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OB/GYN > OB 2 > Flashcards

OB 2 Flashcards

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

A

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

23
Q

what are the different types of placental invasion?

A

accreta, increta, percreta

24
Q

placental accreta

A

the placental abnormally adheres to the superficial uterine wall

25
Q

placenta increta

A

the placental abnormally attaches to the myometrium

26
Q

placenta precreta

A

the placental abnormally invades into the uterine serosa, bladder wall (hematuria), or rectum wall (retal bleeding)

27
Q

what can happen if the placenta cannot detach form the uterine wall after delivery

A

catastrophic hemorrhage and shock; patients often require a hysterectomy

28
Q

placental abruption

A

premature separation of the placenta from the uterus; can occur before, during or after labor

29
Q

what are the complications of a large placental abruption

A

life-threatening bleeding, premature delivery, uterine tetany, DIC, hypovolemic shock

30
Q

precipitating factors of placental abruption

A

maternal HTN, prior placental abruption, maternal cocaine use, external trauma, maternal smoking

31
Q

presentation of placental abruption

A

third trimester bleeding, severe abdominal pain, contractions, possible fetal distress

32
Q

how to distinguish placenta previa from placental abruption

A

transabdominal US, though placental abruption may still not be seen

33
Q

concealed placental abruption

A

blood is within the uterine cavity, placenta is more likely to be completely detached

34
Q

complications of concealed placental abruption

A

DIC, uterine tetany, fetal hypoxia, fetal death, sheehan syndrome (postpartum hypopituitarism)

35
Q

external placental abruption

A

blood drains through cervix, placental more likely to be partiall detached

36
Q

complications of external placental abruption

A

usually smaller than concealed and with minimal complications

37
Q

indications for cesarean delivery for placental abruption

A

uncontrollable maternal hemorrhage, rapidly expanding concealed hemorrhage, fetal distress, rapid placental separation

38
Q

indication of vaginal delivery for placental abruption

A

placental separation limited, fetal heart tracing is assuring, separation is extensive and fetus is dead

39
Q

risk factors for uterine rupture

A

previous cesarean deliveries, trauma, uterine myomectomy, uterine overdistention, placenta percreta

40
Q

presentation of uterine rupture

A

sudden onset of extreme abdominal pain, abnormal bump in abdomen, no uterine contractions, regression of fetus

41
Q

regression of fetus

A

fetus was moving toward delivery, but is no longer in the canal because it withdrew into the abdomen

42
Q

treatment of uterine rupture

A

immediate laparotomy with delivery of fetus; either repair of uterus or hysterectomy

43
Q

pregnant patient with previous repair of uterine rupture; what do you do?

A

deliver all future children via cesarean at 36 weeks

44
Q

Rh incompatibility

A

mother is Rh negative and baby is Rh positive; issue occurs with 2nd Rh+child because mother developed antibodies from first kid

45
Q

hemolytic dz of the newborn

A

cause by mother’s antibodies attacking the Rh+ baby resulting in fetal anemia and extramedullary RBC productions

46
Q

antibody screen

A

done to see if mother is Rh- or Rh+

47
Q

antibody titer (indirect antiglobulin test)

A

done to see how many antibodies to Rh+ blood the mother has

48
Q

times when RhoGAM is given

A

amniocentesis, abortion, vaginal bleeding, placental abruption, delivery

49
Q

placental antibody screening occurs when

A

28 and 35 weeks

50
Q

unsensitized mothers get RhoGAM when

A

at 28 weeks and then again at delivery if baby is Rh+

51
Q

sensitized mothers

A

antibody titer of lever more than 1:4

52
Q

what do you do if antibody titer is >1:16

A

serial amniocentesis to evaluate for fetal bilirubin level

53
Q

what are the causing of 3rd trimester bleeding?

A

placenta previa, placental invasion (accreta, increta, precreta), placental abruption and uterine rupture

OB/GYN (4 decks)

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