OB Flashcards
define spontaneous abortion
b4 20 weeks
fetal RF for spont abortion
chromosomal abornamlities MC is trisomy
materal RN for spont abortion
-smoking**** STIs trauma BMI under or over celiac dz
which type of spont aortion is viable
threatened
bloody vaginal discharge
cervical os closed
POC intact
thereatened abortion
tx for threatened abortion
supportive—observation at home, bedrest, close follow up
serial BHCG to if
POC intact
cervical os dilated without passage of tissue
inevitable abortion
some POC expelled
os is dilated
incomplete
all POC expelled from uterus
os is usually closed
complete
POC intact
cervical os closed
missed
***fetus died before 20 weeks and POC remain intrauterine
medical abortion
mifepristone (antiprogestin) 1st
misoprostol (prostaglandin) 2nd
mifepristone
progesterone recp antagonist
-leads to dilation and softening of cervix and placental detachement
misopristol
prostaglandin E1 analog (caues uterine contractions)
-
three times we give RHOGAM
- at 28 weeks
- within 72 hours of birth
- after any mixing of blood– ectopic, abortion, amniocentesis etc
define PP hemorrhage
vaginal = >500 CS= >1000
etiologies for PP hem
and whih is MC
FOUR T’s
- TONE–uterine atony– MC– uterus cannot contract
- TISSUE–retained placental tisssue
- TRAUMA–to cervix, perineum or vagina, uterine rupture, lacerations
- THROMBIN—coag abnorm (hem A/B, von willie, ITP or DIC)
RF for uterine atony
prolonged labo overdistended uterus CS anesthesia retained placenta
soft flaccid boggy uterus with dilated cervix
uterine atony
tx for PP Hem
- uterine massage and compression
- IV oxytocin
- Metagen (methylergonovine) if not HTN
- IM Hemobate (Carboprost tromethamine) if no asthma
- TXA
- Cytotec or misoprostol
define ectopic pregnnacy
implantation outside uterine cavity
locations for ectopic
-mc
98% FT—– ampulla
abdomen (`1.4%)
ovary and cervix (.3%)
strongest RF for ectopic
-others
previous ectopic **
others: PID causing salpingitis IUD previous tubual suregyre endometriosis IVF
abd pain, left shoulder pain, vag bleeding
Ectopic
***shoulder pain= Kehr sign
US findings for ectpic
absence of gestational sac with bHCG >1500 or 2000
tx for ectopic
IM methotrexate –destroys trophoblastic tissue
Only if beta HCG < 5,000, ectopic mass is < 3.5 cm, no fetal heart tones, hemodynamically stable, no blood disorders, no pulmonary disease, no peptic ulcer, normal renal function, normal hepatic function, compliant pt that can return for follow up
RH- mom gets rhogam
contra for methrotexate
- currently BF
- active pulm dz
- allergy
mc cause of third trimester bleeding
placenta abruption
painful bright red bleeding
placental abruption
placental abruption
partial or complete premature separation of placenta from uterus wall
-blood can be concealed within uterine cavity or external
**BV in decidus basalis
MC RF for placental abruption
maternal HTN—-chonic, pre or eclp
smking
prior abruption
cocaine
sudden onset of painful third trimester vaginal bleeding
severe abd pain
abruption
uterus is tender rigid hypertonic
abruption
what not to do if PT has placental abruption
pelvic exam
painless vaginal bleeding in 3rd tri + soft nontender uterus
previa
painful vaginal bleeding in third tri + abd pain + firm tender utuerus
aprution
tx for abruption
delvery of fetus and placenta= definitive
blood type
corticosteroids if prematue lungs
RF for previa
prior cS
multiple gestations
multiple induced abortions
adv maternal age
what is contraindicated to do with a previa case
vaginal exam
–can cause futehr separation
time pd for pre eclampsia to coccur
20 weeks gestation to 6 wks PP
triad for pre eclampsia
HTN + proteinuria + edema after 20 wks gestation
MUST HAVE HTN AND PROTEINURIA the edema is +/-
BP 140/90 to 160/110
PU >300 in 24 hrs or +1
edema hands face feet
mild
when do we give betamethasone for lung maturtion
26-30 weeks
define severe preeclampsia
> 160/110
PU >5 grams or +3
cerebral visual change
pulm edema
tx for severe pre eclampsia
IV MAG
BP meds if >180/110—– methyldopa, labtealol, nifidepine—– hydralazine is apparently alternative
HELLP syndrome
heomlytic anemia
elevated liver zynes
low platetes
tx for eclampsia
mag for seizures
delivery of fetus
BP meds=hydralazine IV or labetalol
give lorazepam for seixures if refractory to mag
total weight gain range for normal BMI
25-35 pounds
obese women preggo weight gain
<15 pounds
Naegeles rule
1st day of last menstrual period + 7 days -3 months +1 year= expectant due date
triple screen
AFP
HCG
estriol
quad screen
AFP
estriol
HCG
Inhibin A
when is chorionic villus sampling done
10-12 weeks
amniocenteiss done?
15-18 weeks
when is 72 hour glucose test done
26-28 weeks
GBS done?
35-37 weeks
high AFP
neural tube defect
ancephaly
spinal bifida
ow afp
down syndrome
MCC for abnormal AFP
unknown/incorrect dats of LMP
trisomy 18
edwards syndrome
