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MS3 Year > OB > Flashcards

OB Flashcards

1
Q

Name 9 conditions all associated with breech presentation

A

1) prematurity; 2) multip gest; 3) genetic disorders; 4) polyhydramnios; 5) hydrocephaly; 6) anencephaly; 7) placenta previa; 8) uterine anomalies; 9) uterine fibroids

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2
Q

Name 6 conditions associated with increased incidence of shoulder dystocia

A

1) fetal macrosomia; 2) maternal obesity; 3) DM; 4) postterm pregnancy; 5) prior should dystocia delivery; 6) prolonged second stage of labor

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3
Q

What qualifies as prolonged 2nd stage?

A

gt 3 hours (nulli)

gt 2 hours (multi)

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4
Q

What qualifies as prolonged latent phase?

A

gt 20 hrs (nulli)

gt 14 hrs (multi)

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5
Q

What qualifies as prolonged active phase?

A

slower than 1.5 cm/hr (nulli)

slower than 1.2 cm/hr (multi)

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6
Q

What qualifies as arrest of active phase

A

4 hrs of adequate ctx (200 mV in 10 mins)
or
6 hrs of all type

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7
Q

What is the most common type of breech (and the next two?)

A

Frank breech then footling, then complete

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8
Q

When is the fetus at greatest teratogenic risk?

A

Weeks 3-8

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9
Q

There is no increase seen in fetal anomalies or pregnancy losses with ionizing radiation exposure less than ___. Fetus is at greatest risk of exposure brown __ and __ weeks

A

5 rads; 8-15 weeks

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10
Q

Smoking increases the risk of these 5 serious complications

A

1) placental abruption; 2) placenta previa; 3) fetal growth; 4) preeclampsia; 5) infxn

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11
Q

Name 5 tocolytics

A

1) nifedipine; 2) terbutaline; 3) ritodrine; 4) magnesium sulfate; 5) indomethacin

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12
Q

Which two tocolytics are contraindicated in diabetic pts? Which one in myasthenia gravis?

A

terbutaline and ritodrine (terbutaline is no longer used to stop preterm labor in anyone); magnesium sulfate

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13
Q

___ (a tocolytic) is contraindicated at 33 weeks due to risk of premature __ closure.

A

Indomethacin; ductus arteriosus (also associated with oligohydramnios)

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14
Q

How does magnesium sulfate work as a tocolytic? Beta adrenergic agents? CCB? NSAIDs?

A

by competing with calcium entry into cells; increasing cAMP thereby decreasing free calcium; CCBs prevent calcium entry into muscle cells by inhibiting ca transport; NSAIDs block PG production

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15
Q

Name 3 side effects of magnesium sulfate and the order in which they appear. What is the antidote?

A

1) loss of DTR; 2) respiratory depression (12-15mg/dl); 3) cardiac depression (gt 15mg/dl)

calcium

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16
Q

Name 2 bad side effect associated with nifedipine.

A

fetal hypoxia and decreased uteroplacental blood flow

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17
Q

In addition to increasing pulmonary maturity and reducing the incidence of RDS in the newborn, betamethasone from 24-34 wks has been associated with a decrease in __ and __.

A

intracerebral hemorrhage; necrotizing enterocolitis

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18
Q

___ is an extracellular matrix protein that acts as an adhesive btwn the fetal membranes and the underlying decidua. Its presence in the cervical mucus btwn __ and __ weeks is thought to indicate a disruption to the __. It has a strong positive/negative predictive value only

A

fibronectin; 22-34 (it is normally found in cervical secretions in first half of preg); maternal-fetal interface; negative (if you have negative you have a 99/100 chance of not delivering in the next 14 days)

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19
Q

During delivery a fibrinogen is checked; what do you expect to see

A

fibrinogen should go up

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20
Q

if a pregnant woman is hypotensive, what is the first thing you do?

A

turn her on her left side (ivc compression)

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21
Q

what happens to a pregnant woman in regard to clotting?

A

clotting increases

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22
Q

what pulmonary function test gets worse (decreases) in pregnancy?

