OB extra info from Weil

Question 1

persistent and severe vomiting during pregnancy

Answer 1

hyperemesis graviarum

Question 2

first line treatment for HEG

Answer 2

reassurance, bland diet, clear fluid
Vitamin B6 (pyridoxine)
Doxylamine (1st gen antihistamine)

Question 3

What antiemetics can you give for HEG?

Answer 3

promethazine (phenergan)
metoclopramide (Reglan)
ondansetron (zofran)

Question 4

how should a woman with HEG adjust her diet?

Answer 4

multiple small meals throughout the day

Question 5

what can be associated with HEG? What lab values should you check?

Answer 5

hyperthyroidism

TSH and FT4

Question 6

How often should hCG levels double in pregnancy?

Answer 6

every 48 hours

Question 7

When do hCG levels peak? When do they fall?

Answer 7

50-75 days

2nd/3rd trimester

Question 8

hCG levels rise and then platea and may drop off, indication?

Answer 8

ectopic pregnancy

Question 9

hCG levels rise very very high, indication?

Answer 9

molar pregnancy

Question 10

what is important to observe when measuring hCG levels?

Answer 10

trend

Question 11

what hCG level will turn a urine pregnancy test positive?

Answer 11

10-100 (avg is 25)

Question 12

what conditions put you at risk for ectopic pregnancy?

Answer 12

PID, tubal ligation, infertility, ruptured appendix

Question 13

what is someone with ectopic pregnancy at risk for?

Answer 13

shock

Question 14

MCC of maternal death in 1st trimster

Answer 14

undiagnosed/undetected ectopic pregnancy

Question 15

where are 98% of ectopic pregnancies located?

Answer 15

fallopian tube

Question 16

signs and symptoms of ectopic pregnancy

Answer 16

LQ pain, sudden/intermittent/stabbing pain, non-radiating, possible spotting

Question 17

what may appear on CBC for ectopic pregnancy?

Answer 17

anemia or leukocytosis

Question 18

If patient has (+) pregnancy test, elevated hCG, but no IUP on transvaginal US, what should you think?

Answer 18

ectopic pregnancy

Question 19

US should show gestational sac @ ____ and fetal pole @ ___ if IUP

Answer 19

5-6 wks

6 wks

Question 20

procedure of choice for diagnosing and removing ectopic pregnancy

Answer 20

laparoscopy

Question 21

Medical therapy for early ectopic pregnancy (< 3.5 cm, no FHT, no bleeding, normal renal/liver function)

Answer 21

methotrexate IM

Question 22

when would you not give methotrexate for ectopic pregnancy? What would you do?

Answer 22

unstable

type and cross → surgery

Question 23

1st stage of labor is broken up into

Answer 23

latent and active phase

Question 24

what happens in the 1st stage of labor?

Answer 24

contractions and cervical dilation

Question 25

what happens in the 2nd stage of labor?

Answer 25

fetal descent and delivery

Question 26

what happens in the 3rd stage of labor?

Answer 26

placenta delivery

Question 27

how long is the latent phase of labor in nullipara? | How long in multipara?

Answer 27

<20 hr | <14 hr

Question 28

how does the cervix change in the latent phase of labor?

Answer 28

change in consistency, effacement, anterior postitioning

Question 29

when should a woman go to the hospital in the latent phase?

Answer 29

bleeding, ROM, painful contractions 3-4 min apart, loss fetal movement

Question 30

at what cervical dilation does the active phase start?

Answer 30

4-5 cm

Question 31

what is the typical rate of cervical dilation in the active phase?

Answer 31

1-1.5 cm/hr

Question 32

what are the cardinal movements of delivery?

Answer 32

engagement → descent → flexion → internal rotation → extension → external rotation → expulsion

Question 33

what is EFM monitoring for in the active phase?

Answer 33

decelerations

Question 34

how long on average is the second stage of labor?

Answer 34

20-50 minutes

Question 35

if a woman is pushing longer than 2 hours this should alert the provider to…

Answer 35

cephalo-pelvic disproportion (CPD)

Question 36

when should you do FHT monitoring in the 2nd stage of labor?

Answer 36

every 10-15 min

Question 37

what marks the end of the 2nd stage of labor?

Answer 37

delivery of baby

Question 38

How should you coach mom when delivering the anterior shoulder?

Answer 38

push hard

Question 39

how should you coach mom when delivering the posterior shoulder?

Answer 39

easier, gentle push

Question 40

what is the start of the 3rd stage of labor?

Answer 40

delivery of baby

Question 41

what may be needed to facilitate the delivery of the placenta?

Answer 41

gentle traction, uterine massage, breastfeeding

Question 42

how does uterine massage and breastfeeding assist with the delivery of the placenta?

Answer 42

contractile state and decrease uterine atony

Question 43

what is the time frame for the "4th stage" of labor?

Answer 43

birth of placenta → 2-4 hours PP

Question 44

what do you do in the 4th stage of labor?

Answer 44

monitor for hemorrhage, vitals q15 min, uterine massage, evaluate for lacerations, repair episiotomy

Question 45

what is defined as postpartum hemorrhage?

Answer 45

any blood loss that results in s/s of hemodynamic instability if left untreated

Question 46

early vs late PPH

Answer 46

early → < 24 hr after delivery | late → >24 hr after delivery

Question 47

MCC of PPH

Answer 47

uterine atony and lacerations

Question 48

what can decrease PPH by 2/3?

Answer 48

early oxytocin and cord clamping

Question 49

what lab work should you order in patient suspecting PPH?

Answer 49

CBC, type and cross, fibrinogen, fibrin split products, PT/PTT

Question 50

in postpartum you should palpate firming uterus, if the uterus is firm and the patient is still bleeding, what should you look for?

Answer 50

lacerations

Question 51

what are some indications for a C-section?

Answer 51

malpresentation, abnormal placentation, previous uterine incision, non-reassuring FHT, arrest of labor, infection

Question 52

primary tool for antepartum fetal monitoring

Answer 52

nonstress test

Question 53

tool for monitoring 2nd and 3rd trimester fetal well being

Answer 53

nonstress test

Question 54

what is the definition of a reactive reading on NST?

Answer 54

> 2 accelerations above baseline FHR of 15 bpm for 15 seconds in 20 min period

Question 55

absence of accelerations with exclusion of sleep state

Answer 55

nonreactive

Question 56

possible causes of nonreactive reading on NST

Answer 56

maternal narcotics, extreme prematurity, fetal cardiac or CNS anomalies

Question 57

what is biophysical profile (BPP)?

Answer 57

ultrasound assessment of fetal well-being

Question 58

what is the contraction stress test (CST)?

Answer 58

oxytocin challenge