Kim teaches small group Flashcards
Molar pregnancy age distribution
the extremes
Old and young
labs for DIC
fibrinogen
Increased D-dimer
Thrombocytopenia
PT-PTT INR
Symptoms of prego mole
- Hyperemesis
- Irregular heavy bleeding
- Toxemia
- thyroid storm
- large uterus
- absent fetal heart
- tone/movement
- passage of tissue
HYDATDIFORM MOLE treatment
suction D/C to evacuate abnormal tissue
IV oxytocin will prevent hemorrhage and expel products
Put them on OCPs
HYDATDIFORM MOLE HCG checks
weekly until under 2 for three measurements
Then once a month for 6 months
need to be on birth control (differentiate why there is Hcg)
HYDATDIFORM MOLE is asc. with what cancer
Choriocarcinoma
monitored via HCG
Choriocarcinoma
Malignant tumor composed of trophoblasts and syncytlotrophoblasts; mimics
placental tissue, but villi are absent
Endodermal sinus tumor
Malignant tumor that mimics the yolk sac; most common germ cell tumor in
children
Serum AFP is often elevated.
Risk of recurrent molar prego
1-2%
after 2 moles, recurrent 10%
BRCAl mutation carriers have an increased risk for ____________ of the
ovary and fallopian tube
serous carcinoma
two most common subtypes of the most common ovarian tumor _________ are _________
SURFACE EPITHELIAL TUMORS are the most common
subtypes: serous and mucinous
SURFACE EPITHELIAL TUMORS are made of what
Derived from coelomic epithelium that lines the ovary
Symptoms of cervical cancer
post coidal bleeding
What happens when you get a pap + for adenocarcinoma of cervix
You need to get a biopsy of cervix
BUT it could also be from endometrium or ovary
Uterus polyp vs fibroid
Polyp is endometrial origin- soft
Fibroid is myometrium- hard
Postmenopausal endometrium strip size
Normal 4 mm or less
4 mm or larger is not good
What is a partial hysterectomy
partial will leave behind the cervix
__________ intake can increase the pain associated with fibrocystic breast changes
Caffeine
A normal mammogram does not rule out breast cancer, especially in the presence of ?
bloody discharge.
Most postpartum mastitis is caused by
- staphylococcus aureus, so a penicillin-type drug is the first line of treatment
- Dicloxacillin (penicillin resistant staphylococci)
- Erythromycin may be used in penicillin allergic patients.
Prostaglandins are used for cervical ripening and are contraindicated in patients with history of _________
previous Cesarean section
What prostaglandin is for prego
prostaglandin E2
A biophysical profile is not of any value in ?
labor.
___________ may be used for repetitive variable decelerations
Amnioinfusion
Early decelerations are physiologic caused by ?
fetal head compression during uterine contractions, resulting in vagal stimulation and slowing of the heart rate
characteristic mirror image of the contraction
A late deceleration is a symmetric fall in the fetal heart rate, beginning at ?
start at/ after the peak of the uterine contraction and returning to baseline only after the contraction has ended.
Late decelerations are associated with?
uteroplacental insufficiency.
Variable decelerations show an ?
“V-Shape”
acute fall in the FHR, with a rapid down slope and a variable recovery phase.
may not bear a constant relationship to uterine contractions.
Variable decelerations are typically associated with ?
cord compression, especially in the setting of low amniotic fluid volume.
Fetal Bradycardia?
under 110
Fetal Tachycardia?
Over 160
Absent variability fetal HR
no changes in HR
hypoxia or other problems
Mild variability fetal HR
less than 5 changes in HR
hypoxia or other problems
Moderate variability fetal HR
2-25 changes in HR
Reassuring =)
Marked variability fetal HR
over 26 changes in HR
VEAL CHOP
Variable decelerations…..Cord compression
Early decelerations………Head compression
Accelerations…………….OK, may need Oxygen
Late decelerations……….Placental Insufficiency
Variable decelerations…..
Cord compression
Variable decels → reposition mother to knee-chest position to get baby’s head off the cord OR use two fingers to lift the baby’s head off the cord until further interventions required
amnioinfusion may be used to treat patients with variable decelerations
Early decelerations………
Head compression
sign that baby is descending into the pelvis, monitor as needed
Accelerations…………….
OK, may need Oxygen
reassuring (normal) sign; last for 15+ seconds and peaks 15+ beats/min
Late decelerations……….
Placental Insufficiency
worrisome sign; reposition mother, administer IV fluids and anticipate discontinuing/decreasing Oxytocin or administering a tocolytic to decrease
Sinusoidal fetal HR
last 20 minutes–> immediate delivery
Looks like a sign wave
Late decelerations when_____________ are an ominous sign
viewed as repetitive and/or with decreased variability
Initial measures to evaluate and treat fetal hypoperfusion include
- maternal position to left lateral position–> ↑ perfusion to the uterus
- maternal O2
- treatment of maternal hypotension
- discontinue oxytocin
- consider intrauterine resuscitation with tocolytics
- intravenous fluids
- fetal acid-base assessment with fetal scalp capillary blood gas or pH measurement.
