Learnin on the Job Flashcards
Normal days in a menstrual cycle
Normal is 26-35
So 14 yo/31 days/5 days is normal…
3 risks of oxytocin
- tachysystole
- baby doesn’t have enough time to recover btwn contractions bc uterus doesnt fully contract - severe hyponatremia
- 2/2 oxytocin cross-reactivity w/ ADH receptors - neonatal hyperbilirubinemia
4 steps of resuscitation when you see a category 2 fetal heart tracing
3 things to increase blood flow to the baby (by increasing O2 to mother)
- turn mother on side: decrease compression of IVC
- IV fluid bolus (increase volume)
- O2 face mask (controversial)
- hold any augmentation (ex: pit)
What is a modified BPP?
Modified BPP = AFI + NST
Modified biophysical profile = measure amniotic fluid index and do nonfetal stress test
List the normal values for a OGTT
OGTT: give 100g load fasting: under 95 1 hr: 180 2 hr: 155 3 hr: 140
Differentiate the two steps of induction of labor
- Cervical ripening
-evaluate w/ Bishop score (favorable if over 6)
Agents: foley balloon, cytotec, cervidel - Augmentation of labor w/ Pit + AROM
Define a category III fetal heart tracing
Absent variability w/ repetitive variables OR repetitive late decels, or fetal bradycardia (under 110) or sinusoidal pattern
What is a prolonged decel?
Becomes a prolonged tracing (decel/accel) after lasting for over 2 minutes
If lasts over 10 minutes = change in baseline
Describe augmentation of labor
- when indicated
- 2 mechanisms
Augmentation of labor: once cervix is favoriable (Bishop over 6)
- Pit
- AROM
- extremely effective in multips
Lab abnormalities seen in infants born to GDM mothers
hypoglycemia
hypocalcemia
hyperbilirubinemia (jaundice)
Define a fetal heart rate acceleration
15 bpm above baseline for 15+ seconds
If under 32 weeks: 10bpm above baseline for 10+ seconds
Key measure of fetal pH status
FHR variability in the single best indicator of fetal acidemia
Where is AFP produced?
Towards end of pregnancy- AFP almost primarily produced by the fetal liver
GDMA2 at 38 wks w/ well controlled diabetes- what is the delivery plan?
Expectant management- if GDM is well controlled, don’t need to have a different than usual birth plan
Differentiate the 3 cervical ripening agents
- foley balloon- mechanically dilate to 3/4 cm to cause endogenous release of prostaglandins
- only method indicated in TOLAC - exogenous PGE1 = Cytotec (misoprostol)
- tab placed vaginally - exogenous PGE2 = Cervidel (Dinoprostol)
- benefit that it is on a string
Both 2/3 are contraindcated in TOLAC pts 2/2 increased risk of uterine rupture
Risk of uterine rupture w. TOLAC
W. One prior c section- risk of uterine rupture is 1%
Risk of post-term delivery to the fetus
The placenta expires! Calcifies => increased risk of fetal demise
Define a category I fetal heart tracing
Normal baseline HR (110-160) w/ moderate variability (6-25)
- w/ OR w/o accels (don’t need accels!)
- NO late or variable decels (but there can be earlys!!)
Goal blood glucose levels for GDM
Goals:
fasting under 95, 2 hr postprandial under 120
List the normal values for a GCT
GCT (glucose challenge test) = GDM screening test
50g load: considered positive if one hr later blood glucose is over 130-140
Why is methergine contraindicated in pts w/ h/o HTN?
B/c methergine is a vasoconstrictor => could cause crazy high dangerous BP
Name the exact criteria for diagnosis of PCO
Rotterdan’s criteria: 2 of 3 = PCO
- clinical evidence of hyperandrogenism
- ultrasound finding of PCO (ex: pearl necklace- aka tons of follicles that haven’t been ovulated)
- abnormal menstrual cycle
Quad screen results associated w/ gastrochiesis
Elevated AFP, normal beta-hCG estriol and inhibin A
Quad screen results associated w/ increased risk of trisomy 21
(a) Another test to confirm quad screen results
Down’s: low AFP, elevated beta-hCG, low estriol, high inhibin A
(a) Do nucchal thickness, thicker nuccal translucency associated w/ Downs
Give some etiologies of uterine size being larger than predicted for gestational age
- error in measurement (medical student measured…)
- polyhydramnios
- twins
- fibroids (often grow during pregnancy)
- fetal macrosomia
- full bladder
What do the different types of decelerations indicate?
Early decels = fetal head compression
-mirror image of contractions, seeing compression of ICP
Late decels = sign of uteroplacental insufficiency => most concerning
Variable decels = umbilical cord compression
Mother at 24 weeks p/w GBS UTI, when do you retest for colonization?
You don’t, GBS UTI is considered colonization => treat as GBS+ and don’t need to retest
When do we treat GBS? Why then?
Give penicillin for GBS+ at labor- no point in treating mother earlier, b/c mother is colonized and she’ll just recolonize
While responding to an obstetric hemorrhage team- why is it relevant is the pt had preeclampsia?
Preeclamptics don’t have nearly as large an increase in their blood volume during pregnancy => they tolerate a smaller amount of blood loss
Ex: Preeclamptic F may increase blood volume by only 10-20% (instead of the average 50%), so a EBL of 1,200L may cause much more severe consequences
Etiologies of AFP elevation
Elevated maternal serum AFP:
- neural tube defects
- abdominal wall defects: gastrochiesis (no sac) and omphalocele (sac)
- anything that increases fluid around baby: esophageal atresia etc
Mechanism by which HPL can induce gestational diabetes
HPL (human placental lactogen) induces lipolysis => increased free fatty acids = increased substrate for gluconeogenesis
When is the quad screen perfromed
At 15-20 weeks
Contraindications to induction of labor
- abnormal lie (traverse/breech)
- vasa previa/ placenta accreta
- prior classical incision, uterine rupture, or or transmural incision on myomectomy
Mechanism by which gestational diabetes causes fetal macrosomia
Maternal glucose (not maternal insulin!) crosses the placenta => induces fetal hyperinsulinemia, and insulin is an anabolic/growth stimulating hormone => macrosomia
Medically- why aim for TOLAC over C-sxn
When all is said and done C-sxn holds a higher rate of maternal mortality
4 parts of the quad screen
- beta-hCG
- inhibin
- AFP
- estradiol
Postpartum follow up for GDM mothers
OGTT at 6-12 weeks postpartum
Quad screen results associated w/ increased risk of trisomy 18
Edward’s: low AFP, low beta-hCG and low estriol, normal inhibin A
Define tachysystole
Tachysystole =more than 5 contractions in 10 minutes averaged over 30 minutes
Bishop score
- components
- utility
Bishop score = ‘cervix’ score to predict cervical favorability for labor
-predict need for cervical ripening agents
Bishop score of 6 or under predicts needing cervical ripening agents (foley balloon, cervidel, cytotec)
5 components, each gives 0-2 pts
- cervical dilation
- cervical effacement
- fetal station
- cervical consistency
- cervical position
