Miscellaneous Flashcards
N/V up to 16 weeks is considered _____.
Morning sickness
Severe, excessive N/V associated with weight loss and electrolyte imbalance that persists > 16 weeks is known as _____.
HEG- Hyperemesis Gravidarum
*Multiple gestations and molar pregnancies are RFs
Acidosis (from starvation) and metabolic hypochloremic alkalosis (from vomiting) are associated with ____.
HEG
1st line antiemetics during pregnancy are:
- Pyridoxine (Vitamin B6)
- Doxylamine (antihistamine)
- Promethazine
Fetal Hydrops is fluid accumulation in 2 or more spaces including:
*May be associated with effects of Rh alloimmunization on subsequent newborns
- pericardial effusion
- ascites
- pleural effusion
- subcutaneous edema
Rhogam is given at ___ weeks gestation AND within ___ hours of delivery of an Rh positive baby OR after any potential mixing of blood.
RhoGAM given at 28 weeks and within 72 hours of delivery
How is erythroblastosis fetalis treated?
Antigen-negative RBCs through US-guided umbilical vein transfusion
When do you screen for gestational DM?
24-28 weeks gestation through 50g oral glucose challenge test
If blood glucose is ≥ ____ mg/dL after 1 hour then you should perform 3 hour oral GTT.
140
_____ is the gold standard for diagnosing gestational DM.
3 hour 100g oral GTT
Positive if:
- Fasting > 95
- 3 hour > 140
_____ is treatment of choice for gestational DM.
Insulin (doesn’t cross placenta)
*Glyburide doesn’t cross placenta but there’s a higher risk of eclampsia
Treatment goal for gestational DM is fasting glucose < ____.
95 mg/dL
If gestational DM is uncontrolled/macrosomia then labor induced at ___ weeks. If it is controlled and there is no macrosomia then at ___ weeks.
Uncontrolled- 38 weeks
Controlled- 40 weeks
Mothers with gestational DM have a ___ chance of developing DM post-baby and a ___ chance of recurrence with subsequent pregnancies.
50%
*Mothers should be screened at 6 weeks postpartum for DM and yearly afterwards
HTN with NO proteinuria AFTER 20 weeks gestation is known as _____.
Gestational (Transitional) HTN
*Resolves 12 weeks postpartum
HTN with proteinuria +/- edema AFTER 20 weeks gestation is known as _____.
Preeclampsia
Mild preeclampsia defined by a BP ≥ ___ / ___.
140/90
Severe preeclampsia defined by a BP ≥ ___ / ____.
160/110
- May have thrombocytopenia +/- DIC
- *May have HELLP Syndrome–> Hemolytic anemia, Elevated Liver enzymes, Low Platelets
Management of mild and severe preeclampsia…
Mild: Delivery @ 37 weeks gestation
Severe: PROMPT DELIVERY ONLY CURE + Mag Sulfate to prevent eclampsia szs
BP Meds: Hydralazine and Labetalol
Preeclampsia + Seizures is known as ____.
Eclampsia
Management of eclampsia…
ABCDs
- Mag sulfate for szs
- Deliver fetus once patient is stabilized
- BP meds!
HTN BEFORE 20 WEEKS gestation or before pregnancy is known as ____.
Chronic HTN
How is mild HTN monitored?
Weekly NST during 3rd trimester, serial BP, and urine protein
How is moderate/severe HTN managed?
Meds if BP ≥ 150/100
- METHYLDOPA is treatment of choice
- Labetalol good option too
3 categories of abnormal labor progression include:
*Hint: think 3 P’s
- Power- uterine contraction
- Passenger- presentation size or position of fetus
- Passage- uterus or soft tissue abnormalities
The ____ maneuver is a non-manipulative approach to the treatment of shoulder dystocia. It helps to increase the pelvic opening with hip hyperflexion.
McRoberts
The _____ maneuver is a 180 shoulder rotation for shoulder dystocia.