A

FRC

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23
Q

what is the expected change in hemoglobin in pregnancy?

A

blood volume increases but hgb (concentration) falls; normal is to nadir at 10

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24
Q

what happens to the tidal volume in pregnancy?

A

increases

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25
Q

what is the expected change in creatinine in pregnancy?

A

goes down

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26
Q

How do you treat GERD in a pregnant woman?

A

PPI

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27
Q

prior to pregnancy what vaccines should mom receive? What vaccine can mom NOT get once pregnant?

A

influenza, hep B, MMRV; MMRV

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28
Q

What vitamin should a woman who wants to get pregnant be on?

A

folic acid

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29
Q

Mom has HTN and wants to get pregnant. What do you put her on?

A

alpha methyl dopa (hydralazine, labetalol, nifedipine)

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30
Q

Mom is Rh-antigen positive, what do you put her on?

A

nothing

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31
Q

Pt has diabetes and wants to get pregnant, what do you do?

A

switch to insulin

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32
Q

What are the followup periods for pregnancy?

A

q4w until 28 wks, q2w until 36 wks, q1w until delivery

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33
Q

What is the quad screen for down syndrome?

A

increased: bHCG, inhibin
decreased: AFP, estriol

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34
Q

What is sequential screening?

A

1st then 2nd trimester screens - more unnecessary testing, more abortion advantage

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35
Q

What is combine screening?

A

1st and 2nd trimester screens at once - less unnecessary testing, less room for intervention

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36
Q

Nuchal translucency screen - when and for what?

A

1st tri screening for aneuploidy and spina bifida

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37
Q

What age is considered increased risk for aneuploidy? (AMA age)

A

35

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38
Q

Rh ? mom, Rh+ baby, Rh Ab-, what do you do?

A

Rhogam at 28 wks and w/in 72 hrs from delivery

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39
Q

How do you screen for gestational diabetes?

A

1 hr glucose tolerance test - 50g, sugar should be less than 140

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40
Q

For 3hr glucose tolerance test, what are the four glucose levels to look for?

A 
give 100g; fasting gt 95
1 hr gt 180
2hr gt 155
3hr gt 140
(need 2/4 to be positive)
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41
Q

What constitutes anemia in a pregnant woman?

A

hgb lt 10; hct lt 30

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42
Q

Rh ? mom, Rh + baby, what do you do?

A

check mom for antibodies

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43
Q

How do you test to confirm a pregnancy?

A

ultrasound

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44
Q

How do you treat fetal anemia?

A

PUBS and transfuse (PUBS = percutaneous umbilical cord sampling)

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45
Q

When do you get an amniocentesis? What can it show? What is the risk of loss?

A

16-20 wks; AFP, genetics, fetal lung maturity, assess for infxn; 0.5%

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46
Q

How do you screen for fetal anemia? How do you confirm?

A

transcranial doppler (highly sensitive); PUBS

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47
Q

When do you perform chorionic villous sampling? What can it show? What is the risk of loss?

A

10-13 wks; genetics, karyotyping; 1-3%

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48
Q

Which is more invasive, CVS or amniocentesis?

A

CVS

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49
Q

What medication can you use in pregnancy for hyperthyroid?

A

PTU

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50
Q

A pregnant woman has n/v so bad that she has electrolyte abnormalities, next step?

A

IV hydration (THEN work it up)

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51
Q

A woman gets pregnant and has hypothyroid, what do you do with her synthroid?

A

increase it (thyroid binding proteins are increasing) - trend TSH q4wks (instead of q12)

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52
Q

Who do you tx when you find a positive UTI without symptoms?

A

pregnant women only

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53
Q

Cystitis in pregnant woman, what do you give?

A

amoxicillin (nitrofurantoin if penicillin allergic) x 7d (complicated UTI!)

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54
Q

How do you diagnose diabetes BEFORE she gets pregnant?

A

A1c or 2 hr glucose tolerance test

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55
Q

Who do you screen with urinalysis?

A

pregnant women!

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56
Q

The thyroid has to come out. When is it safe for thyroidectomy?

