OB extra info from Weil Flashcards
persistent and severe vomiting during pregnancy
hyperemesis graviarum
first line treatment for HEG
reassurance, bland diet, clear fluid
Vitamin B6 (pyridoxine)
Doxylamine (1st gen antihistamine)
What antiemetics can you give for HEG?
promethazine (phenergan)
metoclopramide (Reglan)
ondansetron (zofran)
how should a woman with HEG adjust her diet?
multiple small meals throughout the day
what can be associated with HEG? What lab values should you check?
hyperthyroidism
TSH and FT4
How often should hCG levels double in pregnancy?
every 48 hours
When do hCG levels peak? When do they fall?
50-75 days
2nd/3rd trimester
hCG levels rise and then platea and may drop off, indication?
ectopic pregnancy
hCG levels rise very very high, indication?
molar pregnancy
what is important to observe when measuring hCG levels?
trend
what hCG level will turn a urine pregnancy test positive?
10-100 (avg is 25)
what conditions put you at risk for ectopic pregnancy?
PID, tubal ligation, infertility, ruptured appendix
what is someone with ectopic pregnancy at risk for?
shock
MCC of maternal death in 1st trimster
undiagnosed/undetected ectopic pregnancy
where are 98% of ectopic pregnancies located?
fallopian tube
signs and symptoms of ectopic pregnancy
LQ pain, sudden/intermittent/stabbing pain, non-radiating, possible spotting
what may appear on CBC for ectopic pregnancy?
anemia or leukocytosis
If patient has (+) pregnancy test, elevated hCG, but no IUP on transvaginal US, what should you think?
ectopic pregnancy
US should show gestational sac @ ____ and fetal pole @ ___ if IUP
5-6 wks
6 wks
procedure of choice for diagnosing and removing ectopic pregnancy
laparoscopy
Medical therapy for early ectopic pregnancy (< 3.5 cm, no FHT, no bleeding, normal renal/liver function)
methotrexate IM
when would you not give methotrexate for ectopic pregnancy? What would you do?
unstable
type and cross → surgery
1st stage of labor is broken up into
latent and active phase
what happens in the 1st stage of labor?
contractions and cervical dilation
what happens in the 2nd stage of labor?
fetal descent and delivery
what happens in the 3rd stage of labor?
placenta delivery
how long is the latent phase of labor in nullipara?
How long in multipara?
<20 hr
<14 hr
how does the cervix change in the latent phase of labor?
change in consistency, effacement, anterior postitioning
when should a woman go to the hospital in the latent phase?
bleeding, ROM, painful contractions 3-4 min apart, loss fetal movement
at what cervical dilation does the active phase start?
4-5 cm
what is the typical rate of cervical dilation in the active phase?
1-1.5 cm/hr
what are the cardinal movements of delivery?
engagement → descent → flexion → internal rotation → extension → external rotation → expulsion
what is EFM monitoring for in the active phase?
decelerations
how long on average is the second stage of labor?
20-50 minutes
if a woman is pushing longer than 2 hours this should alert the provider to…
cephalo-pelvic disproportion (CPD)
when should you do FHT monitoring in the 2nd stage of labor?
every 10-15 min
what marks the end of the 2nd stage of labor?
delivery of baby
How should you coach mom when delivering the anterior shoulder?
push hard
how should you coach mom when delivering the posterior shoulder?
easier, gentle push
what is the start of the 3rd stage of labor?
delivery of baby
what may be needed to facilitate the delivery of the placenta?
gentle traction, uterine massage, breastfeeding
how does uterine massage and breastfeeding assist with the delivery of the placenta?
contractile state and decrease uterine atony
what is the time frame for the “4th stage” of labor?
birth of placenta → 2-4 hours PP
what do you do in the 4th stage of labor?
monitor for hemorrhage, vitals q15 min, uterine massage, evaluate for lacerations, repair episiotomy
what is defined as postpartum hemorrhage?
any blood loss that results in s/s of hemodynamic instability if left untreated
early vs late PPH
early → < 24 hr after delivery
late → >24 hr after delivery
MCC of PPH
uterine atony and lacerations
what can decrease PPH by 2/3?
early oxytocin and cord clamping
what lab work should you order in patient suspecting PPH?
CBC, type and cross, fibrinogen, fibrin split products, PT/PTT
in postpartum you should palpate firming uterus, if the uterus is firm and the patient is still bleeding, what should you look for?
lacerations
what are some indications for a C-section?
malpresentation, abnormal placentation, previous uterine incision, non-reassuring FHT, arrest of labor, infection
primary tool for antepartum fetal monitoring
nonstress test
tool for monitoring 2nd and 3rd trimester fetal well being
nonstress test
what is the definition of a reactive reading on NST?
> 2 accelerations above baseline FHR of 15 bpm for 15 seconds in 20 min period
absence of accelerations with exclusion of sleep state
nonreactive
possible causes of nonreactive reading on NST
maternal narcotics, extreme prematurity, fetal cardiac or CNS anomalies
what is biophysical profile (BPP)?
ultrasound assessment of fetal well-being
what is the contraction stress test (CST)?
oxytocin challenge
