OB Flashcards
What is the treatment for morning sickness?
Vit B6
Can add Doxylamine
What is hyperemesis gravidarum and how do you treatment?
Intractable vomiting during pregnancy
Tx: IV fluids, electrolyte replacement, Zofran/Promethazine, ginger, steroids
What is characterized by an increase in hCG despite the absence of fetal heart tones?
Gestational Trophoblastic Disease
What is the treatment for gestational trophoblastic disease?
Refer to OB for D&C
What is considered a threatened abortion?
Any bleeding before 20 weeks
What can occur if a fetus is Rh+ and a mother is Rh-, and how does this happen?
Rh Incompatibility
The Rh+ pos fetus’ blood can mix with the Rh- mother’s blood
The mother’s immune system makes antibodies against the antigens of the Rh+ fetus
The antibodies attack the fetal RBCs and cause hemolytic disease of the newborn (HDN)
What is the treatment for Rh incompatibility?
Give RhoGAM to Rh- mother at 28 weeks and after delivery
What is preterm labor and what are the signs/symptoms?
Labor that occurs before 37 weeks
> 6 contractions in 1 hour, maybe premature rupture of membranes and cervical dilation
What is the treatment for preterm labor?
IV hydration
Tocolysis (terbutaline, nifedipine, prostaglandin inhibitors, mag sulfate)
Steroids (2 doses of betamethasone if < 34 weeks)
Fetal fibronectin
What is the treatment if there is premature rupture of membranes?
Ampicillin
Expectant management if > 34 weeks
Steroids & tocolysis if < 34 weeks
When is a mother tested for Group B strep?
35-37 weeks
What is the treatment if a mother tests positive for Group B strep?
IV abx (penicillin) at the beginning & throughout labor
When would you treat empirically for Group B strep?
If mother goes into labor at < 37 weeks
If membranes rupture > 18 hrs before delivery
If mother has a fever during labor
What is the difference between placenta previa and abruptio placenta?
Placenta previa: painless bleeding
Abruptio placenta: painful bleeding
What is vasa previa?
The umbilical cord covers the internal cervical os
What are the different positions a fetus/baby can be in?
Occiput posterior: back of baby’s head is toward mom’s spine
Breech: baby’s bottom is presenting
Transverse lie: baby is sideway
Face presentation: hyperextension of the head w/occiput to the back
Compound & brow presentation: hand or foot (compound) or forehead (brow)
How does shoulder dystocia occur?
The anterior shoulder gets impacted against the symphysis pubis after delivery of the head
How do you treat shoulder dystocia?
McRoberts maneuver
Suprapubic presser
Woods’ screw maneuver
Zavanelli maneuver (push baby back in and do c-section)
What kind of heart decelerations may be seen on a fetal cardiac monitor?
Variable decel: from cord compression, brady <100
Late decel: decrease HR after onset of contraction
Decreased variability: < 3-5 beat change
What HR indicates that there is fetal distress?
> 160 or < 110
What is the 3rd leading cause of maternal death?
Postpartum hemorrhage
What are the signs/symptoms of postpartum hemorrhage?
Blood loss > 500mL in 24 hrs
Hypotension
Tachycardia
What is the treatment for postpartum hemorrhage?
Large-bore IV
Pitocin
Check placenta
Fundal massage
Explore uterus
Check for cervical/vaginal lacs
When is a glucose tolerance test performed?
24 weeks
What is the process for diagnosing gestational diabetes?
1 hr glucose tolerance test: abnormal if > or = 140
If 1 hr test abnormal, perform 3 hr test
3 hr glucose tolerance test: abnormal if > 180 at 1 hr, > 155 at 2 hrs, > 140 at 3 hrs
What establishes the diagnosis of gestational diabetes?
2 or more abnormal results during the glucose tolerance test
What is the non-pharm treatment for gestational diabetes?
Tight glucose control (fasting BG < 95, 1 hr < 140, 2 hr <120)
Refer to dietician
Encourage exercise
If non-pharm treatment of gestational diabetes fails, what is the 1st line medication treatment?
