OB 2 Flashcards
when do you screen for group B strep?
universal screening at 35-37 weeks gestation
swab both lower vagina and rectum
GBS
MC neonatal sepsis
PCN is tx
placenta completely covers cervical os
Complete previa
placenta overlies part, but not all of cervical os
partial previa
placental edge in lower uterine segment but does not reach internal os
low-lying placenta
painless bright red vaginal bleeding in 3rd trimester
placenta previa
RF of placenta previa
prior C-section
multiple gestations
multiple induced abortions
advanced maternal age
dx placenta previa
ultrasound
Placental tissue extends into superficial layer of myometrium
Placenta accrete
entire placenta separates from uterine wall
complete placenta abruption
premature separation of normally implanted placenta
occurs due to any number of causes (trauma, idiopathic, etc.)
placental abruption
painful vaginal bleeding that may not be externally present
placental abruption
blood penetrates uterus; uterine serosa becomes blue-purple in coloration
complication of ____ called ____
placental abruption
called couvelaire uterus
bleeding occurring during vasa previa belongs to…
fetus!
common cause of small gestional age
tobacco
macrosomia newborns are common among ____ mothers
DB mothers
Gestational HTN
onset after 20 weeks gestational age w/o proteinuria
Development of hypertension after 20 weeks’ gestational age with proteinuria
Peeclampsia
when to evaluate edema
does not improve with rest
involves upper extremities, face, sacral region
earliest week that delivery is recommended with severe preeclampsia
34 weeks
drugs encouraged/recommended during pregnancy for HTN
methyldopa
labetalol
how to treat and prevent preeclampsia
magnesium sulfate when induction (at labor time) is initiated
loss of patellar reflexes
warmth feeling, flushing
slurred speech
muscle paralysis
respiratory difficulty
hypermagnesemia - Mag toxicity
treated with calcium gluconate
eclampsia means you now have…
seizures
HELLP
HTN in pregnancy
H: hemolysis E: elevated L: liver enzymes L: low P: platelet count
HELLP is MC in
multiparous pts
RUQ pain
N/V
General malaise
are all sx of…
HELLP syndrome
peripartum cardiomyopathy occurs in..
last month of pregnancy or within 6 months of delivery
dx test required for peripartum cardiomyopathy
ECHO
medication to avoid when treating peripartum cardiomyopathy
ACE-i
what is peripartum cardiomyopathy
dilated cardiomyopathy that presents in pregnancy with no demonstrable cause for heart failure/hx of heart disease
MC isoimmunization of the mother
delivery of baby/placenta
what is the Rh factors of mom? dad? in Rh incompatibility of pregnancy
Mom: Rh Neg
Dad: Rh Pos
isoimmunization of pregnancies requires administration of…
RhoGam
Death of fetus in utero > 20 weeks’ gestation
intrauterine fetal demise
- Absent fetal movement
- Decrease in pregnancy symptoms (e.g., nausea, breast tenderness)
- Vaginal bleeding
- Labor/contractions
signs and sx of intrauterine fetal demise
How to dx intrauterine fetal demise
U/S
MC reason for intrauterine fetal demise
unexplained
BEAU-CHOPS of maternal cardiac arrest
B: bleeding/DIC
E: embolism
A: anesthesia complications
U: uterine atony
C: cardiac conditions H: hypertension/preeclampsia O: others (5H's and 5T's) P: placenta previa/abruption S: sepsis
Shorter and less intense than true labor
Not associated with cervical dilation
Braxton-Hicks Contractions
Fetal head descends into maternal pelvis
Associated with increased pelvic pressure
Lightening
cervical thinning
effacement
Extrusion of mucus from endocervical glands
Bleeding from small vessels
Associated with cervical thinning (effacement)
Bloody show of maternal changes prior to labor
relation of fetal long axis to maternal long axis
fetal lie
position of fetus lowest in birth canal
fetal presentation
relation of fetal presenting part relative to maternal pelvis
fetal position
Cervical dilatation expressed in
centimeters
Cervical effacement expressed as
% of thinning
Level of presenting part relative to ischial spines
fetal station
Meconium is a sign of
fetal distress
edema of fetal scalp
Caput succedaneum
Episiotomy
cutting vaginal opening to enlarge it
MCC of postpartum hemorrhage
uterine atony
Absence of uterine muscle tone resulting in hemorrhage
uterine atony
abnormal labor
labor dystocia “difficult labor”
Leading indication for Cesarean delivery in the United States
labor dystocia
MC breech presentation
frank: butt first with hips flexed and knees extended
Maternal hips hyperflexed to increase AP diameter; usually accompanied by downward suprapubic pressure
McRobert’s maneuver for shoulder dystocia
common neuro finding with shoulder dystocia
brachial plexus injuries
Full term
Clear amniotic fluid; no meconium or purulent fluid
Spontaneous
breathing/crying
Good muscle tone
reassuring characteristics of the newborn
5 signs of apgar scoring
color HR reflex activity muscle tone respirations
when do you do apgar scoring
1 minute and then 5 minutes after delivery
then every 5 minutes all the way to 20 minutes if initial 5 minute score is <7
when does the umbilical cord fall off?
Sloughs off in 3-5 days
erythromycin in the eyes…
treats gonococcal infection
pulse < 100 bpm
provide positive pressure ventilation
Pulse < 60 bpm despite PPV
chest compression
pulse < 60 bpm despite PPV and chest compressions
give epi
MC source of bleeding for postpartum hemorrhage
uterine atony (80&)
how do you prevent uterine atony
nipple massage
nursing
uterine massage
administer oxytocin
must wait how long for sexual activity after birth
minimal 2 weeks postpartum
postpartum blues
occurs in 70-80%
mild, intermittent feelings of sadness, anxiety, anger
onset of 2-4 days and abates by 1-2 wks
postpartum blues vs. postpartum depression
interferes with daily functioning
worsens over weeks
unknown causes
Individuals with… are more likely to have ____
Personal history of depression/anxiety
Family history
Acute stressors
Child with difficult health issues
Depression in pregnancy (strong predictor)
postpartum depression
postpartum psychosis is a ….
medical emergency
