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SG F3 E5 > OB 5 > Flashcards

OB 5 Flashcards

1
Q
  • Rh+ means what?
  • Rh- means what?
  • Rh incompatibility is referred to as what?
A
  • Rh+ = D antigen is present
  • Rh- = D antigen is absent***
  • Alloimmunization (maternal immune system exposed to Rh+ RBC from fetus. Incidence ↑ w/ subsequent pregnancies)
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2
Q

Rh antigens can cross placenta freely. Rh- mother develops antibodies to the Rh+ antigens. Maternal antibodies do what?

A

Maternal antibodies cross the placenta and fetal RBC hemolysis occurs (causes fetal death)

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3
Q

What is the method of prevention for Rh- moms?

A

RhoGAM is Rh immunoglobulin which attaches to Rh+ antigen and prevents mother’s immune response

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4
Q

RhoGAM is only administered to mother who are not what?

A

Alloimmunized (maternal immune system already exposed to Rh+ RBCs)

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5
Q

When is RhoGAM given?

A

1st dose: 28 weeks (prophylaxis)

2nd dose: within 72 hours of delivery of Rh+ infant

Or… at time of:

  • Amniocentesis
  • Ectopic pregnancy
  • Spontaneous or induced abortion
  • Bleeding during pregnancy
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6
Q

What are the 2 main risks to the fetus w/ Rh Incompatibility?

A
  • Anemia
  • Hyperbilirubinemia
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7
Q

Hemolytic Disease of the Newborn

A

Erythroblastosis Fetalis (Anemia) d/t Rh Incompatibility

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8
Q

Edema, cardiac failure

Severe and often fatal in utero

A

Hydrops Fetalis (anemia d/t Rh Incompatibility)

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9
Q

Toxic levels of unconjugated bilirubin

A

Kernicterus (hyperbilirubinemia d/t Rh Incompatibility)

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10
Q

Physiologic Jaundice of newborn

A

Hyperbilirubinemia (d/t Rh Incompatibility)

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11
Q

How should you manage maternal alloimmunization?

A

As a PA you will not manage these patients. REFER to perinatologist!

They will follow maternal anti-D titers to assess risk for Hemolytic Disease of Fetus or Newborn (HDFN)

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12
Q

What is the tx for Hemolytic Disease of Fetus or Newborn (HDFN)?

A

Intrauterine Transfusion

Early delivery

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13
Q

Which type of breech?

  • Both hips flexed with knees extended so feet are adjacent to head (50 -70%)
A

Frank Breech

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14
Q

Which type of breech?

  • Both hips and knees are flexed (5 -10%)
A

Complete Breech

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15
Q

Which type of breech?

  • One or both hips are NOT completely flexed (10 – 40%)
A

Incomplete Breech

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16
Q

What is the MC type of breech?

A

Frank (both hips flexed & knees extended)

17
Q

When during gestation do most breech presentations occur?

A

Prior to 28 weeks (25%)

Next MC is 32 weeks (16%)

Only 3-4% occur at term

18
Q

What are some RF of Breech?

A

◦Pre-term gestation

◦Prior breech presentation

◦Uterine abnormality (fibroid, bicornuate uterus)

◦Placental abnormality (previa)

◦Multiparity

◦Extremes of fluid volume (↓ Vs ↑)

◦Advanced maternal age

◦Contracted maternal pelvis

◦Fetal anomaly (hydrocephaly, ancephaly)

19
Q

How is breech diagnosed? (2)

A
  • Palpate soft mass (buttocks) in the lower uterine segment (absence of fetal skull)
  • US will confirm fetal head at the fundus
20
Q

What is treatment for breech presentation?

(2)

A
  • External cephalic version at 34-35 weeks (usually does not work)
  • C-section (this is usually the tx)
21
Q

What is cord prolapse?

A

Umbilical cord slips AHEAD of the presenting part of fetus, protruding into the cervical canal/vagina

22
Q

Cord Prolapse is considered an obsterical emergency since the cord is vulnerable to compression causing what 3 things?

A
  • Umbilical vein occlusion
  • Umbilical artery vasospasm
  • ↓ fetal oxygenation
23
Q

What is the etiology of cord prolapse?

A

High outward flow of amniotic fluid vs. disengagement of presenting part

24
Q

How is cord prolapse diagnosed? (2)

A

Visualization

Palpation of umbilical cord ahead of presenting part

25
Q

What are the 5 maternal RF of cord prolapse?

A
  1. Prolonged labor
  2. low lying placenta
  3. pelvic deformities
  4. uterine anomalies
  5. polyhydramnios
26
Q

What are the 4 fetal RF of cord prolapse?

A
  1. prematurity
  2. malpresentation
  3. low birth weight
  4. second twin
27
Q

What are 6 obsterical interventions which can cause cord prolapse?

A
  • Iatrogenic rupture of membranes
  • cervical ripening with balloon catheter
  • induction of labor
  • manual rotation of fetal head
  • application of scalp electrode
  • Application of intrauterine pressure catheter
28
Q

What is tx for Cord Prolapse

A

Emergent C-section

29
Q

Describe a Cesarean Section?

A

Delivery of fetus through incision in abd wall (laparotomy) & uterine wall (hysterotomy)

30
Q

What is the MC type of C-section?

A

Low transverse cesarean section (incision made in lower uterine segment)

31
Q

What would a “classical c-section” be performed?

Describe it.

A

In cases of pre-maturity bc/ lower segment is not developed or if fetal position precludes its use

(Vertical incision in upper contractile portion of uterus)

32
Q

What are 6 indications for a C-section?

A
  1. Fetal distress
  2. Prior breech (incidence increases w/ each pregnancy)
  3. Transverse lie
  4. Dystocia or failure to progress (difficult to get baby out)
  5. Prior C-section (pt may not want “trial of labor or V-back”)
  6. Uterine malformations (placenta previa)
33
Q

What is dystocia?

A

Cervix fails to dilate progressively over time and fetus fails to descend

34
Q

What are the 3 etiologies of Dystocia?

A
  • Pelvis: cephalopelvic disproportion (pelvis not large enough to allow infant to pass)
  • Power: inadequate uterine contractions (needed to dilate cervix & expel infant)
  • Passenger: abnormal fetal lie, presentation, or large head
35
Q

3 RF of dystocia?

A
  • Prolonged interval between pregnancies
  • Primigravid birth
  • Hx of multiple births
36
Q

4 complications of Dystocia?

A
  • Fetal death
  • Resp depression
  • Hypoxic ischemic encephalopathy
  • Brachial nerve damage
37
Q

Cervix fails to dilate and fetus fails to descend.

Pelvis isn’t large enough.

Uterine contractions are not powerful enough.

Fetus has large head.

What is dx and tx?

A

Dystocia

  • Oxytocin
  • Forceps
  • Vacuum
  • C-section (last resort)
38
Q
A

SG F3 E5 (23 decks)

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