A

2nd trimester

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57
Q

How do you tx pyelonephritis in a pregnant woman?

A

ceftriaxone - if no improvement after 3 days, U/S looking for abscess

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58
Q

Pregnant pt with epilepsy - what can you give to prevent seizures? What can you give to abort seizures?

A

levetiracetam or lamotrigine; phenobarbital or benzos (ok in late pregnancy)

folate for all women on AEDs looking to get pregnant!

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59
Q

Latent phase of pregnancy is __ to __ and should take no longer than __ (nulli) or __ (multi)

A

0cm to 6cm; 20 hrs; 14 hrs

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60
Q

Active phase of pregnancy is __ to __ and should take no longer than __ (nulli) or __ (multi), __ (max)

A

6cm to 10cm; 1.2cm/hr; 1.5 cm/hr; 5hrs

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61
Q

What is the beginning and end of stage 1 of labor

A

0cm w/contractions to 10 cm max dilation

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62
Q

What defines stage II of labor? How long should it take?

A

delivery of fetus - from max dilation 10 cm to fetus out; 3 hrs (nulli) or 2hrs (multi); add one hour for epidural

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63
Q

Breech birth + external version fails, whats next?

A

C section

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64
Q

Define stage III of labor. How long should it take?

A

delivery of placenta, from fetus out to placenta out; less than 30 minutes

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65
Q

Fetal station is the number of centimeters from the __

A

ischial spine

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66
Q

We can simulate head engagement with?

A

cervical ripening balloon (CRB)

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67
Q

If prolonged latent phase, how can you tx?

A

augmentation of labor (balloon, oxytocin, misoprostol, amniotomy)

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68
Q

Mom has been pushing for 3 hrs since maximum dilation, baby is still at station -1, next step?

A

assess for progress/descent of fetal head - if not progressing offer cesarean (this is how to tx prolonged 2nd stage with negative station)

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69
Q

Baby’s head can be seen just at the vaginal opening, but it’s been going for 4 hours (maternal exhaustion). Next step?

A

vacuum or forceps (this is how to tx prolonged 2nd stage with positive station)

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70
Q

Define arrest of active phase. How do you tx?

A

4hrs of adequate ctx (gt 200 mV) or 6 hrs all comer. If decreased frequency or adequacy, oxytocin; everything else: C/S

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71
Q

What is considered adequate frequency of contractions in labor?

A

3 ctx in 10 mins = good; less than 3 in 30 mins is bad (this tells you nothing about the power of the ctx)

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72
Q

What are the 3 ways to tx prolonged stage 3 of labor?

A

1st: uterine massage; 2nd: oxytocin; 3rd: manual extraction

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73
Q

Mom has a fever after delivering baby 6 hrs ago, placenta out came 5.5 hours ago, diagnosis and next step?

A

endometritis - antibiotics (gentamicin + ampicillin)

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74
Q

Mom has had ROM and she’s been laboring for 20 hours. She’s progressing, just slowly - diagnosis and next step?

A

prolonged ROM (gt 18 hrs!); give GBS ppx (ampicillin) - watch out for endometritis and chorioamnionitis

75
Q

A woman at 20 gestational weeks has a rush of fluid, her membranes are ruptures, diagnosis and next step?

A

previable PPROM - counsel on expectant mgmt vs delivery; counsel on risk of infxn

76
Q

Mom has a rush of fluid, she is at 38 wks, but not contracting, diagnosis and next step?

A

PROM (premature rupture of membranes); GBS ppx if indicated; induce labor

77
Q

A woman at 30 wks has a rush of fluid, her membranes are ruptured. Diagnosis and next step?

A

PPROM (preterm premature ROM); steroids for fetal lung maturity (betamethasone) and antibiotics for latency

Infxn is usually cause for PPROM

78
Q

How do you treat PPROM?

A

gt 34 weeks = deliver
24-34 wks = cortiocosteroids
lt 24 wks = nonviable

79
Q

What does premature in PROM mean?

