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SG F3 E5 > OB 2 > Flashcards

OB 2 Flashcards

1
Q

What 4 prenatal labs are obtained during the 3rd trimester?

At what weeks?

A

Gestational Diabetes (24-28 w)

Repeat antibody screen in Rh neg women (26-28 w)

Hemoglobin & Hematocrit (35 w)

Perform GBS screen (35-37 w)

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2
Q

Describe the Gestational Diabetes Screening

A

24-28 weeks gestation

  • 50g 1 hour glucose challenge test
  • Normal = <130
  • If >130, do 3 hr glucose tolerance test
  • 3 hr: 100g glucose, blood glucose obtained at:
    • fasting, 1, 2, 3 hr
    • 2 of these 4 values need to be abnormal for dx
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3
Q

What is performed at 26-28 weeks gestation?

A

Antibody Screening

  • Repeat antibody screen in Rh neg women
  • If neg, administer RhoGAM at 28 weeks
  • RhoGAM attaches to Rh+ antigen, preventing mothers immune system from attacking fetal RBCs
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4
Q

What is performed at 35-37 weeks gestation?

A

GBS screen

  • GBS + women planning a vag delivery require intrapartum IV abx
  • (Ampicillin 2g, then 1g ever 4 hrs till delivery)
  • If pcn allergy: Clindamycin
  • ALL WOMEN in labor PRIOR to GBS screen, require empiric abx therapy
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5
Q

GBS causes what infections in infants?

A

Sepsis

PNA

Meningitis

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6
Q

What are the dietary recommendations for:

  • Calories
  • Protein
  • Iron
  • Calcium
A
  • Calories: 350 additional / day
  • Protein: 1g/kg/day (50kg pt = 50g/day)
  • Iron: 30 mg/day
  • Calcium: 250mg/day
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7
Q

How much Folic Acid is needed/day?

Why?

A

0.4mg/day (minimum)

↓ neural tube defects & spina bifida

Required for brain, skull, spinal cord development

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8
Q

What 4 things might you need to supplement in a vegetarian/vegan diet?

A
  • Calcium
  • B12
  • Iron
  • Zinc
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9
Q

What is the recommended caffeine consumption in pregnancy?

A

<200 mg /day

Otherwise there is an ↑ risk of spntneous abortion, low birth weight, pre-term delivery

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10
Q

What 4 fishes should pregnant women avoid eating?

A
  • Shark
  • Swordfish
  • Marlin
  • Bigeye Tuna

Can eat: crab, salmon, lobster, tilapia, canned light tuna

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11
Q

Why should pregnant women avoid undercooked meat?

A

Listeria monocytogenes / Toxoplasmosis

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12
Q

Why should pregnant women avoid contaminated raw milk/cheese?

A

Brucellosis

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13
Q

Women should avoid exercise while lying on back at how many weeks gestation?

A

>20 weeks bc/ ↑ fetal weight can compress IVC blood which will ↓ flow to fetus

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14
Q

What are some signs a woman should stop exercising in pregnancy? f

A

Fatigue, uncomfortable, dehydrated, overheated

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15
Q

2 vaccines to update during pregnancy?

A

Tdap & INACTIVE influenza

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16
Q

What vaccines are avoided in pregnancy? (3)

A

ALL LIVE VACCINES:

  • MMR, Varicella, Influenza (live)
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17
Q

Travel recommendations for pregnancy women?

A
  • Avoid travel to areas w/ Zika virus (basically everywhere)
  • Avoid travel in general >35 weeks
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18
Q

What is the normal length of cervix?

A

2.5cm or greater

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19
Q

What is the “station” in the process of labor?

A

Degree of descent of presenting part in birth canal in relation to ischial spines

(reported w/ + or - signs)

20
Q

What are the 3 P’s?

A

Power: uterine contractions

Passenger: size, position, lie, attitude, presentation

Pelvis/Passage: bony & soft tissue structures of maternal pelvis

21
Q

What does the 1st stage of labor consist of?

A

Interval between: onset of labor –> full cervical dilation & effacement

Latent phase: 1st contractions –> 3-4cm dilation (rate of dilation is SLOW 0.5cm/hr)

Active phase: Dilation rate increases 1cm/hr –> ends w/ COMPLETE dilation

22
Q

What does the 2nd stage of labor consist of?

A

Complete dilation –> delivery

(pushing phase)

23
Q

What does the 3rd stage of labor consist of?

