OB Flashcards
SECONDARY AMENORRHEA 2 MOS:
OFFICE
FIRST PRENATAL VISIT
MORNING SICKNESS
IWU:
Q-BHCG
U-KETONES: IVA, NSS, PHENERGAN, CHLOROP, ANTI 5HT3, FREQ SMALL WARM MEALS….
WT
FM:
PELVIC US
TSH
FIRST VISIT WU:
CBC UA U C&S RUBELLA IgG U NAAT G C ATYPICAL Ab KELL DISCUSS AFP HIV ELECTROP Hb RPR
FU
e/ 4 wks TO 28 Wks
e/ 2 wks TO 36 Wks
Then Wkly
PREGNANCY COUNSEL
TOBACCO
ALCOHOL
GESTORRHAGIA FISRT HALF:
ER-INPATIENT
DDX:
ABORPTION
ECTOPIC
MOLE
IWU
Q BHCG CBC PELVIC US BLOOD TYPE ATYPICAL Ab COAGULATION PROFILE
FWU:
THREATENED OR COMPLETE OS CLOSED: REASSURE
INEVITABLE INCOMPLETE: OS OPEN: NPO, IVA, NSS, OB GYN CONS, METHYL ERGONOVIN, D AND C, CEPHAZOLIN,FOLEY,CXR-EKG PREOP……..
RHOGAM - 72 HRS
GRIEF
PLANIF FAMIL
FU
Q BHCG TO ZERO
GESTORRHAGIA FIRST HALF
PE: ADNEXAL R TENDER
ER-INPATIENT
DDX:
ECTOPIC ABORPTION ENDOMETRIOSIS APPY PID OVARIAN CYST FOLLICULAR
IWU
Q BHCG: 1500 = 5 Wks. CUTOFF TO SEE VAG US
VAG US: 1500 AND YOU DON’T SEE = ECTOPIC
BLOOD TYPE
CBC
FM:
Q BHCG: FAILS TO DOUBLE 2 DYS BASELINE= ECTOPIC
IV MTX: CUTOFF 5000 U AND 3.5 CM
SURGERY:
STABLE-PARITY:
LAP VS OPEN
LINEAR OSTOMY VS ECTOMY
FU
Q BHCG TO ZERO
GRIEF
…..
POST ABORTAL ENDOMYOPARAMETRITIS
RETAINED PRODUCTS:
ER-INPATIENT
IWU:
CBC Q BHCG: 1800 UA BLOOD, U ,CERVICAL C&S ABG BLOOD TYPE COAGULATION PROFILE
FM:
D AND C: PREOP - NPO, IVA, NSS, OB GYN, STOCKING COMPRESS, EKG CXR …..
AMPICILLINA - GENTA Y CLINDA: AEROB Y ANEROB
30 YO 17 WKS
AFP 3 XXX
PE: UTERO UMBLICAL
DOPPLER HEART 155 MIN
DDX
DATING ERROR MMF
NTD VENTRAL ABD MULTIPLE PLACENTAL NEPHROSIS CONG DEMISE
IWU:
OB US DATING : BD -AC - FL
FM:
GENETIC COUNSELING
ACT: AFP MORE PPV, ACETYL CHOLINESTERASE
KARYO
FIRST PRENATAL VISIT
O NEG 31 G2P1 12 wks. O>: AB POS CHILD: B POS
DDX
ISOINMUNIZATION
IWU
ANTI D TITERS > 1:8
LOUIS IS HARMLESS
ATYPICAL KELL Ab: POSITIVE 1:2
FM:
ANTI KELL MONTHLY
ANTI KELL TITER 1:8 = ANEMIA
PCUS OR ACT
FU:
RHOGAM: 28 WKS + , 72 HRS IF KELL TITERS < 1:8
35 YO 16 WKS DISTANT RELATIVE DOWN SYN CONCERN WANTS TO AVOID INVASIVE PROCEDURES SEIZURE DISORDER - VALPROATE
DDX
ADVANCED MATERNAL AGE
PRENATAL DZ TRISOMY 21
NTD
IWU
TRIPLE MARKER
VALPROATE LEVEL
FM QUADRA GENETIC COUNSELING INCREASES NTD, VALPROATE, GENETIC SONOGRAM BDP, HC, CA FL NUCHAL TRANSLUC SKIN FOLD
