OB/GYN 2 Flashcards
When there is PROTRACTED ACTIVE phase of stage 1 labor (<1cm/2hrs), what 2 things can you do?
- Amniotomy
2. Oxytocin IF inadequate contractions.
What is the normal time frame of:
stage 1 labor (nulliparous vs not)?
Stage 2 labor (nulliparous vs not)?
Stage 3 Labor (nulliparous vs not)?
Stage 1: up to 10 cm.
Nulliparous= up to 20 hours
Multiparous = Up to 10 hours
Stage 2: 10 cm to delivery
Nulliparous = 30 min -3 hours
Multiparous = 5-30 min
Stage 3: Deliver of placenta
0-30 min regardless of parity
ERB-DUCHENNE PALY presents with waiters tip, asymmetric moro reflex…what nerves are injured?
What is management/TRX?
BRACHIAL PLX C5-C7
TRX - supportive, most recover fully on it’s own.
What is the classic presentation of HELLP syndrome?
What 4 lab abnormalities do you see?
- HA
- Visual change
- Nausea/Vomit
- HTN
- RUQ pain.
LABS:
- MAHA
- Transaminitis
- Low platelets
- +/- Proteinuria.
What is the first line trx for HELP? What dreaded complication are you trying to avoid?
What is the only definitive trx?
What agents do you use to trx HTN in HELLP? At what threshold BP do you treat?
MAGNESIUM SULFATE - trying to prevent seizure.
Definitive trx = delivery
BP >160/110 –> IV HYDRALAZINE or LABETALOL.
Appendicitis during Pregnancy can present atypically. HOW can it be different?
How do you dx in pregnancy?
displacement of organs…
PRESENTATION :
- general R sided pain
- NO peritoneal sings
- NO Mcburneys point tenderness
DX = Graded compression US (if inconclusive then MRI, but try to avoid MRI)
Generally patient who exercised regularly prior to pregnancy are encouraged to maintain mod-intensity regimen during pregnancy…
Except in what 3 groups?
- Increased risk of Pre-term labor
- Cervical insufficiency
- Hx of preterm labor
- PPROM - Increased risk of antepartum bleed?
- Placenta previa
- 2nd/3rd trimester bleed - Underlying severe illness
- HELLP/Pre-E
- Severe anemia
- heart or lung disease
Central Venous Sinus Thrombosis is a rare, life-threatening blood clot in the DURAL SINUS…mainly seeing what 4 scenarios?
It can present with symptoms of increased ICP +/- focal neurologic deficits. WHAT IS THE TRX?
- Pregnancy
- OCP
- Malignancy
- Head trauma
TRX = LMWH
Late preterm labor is defined as labor during 34th - 36th 6/7 weeks.
What two intervention do you want to implement?
- IM Corticosteroids to MOM (mature fetal lungs)
2. PCN to mom >4 hours prior delivery (all pre-term labor gets GBS ppx)
What is the definition of spontaneous abortion?
What is the most common cause?
Abortion < 20 weeks gestation.
Most common cause = Chromosomal abnormalities
(other common causes include congenital abnormality and uterine structural abnormality.
What is CAPUT SECCEDENEUM?
What is the most common culprit?
What is the PE reveal in relationship to midline suture?
What is trx?
Superficial hematoma ABOVE PERIOSTIUM (most superficial layer of bone).
Caused by prolonged labor and vacuum assisted delivery.
CROSSES SUTURE LINE.
TRX = none, self resolving.
What is a CEPHALOHEMATOMA?
What does PE reveal in relationship to suture line.
What is management/TRX?
SUBPERIOSTEAL bleed.
DOES NOT cross SUTURE lines
TRX = get XR to r/o skull fracture. It is largely benign and resolved on it’s own.
How do you define post partum hemorrhage…
For Vaginal vs C-section?
> 500 mL for vaginal birth
>1000 mL for C-section
What is the most common Cause of post partum hemorrhage?
UTERIN ATONY - uterus fails to contract after deliver of placenta.
What is the first line trx in postpartum hemorrhage due to uterine atony?
What is trx if above fails?
What is last line trx?
First line = uterine massage + Oxytocin
2nd line= Uterotonic medications
- Misoprostol
- Carboprostal
Last line trx = Uterine Artery Embolizaiton > Hysterectomy.