Woods (Corkscrew)
______ test is used to diagnose PROM. It turns blue if pH > 6.5.
Nitrazine Paper Test
normal amniotic fluid is 7.0-7.3 and vaginal pH is 3.8-4.2
Crystallization of estrogen and amniotic fluid is seen through the ____ test to diagnose PROM.
Fern Test
How is PROM managed?
Await for spontaneous labor and monitor for infxn (chorioamnioitis or endometritis)
Umbilical cord prolapse
See study guide
*C-section in many cases
Regular uterine contractions (>4-6/hr) with progressive cervical changes before __ weeks gestation is known as Premature Labor.
37
*MC cause of perinatal mortality
PTL defined as cervical dilation > ___ cm and ≥ ___ % effacement.
> 3cm and ≥80% effacement
Presence of fetal ____ between 20-34 weeks strongly suggests PTL.
Fibronectin
_____ is given to enhance fetal lung maturity if L:S ratio < 2:1 and <34 weeks gestation.
Betamethasone
*Tocolytics can be given for up to 48hrs to delay delivery so steroids can take effect on fetus
Tocolytics in labor…
- Indomethacin: 24-32 wks
- Nifedipine: 32-34 wks (or 2nd line for 24-32 wks)
- Mag Sulfate
_____ is given for abx prophylaxis in patients with GBS.
Ampicillin followed by PO Amoxicillin and Azithro
Allergy–> Cefazolin followed by PO Cephalexin and Azithro
What are some contraindications to induction of labor?
- prior uterine rupture
- prior c-section
- active genital herpes infxn
- umbilical cord prolapse
- placenta previa or vasa previa
- transverse fetal lie
Early induction v. late induction agents…
Early induction: promotes cervical ripening in women with unfavorable cervixes- Prostaglandin gel or balloon catheter
Later induction: if cervix is dilated < 1cm with some effacement- IV Oxytocin (Pitocin)
*Amniotomy (artificially rupturing membranes with small hook) can be done if cervix is partially dilated and there is effacement
Normal fetal HR is between ___ and ___.
120-160bpm
Reactive NST is ___ (good/bad).
GOOD
A positive CST is ____ (good/bad).
BAD
The MC cause of postpartum hemorrhage is ____.
Uterine atony: uterus unable to contract to stop the bleeding.
PE- soft, boggy uterus with dilated cervix
Management of postpartum hemorrhage entails:
- Bimanual uterine massage and treat underlying cause
2. Uterotonic agents like pitocin or misprostol (only if uterus is soft and boggy)
_____ is the biggest RF for Endometritis (infxn of the uterine endometrium).
C-section
*also prolonged ROM >24hr, vaginal delivery, dilation and curettage (or evacuation)
_____ + ______ is given for an endometritis infxn post c-section.
Clindamycin + Gentamicin (may add Ampicillin for GBS coverage)
_____ + ______ is given for infxn after vaginal delivery or chorioamnionitis.
Ampicillin + Gentamicin
Prophylaxis for endometritis involves what class of medication?
1st generation cephalosporin x 1 dose during c-section
Fever + soft, tender uterus and lochia +/- foul odor after giving birth is associated with what dx?
Endometritis
Hyperplasia due to continuous unopposed estrogen is known as ____ hyperplasia.
Endometrial hyperplasia
*Often occurs within 3 years of estrogen-only treatment and MC POSTMENOPAUSAL
Common cause of postmenopausal bleeding is _______.
Endometrial hyperplasia
Endometrial hyperplasia is diagnosed by what modality?
TVUS- endometrial stripe >4mm
*ENDOMETRIAL BX IS DEFINITIVE DX
Treatment of endometrial hyperplasia WITHOUT atypia is:
Progestin (PO or Mirena)
*repeat endometrial bx in 3-6 mos
Treatment of endometrial hyperplasia WITH atypia is:
Hysterectomy
