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OB > MTB 2 > Flashcards

MTB 2 Flashcards

1
Q

MC used tocolytic

A

Magnesium Sulfate

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2
Q

AE’s of Magnesium Sulfate

A

Flushing, HA, diplopia, fatigue

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3
Q

What do we check when administering Magnesium Sulfate

A

DTRs

Magnesium toxicity - respiratory depression and cardiac arrest

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4
Q

Complications with PROM

A

Preterm labor
Cord prolapse
Placental abruption
Chorioamnionitis

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5
Q

What is the Tx of PROM w chorioamnionitis

A

Obtain cervical cultures
Broad spectrum IV Abx
Deliver immediately

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6
Q

Pt presents w fever, maternal tachycardia, fetal tachycardia, maternal leukocytosis, uterine tenderness, foul smelling amniotic fluid?

A

Chorioamnionitis

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7
Q

Tx of PROM at term, no Chorioamnionitis

A

Wait 6-12 hours for spontaneous delivery.

If does not occur - Induce labor

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8
Q

Tx of Preterm fetuses w/out Chorioamnionitis

A
  1. Betamethasone
  2. Tocolytics
  3. Amp and Gent
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9
Q

What is placenta previa

A

Abnormal implantation of placenta over internal cervical os

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10
Q

Presentation of placenta previa

A

Third trimester painless bleeding

Usually after 28 wks

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11
Q

Pt presents with bleeding, no CTX, no pain, stable. Next step?

A

Transabdominal US

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12
Q

What is CI in third trimester bleeding

A

DRE

TV US

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13
Q

What is the tx for placenta previa

A

If large volume bleeding/drop in Hct

- Strict pelvic rest w nothing in vagina

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14
Q

Indications for immediate C-section in placenta previa

A
  1. Unstoppable labor (cervical dilation > 4 cm)
  2. Severe hemorrhage
  3. Fetal distress
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15
Q

What is placental abruption

A

Premature separation of placenta from uterus

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16
Q

Risk factors for placental abruption

A

Maternal HTN
Prior placental abruption
Cocaine
Trauma

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17
Q

Dx test for placental abruption

A

Transabdominal US

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18
Q

Types of placental abruption

A

Concealed - completely detached, serious complications

External - partially detached, smaller w/minimal complications

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19
Q

Tx for placental abruption

A

C-section or Vaginal delivery

20
Q

Uterine rupture presentation

A

Sudden extreme abdominal pain
Abdominal bump
No uterine CTX
Regression of fetus

21
Q

Risk factors for uterine rupture

A 
Previous C section
Trauma - MVAs
Uterine myomectomy
Uterine overdistension - polyhydramnios, multiple gestations
Placenta percreta
22
Q

Tx for uterine rupture

A

Immediate laparotomy w delivery of fetus

23
Q

Rh Incompatibility

A

Mother - Rh Negative
Baby - Rh Positive
First baby delivered -> fetal RBCs cross placenta into mother’s bloodstream . Mother makes abs against Rh positive blood

24
Q

Hemolytic Dz of the NB presentation

A

Fetal anemia - extramedullary production of RBCs

Increased heme and BR in plasma

25
Q

When is prenatal antibody screening done?

A

28 weeks

35 weeks

26
Q

When is BP above 140/90 gestational HTN?

A

When it starts after 20 week

27
Q

What is the difference b/t mild and severe preeclampsia

A

Mild >140/90, 1+ proteinuria, 24 hr urine >300 mg, Edema in hands/feet/face

Severe >160/110, 3+ proteinuria, 24 hr urine > 5 g, Generalized edema, mental status changes, vision changes, impaired liver fnc

28
Q

Tx of gestational HTN

A

ONLy during pregnancy w
Labetolol
methyldopa
Nifedipine

29
Q

What is eclampsia

A

Preeclampsia + seizures

30
Q

Tx for preeclampsia if Near term

A

Delivery!
Seizure control with magnesium sulfate
BP control w/hydralazine or IV labetolol

31
Q

HELLP Syndrome

A

Hemolysis
Elevated Liver enzymes
Low platelets

32
Q

Liver manifestations seen with HELLP

A

Centrilobar necrosis
hematoma
Thrombi in portal capillary system
- Swelling of liver w/distension of hepatic capsule that causes (Glisson’s) pain

33
Q

Complications with pregestational Diabetes - Maternal

A

Spontaneous abortion - 2X
Preeclampsia - 4X
Increased rate of Infxn
Increased risk of PPH

34
Q

Complications with pregestational Diabetes - Fetal

A 
Congenital anomalies
 - Heart
- NTDs
Macrosomia 
- Shoulder dystocia
- Preterm
35
Q

Which diabetes medication is not used in pregnancy

A

Sulfonyureas

36
Q

What tests are done at 32-36 wks

A

Weekly NST

US

37
Q

What tests are done at > 36 weeks

A

Twice weekly:
One NST
One BPP

38
Q

What tests are done at 37 weeks

A

L:S ratio

39
Q

What tests are done at 38-39 weeks

A

None.

Induction of labor

40
Q

Complications seen with gestational diabetes

A 
Preterm birth
fetal macrosomia and birth injuries
Fetal hypoglycemia
Pyelonephritis
Meconium aspiration
Still birth
41
Q

When is screening for gestational diabetes

A

Between 24-28 weeks
Glucose load test: if above 140 then
Glucose tolerance test: if any are elevated, confirmed

42
Q

Tx for gestational diabetes

A
  1. Diet and Exercise
  2. Insulin w NPH if
    - fasting > 95
    - one hour postprandial > 140
43
Q

What drugs cross placenta to cause fetal hyperinsulinemia

A

Sulfonyureas:
Chlorpropamide
Tolbutamide

44
Q

Tx for preeclampsia if severe and far from term

A 
Monitor closely inpatient
Maintain BP < 155/105
If using Labetolol IV, DBP < 90
MgSO4 - seizures PPX
Induce as soon as fetus is considered viable
45
Q

What is mild preeclampsia? Severe preeclampsia?

A 
Mild = BP > 140/90
Severe = 160/110

OB (4 decks)

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