OB/gyn Flashcards
When is gest sac able to be seen (bchg level)
1500
What does BhCG do early in pregnancy?
BhCG needs to rise right away because it maintains the pregnancy with progesteroner until the placenta can make its own
How is viable pregnancy confirmed?
Viable pregnancy confirmed with FHT by 10 weeks on U/S
Do Braxton Hick’s change the cervix?
No, braxton Hicks are irregular and in the lower back and don’t increases in intenseity or amount and do NOT change the cervix
What is PUPP
Pruritic papules and palques, plaques on trunks and legs
How is PUPP treated
Topical steroids for PUPP
Mortality of PUPP
No mortality associated with PUPP
How is intrahepatic choelstasis (high prog) treated inpregnancy
High prog in pregnancy causes cholestasis which also causes itching and can result in still birth, give ursodeoxycholic acid and monitor fetus
Why is edema in pregnancy
Increased fluid volume and venous pressure due to gravid uterus compressing IVC
Why do women in pregnancy have a low Hg?
It is dilutional due to increase in plasma volume, they actually have increaed reticuloctye count with normal MCV, it is a normoctyic anemia without hemolysis due to diluation, plasma osmo is decreased
What type of respiratory changes are present in pregnancy?
Less FRC and less RV due to high diaphragm frmo uterine compression and increased RR to compensate causing a respiratory alkalosis
What urinary infection complication do women commonly get
They get high risk for pyelo due to urinary stasis from right hydroureter/gravid compression and need tx if they have asyx bacteriuria
What happens to Cr and BUn in pregnancy?
They get a physiologic increase in GFR due to high blood volume resulting in more clearance and drop of Cr and BUN
Why does x2 NST start at 41 w
women at 41 weeks have higher risk morbidity/mortality and so 2x weekly NST is done
After 41w with x2 NST tests, what is an indication for delivery
After 41 weeks delivery is indicated with oligohydramnios or fetal demise
what is most reliable way of dating?
most reliable way of dating is CRL at 10w via U/S
When is GBS testing done ?
35-7w
When is a CST done
CST is done after nonreactive NST, but do not do at women high risk for preterm delivery
How is IUGR measured?
Measure IUGR with serial U/S
What is modified BPP
modified BPP is NST + AFI starting 2x at 41 weeks, oligohydramnios is indication for delivery
What is one way to assess IUGR
IGUR can be assessed with doppler to look at MCA
When do you use doppler to look at MCA
use doppler to look at MCA in IUGR which shows flow absence, reversal/low flow
MCC og abnormal quad screen?
wrong dates
What should you do if someone has an abnormal quad screen?
The MCC of abnormal quad screen is wrong dates, get a U?S
What is unique to NTD
Unique to NTD is high AFP, it is normal or low in other aneuplodies
high AFP what do you think of first?
NTD for high AFP
What is diagnostic alrogithm for abnormal quad?
Abn quad (likely wrong dates) –> U/S–> U/S Abn –> amniocentesis
When is amniocentesis used?
Amniocentesis is used after U/S when a quad screen is abn (quad – us – amnio) has risk of 0.5% fetal loss
What has higher risk CVS or amniocenteiss
CVS has higher risk because you punture villi as opposed to just getting amniotic fluid in AFI
When is CVS done
CVS is done BEFORE amniocentesis at 10-13 weeks, it only tells genetic issues, not NTD or omphalocele
What does CVS increase risk of if it doesnt kill fetus or cause limb injury
Isoimmunization
When is labor protracted in phase 1?
over 20 hours null 14 hours multi
when is labor protracted phase 2?
4cm starts phase 2 and should be 1.2 nulli or 1.5/hr multi
When do you do a sterile digital exam vs SPE on labor presentation
do SPE on presentation when ROM is suspected as it can show you ferning, do nitrzine or pH testing (basic), do digital sterile exam when RoM has not happened yet
When do you attempt external cephalic reversion
When there is breech present at 37w, often corrects its own, just monitor until then
What is the risk of delivering breech baby?
Umbilical cord prolapse
Should you attempt cephalic reversion during labor?