A

absent contractions

80
Q

Name 4 ways to confirm ROM

A

1) speculum shows pooling of fluid; 2) nitrazine test turns blue; 3) fern sign on a glass slide; 4) can also do U/S for AFI (shows oligo)

81
Q

A woman at 38 wks has a rush of fluid, her membranes are ruptured, next step?

A

Deliver!

82
Q

Mom has contractions at 28 wks, but there is no cervical change, and then they stop, diagnosis?

A

Braxton hicks (ctx, but not labor)

83
Q

At 42 wks mom still hasn’t delivered; what do you do? What is called when baby is gt 42 wks? Name 5 fetal risks

A

induction of labor, if that fails C/S; post dates; 1) macrosomia; 2) shoulder dystocia; 3) meconium aspiration; 4) fetal demise; 5) oligohydramnios

84
Q

Mom has ct. at 28 wks. There are cervical changes, diagnosis and next step?

A

Preterm labor; give mag sulfate (for neuroprotection); give steroids (for lung maturation) and can also give tocolytics (just really to get mom to a tertiary center)

85
Q

Name 6 causes of preterm labor

A

1) idiopathic; 2) smoking; 3) young maternal age; 4) preterm mom; 5) anatomical (short cervical length); 6) multiple gestations (twins)

86
Q

Proteinuria in pregnancy + HTN, diagnosis?

A

pre-eclampsia (look for severe features)

87
Q

Pregnant woman seizing who does not have epilepsy, next step?

A

Mag, benzos, and deliver (eclampsia)

88
Q

BP gt 160/110 in pregnancy, no HTN at baseline, diagnosis?

A

gestational HTN vs preeclampsia - look for proteinuria

89
Q

Name 7 alarm sxs that earn you preeclampsia with severe features

A

1) decreased plts; 2) increased LFTs; 3) RUQ abdominal pain; 4) increase creatinine (gt 1.1 or 2x baseline); 5) pulmonary edema; 6) HA/vision changes; 7) BP gt 160/110

90
Q

Why might you get RUQ abd pain and increased LFTs with preeclampsia?

A

There is a stretch of glisson’s capsule leading to decreased blood flow to the liver, leading to increased LFTs; pain is due to inflammation and stretching of the capsule around the liver

91
Q

HA, vision change, HTN in pregnancy, diagnosis and next step?

A

pre eclampsia with severe features; tx with Mag and deliver

92
Q

RUQ pain and HTN in a pregnant woman, diagnosis?

A

Pre-E

93
Q

How do you tx Pre-E without severe features? With severe features? Eclampsia?

A

antenatal testing, deliver at 37 wks if stable; Mag + BP monitor + deliver urgently (induce); Mag + deliver emergently (section)

94
Q

You get a lab question about a delivery: INR is elevated, plts are low, fibrinogen is low/normal and hub is low. Likely dx?

A

DIC

95
Q

How do you tx Pre-E without severe features and gt 37 wks

A

deliver

96
Q

You get a lab question about a pregnant woman, AST and ALT are up, the plts are down, the hgb is low, dx and next step?

A

HELLP; Mag and deliver emergently (section)

97
Q

What is the primary risk factor for preterm ROM? Name 3 other risk factors

A

genital tract infxn (especially assoc w/bacterial vaginosis); smoking, previous premature ROM, shortened cervical length

98
Q

Variable decelerations are a result of ___, which is frequently caused by a lack of ___.

A

cord compression; lack of amniotic fluid (can be seen with oligohydramnios or PPROM)

99
Q

In some cases of preterm ROM, amniocentesis may be performed to detect intra-amniotic infxn. A low __ is an indication of infxn. The presence of __ has the lowest predictive value for the dx of chorioamnionitis

A

amniotic fluid glucose; amniotic leukocytes

100
Q

What can be administered weekly (starting btwn 16-20 wks to 36 wks) to reduce the risk of premature labor?

