OB/GYN Flashcards
Uterine tachysystole
> 5 contractions/10 min, may cause fetal compromise (eg, hypoxemia, acidemia) due to interruption of intervillous blood flow and inadequate recovery time between contractions (eg, late decelerations). Management is with supportive measures and discontinuation of uterotonic agents (eg, oxytocin).
Pregnant pts and HIV?
Pregnant women with HIV and a viral load >1,000 copies/mL at delivery are at high risk for vertical transmission. These patients require cesarean delivery and intrapartum zidovudine, both of which help decrease neonatal HIV infection risk. In contrast, patients with a viral load ≤1,000 copies/mL are candidates for vaginal delivery and do not require intrapartum zidovudine.
Fetal HR?
Increased if > 160. Persistently absent or minimal variability in fetal heart rate monitoring typically indicates fetal metabolic acidosis. However, certain medications (eg, opioids) can also cause decreased variability (eg, fetal CNS depression).
Vasa previa
Fetal vessels overlie the cervix, making them prone to tear with rupture of membranes or the onset of labor. Patients with vasa previa may have painless, minimal vaginal bleeding and rapid fetal deterioration or demise.
Polyhydramnios
Excessive amniotic fluid index (≥24 cm), can occur due to impaired fetal swallowing (eg, tracheoesophageal fistula). Patients with polyhydramnios are at higher risk of obstetric complications (eg, preterm prelabor rupture of membranes) due to uterine overdistension and increased intraamniotic pressure
Twin pregnancies are at increased risk
Preterm delivery (ie, <37 weeks gestation) due to spontaneous preterm labor and medically indicated deliveries secondary to maternal (eg, preeclampsia) and fetal (eg, fetal growth restriction) complications.
Parvovirus B19 infection in pregnancy
Severe fetal anemia due to viral cytotoxicity to fetal erythrocyte precursors. Fetal anemia increases cardiac output, which can lead to high-output fetal heart failure, subsequent hydrops fetalis (eg, skin edema, ascites), and possible fetal demise
Pregnant patients positive for group B Streptococcus (GBS)
intrapartum antibiotic prophylaxis to prevent early-onset neonatal GBS disease. Patients with a penicillin allergy that is low risk for anaphylaxis receive cefazolin.
Septic pelvic thrombophlebitis
Postoperative or postpartum infected thrombosis of the deep pelvic or ovarian veins. Patients have persistent fever unresponsive to antibiotics. Treatment includes anticoagulation and broad-spectrum antibiotics.
Intrahepatic cholestasis of pregnancy
Third trimester with pruritus that is worse on the hands and feet with no associated rash. Diagnosis is confirmed by elevated total bile acids (≥10 µmol/L). Management includes ursodeoxycholic acid and delivery at 37 weeks gestation.
Perineal lacerations
Common after vaginal delivery and typically cause perineal edema and pain with urination. Uncomplicated perineal lacerations (eg, no fever or purulence) are managed conservatively (eg, nonsteroidal anti-inflammatory drugs, sitz baths
Quiet fetal sleep
The common cause of a nonreactive nonstress test (eg, no accelerations). Because a fetal sleep cycle can last as long as 40 minutes, a nonreactive nonstress test is extended (eg, 40-120 min) to ensure that fetal activity outside of sleep is captured
Opioid substitution therapy
With methadone or buprenorphine is the first-line treatment for opioid-dependent pregnant patients. Compared with abstinence, it is safer and associated with improved maternal and neonatal outcomes and lower risk of relapse.
Patients with hydatidiform mole are at risk for
gestational trophoblastic neoplasia. Management of hydatidiform mole is by suction curettage, followed by serial β-hCG levels until levels are undetectable for at least 6 months. As pregnancy makes it difficult to determine the significance of a rising β-hCG level, contraception is required during the surveillance period
Patients with new-onset hypertension
(ie, systolic ≥140 or diastolic ≥90 mm Hg) at ≥20 weeks gestation without signs of end-organ damage and absent/minimal proteinuria on urinalysis require a 24-hour urine collection for total protein to differentiate between gestational hypertension and preeclampsia.
Normal labor progression
Mucoid vaginal bleeding (ie, bloody show), particularly during active labor, due to rapid cervical dilation. Expectant management can continue for patients with bloody show and reassuring maternal-fetal status (ie, stable vital signs, category I fetal heart rate tracing).
Genitourinary tract infection, particularly asymptomatic bacteriuria,
is a risk factor for preterm prelabor rupture of membranes. Therefore, universal urine culture screening, timely treatment, and reculturing for test of cure are recommended in pregnancy.
Eclampsia
Generalized tonic-clonic seizures, can develop in patients with preeclampsia with severe features (eg, hypertension with elevated creatinine). Patients may present in a postictal state with persistent headache and hyperreflexia. Treatment is with magnesium sulfate infusion.
Vertical transmission of group B Streptococcus (GBS) during vaginal delivery
Early-onset neonatal GBS infection (eg, sepsis, pneumonia). Patients with GBS bacteriuria in their current pregnancy or those who delivered a prior infant with early-onset GBS infection are at high risk for transmission; therefore, these patients require intrapartum antibiotic prophylaxis
Stress urinary incontinence
Common after vaginal delivery due to pelvic floor muscle weakness (resulting in urethral hypermobility) and stretch injury to the pudendal nerve. Patients in the immediate postpartum period (ie, <6 weeks after delivery) are managed with observation and reassurance because the condition is typically self-limited.
Fetal macrosomia
Risk factor for shoulder dystocia. Excessive traction on the head and neck during a difficult delivery can result in Erb-Duchenne palsy with the characteristic “waiter’s tip” posture. Management involves observation alone because most infants recover arm function spontaneously within a few months.
Management of preterm premature rupture of membranes
diagnosed at <34 weeks gestation is typically expectant. However, in patients with overt signs of intraamniotic infection (eg, fever, fetal tachycardia), delivery is indicated to decrease maternal and neonatal morbidity
Large, symptomatic Bartholin duct cysts
Vaginal discomfort and pressure with sexual activity, walking, or sitting. Physical examination reveals a soft, mobile, nontender mass located behind the posterior labium majus with possible extension into the vagina. Treatment of symptomatic Bartholin duct cysts is with incision and drainage.
ACE inhibitors and angiotensin II receptor blockers are teratogens.
The use of either medication during pregnancy can cause fetal renal hypoplasia (eg, bilateral, underdeveloped fetal kidneys) and oligohydramnios.
