OB Flashcards
Heavy blood loss during delivery (hypotension / blood transfusion)
Lactation failure, amenorrhea, weight loss, lethargy, hyponatremia, hypotension
Sheehan syndrome (postpartum pituitary infarction) -> hypopituitarism (low prolactin, FSH/LH etc)
Amniotic fluid embolism
Sx and tx?
Risk factors?
Cardiogenic shock, hypoxemic resp failure, DIC, seizures, coma
Tx: supportive care
Woman in labor with active HSV… what to do?
C section!
Ultrasound shows thin endometrial stripe
Makes what unlikely?
Suggests empty and normal uterine cavity
Retained placenta unlikely
Most common cause of Postpartum hemorrhage
Soft (boggy) and enlarged uterus
Atony
First line Treatment for uterine atony
Second line?
Oxytocin and bimanual massage
Second line is methylergonovine, but contraindicated for hypertension
Or carboprost but contraindicated for asthma
Antihypertensives in pregnancy
Labetalol, hydralazine, methyldopa, nifedipine
Don’t use ace and arbs
Don’t volume deplete, so don’t use thiazides or loops
Oxytocin overdose leads to
Hyponatremia (bc oxytocin similar to ADH)
Hypotension
Tachysystole
What is HELLP
Preeclampsia with:
Hemolytic anemia
Elevated Liver enzymes
Low Platelets
Pathogenesis: hepatic and systemic inflammation, activation of coagulation, platelet consumption
Treatment of HELLP
If >=34 weeks, OR abnormal fetal testing or severe/worsening maternal status, just DELIVER!
Mg for seizure prophylaxis
Antihypertensive drugs
Fetal growth restriction, symmetric vs asymmetric
Early insult -> everything small
Late insult -> asymmetric (“head-sparing” growth lag because head grew first)
When to give Rhogam
To D-negative woman with negative antibody screen
Give at 28-32 weeks gestation and again after delivery if baby is Rh+
breastfeeding contraindications
active untreated TB maternal HIV herpetic breast lesions active varicella infection chemo/rad active substance abuse (including marijuana)
Can still breastfeed with Hep B or C infection! :-O
Definition of preeclampsia
New onset HTN (sBP>140 OR dBP>90) at 20 weeks
+ proteinuria (>300mg/24hr, Urine protein/creatinine ratio>0.3, or dipstick>1+)
and/or end-organ damage
What is criteria for proteinuria in preeclampsia vs nephrotic syndrome?
preeclampsia >300mg/24hr
nephrotic syndrome >3g/24hr
what are the features in “preeclampsia with severe features?”
ANY of:
sBP>160 OR dBP>110 (both 20 higher than HTN cut-off) thrombocytopenia increased Cr increased transaminases pulmonary edema visual/cerebral symptoms
tx for maternal hypertensive crisis
IV labetalol, IV hydralazine, or PO nifedipine
Note: labetolol is a b blocker, so don’t give if pt is bradycardic
most common cause of neonatal sepsis
GBS
treatment fof postpartum endometritis
polymicrobial, use clinda + gent
treatment of syphilis in penicillin-allergic, pregnant vs. nonpregnant
pregnant: desensitize after skin test (if IgE+), then use penicillin
non-pregnant: can use doxy (can’t use in preg)
Postop/postpartum
Persistent fever unresponsive to antibiotics
No uterine tenderness, no lochia
Septic pelvic thrombophlebitis (thrombosis of deep pelvic or ovarian veins)
Tx: anticoagulation and broad-spectrum antibiotics
Not endometritis
1st trimester combined test
PAPP-A, nuchal transparency, HCG
Quad screen
(At halfway mark)
AFP, estriol, HCG, inhibin A
All low for trisomy 18 (Edwards)
AFP, estriol low, HI (HCG, inhibin) high in Down’s
AFP high in neural tube defects, gastroschisis, omphalocele
Umbilical artery Doppler in IUGR
Flow reverses!
AFI cutoff for oligohydramnios
5
Pre-eclampsia (+severe features)
140/90 + 300mg protein
Severe if: 160/110 Protein > 5000mg Headache Scotomata/blurred vision Hyperreflexia RUQ pain, LFT elevation low PLTs hemolysis
(HELLP = hemolysis, elevated LFTs, low PLTs)
Eclampsia
Pre-eclampsia + SEIZURES
Side effects of Mg for seizure prevention in pre-eclampsia
Neuromuscular depression —> respiratory paralysis. Monitor DTRs!
If toxicity, give Ca gluconate