A

17-alpha-hydroxyprogesterone

101
Q

Prostaglandins are used for cervical ripening and are contraindicated in pts with previous hx of __ b/c of increased risk of uterine rupture

A

cesarean delivery

102
Q

Name 5 initial measures to tx fetal hypo perfusion (late decels)

A

1) change in maternal position to left lateral position (which increases perfusion to uterus); 2) maternal supplemental oxygenation; 3) tx of maternal hypotension; 4) discontinuation of oxytocin; 5) intrauterine resuscitation w/tocolytics and IV fluids

103
Q

Amnioinfusion may be used in pts with __

A

variable decelerations

104
Q

What is the most common cause of post partum hemorrhage?

A

uterine atony

105
Q

Name 4 of 9 risk factors of uterine atony

A

1) precipitous labor; 2) multiparity; 3) general anesthesia; 4) oxytocin use in labor; 5) prolonged labor; 6) macrosomia; 7) hydramnios; 8) twins; 9) chorioamnionitis

106
Q

Factors that lead to a __ are risk factors for uterine inversion. Name 4. But what is the most common risk factor?

A

over distended uterus; 1) grand multiparity; 2) multiple gestation; 3) polyhydramnios; 4) macrosomia;

excessive (iatrogenic) traction on the umbilical cord

107
Q

Name 3 risk factors for genital tract lacerations

A

1) precipitous labor; 2) macrosomia; 3) instrument assisted delivery or manipulative delivery (i.e. breech extraction)

108
Q

Name 4 uterotonics (used to increase contractions and decrease uterine bleeding).

A

1) methergine (methylergonovine); 2) prostaglandins (cervidil = dinoprostone = PGE2; hemabate = carboprost = prostaglandin F2alpha); 3) misoprostol (PGE1); 4) oxytocin

109
Q

Which uterotonic should be withheld in pts with HTN and/or preeclampsia? Asthma?

A

methergine; hemabate (carboprost, PGF2alpha)

110
Q

A risk factor for placenta accreta is ___.

A

multiple prior c sections

111
Q

Name 4 risk factors associated with retained placenta

A

1) prior cesarean delivery; 2) uterine leiomyomas; 3) prior uterine curettage; 4) succenturiate lobe of placenta (smaller accessory placental lobe separate from the main disc of the placenta)

112
Q

When is a B lynch suture used?

A

it is a uterine compression suture used in mgmt of unresponsive uterine atony (requires laparoscopic surgery)

113
Q

What is the risk for mono/mono twins?

A

cord entanglement/accident

114
Q

For conjoined twins, when did the eggs split?

A

greater than day 12

115
Q

Name 4 risks of ALL multiple gestations

A

1) preterm; 2) malpresentation; 3) C/S; 4) PPH

116
Q

Identical twins, 2 placentas, 2 sacs - when did the egg split?

A

Day 0-3

monochorion diamnion split 4-8

117
Q

What added risk does monozygotic, mono-chor, and di-amniotic have?

A

twin-twin transfusion

118
Q

Which baby does better in twin-twin transfusion?

A

the transfuser (the little one) - the acceptor has polycythemia which can result in bilirubinemia

119
Q

What added risk does mono-zy, mono-chor, mono-amnio have?

A

coinjoined twins, cord entanglement

120
Q

Post partum hemorrhage and nonpalpable uterus, dx?

A

uterine inversion

121
Q

PPH that cannot be controlled with meds, next step?

A

surgery - ligate arteries

122
Q

When do you do a hysterectomy in the setting of PPH?

A

severe instability or failure of all other options

123
Q

How do you tx uterine inversion?

A

replace funds with pressure - may need to relax uterus (tocolytics)

124
Q

Placenta has vessels to the edge, next step?

A

suspected retained placenta - U/S

125
Q

PPH and a firm uterus, next step?

A

U/S for retained placenta

126
Q

PPH and a boggy uterus, dx?

A

uterine atony

127
Q

What is the goal accelerations you are looking for?

A

15x15, 2 in 20 (before wk 32 its 10x10)

128
Q

Mom can’t feel baby kicking, no accelerations on NST, next step?

A

vibroacoustic stim test

129
Q

Biophysical profile lt 4, next step?

A

deliver

130
Q

Variable decels, what’s the likely dx? Early decels? Late decels?

A

cord compression; head compressions; uteroplacental insufficiency

131
Q

Mom can’t feel baby kicking, next step?

