OB Flashcards
Percent included in 1/2/3 SD?
1 SD = 68%
2 SD = 96%
3 SD = 99%
Sensitivity and specificity
Sens - ability to correctly dx a disease
SN = TP / TP + FN
Spec - ability to correctly exclude a disease
SP = TN / TN + FP
PPV and NPV
PPV = TP/ TP + FP (is a + result really positive?)
NPV = TN / TN + FN (probability that a - result is correct)
Incidence/prevalence
Incidence = number of new cases over a period of time
Prevalence = number of cases at a given point in time
ABD wall and Arcuate line
Superficial –> deep
External obl > internal obl > transverse abdominis
Above Arcuate line - aponeuroses splits
Below - all superficial to rectus
Ovary artery/vein
Arteries directly from aorta
Left ovarian vein –> left renal vein
Right ov vein –> IVC
Branches of posterior division internal iliac (hypogastric)
Iliolumbar
lateral sacral
superior gluteal
Branches of anterior division
Umbilical (medial umbilical ligament)
Obturator
Middle rectal
Internal pudendal
inferior gluteal
Uterine –> vaginal
superior vesicle
Anterior abdominal wall folds
midline
- Urachus = median umbilical ligament
- Obliterated umbilical arteries = medial umbilical ligaments
- Inferior epigastric arteries
lateral
Dermatomes
- Nipple
- Xiphoid
- Umbilicus
- Pubis
Nipple - T4
Xiphoid - T7
Umbilicus - T10
Pubis - L 1-2
Course of pudendal nerve
From S 2,3,4 > exits pelvis through greater sciatic notch > lateral to ischial spine > enters ishiorectal fossa through lesser sciatic notch > Alcock’s canal > innervates perineum, anus and dorsal nerve of clitoris
Nerve palsies
- iliohypogastric
- ilioinguinal
IH: T12-L1, suture entrapment with Pfanny –> sensory loss of skin overlying syphysis down to labia majora
II: T12-L1, also entrapment –> medial aspect of labia majora
Nerve palsies
- Femoral
- Lateral peroneal
- Sciatic
- F: L2-4, self retaining retractor blades, exaggerated hip flexion –> anterior/medial leg/thigh numb, weak quads
- LP: L4-S2, lateral displacement of the knee without support –> foot drop and inversion
- Sciatic: L4-S3, sacroiliac fossa procedures –> weak hamstrings
How long to heal nerve injury?
Compression: heals spontaneously in 6-12 wks
Brachial nerve palsies
- Erb’s
- Klumpke’s
Erb’s: C5-6, waiters tip, grasp reflex intact
Klumpke’s: C8-T1, hand and wrist paralysis, reflex lost
Ureter course and blood supply
15cm abd + 15 cm pelvic
renal pelvis > over psoas from medial to lateral > over common iliac > ovarian fossa > under uterine artery, 1-2 cm from cervix > bladder at trigone
Multiple arterioles from peritoneum
pelvis types, shapes and fetal position
Gynecoid - most common
Android - heart shaped
Anthropoid - wider in AP diameter, associated with OP position
Platypelloid - associated with transverse presentation
pelvimitry
Diagonal conj = pubic bone to sacral promentory
Obstetric conj = diagonal conj - 2 (ideal is 10+)
Mid pelvis = pubic bone to sacral hollow (ideally 11+)
Interspinous distance = ideally 10+
Lie vs presentation vs denominator vs position vs attitude vs synclitism
Lie - long axis of fetus in relation to mother
Presentation - lowest part
Denominator - body part used to describe the presenting part (eg mentum in face presentation)
Position - relation of denominator to maternal pelvis
Attitude - relation of fetal head to fetal spine (flexed, neutral, extended)
Synclitism - lateral flexion of fetal head
Cardinal movements of labor
engagement
descent
internal rotation
extension
restitution
external rotation
expulsion
BPP components
- reactive NST
- at least 1 episode of 30 s breathing
- at least 1 flexion/extension
- at least 3 gross movements
- MVP at least 2 cm
Oligohydramnios
Delivery - 36.0 to 37.6 weeks
Apgars
what to do with low scores
HR - absent, <100, >100
Respirations - absent, slow/weak cry, good/vigorous cry
Grimace - no response, grimace, strong cry
Tone - flaccid, mild flexion, active motion
Appearance - cyanotic, pink with blue extremities, all pink
if < 7 at 5 mins - continue q5 min until 20 mins
if <5 at 5 mins - get UA blood gas
*low scores do not predict future neurologic outcomes
Bishop score
>/=8 or <6?
0-3 points per category
Dilation - closed, 1/2, 3/4, 5+
Effacement - 0-30, 40-50, 60-70, 80+
Station - -3, -2, -1/0, +1/+2
Position - posterior, midposition, anterior, -
Consistency - firm, medium, soft, -
> /=8 means have the same probability of vaginal delivery as if in spontaneous labor
<6 means unfavorable cervix
First stage labor arrests (2)
Unsuccessful IOL - failure to achieve active labor after 12-18 hrs of ROM on pitocin
First stage arrest - no change in cervix for 4 hrs with adequate or 6 hrs with inadequate contractions
200 MVU in 10 mins = adequate
Second stage arrest
> 3 hrs in nullip and > 2 hrs in multip of pushing but can diagnose earlier if no fetal rotation or decent
assess for operative delivery prior to CD
How to dose pitocin
Brow presentation - can deliver vaginally?
Yes, if discovered at a higher station, may still convert to vertex or face
No not manually rotate
Definition of PPH
Stages of hemorrhagic shock
PPH = 1000 cc or si/sz hypovolemia w/in 24 hrs PP
1 - 15% (~750 cc), HR<100, RR<20, normal BP, normal mentation
2 - 15-30% (750-1500 cc), HR>100, RR 20-30, decreased BP, anxious
3 - 30-40% (1500-2000 cc), HR > 120, RR 30-40, decreased BP, confusion + lethargy
4 - 40%+ (2000 cc), HR > 140, RR 40+, decreased BP, confusion/LOC
Bakri balloon
JADA
US guidance > Grasp cervix with forcep > Fill with 300-500 (max) cc saline
JADA - remove air from cervical balloon > confirm cervix dilated >/=3 cm > no not use instrument to insert but may grasp cervix > confirm with US > fill balloon with 60 cc (max 120 cc) at external os > vacuum at 80 mmHg (max is 90 mmHg) > tape to thigh > leave in at least 1 hour > remove air from seal balloon and watch for at least 30 mins before removing > max time 24 hrs, consider abx for prolonged use
JHH MTP
Cooler
#1 - 6u pRBC, 5u FFP, 1u plt
#2 - same
later coolers include cryoprecipitate
