
Q

ectopic pregnancy tx

A
  • medical: get CBC + type/screen + transaminases + beta-HCG –> administer methotrexate (heptotoxic) –> watch for changes in beta-HCG
  • proceed to surgery if ruptured* OR if no changes in beta-HCG
  • surgery: give fluids + blood products + pressers if unstable
  • salpingostomy or salpingectomy
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14
Q

contraindications to methotrexate?

A
  • immunodeficiency –> methotrexate = immunosuppresive
  • liver disease
  • noncompliant –> may need f/u for 2nd dose
  • ectopic > 3.5cm
  • fetal heart beat heard
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15
Q

abortion =

A

a pregnancy that ends before 20 weeks or a fetus <500g

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16
Q

types of abortion

  • complete
  • incomplete
  • inevitable
  • threatened
  • missed
  • septic
A
  • no products of conception left in uterus
  • some products of conception left in uterus
  • intact products of conception + intrauterine bleeding + cervical dilation
  • intact products of conception + intrauterine bleeding
  • death of fetus; no bleeding or cervical changes
  • infection of uterus
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17
Q

multiple gestation px

A
  • exponential growth of uterus
  • rapid weight gain by mother
  • elevated beta-HCG & MSAFP more than expected for GA
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18
Q

twin transfusion syndrome

A

anastomosis of vessels causing 1 twin to receive most of the supply –>

  • 1 twin becomes anemic –> hydrops fettles
  • 1 twin becomes fluid overloaded
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19
Q

preterm labor definition, risk factors

A

= contractions + cervical dilation before 37 weeks

-risk factors: PROM, multiple gestation, placental abruption, previous hx of preterm labor, chorioamnionitis, preeclampsia

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20
Q

preterm labor tx

  • stop delivery if:
  • deliver if:
A
  • stop if 24-33 GA or 600-2500g
  • given betamethasone + tocolytics so that lungs can mature

-deliver if 34-37 GA (lungs already matured)

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21
Q

tocolytics definition, list

A

-slow progression of cervical dilation by decreasing uterine contractions

  • magnesium sulfate
  • CCBs (nifedipine)
  • beta agonists (terbutaline)
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22
Q

premature rupture of membranes (PROM) definition, dx

A

=rupture of chorioamniotic membrane –> “gush of fluids” from vagina

-dx: sterile* speculum exam + fluid in posterior turns nitrazine paper blue + ferning on microscopy

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23
Q

PROM tx

  • chorioamnionitis
  • term infant, no infection
  • preterm infant
A
  • deliver now
  • wait for spontaneous delivery (induce after 12 hours of waiting)
  • betamethasone + tocolytic + ampicillin + azithromycin
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24
Q

