MTB 3 Flashcards
Test for IUGR
US
Complications with IUGR
Premature labor Stillbirth Fetal hypoxia Lower IQ Seizures MR
Causes of IUGR
Chromosomal abnormalities Multiple gestation NTDs Infxn Maternal HTN Renal Dz
What is the #1 preventable cause of IUGR in U.S.?
Smoking
Risk factors for Macrosomia
Maternal Diabetes
Obesity
Advanced maternal age
Postterm pregnancy
What is fundal height in macrosomic baby
Fundal height is 3 cm greater than GA
What is workup for macrosomic baby
US
Complications of macrosomia
Shoulder dystocia
Birth injuries
Low Apgar
Hypoglycemia
Tx for macrosomic baby
Induction of Labor - if lungs mature before fetus is 4500g
C section if fetus > 4500g
What does NST assess
Fetal movements
Fetal HR
What does BPP consist of?
NST Fetal chest expansions Fetal movement Fetal muscle tone Amniotic fluid index
What are normal accelerations
2.15.15.20
TWO movements fetal HR >15 bpm lasting 15 secs over 20 minutes
What are early decelerations indicative of and what are they
Head compression
Decrease in HR occurring w/ CTX
What are variable decelerations indicative of and what are they
Cord compression
Decrease in HR and return to baseline
No relationship w CTX
What are late decelerations indicative of and what are they
Fetal hypoxia
Decrease in HR AFTER CTX started
No return to baseline until CTX end
How to remember decelerations?
VEAL CHOP Variable Early Accelerations Late Dec
Cord compression/cord prolapse, oligohydramnios
Head compression
OK
Placental insufficiency
What are the movements in stage 2 of labor?
Engagement Descent Flexion Internal Rotation Extension External Rotation Delivery - Anterior Shoulder, Posterior shoulder
What do we not give to asthmatic pts during induction of labor?
Prostaglandin - provokes bronchospasm
What is arrest of cervical dilation
No dilation of cervix for more than 2 hours
What is prolonged latent stage
Latent phase > 20 hours primipara
> 14 hours multipara
What is a protracted cervical dilation
Slow dilation during active phase stage 1 labor
< 1.2 cm/hr - primipara
< 1.5 cm/hr - multipara
What are the types of arrest disorders and how do they present
Cervical Dilation - no dilation for 2 hours
Fetal Descent - No descent for 1 hour
Hard circular surface felt in proximal part of uterus on palpation of abdomen?
Fetal head - breech presentation
How does frank breech present
Hips Flexed
Knees extended
How does complete breech present
Hips and knees flexed BL
When is external cephalic version performed?
After 36 weeks
What is shoulder dystocia
Head delivered
Anterior shoulder stuck behind pubic symphysis
First line tx for shoulder dystocia
Maternal flexion of knees into abdomen w suprapubic pressure
What is the definition of postpartum hemorrhage
Bleeding > 500 mL after delivery
What is tx for PPH
- Check to make sure there is no uterine rupture
- Check for retained placenta
- Bimanual compression and massage
- Oxytocin - make uterus contract and constrict BV’s and decrease blood flow
When does ovulatory reserve drop?
4th Decade of life
How do we test for ovulatory reserve drop
Clomiphene challenge test
- Early follicular phase FSH level
What is premature ovarian failure
Amenorrhea
Hypoestrogenism and increased serum gonadotropin in a female > 40 yoa
What are causes of premature ovarian failure
AI Dz
Inheritable factors
Radiation
How is premature ovarian failure diagnosed
Increased serum FSH and LH
Decreased estrogen
Clinical presentation of lactational mastitis
Fever
Firm, red, tender, swollen quad of unilateral breast
+/- myalgia, chills, malaise
Tx for lactational mastitis
Analgesia
Frequent feedings
Abx
Continued nursing q 2-3 hours
What abx are used for lactational mastitis
MSSA - dicloxacillin
MRSA - clindamycin, TMP-SMX, Vanco
What are premies at risk for?
RDS PDA Bronchopulmonary dysplasia IVH Necrotizing Enterocolitis Retinopathy
Rapidly enlarging head circumference + bulging fontanelles + communicating hydrocephalus is what
IVH