Insulin (metformin or glyburide)
What is considered hypertension in pregnancy?
SBP > 140 and/or DBP > 90
What is the treatment for hypertension during pregnancy?
Prevention: 81mg aspirin at 12-28 weeks until delivery if mod-high risk factors
1st line: labetalol (BID up to 2400mg/day) or nifedipine (up to 120mg/day)
What are some medications that are contraindicated in pregnancy?
ACE inhibitors
Angiotensin receptor blockers
Mineralocorticoid receptor antagonists
Nitroprusside
What is the diagnostic criteria for pre-eclampsia?
Meets criteria for HTN with:
> or = 300mg protein in the urine in 24 hr period
Urine protein/creatinine ratio is > or = 0.3
Proteinuria 1+ on dipstick
Meets criteria for HTN w/o proteinuria with:
Thrombocytopenia
Renal insufficiency
Pulmonary edema
Impaired liver function
New onset HA unresponsive to meds
What is HELLP syndrome?
Hemolysis
Elevated liver enzymes
Low platelet count
What is the diagnostic criteria of HELLP syndrome?
Hemolysis: LDH > 600IU/L
AST/ALT: > 2x ULN
Thrombocytopenia: < 100,000 x 10*9/L
What is the treatment for HELLP syndrome?
Blood transfusion (for anemia)
Bedrest
Continuous monitoring mom & baby
Mag sulfate (prevent seizure)
BP meds
Corticosteroids (for fetal lung development)
What is eclampsia?
Progression of the pre-eclamptic patient to the development of generalized tonic-clonic seizures
What are signs/symptoms of iron deficiency anemia?
Lightheadedness
Fatigue
Dyspnea
Palpitations
Skin pallor, pale palpebral conjunctiva on PE
When/how do you screen for iron deficiency anemia in pregnancy?
At 1st prenatal visit and at 28 weeks
Iron studies, B12, folate labs
How do you treat iron deficiency anemia in pregnancy?
Prevention w/good diet & prenatal vitamins
Mild: prenatal vitamin w/iron, B12, folate
Mod (clinically stable with Hgb > 7): oral iron
Hgb < 7 and/or hemodynamically unstable: blood transfusion
What are the signs/symptoms of folate deficiency?
Sore lips/tongue
Nausea
Diarrhea
Anorexia/weight loss
Cognitive dysfunction/dementia
Depression
What treatment is provided to pregnant pts with HIV?
CD4 count < 100: bactrim
CD4 count < 50: azithromycin
Viral load > 1000 or unknown: scheduled c-section at 38 weeks
What is the 2nd most common endocrine disorder in pregnancy?
Thyroid disease
What is the treatment for thyroid disease in pregnant pts?
Prevent w/150mcg of iodine/day
Hypo: levothyroxine; TSH goals by trimester
Hyper: maintain mild maternal hyperthyroid to avoid fetal hypothyroid; PTU (1st trimester), methimazole (2nd trimester)
What is an ectopic pregnancy?
Gestation that implants outside of the endometrial cavity (most commonly ampullary)
What are signs/symptoms of an ectopic pregnancy?
Amenorrhea
Vaginal bleeding
Lower abdominal pain
What is the treatment for an ectopic pregnancy?
Methotrexate OR
Surgery
When can a pt be given methotrexate for an ectopic pregnancy?
Must be hemodynamically stable
Must not have any renal, hepatic, or hematologic disorders
Must attend post-treatment appointments
Serum hCG < 5000
No fetal heart activity
How is methotrexate given for ectopic pregnancy?
1 dose 50mg per square meter of body surface
Return to check hCG in 4 days
Check hCG on day 7
Repeat hCG test every 7 days until reaches 0
What medications/procedures are used to induce abortion?
Mifepristone, Misoprostol, Methotrexate (up to 10 weeks)
Dilation & curettage (12 weeks or less)
Dilation & evacuation (13+ weeks)
What is the definition of infertility?
> 1 year of unprotected intercourse without conception
