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OB > OB > Flashcards

OB Flashcards

1
Q

Triage: ROL

A

Cervical change over 1-2h, regular frequent painful cx

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2
Q

Triage: rule out preterm labor

A
  1. Check with attending (spec/exam)
  2. Sterile spec
  3. Swabs: GCCT, GBS, wet mount, ferning
  4. +/- US cervical length if <32w
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3
Q

Triage: early latent labor

A

Morphine 10-15mg IM
Phenergan 25mg IM
Return precautions 4/5-1-1

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4
Q

Triage: preterm cx—ddx (9), exam (7), orders (7)

A

Ddx: dehydration, recent increased physical exertion, UTI, preE, pyelo, chorio, BV, abruption, preterm labor
Exam: VS, FHT, CVAT, andominal pain, fundal tenderness, VB, 2 CEs 1-2h apart, +/- transvaginal US for cervical length (<2cm bad, >3cm good)
Orders: PO/IVF, UA/UCx, PIH/HELLP panel, Up/c, CBC/diff, wet mount, +/- GCCT

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5
Q

Triage: preterm labor

A

Preterm contraction workup

Consider antepartum admit for betamethasone 12mg q24h x2 (34w0d - 36w6d) if 7 days without previous steroids

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6
Q

Triage: rule-out SROM

A 
Sterile spec 2/3 positive for nitrazine, ferning, pooling
Spont labor if cx
PROM without reg freq cx
PPROM <37w w/o cx
\+SROM = admission, minimize CEs
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7
Q

Triage: nonreassuring NST

A

BPP (tone, mvmt, resp, AFI)
NST
If new oligo, r/o SROM

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8
Q

Triage: preE definition

A

> 140 or >90 x2 4h apart AND one of:

  • proteinuria (>0.3, >300, or +1 on dip)
  • Cr doubled or >1.1
  • plt <100k
  • cerebral edema (HA, vis changes)
  • LFTs x2 ULN
  • severe RUQ pain
  • pulm edema
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9
Q

Triage: preE with severe features definition

A
  • Cr doubled or >1.1
  • plt <100k
  • cerebral edema (HA, vis changes)
  • LFTs x2 ULN
  • severe RUQ pain
  • pulm edema
  • > 160 or >100 x2 separated by minutes
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10
Q

PreE ddx (3)

A

gHTN if >20w, cHTN if <20w, HELLP

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11
Q

PreE workup

A

PIH/HELLP panel, upc (start 24h urine collection if >300, none if SROM), q15min bps, LDH for HELLP, if severe, mag x24h vs through delivery, q6 mag levels & PIH labs, PIH to q12 if improving, 3.5L fluid restriction, no mIVF, monitor UOP

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12
Q

Triage: abdo trauma hx (6)

A

Mechanism, velocity, pain, VB, LOF, FM

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13
Q

Triage: abdo trauma PE

A

abd bruising, uterine tenderness, VB, SVE if cx

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14
Q

Triage: abdo trauma workup (7)

A

cEFM x4h, KB, CBC, fibrinogen (<200 ?DIC), T&S if blood type unknown, US (r/o abruption, low sensitivity), rhogam if rh-, ?2nd dose if KB+

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15
Q

Triage: abdo trauma DC criteria

A

Cx<4/h, no pain/VB, cat I FHT, KB-; if any +, admit for 24h cEFM

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16
Q

VB ddx (7)

A

Placenta previa, vasa previa, placental abruption, cervical polyps, cervical lesion, bartholin cysts, bloody show/mucus plug

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17
Q

When to start pcn for gbs+?

