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OB 2 Flashcards

(53 cards)

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1
Q

premature rupture of membranes presents as

A

h/o a gush of fluid from the vagina

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2
Q

diagnostic tests for premature rupture of membranes (PROM)

A

sterile speculum to confirm amniotic fluid; fluid present at posterior fornix; turns nitrazine paper blue; air dry = ferning pattern

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3
Q

what color does amniotic fluid turn nitrazine paper

A

blue

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4
Q

what pattern does amniotic fluid dry like

A

a fern

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5
Q

what is prolonged rupture of membranes

A

labor starts more than 24 hours before delivery

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6
Q

PROM leads to

A

preterm labor, cord prolapse, placental abruption, chorioamnionitis

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7
Q

what do you do if patient has chorioamnionitis

A

deliver fetus now

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8
Q

what to do with PROM of term fetus w/o chorioamnionitis

A

wait 6-12 hours for SVD, if not induce labor

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9
Q

what to do with PROM of preterm fetus w/o chorioamnionitis

A

give beclomethasone, tocolytics, and ampicillin + 1 dose of azithromycin to decrease risk of developings chorioamnionitis

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10
Q

abx choice to ppx chorioamnionitis if pt is PCN allergic with low risk of anaphylaxis

A

cefazolin + 1 dose of azithromycin

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11
Q

abx choice to ppx chorioamnionitis if pt is PCN allergic with high risk of anaphylaxis

A

clindamycin + 1 dose of azithromycin

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12
Q

placenta previa

A

abnormal implantation of the placenta over the internal cervical os, causes 20% of all prenatal hemorrhages; 3rd trimester

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13
Q

how does placenta previa present

A

painless vaginal bleeding in the 3rd trimester; can be detected on US before 28 weeks

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14
Q

what do you not do in patients with bleeding in the third trimester?

A

never do a digital vaginal exam or transvaginal US; it can result in increased separation of the placenta and uterus causing more hemorrhage

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15
Q

describe a complete placenta previa

A

complete covering of the internal cervical os

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16
Q

describe a partial placenta previa

A

partial covering of the internal cervical os, but covers more than marginal

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17
Q

describe a marginal placenta previa

A

placental is adjacent to the internal os

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18
Q

describe vasa previa

A

fetal vessel is present over the cervical os

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19
Q

describe a low-lying placenta

A

placenta that is implanted in the lower segments of the uterus but not covering the internal cervican os (>0cm but <2cm away)

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20
Q

when do you treat placenta previa

A

large volume bleeding or a drop in the HCT

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21
Q

what is the treatment of placenta previa

A

strict pelvic rest

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22
Q

what are the indications for immediate cesarean delivery in placenta previa

Study These Flashcards
A

unstoppable labor (cervix >4cm), severe hemorrhage, fetal distress

23
Q

what are the different types of placental invasion?

Study These Flashcards
A

accreta, increta, percreta

24
Q

placental accreta

Study These Flashcards
A

the placental abnormally adheres to the superficial uterine wall

25
placenta increta
the placental abnormally attaches to the myometrium
26
placenta precreta
the placental abnormally invades into the uterine serosa, bladder wall (hematuria), or rectum wall (retal bleeding)
27
what can happen if the placenta cannot detach form the uterine wall after delivery
catastrophic hemorrhage and shock; patients often require a hysterectomy
28
placental abruption
premature separation of the placenta from the uterus; can occur before, during or after labor
29
what are the complications of a large placental abruption
life-threatening bleeding, premature delivery, uterine tetany, DIC, hypovolemic shock
30
precipitating factors of placental abruption
maternal HTN, prior placental abruption, maternal cocaine use, external trauma, maternal smoking
31
presentation of placental abruption
third trimester bleeding, severe abdominal pain, contractions, possible fetal distress
32
how to distinguish placenta previa from placental abruption
transabdominal US, though placental abruption may still not be seen
33
concealed placental abruption
blood is within the uterine cavity, placenta is more likely to be completely detached
34
complications of concealed placental abruption
DIC, uterine tetany, fetal hypoxia, fetal death, sheehan syndrome (postpartum hypopituitarism)
35
external placental abruption
blood drains through cervix, placental more likely to be partiall detached
36
complications of external placental abruption
usually smaller than concealed and with minimal complications
37
indications for cesarean delivery for placental abruption
uncontrollable maternal hemorrhage, rapidly expanding concealed hemorrhage, fetal distress, rapid placental separation
38
indication of vaginal delivery for placental abruption
placental separation limited, fetal heart tracing is assuring, separation is extensive and fetus is dead
39
risk factors for uterine rupture
previous cesarean deliveries, trauma, uterine myomectomy, uterine overdistention, placenta percreta
40
presentation of uterine rupture
sudden onset of extreme abdominal pain, abnormal bump in abdomen, no uterine contractions, regression of fetus
41
regression of fetus
fetus was moving toward delivery, but is no longer in the canal because it withdrew into the abdomen
42
treatment of uterine rupture
immediate laparotomy with delivery of fetus; either repair of uterus or hysterectomy
43
pregnant patient with previous repair of uterine rupture; what do you do?
deliver all future children via cesarean at 36 weeks
44
Rh incompatibility
mother is Rh negative and baby is Rh positive; issue occurs with 2nd Rh+child because mother developed antibodies from first kid
45
hemolytic dz of the newborn
cause by mother's antibodies attacking the Rh+ baby resulting in fetal anemia and extramedullary RBC productions
46
antibody screen
done to see if mother is Rh- or Rh+
47
antibody titer (indirect antiglobulin test)
done to see how many antibodies to Rh+ blood the mother has
48
times when RhoGAM is given
amniocentesis, abortion, vaginal bleeding, placental abruption, delivery
49
placental antibody screening occurs when
28 and 35 weeks
50
unsensitized mothers get RhoGAM when
at 28 weeks and then again at delivery if baby is Rh+
51
sensitized mothers
antibody titer of lever more than 1:4
52
what do you do if antibody titer is >1:16
serial amniocentesis to evaluate for fetal bilirubin level
53
what are the causing of 3rd trimester bleeding?
placenta previa, placental invasion (accreta, increta, precreta), placental abruption and uterine rupture

OB/GYN (4 decks)

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