A

NST - accelerations are good

132
Q

Vessels run to the edge of placenta surface over cervical os, dx?

A

vasa previa

133
Q

What do you do for a uterine rupture?

A

Emergent c/section

134
Q

How do you diagnose an abruption?

A

clinically and u/s

135
Q

Baby is in a transverse lie, question about bleeding, dx?

A

placenta previa

136
Q

MVA and 3rd tri bleeding, dx?

A

placental abruption

137
Q

Cocaine, HTN, and 3rd tri bleeding, dx?

A

placental abruption

138
Q

Painless 3rd tri bleeding, dx?

A

placenta previa

139
Q

Contractions, lots of pain, contractions stop, uterus is no longer firm, dx?

A

Uterine rupture (also look for detail about loss of fetal station in stem)

140
Q

Rh-Ag-Neg mom, Rh-Ag-Neg dad, what’s risk to baby?

A

None

141
Q

Rh-Ag-Neg mom, Rh-Ag-Pos daad, what’s the risk?

A

Mom will prime against the NEXT baby

142
Q

Rh-Ag-Pos mom, Rh-Ag-Pos dad, what’s the risk?

A

None (mom is Ag+ so she can never develop Ab)

143
Q

Rh-Ag-Neg mom, Rh-Ag-Pos dad, mom’s first pregnancy, what do you do?

A

Rh-immune globulin (Rhogam) at week 28 and within 72 hours of delivery

144
Q

When do you deliver a fetus with fetal anemia?

A

Transcranial doppler screen is positive and GA is gt 32 wks

145
Q

When do you PUBS and transfuse fetal anemia

A

transcranial doppler screen is positive and GA is lt 32 wks

146
Q

List the tx for group B strep

A

Ampicillin, cefazolin (if pen allergic), clinda (if pen anaphylaxis), vanco (if can’t tolerate any of above)

147
Q

Who gets intrapartum antibiotics for group B strep (3 groups)?

A

If GBS positive ever. Prolonged ROM, intrapartum fever

148
Q

Hep B core ANTIBODY means what?

A

They’ve been exposed (unsure if active infxn or immune - look for Hep B surface antibody)

149
Q

Hep B positive mom, what do you do for baby?

A

IVIG and vaccine at birth (no evidence C/S reduces vertical transmission)

150
Q

Mom giving birth, HIV positive, next step?

A

AZT during birth

151
Q

Tx for late latent syphilis? Tertiary syphilis? Secondary syphilis? Primary syphilis? Early latent syphilis?

A

penicillin IM qwk x 3; penicillin IV x 7-10 days; penicillin IM x 1; penicillin IM x 1; penicillin IM x 1

152
Q

When it’s not clinical, make the diagnosis of HSV using ___.

A

PCR (never the tzanck prep)

153
Q

What test do you use to diagnose primary syphilis? Tertiary syphilis? secondary syphilis?

A

Darkfield microscopy (pick “gram stain”); CSF VDRL; RPR to FTL-antibodies

154
Q

Painful prodrome, vesicles on an erythematous base suggests?

A

HSV

155
Q

Tx of tertiary syphilis in a pregnant woman allergic to penicillin?

A

Penicillin IV x 7-10 days (give it anyways! desensitize)

156
Q

Tx for herpes simplex virus in a pregnant woman?

A

(Val)-acyclovir

157
Q

What is a risk of vacuum suction delivery?

A

fetal: cephalohematoma
maternal: catching vagina in suction can cause vaginal trauma

158
Q

What’s wrong with opiates for pain control in labor?

A

They go to baby

159
Q

Cephalohematoma = ?

A

Complication of vacuum delivery, hemorrhage beneath periosteum (will not cross suture line)

160
Q

Why/when do you cerclage?

A

Dx of cervical insufficiency; usually placed in second tri

161
Q

Station +2, fetal distress, what do you use?

A

forceps or vacuum

162
Q

When do you undo the cerclage?

A

by 36 wks, or if labor begins

163
Q

What do you need if you do epidural?