NO. Go to OR
MCC of PPH
uterine atony, tx with pitocin/methergine/hemabate, misoprostol
When is amnioinfusion used
Amnioinfusion is used in VARIABLE due to cord compression, not due to late decels that have oligo
Why is amnioinfusion only used for variable and not for late decels with oligohydramnios?
Amnioinfusion is used in variable to prevent cord compression and not in late decels which are uteroplacental in which amniotic fluid does nothing, even if they have oligohyrdamnios
What is fetal tachycardia
Fetal tachycardia is >160 for 10m likely due to maternal infection and chorioamnionits
What hormone is pitocin/oxy like
Oxytocin is made and similar to ADH
what can oxy cause as an AE?
It looks like ADH and can cause hyponatremia dn seizure and daeth
What is used to ripen cervix
PGE1
What does PGE1 do and when is it used?
pGE1 is a cervical ripening agent used at 41w in a posterior cervix for induction
What is a C/I to cervical ripening?
Classic cesarean delivery
What is placenta previa an indication for?
Pelvic rest, no digital vaginal exam and cesarean section
When are forceps used
If used, presenting part must be fully engaged
What is diff between vacuum and forceps
More room in canal and less injury to vaginal canal
What is caput succedaneum
Swelling of fetal head due to prolonged engagement crossing suture lines, resolves on its own
Why is caput succ formed?
Prolonged engagement
What is cephalohematoma?
blood under periosteum not crossing suture lines that resolves in weeks
What is a way to prevent hypotension with nerve blocks in obstetrics
Prior infusion of 1L saline to increase CO
What mal-effects does epidurals have on delivery overall?
Epidurals prolong labor and can result in chorioamnionitis, more forcep deliviries and high Csxn rate and may result in maternal meningitis
What does a boggy uterus after birth mean?
PPH is coming due to uterine atony
Why do women get distended baldder after birth and wha tis tx?
Cath them. It is paralytic due to epidural or from trauma and need immediate cath with urinary retention PP, even though it resolves. Cath.
What is the KB test
The KB test detects fetal maternal hemorrhage in Rh- mothers, you have 72 hours to administer RhoGam
What is a huge risk for endometritis
A big risk for endometritis is Csxn
What are other risks of endometritis other than Csxn
prolonged RoM, multiplle vaginal exams and internal monitors
What is 5-10x more likely after Cxn
Endometritis is 5-10x more likely after Csxn
When does endometritis occr
endometritis occurs 2-3D PP
How is endometritis treated?
Endometritis is treated for polymicrobial infection with amp, gent (gent for gram -)
what bugs causes endometritis
endometritis is polymicrobial so it is treated with amp and gent
What is the s/s of septic thrombophlebitis
septic thrombophlebitis is spiking fever WITHOUT s/s of endoemtritis
how is a spiking fever with s/s of endometritis treated?
thrombophlebitis is spiking fever w/o s/s of endometritis treated with heparin
how is septic thrombophlebitis treated?
septic thrombophlebitis is treated with heparin
What hormone for contraception can be used in lactation?
Progesterone. Not breast milk excreted and does not decrease amount of breast milk
When is digital exam indicated with RoM
when there is fetal brady cardia with RoM it is likely due to cord prolapse - digital exam is then INDICATED even witih RoM ro r/o polapse
When prolapse is felt, what medicine given?
Tocolytic like magnesium or terbutaline as contractions decrease blood flow
What are AE of nifedipine tocolysis?
nifedipine causes pulmonary edema and respiratory depression, as does b2 agonist agents like terbutrine
what does tocolysis in general often cause
tocolysis causes PPH beacuse the uterus cannot contract on itself
How is bronchiectasis picked out
extremely frequent lung infection in setting of COPD + a lot more sputum production and often hemoptysis with no masses found on XR/CT. Get a CT to diagnose.
cause of goodpasture syndrome?
Ab to GBM collagen a3 type IV with linear Ig deposition
Linear Ig - Ab on the GBM?
Goodpasture, look for hemoptysis due to a3 type IV collagen
When don’t you do a tap of an effusion
Do NOT tap an effusion in clear-cut CHF