placenta previa definition, px, dx, tx

A

=abnormal implantation of placenta over internal cervical os

  • px: painless* vaginal bleeding
  • dx: trans-abdominal US (vaginal exam contraindicated**)
  • tx: strict pelvic rest + c-section
25
types of placenta pre via
- complete -- totally covering the os - partial - marginal -- adjacent to os - vasa previa -- fetal vessels over the os - low-lying placenta -- doesn't cover os
26
placental invasion definition, types, risk
=abnormal attachment of placenta to uterus - accreta = attaches to superficial uterine wall - increta = attaches to myometrium - percreta = passes thru uterine serosa to bladder or rectum - risk of hemorrhage/shock if placenta cannot be delivered --> hysterectomy * normally implants to decidua
27
placental abruption definition, px, types, dx, causes, risks
=premature separation of placenta from uterus --> bleeding - px: painful* vaginal bleeding + contractions + possible fetal distress - types: concealed vs external - dx: trans-abdominal US - causes: maternal HTN, cocaine use, trauma, smoking, prior hx - risks: uterine tetany, DIC, hypovolemic shock
28
uterine rupture risk factors, px, tx
- risk factors: previous c-section (classical incision), trauma, uterine overdistension (polyhydramnios, multiple gestation), placenta percreta - px: sudden extreme abdominal pain + no contractions + abnormal bump in abdomen (=fetus in abdominal cavity) -tx: immediate laparatomy with delivery -no c-section bc baby can be in abdominal cavity +/- hysterectomy or uterus repair
29
hemolytic disease of the newborn results in?
- fetal anemia --> extramedullary RBC production (liver, spleen) - inc bilirubin --> kernicterus - erythroblastosis fetalis (high fetal cardiac output)
30
instances where fetal blood can cross into maternal blood?
- abortion - delivery - abruption - amniocentesis - vaginal bleeding
31
when is prenatal antibody screening done for Rh(-) moms?
28 and 35 weeks
32
what antibody level constitutes a sensitized Rh(-) mother? * sensitized = Rh(-) mom having anti-Rh antibodies against fetus * unsenzitized = no anti-Rh antibodies
- initial titer >1:4 - reaching 1:16 at any point during the pregnancy *screen fetus with serial amniocentesis to monitor bilirubin levels
33
chronic vs gestational HTN
BP >140/90 before vs after 20 weeks
34
tx for preeclampsia/ eclamspia/ HELLP syndrome
- stabilize pt (with hydralazine & magnesium sulfate) - deliver - give betamethasone if preterm - induce delivery if at term
35
risks of pre-gestational DB
- preeclampsia - spontaneous abortion - infection - postpartum hemorrhage - congenital anomalies of fetus - macrosomia/ shoulder dystocia - preterm labor
36
when is screening of gestational DB done? how? glucose level to dx DB?
- 24 to 28 weeks - glucose load test (nonfasting ingestion of 50g glucose --> measure 1 hour later) - glucose tolerance test (fasting ingestion of 100mg --> 3 measurements after) -dx: >140mg/dL
37
gestational DB tx
- diabetic diet - exercise - insulin - glyburide, metformin
38
symmetric vs asymmetric IUGR
- occurs before vs after 20 weeks | - brain in proportion vs smaller than rest of body
39
IUGR causes
- chromosomal abnormalities - neural tube defect - infection (rubella, varicella, CMV, etc) - multiple gestation - maternal HTN - maternal renal disease - maternal malnutrition - maternal substance abuse (smoking, alcohol)
40
if pt is 28 weeks gestation, the fundal heigh should be how many cm?
28 cm fundal height ~ gestational age
41
NST (non stress test) looks at?
- fetal movements x2 - accelerations x2 of >15bpm lasting 15-20s over a 20min period -vibroacoustic stimulation to wake up baby
42
BPP (biophysical profile) looks at?
- NST - fetal tone - fetal movement - fetal chest expansions - amniotic fluid index (AFI) -each category is worth 2 points; normal BPP: 8-10
43
fetal heart rate parameters - bradycardia - normal - tachycardia
- below 110 bpm - 110-160 - over 160 bpm
44
what do the different types of decelerations represent? - early - variable - late
- head compression; occurs during contractions - umbilical cord compression; no relationship to contractions - fetal hypoxia & uretoplacental insufficiency
45
what is bloody show?
- release of bloody mucus plug from cervix | - occurs with cervical effacement
46
what is fetal station?
where the fetus head is in relation to the pelvis
47
- stage 1: latent vs active - stage 2 - stage 3
``` stage 1: -latent: onset of labor --> 4cm dilated -active: 4cm --> full dilation stage 2: delivery of neonate stage 3: delivery of placenta ```
48
medications/ means to induce labor
- prostaglandin E2 - oxytocin - amniotomy
49
prostaglandins are contraindicated in what population?
asthmatics
50
prolonged latent stage definition, tx
- latent stage longer than 20 hours (primipara) - >14 hours (multipara) -tx: rest, hydration
51
protracted cervical dilation
slow dilation during active phase | - <1.5cm (multipara)
52
protracted cervical dilation causes, tx
- Power: strength & frequency of contractions - Passenger: size & position of fetus - Passage: cephalopelvic disproportion -tx: oxytocin (for power probs) or c-section (for passage probs)
53
malpresentation tx
- external cephalic version (after 36 weeks) | - c-section
54
MCC of postpartum hemorrhage
uterine atony -normally uterine contractions compress the blood vessels to stop the blood loss
55
uterine atony causes
- anesthesia - uterine overdistension (multiple gestation, polyhydramnios) - prolonged labor - laceration - retained placenta - coagulopathy
56
uterine atony tx
- bimanual compression and massage | - oxytocin
57
Sheehan syndrome
ischemia of the pituitary after postpartum hemorrhage --> lactotrophs die --> inability to breast feed
58
definitions - low birth weight - IUGR (small for gestational age) - macrosomia - large for gestational age
- 4500g - >90th percentile