Kaplan High Yield Ob Flashcards
pre-viable vs preterm vs term fetus
<24 weeks vs 25-37 weeks vs 38-42 weeks
Goodell sign
Ladin sign
Chadwick sign
- softening of cervix; 4 weeks
- softening of midline of uterus; 6 weeks
- blue discoloration of cervix/ vagina; 6-8 weeks
what is the cause of morning sickness?
inc progesterone, estrogen, beta-HCG
physiologic changes during pregnancy
- cardiac
- GI
- renal
- hematology
- 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
triple vs quad screen? when are they done? what is it used for?
- MSAFP + beta-HCG + estriol
- MSAFP + beta-HCG + estriol + inhibin A
- performed during 2nd tri
- used to screen for chromosomal abnormalities
Braxton-Hicks contractions vs preterm labor
- B-H = sporadic contractions withOUT cervical changes
- preterm labor = regular contractions with cervical changes before 37 weeks
3rd tri tests?
- CBC –> for anemia
- glucose load test
- cervical and rectovaginal cultures –> for chlamydia/ gonorrhea and GBS
chorionic villus sampling: when? what does it dx? how?
- 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)
amniocentesis: when? what does it dx? how?
- when: after 14 weeks
- dx: obtains fetal karyotype
- how: withdraws amniotic fluid via inserting a needle trans-abdominally
fetal blood sampling: when? what does it dx? how?
- 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
risk factors for ectopic pregnancy?
- PID
- IUD
- previous ectopic
ectopic pregnancy px
-px: unilateral lower abdominal or pelvic pain + vaginal bleeding + hypotensive (if ruptured)
ectopic pregnancy tx
- 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
contraindications to methotrexate?
- immunodeficiency –> methotrexate = immunosuppresive
- liver disease
- noncompliant –> may need f/u for 2nd dose
- ectopic > 3.5cm
- fetal heart beat heard
abortion =
a pregnancy that ends before 20 weeks or a fetus <500g
types of abortion
- complete
- incomplete
- inevitable
- threatened
- missed
- septic
- 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
multiple gestation px
- exponential growth of uterus
- rapid weight gain by mother
- elevated beta-HCG & MSAFP more than expected for GA
twin transfusion syndrome
anastomosis of vessels causing 1 twin to receive most of the supply –>
- 1 twin becomes anemic –> hydrops fettles
- 1 twin becomes fluid overloaded
preterm labor definition, risk factors
= contractions + cervical dilation before 37 weeks
-risk factors: PROM, multiple gestation, placental abruption, previous hx of preterm labor, chorioamnionitis, preeclampsia
preterm labor tx
- stop delivery if:
- deliver if:
- stop if 24-33 GA or 600-2500g
- given betamethasone + tocolytics so that lungs can mature
-deliver if 34-37 GA (lungs already matured)
tocolytics definition, list
-slow progression of cervical dilation by decreasing uterine contractions
- magnesium sulfate
- CCBs (nifedipine)
- beta agonists (terbutaline)
premature rupture of membranes (PROM) definition, dx
=rupture of chorioamniotic membrane –> “gush of fluids” from vagina
-dx: sterile* speculum exam + fluid in posterior turns nitrazine paper blue + ferning on microscopy
PROM tx
- chorioamnionitis
- term infant, no infection
- preterm infant
- deliver now
- wait for spontaneous delivery (induce after 12 hours of waiting)
- betamethasone + tocolytic + ampicillin + azithromycin
placenta previa definition, px, dx, tx
=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
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
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
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
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
hemolytic disease of the newborn results in?
- fetal anemia –> extramedullary RBC production (liver, spleen)
- inc bilirubin –> kernicterus
- erythroblastosis fetalis (high fetal cardiac output)
instances where fetal blood can cross into maternal blood?
- abortion
- delivery
- abruption
- amniocentesis
- vaginal bleeding
when is prenatal antibody screening done for Rh(-) moms?
28 and 35 weeks
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
chronic vs gestational HTN
BP >140/90 before vs after 20 weeks
tx for preeclampsia/ eclamspia/ HELLP syndrome
- stabilize pt (with hydralazine & magnesium sulfate)
- deliver
- give betamethasone if preterm
- induce delivery if at term
risks of pre-gestational DB
- preeclampsia
- spontaneous abortion
- infection
- postpartum hemorrhage
- congenital anomalies of fetus
- macrosomia/ shoulder dystocia
- preterm labor
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
gestational DB tx
- diabetic diet
- exercise
- insulin
- glyburide, metformin
symmetric vs asymmetric IUGR
- occurs before vs after 20 weeks
- brain in proportion vs smaller than rest of body
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)
if pt is 28 weeks gestation, the fundal heigh should be how many cm?
28 cm
fundal height ~ gestational age
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
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
fetal heart rate parameters
- bradycardia
- normal
- tachycardia
- below 110 bpm
- 110-160
- over 160 bpm
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
what is bloody show?
- release of bloody mucus plug from cervix
- occurs with cervical effacement
what is fetal station?
where the fetus head is in relation to the pelvis
- 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
medications/ means to induce labor
- prostaglandin E2
- oxytocin
- amniotomy
prostaglandins are contraindicated in what population?
asthmatics
prolonged latent stage definition, tx
- latent stage longer than 20 hours (primipara)
- > 14 hours (multipara)
-tx: rest, hydration
protracted cervical dilation
slow dilation during active phase
- <1.5cm (multipara)
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)
malpresentation tx
- external cephalic version (after 36 weeks)
- c-section
MCC of postpartum hemorrhage
uterine atony
-normally uterine contractions compress the blood vessels to stop the blood loss
uterine atony causes
- anesthesia
- uterine overdistension (multiple gestation, polyhydramnios)
- prolonged labor
- laceration
- retained placenta
- coagulopathy
uterine atony tx
- bimanual compression and massage
- oxytocin
Sheehan syndrome
ischemia of the pituitary after postpartum hemorrhage –> lactotrophs die –> inability to breast feed
definitions
- low birth weight
- IUGR (small for gestational age)
- macrosomia
- large for gestational age
- 4500g - >90th percentile