CELL FREE DNA
CVS FROM 9 TO 15 W
ACT AFP - KARYOT
COUNSELING REGARDING PREGNANCY MGMT OPTIONS
GESTATIONAL DIABETES SCREENING
DZ X
FALSE POSITIVE DIABETES SCREEN
1 HR OGT 15% FALSE POSITIVE RULE IN SENSITIVITY
PRE GESTATIONAL OG INTOLERANCE
IWU
RULE OUT SPECIFICITY
3 HRS 100 OGT
DZ 2 OF 3
EDUCATION
HOME GLUCOSE MONITORING
WKLY PRENATAL OFFICE
MONTHLY US
GESTATIONAL DIABETES
FAILED DIETARY THERAPY
MACROSOMIA
IWU OUTPATIENT INSULIN THERAPY GOAL FAST: 90 2HRS: 120
FM
START AT 32 WK
2 TIMES / WK: NON STRESS TEST, AFI, BIOPHYSICAL PROFILE
C-SECTION 4000 gr OR 4500 gr NON DIABETES
MACROSOMIC INFANT OF A DIABETIC MOTHER WITH A BRACHIAL PLEXUS INJURY.
DZ DYSFUNCTIONAL ACTIVE PHASE 1.2 CM/HR NULLIPARES 1.5 CM/HR MULTIPARES MC ROBERT's VACUUM ASSISTED 4600 gr
MONITOR NEONATE
HYPOGLYCEMIA
HYPOCALCEMIA
POLYCITEMIA
ARDS
POST PAR-TUM ATONE OVER DISTENSION
FU:
FSB 6 WKS AFTER TYPE II DM
SMALL FOR DATES
UH: 28 + GA 33 WK.
DZ:
MORE THAN 3 CM DIFFERENCE
AFI:
8 TO 25
5 TO 8 BORDER
< 5 OLYGO
DZ X
ASYMMETRIC INTRAUTERINE GROWTH RESTRICTION
CHRONIC HTN
IWU
OB US
DATING ERROR HC BPD AC LF
AFI , HR, BREATHING, MOV,
FM
NST: REACTIVE
SERIAL: NST, AFI, BPP - WEEKLY
SERIAL e/ 2 WK US - FUNDAL HEIGHT
DELIVER IF COMPROMISE EVIDENT
ASSES IF TOLERATE LABOR: STRESS TEST
IM BLEEDING
BRIGHT RED
PREVIOUS C/S BREECH
COCAINE USE
DZ X PLACENTA PREVIA - MLD VASA PREVIA 3: ROM + BLOOD + FETAL BRADI ABRUPTIO RUPTURE BLOODY SHOW LOWER GENITAL TRACT LESION
IWU:
OB US: BPP, AFI
CBC
TYPE AND SCREEN
FM DO NOT PERFORM PELVIC EXAMINATION IVA RBC 2 UNITS FOLEY U OUTPUT FM KLEIHAUER BETKE PAD COUNT FU: SERIAL CBC MATERNITY IN PATIENT UNIT
PATH:
PROSTAC - TXA IMBALANCE VASOCONSTRICTION
DZX
PREECLAMPSIA SPECTRUM : MILD —– SEVERE
TRANSIENT: NORMAL LAB, ONSET > 20 W
HELLP
CHRONIC HTN
TARGET LESIONS
BE 4 20 WKS
IM
BPM / 15 MIN
R/O: DIC AND ASSESS BPP
IWU:
UA U TOXICOLOGY PT,PTT HTO ASAT - ALAT URIC ACID PLATELET COUNT BUN/CREA
FM:
MILD PRE ECLAMPSIA
LESS 36 WK:
CONFIRM FWB
OB US: AFI, BPP
BETHAMETASONE 2 DOSES IM BEFORE 34 WKS
OVER 36 WKS:
INDUCTION OXYTOC
IV MgSO4 PROPHYLAXIS
33 WKS
160/110 PLAT 85 - ASAT 250 - ALAT 275 - PROT > 5.0 GR/DY
IM:
MgSO4 SEIZURE PROPHYLAXIS HYDRALAZINE OR LABETALOL IV GOAL DBP 90-100 INDUCE LABOR : OXYTOCIN PROMPT DELIVERY VAGINAL