A

tocodynamometer (she can’t feel ctx anymore)

164
Q

What is female surgical contraception? Male?

A

tubal ligation; vasectomy

165
Q

What are two major contraindications to OCPs?

A

gt 35 yo and smoking (increased risk of DVTs!)

166
Q

What is the emergency contraception for condom failure/rape?

A

Plan B = levonorgestrel, or ella = ulipristal, or copper IUD

167
Q

Postpartum fever day 0, 1-2, 2-3, 4-5, 5-6, 7-21

A

0: atelectasis
1-2: UTI
2-3: endometritis (risk factors c/s after prolonged ROM and prolonged labor)
4-5: wound infxn
5-6: septic thrombophlebitis or pelvic abscess (pelvic mass)
7-21: infectious mastitis

168
Q

How do you manage a pt with septic thrombophlebitis?

A

IV heparin for 7-10 days, keeping PTT values at 1.5-2x baseline

169
Q

Postterm pregnancies are associated with these 4 things

A

1) placental sulfatase deficiency; 2) fetal adrenal hypoplasia; 3) anencephaly; 4) inaccurate or unknown dates

170
Q

Define postterm pregnancy; define late term

A

postterm: gt/= 42 0/7

late-term: 41 0/7 to 41 6/7

171
Q

Fetus is born and is withered, meconium stained, long nailed, fragile, and has an associated small placenta. What is this called and who do you see it in?

A

Dysmaturity; postterm pregnancies

172
Q

The systolic/diastolic (S/D) ratio of the umbilical artery is determined by __. An increase in the S/D ratio reflects increased __. It is a common finding in __ fetuses.

A

doppler u/s; vascular resistance; IUGR

increased S/D associated with increased rate of perinatal morbidity and mortality

173
Q

IUGR is a significant risk factor for the subsequent development of diseases as an adult such as these 6

A

1) CV disease; 2) chronic HTN; 3) stroke; 4) chronic obstructive lung disease; 5) type 2 DM; 6) obesity

(asthma, cardiomyopathy, and type 1 DM are not associated with IUGR)

174
Q

Macrosomia is defined as a fetus greater than ___. A fetus with biparietal diameter greater than __, could benefit from a C/S

A

4000 grams; 12 cm

175
Q

What complication is less likely to occur with a vacuum then with forceps delivery?

A

maternal laceration

176
Q

External cephalic versions and internal versions are contraindicated in ___. Instead, if baby is breech, do a __.

A

active labor; c/s

177
Q

What are the four signs of placental separation?

A

1) gush of blood; 2) lengthening of the cord; 3) globular-shaped uterus; 4) uterus rising to the anterior abdominal wall

178
Q

Hyperemesis gravidarum is a severe persistent form of n/v of pregnancy that results in __, __, and __. Name 3 risk factors.

A

weight loss of gt 5% pre pregnancy weight; electrolyte abnormalities; ketonuria
1) multiple gestation; 2) hydatidiform mole; 3) hx of esophageal reflux
(HG is typically unresponsive to anti-emetics

179
Q

Name 7 contraindications to external cephalic version

A

1) indications for C/S delivery regardless of fetal lie; 2) placental abnormalities (prevue or abrupt); 3) oligo; 4) ROM; 5) hyperextended fetal head; 6) fetal or uterine anomaly; 7) multiple gestation

180
Q

Name 5 risk factors of postpartum endometritis. What’s the tx?

A

1) C/S; 2) chorioamnionitis; 3) group B strep colonization; 4) prolonged ROM; 5) operative vaginal delivery;
clinda + gentamicin

181
Q

Which antibiotic is given for lactation mastitis?

A

dicloxacillin

182
Q

To dx proteinuria for preeclampsia, you need a __ or __.

A

urine protein to cretatinine ratio of gt/= 0.3 or a 24-hr urine collection for total protein of gt 300mg

183
Q

Name 6 contraindications to breast feeding

A

1) active untreated TB; 2) maternal HIV infxn; 3) herpetic breast lesions; 4) active varicella infxn; 5) chemo or RT; 6) active substance abuse

MS3 Year (18 decks)

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