OB Flashcards
Best initial test in the setting of suspected fetal anemia?
1) Transcranial doppler of fetal middle cerebral artery
2) Percutaneous Umbilical Blood Sampling (PUBS) gives you the hemoglobin definitively (best diagnostic, confirmatory test) and gives access to transfusion. Done AFTER the transcranial Doppler tells you that there may be fetal anemia.
Woman comes in complaining of decreased fetal movement… what next?
Non-stress test (NST), then non-stress test with vibroacoustic stimulation (NST-VAS), then biophysical profile (BPP) or Contraction stress test (CST)
You only go to the next step if you fail the test before it.
Eclamptic patient actively seizing
1) Stabilize the seizure by infusion of magnesium sulfate
2) Emergent delivery of the fetus by C section
Mom with prolonged active phase (should be 6cm–> 10 cm within 4 hrs). What to do next?
Problem with the power, the passenger, or the passage. An intrauterine pressure catheter allows us to evaluate the strength/power of her contractions and if weak give oxytocin.
What are Variable decelerations?
At least 15 beats from baseline, lasting more than a few seconds but less than a couple of minutes, and having no association with contractions.
Due to Umbilical cord compression
What is the treatment for variable decelerations?
Reposition mom while providing supplemental oxygen is usually enough to fix the issue
What are late decelerations?
Due to fetal-placental insufficiency
Baby is hypoxemic and will die if not delivered soon
TX: C section
What is chorioamnionitis?
Ascending infection of the amniotic fluid or placenta while the baby is still inside the uterus.
Fever, leukocytosis, and fetal tachycardia
Gestational Diabetes Management
In GESTATIONAL DIABETES the blood glucose control must be much tighter, that is, < 95 on fasting glucoses.
Diet and exercise–> insulin
What is HELLP syndrome?
RUQ pain, hemolysis, low hemoglobin, elevated bili and LFTs, Low platelets–> “curable DIC” or HELLP syndrome
TX: Prompt delivery of baby
Management of arrest of 3rd phase of delivery?
If placenta delivery is arrested (more than 30 mins) try:
1) Uterine massage
2) Oxytocin
3) manual retrieval
What is placental abruption?
Occurs when there is a mechanical trauma, cocaine use, or severe hypertension.
Placenta rips out of the wall of the uterus, and mom bleeds.
When does uterine rupture occur?
Often occurs in women who are undergoing trial of vaginal birth after previous C section TOLAC
Mom’s uterus tears. Mom knows: she hurts and her vitals change
Baby gets sick fast because of hemorrhage and loss of placental perfusion
What is placenta vs vasa previa?
“Vasa Previa” means “the vessel is in a bad spot so it tears when the os opens”- mom will have painless bleeding
“Placenta Previa” means “the placenta is in a bad spot so that it tears when the os opens- mom will have painful bleeding
A paracervical block is performed with subcutaneous lidocaine and suddenly the fetal heart monitor shows a fetal bradycardia. Next step?
Only instance where fetal bradycardia can be offered reassurance.
Procedure of the block gets some lidocaine into baby. It is not a big deal - it is temporary and will wear off
Epigastric pain in pregnancy
GERD or Eclampsia range disease
In case of exclampsia- pain is due to stretch on organs due to high BP
what is mild pre- Eclampsia?
> 140 / >90
Sustained after 20 weeks
> 300mg/dL protein
Tx: >36 wks: Mag+Deliver
<36 Weeks: Deliver
What is Severe Pre- Eclampsia?
> 160 / >110
Sustained after 20 weeks
> 500mg/dL protein
Tx: Magnesium and Urgent delivery