A

6cm primip, 4cm multip

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18
Q

Cervical ripening indicated if Bishops

A

6

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19
Q

Miso: q__h x__ max, can’t give if ________, may cause ________

A

4, 6, tachysystole, fever

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20
Q

Low dose pit for cervical ripening: max ____

A

10mU/min

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21
Q

_______ is the most significant sign if fetal compromise

A

Persistently minimal or absent FHR variability

22
Q

Accel: >______ bpm above baseline for >_____ sex

A

15, 15

23
Q

Gradual decel: onset to nadir >___ sec

A
24
Q

Early decel: _____ decrease in FHR with onset to nadir >____ sec, nadir occurs with cx peak

A

Gradual, 30

25
Q

Late decel: onset to nadir >____ sec, ____ after _____ of cx (x2)

A

Onset—beginning, nadir—peak

26
Q

Variable decel: abrupt decrease of >____ bpm, lasts between _____ and ____ not including _______

A

15, 15 sec, 2 min, shoulder

27
Q

Recurrent decels: >____% of cx over ____ min period

A

50, 20

28
Q

Prolonged decel: decrease of >____ bpm lasting >____ min but less than ____ min

A

15, 2, 10

29
Q

Etiologies of prolonged decel (7)

A

Maternal hypotension, uterine hyperactivity, cord prolapse, cord compression, abruption, artifact, maternal seizure

30
Q

Management of prolonged decel/NRFHT

A 
Positioning (roll, hands&knees)
Oxytocin (half or off)
Infusion (amnioinfusion, IV bolus)
SVE, systolic (check BP)
Oxygen
Notify attg
\+terbutaline to room l
\+ephedrine for post-epidural hypotension
31
Q

Amnioinfusion: ___cc followed by ___ cc/h

A

300, 150

32
Q

Terbutaline increases _____ risk, requires _____ for infant

A

PPH, glucose protocol

33
Q

Goal bg in labor

A

70-110

34
Q

Tachysystole: >___cx in ___ min averaged over ____ min

A

5, 10, 30

35
Q

Glucose monitoring: latent ____, active ____

A

Fasting + QID AC

q1-2h

36
Q

PP bg checks GDM/DM

A

A1: fasting & ACx1
A2: fasting & qid AC x24h

37
Q

Chorio: criteria

A

Single T101 or 2x 100.4 before delivery AND WBC>15c, mat tachy, fetal tachy, ROM>12h, uterine tenderness, malodorous amniotic fluid

38
Q

Chorio: med

A

Unasyn 3g q6 until deliv, 1 add’l dose pp vs 24h afebrile

39
Q

Endometritis: signs

A

Pp fever, uterine tenderness

40
Q

Endometritis: med

A

Unasyn if not sick, clinda+gent if sick, augmentin as outpt

41
Q

Never use miso for ______

A

TOLAC

42
Q

Active 3rd stage management

A

Pit to 150-200 mU/min after anterior shoulder delivery, gentle cord traction + fundal massage

43
Q

Meds for manual sweep

A

2g IV cefazolin (attg dependent)

44
Q

PPH 4 Ts

A

Tissue
Tone (fundal massage, lower uterine sweep)
Trauma (lacs)
Thrombin (DIC panel)

45
Q

PPH 5 meds

A

Pitocin, miso, methergine, hemabate, txa

46
Q

PPH: pitocin ___ max PP, one bag is ____, can give ____ IM

A

80U, 30U, 10U

47
Q

PPH: miso dose ____ (____ onset) or ____ (____ onset), repeat? ___, may cause ____

A

400mcg PO, 8 min
800mcg PR, 30-100 min
No
Shiver/fever

48
Q

PPH: methergine dose _______, contraindication _______

A

0.2mg IM q2-4h x5 max

Htn

49
Q

PPH: hemabate dose _____, contraindication ______, give with ______

A

250 mcg IM q15min x8 max, imodium

50
Q

Unstable PPH management

A 
2 lg bore IV
IVF
T/S or 2 U Oneg stat
Notify charge RN, labor/fellow
Pack
OR for D&C or bakri
51
Q

Shoulder dystocia management

A

Call for help
McRoberts
Suprapubic pressure “to window/door” to disimpact ant shoulder
Sweep posterior arm across chest, deliver posterior arm, then rotate baby to dislodge ant shoulder
Rubin/reverse woodscrew: palm facing baby dacing direction to rotate posterior shoulder to 180deg and deliver
Gaskin: hands/knees, deliver post shoulder

OB (2 decks)

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