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Obstetrics > OB extra info from Weil > Flashcards

OB extra info from Weil Flashcards

1
Q

persistent and severe vomiting during pregnancy

A

hyperemesis graviarum

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2
Q

first line treatment for HEG

A

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

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3
Q

What antiemetics can you give for HEG?

A

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

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4
Q

how should a woman with HEG adjust her diet?

A

multiple small meals throughout the day

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5
Q

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

A

hyperthyroidism

TSH and FT4

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6
Q

How often should hCG levels double in pregnancy?

A

every 48 hours

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7
Q

When do hCG levels peak? When do they fall?

A

50-75 days

2nd/3rd trimester

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8
Q

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

A

ectopic pregnancy

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9
Q

hCG levels rise very very high, indication?

A

molar pregnancy

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10
Q

what is important to observe when measuring hCG levels?

A

trend

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11
Q

what hCG level will turn a urine pregnancy test positive?

A

10-100 (avg is 25)

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12
Q

what conditions put you at risk for ectopic pregnancy?

A

PID, tubal ligation, infertility, ruptured appendix

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13
Q

what is someone with ectopic pregnancy at risk for?

A

shock

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14
Q

MCC of maternal death in 1st trimster

A

undiagnosed/undetected ectopic pregnancy

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15
Q

where are 98% of ectopic pregnancies located?

A

fallopian tube

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16
Q

signs and symptoms of ectopic pregnancy

A

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

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17
Q

what may appear on CBC for ectopic pregnancy?

A

anemia or leukocytosis

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18
Q

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

A

ectopic pregnancy

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19
Q

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

A

5-6 wks

6 wks

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20
Q

procedure of choice for diagnosing and removing ectopic pregnancy

A

laparoscopy

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21
Q

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

A

methotrexate IM

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22
Q

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

A

unstable

type and cross → surgery

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23
Q

1st stage of labor is broken up into

A

latent and active phase

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24
Q

what happens in the 1st stage of labor?

A

contractions and cervical dilation

25
Q

what happens in the 2nd stage of labor?

A

fetal descent and delivery

26
Q

what happens in the 3rd stage of labor?

A

placenta delivery

27
Q

how long is the latent phase of labor in nullipara?

How long in multipara?

A

<20 hr

<14 hr

28
Q

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

A

change in consistency, effacement, anterior postitioning

29
Q

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

A

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

30
Q

at what cervical dilation does the active phase start?

A

4-5 cm

31
Q

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

A

1-1.5 cm/hr

32
Q

what are the cardinal movements of delivery?

A

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

33
Q

what is EFM monitoring for in the active phase?

A

decelerations

34
Q

how long on average is the second stage of labor?

A

20-50 minutes

35
Q

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

A

cephalo-pelvic disproportion (CPD)

36
Q

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

A

every 10-15 min

37
Q

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

A

delivery of baby

38
Q

How should you coach mom when delivering the anterior shoulder?

A

push hard

39
Q

how should you coach mom when delivering the posterior shoulder?

A

easier, gentle push

40
Q

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

A

delivery of baby

41
Q

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

A

gentle traction, uterine massage, breastfeeding

42
Q

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

A

contractile state and decrease uterine atony

43
Q

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

A

birth of placenta → 2-4 hours PP

44
Q

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

A

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

45
Q

what is defined as postpartum hemorrhage?

A

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

46
Q

early vs late PPH

A

early → < 24 hr after delivery

late → >24 hr after delivery

47
Q

MCC of PPH

A

uterine atony and lacerations

48
Q

what can decrease PPH by 2/3?

A

early oxytocin and cord clamping

49
Q

what lab work should you order in patient suspecting PPH?

A

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

50
Q

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

A

lacerations

51
Q

what are some indications for a C-section?

A

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

52
Q

primary tool for antepartum fetal monitoring

A

nonstress test

53
Q

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

A

nonstress test

54
Q

what is the definition of a reactive reading on NST?

A

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

55
Q

absence of accelerations with exclusion of sleep state

A

nonreactive

56
Q

possible causes of nonreactive reading on NST

A

maternal narcotics, extreme prematurity, fetal cardiac or CNS anomalies

57
Q

what is biophysical profile (BPP)?

A

ultrasound assessment of fetal well-being

58
Q

what is the contraction stress test (CST)?

A

oxytocin challenge

Obstetrics (17 decks)

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