MAGNESIUM TOXICITY
5 G LOAD /20MIN
2G/HR
VITALS
DTR: 1/5
RR: 5 RPM
UO: 15 ML/HR
IM:
OXY THERAPY 8 TO 10 L
PULSE OXY MONITOR
IV CALCIUM GLUCONATE
NON REASSURING EXTERNAL FETAL MONI TRACING CAUSED BY OXY HYPERSTIM
31 YO
ACTIVE PHASE 6 CM 100% EFFACED
OXYTOCIN AUGMENT - AREEST AT 5 CM
FETAL MONITORING:
BASELINE 170
MINIMAL VARIABILITY
LATE DECELERATIONS
DZX
OXY HYPERSTIM
CORD COMP
HEAD COMP
PLACENT INSUF
IM:
INTRAUTERINE RESUCITATION
OXYT OFF RINGER - PERFUSE PLAC OXY THER 8-10L MATERNAL POSITION LEFT LAT - IVC DIGITAL VAG EXAM - R/O PROLAPSE DIGITAL SCALP STIM - ACELERATIONS - REASSURE
FM: DO NOT RESP
PROMPT DELIVERY
POSTERM PREGNANCY
UNFAVORAB CERVIX
PRENATAL VISIT 42 WKS PREVIOUS POSTERM 4100 GR MECONIUM FH: 42 FHR: 125 PE: OS CLOSED 0 % EFFACED
DZX
INACCURATE DATE
IWU:
MHR: LP NORMAL & SURE.
CLR: FETAL HEART TONES 10-12 WK DOPPLER QUICKENIG 16-20 WK
OB US REVIEW: EX; 18 WK US CONSISTENT W/ AGE
FM:
NST: REACTIVE
AFI: 4 CM
FM:
CERVICAL RIPPENNING INDUCTION OF LABOR PROSTAG E2
POSTDATE PREGNANCY
INTRAPARTUM MECONIUM SECONDARY TO GI MOTILITY
MILD VARIABLE DECELERATIONS WITH REASSURING FETAL STATUS
6CM 100 % EFFACED DYN: 3 X 10 'X 50 '' FHT: 155 DECREASED VARIABILITY IRREGULAR DECELERATIONS AMNIOTOMY: MECONIUM
DZX:
FETAL HYPOXIA PLACENTAL INSUF
NORMAL GASTROINTEST MOTILITY
IM:
INTERNAL FETAL SCALP MONITORING
AMNIOINFUSION WITH SALINE
FM:
AMNIOINFUSION TILL DELIVERY
SUCTION FETAL NOSE AND PHARYNX
PERFORM LARINGOSCOPY TRACHEAL ASPIRATION AFTER DELIVERY OF FETAL BODY
PPH
ATONY INVERSION
LACERACTION
RETENTION
DIC
IM:
IVA NSS TYPE CROSS MATCH CBC PALPATE UTERUS FOLEY
FM:
VIGOROUS BI MANUAL MASSAGE
IV OXYT
IV METHERGOLINE
IM 15 METHYL F 2 ALPHA PROSTAGLANDIN
PRETERM LABOR AND CONTRACTIONS
TWIN 28 WK
UTI
IRON DEF ANEMIA
RF: PRIOR SMI RF PROM CORIOAMNIONITIS UTI MULTIPLE
ANEMIA
IM:
OBSERVE
ORAL HYDRATION
ORAL FE SO4 3 XXX DY
NITROFURANTOIN
CERVIX: CUTOF 2 CM 1-2 DIL MIDPOSITION 1 CM LONG DYN: 3 X 10'
INPATIENT MATE UNIT:
FM:
IV MG S04
IV AMPICILLIN
UTI ABx
IM BETHAMETASONE 2 BOLUS 12MG - 24 HRS
TOCOLISIS DOES NO AFFECT PRETERM LABOR RATES
ALLOWS YOU STREP B PROF AND LUNG MATURATION
B2 AGO RITODRINE K ISSUES
CCB NIFEDIP REFLEX TKC
INHIB PROSTAG INDOMETHACIN PDA