A

Delivery of infant –> Delivery of placenta

(placenta is usually delivered <30 mins after delivery of infant)

24
Q

Describe “Acceleration” of Fetal Monitoring

A

Normal/Good/Reassuring of fetal well-being

Increases 15 bpm above baseline and lasts 15 seconds

25
Q

Describe “Deceleration” of Fetal Monitoring

A

BAD

Variable: d/t cord compression (seen in respect w/ timing of contraction, shape, severity)

Late: baby is in distress, fetal hypoxia, placental insufficiency, maternal hypotension, maternal hypoxia

26
Q

What is hypocontractile uterine activity (power)

Measured how?

Solution?

A
  • Monitored by external tocometry
    • <3 contractions in 10 mins or contractions lasting <50 seconds
  • Measured by internal pressure catheter (IUPC)
    • <200-250 Montevideo units (MVUs)
  • Solution: augment w/ Pitocin
27
Q

What is Cephalopelvic Disproportion?

A

non-gynecoid pelvis (looks like a mans pelvis)

Can be d/t injury or illness causing contracted pelvis

Solution: abdominal delivery

28
Q

What is considered an abortion?

A

Pregnancy loss prior to 20 w gestation

Causes: chromosomal (50%) & teratogens

29
Q

What is the MC complication in early pregnancy?

A

Abortion (80% occur in 1st trimester)

=pregnancy loss prior to 20 w gestation

30
Q

Which type of abortion?

Vaginal bleeding with a closed cervix

A

Threatened

31
Q

Which type of abortion?

Vaginal bleeding with an open cervix

A

Inevitable

32
Q

Which type of abortion?

Products of conception have partially passed

A

Incomplete

33
Q

Which type of abortion?

Passage of the entire conceptus

A

Complete

34
Q

Which type of abortion?

Pregnancy is retained despite death of the fetus

A

Missed

35
Q

Which type of abortion?

Recent spontaneous abortion complicated by intrauterine infection

A

Septic

36
Q

What are 6 RF of abortion?

A
  • Advanced maternal age
  • Prior spontaneous abortion
  • Multigravity
  • Alcohol
  • Ilicit drug use
  • Smoking
37
Q

Clinical presentation of abortion? (3)

A
  • Vaginal bleeding
  • Pelvic pain
  • Incidental finding on US
38
Q

What 2 labs should be obtained for abortion?

A
  • CBC
  • beta HCG quant
39
Q

What is seen on transvaginal US w/ abortion?

A
  • Absent fetal heart tones
  • Absent / failed growth of fetal pole, gestational sac/yolk sac
40
Q

T/F

Abortion does not require Rhogam

A

False, give Rhogam if Rh neg

41
Q

3 treatment options for abortion

A

Expectant: get preg test 2w later

Surgical: Dilation & Curettage (must ensure pathology contains chorionic villi)

Medical: Misoprostol 800mg/vagina, repeat US 24hrs later, pregnancy test in office 2 w later

42
Q

What should you warn patient about if any instruments are used? such as forceps?

A

Asherman’s Syndrome (adhesions in uterus, can affect subsequent pregnancies)

43
Q

Dx? Tx?

Recent spontaneous abortion followed by fever, chills, malaise, abd pain, vaginal bleeding/hemorrhage, malodorous vag discharge

A

Septic Abortion

Tx: hospitalization for IV abx: Cefoxitin + Doxycycline

44
Q

Elective Abortion

What is the “medical” option?

A

Medical:

  • Day 1: Mifepristone 200mg oral
  • 24-48 hrs later: Misoprostol 800mcg bucally
  • Used ONLY for pregnancies up to 70 days gestation
45
Q

Elective Abortion

What is the surgical option? (2)

A

Suction curettage: 1st trimester

Dilation & evacuation: 2nd trimester, Laminaria (osmotic dilator) placed within endocervix 24-48 hrs prior to procedure

46
Q

5 complications of Elective Abortions?

A
  • Hemorrhage
  • Uterine perforation
  • Infection/retained products of conception
  • Death
  • Postabortal syndrome
47
Q

Dx? Tx?

Immediate abdominal pain within 1 hr of procedure, diaphoresis, nausea, tachycardia, large globular uterus on bimanual exam

A
  • *Postabortal Syndrome**
  • *Tx:** Methergine 0.2 mg IM & Dilation and Curettage

SG F3 E5 (23 decks)

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