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Women's health > labor & delivery complications + PP care (14%) > Flashcards

labor & delivery complications + PP care (14%) Flashcards

1
Q

3 categories of dystocia

A

power (uterine ctx)
passenger (presentation/size of fetus)
passage (uterus/soft tissue abnormalities)

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2
Q

tx for shoulder dystocia

A

non-manipulative- 1st line- McRoberts (hip hyper flexion to inc pelvic opening)
manipulative- 2nd line- woods “corkscrew” (180 degree shoulder rotation)
c/s last resort

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3
Q

complications of shoulder deistic

A

erb’s palsy (brachial plexus injury)

esp in macrosomic, multiparity, gestational DM

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4
Q

what is the definition of PROM

A

water breaks <37wks

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5
Q

RFs for PROM

A

STIs
smoking
prior preterm delivery
multiple gestations

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6
Q

dx of PROM

A

sterile speculum exam- pooling of secretions
nitrazine paper test- blue if pH >6.5 (likely PROM)
fern test- crystallized estrogen + Fluid
US- AVOID DIGITAL EXAM

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7
Q

normal vaginal vs amniotic fluid pH

A

vaginal- 3.8-4.2

amniotic fluid- 7-7.3

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8
Q

tx of PROM

A

wait for spontaneous labor
monitor for chorio or endometritis
terbutaline/mag sulf to delay labor

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9
Q

definition of premature labor

A

regular uterine ctx + progressive cervical changes <37wks

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10
Q

what is the MC cause of perinatal mortality

A

premature labor

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11
Q

when is a pt definitely in PTL

A

dilated 3+cm

effaced 80%+

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12
Q

when is a pt likely in PTL

A

dilated 2-3cm

effaced <80%

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13
Q

when is a pt unlikely in PTL

A

dilated 2cm or less

effaced <80%

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14
Q

when should steroids be given to mom in PTL

A

if L:S ratio <2:1 or <34wk GA

betamethasone

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15
Q

when should tocolytics be used in PRL

A

if no chorio is present (no infxn)

give for 48h to delay until steroids work

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16
Q

what tocolytics can you give in PTL

A

indomethacin
nifedipine
mag sulfate
terbutaline (beta2 agonist)

17
Q

rules w mag sulfate use in PTL

A

(MUST ADMIT IF ADMINISTERED, don’t use w nifedipine)

18
Q

ADR of terbutaline

A

maternal pulmonary edema

19
Q

what abx should be given in PTL

A

GBS ppx:
ampicillin followed by PO amox + azithro

OR

cefazolin followed by PO keflex + azithro if PCN allergy

20
Q

contraindications for induction of labor

A 
prior uterine rupture or C/S
active genital herpes infxn
umbilical cord prolapse
placenta previa or vasa previa
transverse fetal lie
21
Q

types of induction

A

early- women w unfavorable cervix to promote ripening (cervidil, balloon cath, laminar, miso)

later- when cervix is <1cm dilated w some effacement (IV oxytocin, monitor uterine activity + fetal HR)

amniotomy- cervix partially dilated + there is effacement; use small hook to rupture membranes

22
Q

what is the definition of PP hemorrhage

A

> 500ml blood loss in vaginal birth

>1000ml blood loss in c-section

23
Q

MC etiology of PP hemorrhage

A

uterine atony

others: uterine rupture, congestion, DIC, bleeding disorders

24
Q

presentation of PP hemorrhage

A

hypovolemic shock- hypotension, tachycardic, pale/clammy skin, dec cap refill
uterine atony- soft, boggy uterus w dilated cervix

25
Q

tx of postpartum hemorrhage

A 
bimanual uterine massage
tx underlying cause
IV access
uterotionic agents (oxytocin, methylergonovine, IM carboprost, tromethamine, misoprostol) to inc ctx (only if uterus is soft + boggy)
suction + curettage if products retained
26
Q

early vs delayed PP hemorrhage

A

early- 24hr

delayed 24hr-8wks

27
Q

what is the presentation of endometritis

A 
fever >!00.4
tachycardia
abd pain
uterine tenderness 
\+/- vaginal bleeding/dc, foul odor
28
Q

when does endometritis usu occur

A

2-3 days PP

29
Q

tx of endometritis

A

post c/s- clinda + genta +/- amp

post vag or chorioamnionitis- amp + gent

30
Q

biggest RF for endometritis

A

c-section

31
Q

ppx for endometritis

A

if c-section, give 1st gen cephalosporin during surgery

32
Q

describe postpartum blues

A

starts 2-4days PP, resolves w/i 10 days
NO THOUGHTS OF HARMING BABY
no tx, self-limited

33
Q

describe postpartum depression

A

starts 2wks-2mo PP, lasts 3-14mo
+/- THOUGHTS OF HARMING BABY
+/- antidepressant tx

Women's health (7 decks)

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