Ob/Gyn Flashcards
Term lengths: Previable - Preterm - Term - Early - Full - Late - Postterm -
Term lengths: Previable - <24 w Preterm - 25-37 w Term - 37 w Early - 37 to 38 and 6 Full - 39 to 40 and 6 Late - 41 to 41 and 6 Postterm - >42 w
Beta hCG >1500 or 5 weeks =
gestational sac on U/S
Fibrinogen is _ in pregnancy
increased
Routine prenatal labs
- Initial prenatal visit
- 24-28 weeks
- 35-37 weeks
Routine prenatal labs
- Initial prenatal visit: Rh(D) type, ab screen, Hb/Hct/MCV*, HIV, VDRL/RPR, HBsAg, Rubella and Varicella immunity, Chlamydia, urine culture, urine protein
- 24-28 weeks: Hb/Hct, ab screen if Rh(D) negative, 50 g 1-h oral glucose challenge test**
- 35-37 weeks: GBS culture
- treat iron deficiency anemia with iron + stool softener
- *if positive, perform glucose tolerance test
what labs do you need for someone taking methotrexate?
liver enzymes
medical tx of ectopic pregnancy
1) get baseline exams: CBC, blood type/screen, LFTs, and beta-hCG
2) give methotrexate and recheck beta-hCG in 4-7 days
3) if <15% drop in beta-hCG, give second dose
4) if persistently high levels –> surgery
ectopics >3.5 cm are at greater risk of failure with MTX
if surgery is performed, Rh negative mothers should receive RhoGAM
types of abortion
- complete
- incomplete
- inevitable
- threatened
- missed
- septic
types of abortion
- complete - no products of conception left
- incomplete - some products
- inevitable - products intact, bleeding, cervix dilated
- threatened - same as above, but cervix closed
- missed - intact but dead
- septic - infection
Late and postterm pregnancy complications for the fetus and the mother
fetus - oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions
mother - cesarean delivery, infection, postpartum hemorrhage, perineal trauma
circumstances in which preterm labor should not be stopped with tocolytics and delivery should occur
- severe hypertension (preeclampsia, eclampsia)
- cardiac disease
- cervical dilation >4 cm
- hemorrhage
- fetal death
- chorioamnionitis
if preterm labor is occurring (contractions + cervical dilation), when do you stop and when do you deliver?
stop if 24-33 w (or 600-2500 g) –> give betamethasone*, tocolytics, if <32 w –> add magnesium sulfate**
deliver if >34 weeks (or >2500 g)
*steroids need 24 h for full effect (beta completion), peak at 48 h, and last 7 days; must give tocolytic to allow then time to work
** magnesium tox can lead to respiratory depression and cardiac arrest, so check DTRs often
what to do with patient with PROM and term fetus? preterm fetus?
PROM + term fetus –> wait 6-12 hours for spontaneous delivery –> none –> induce labor
PROM + preterm fetus –> give betamethasone, tocolytics, and antibiotics (to lower risk of chorioamnionitis)
- no allergies - ampicillin + azithromycin
- penicillin allergy - cefazolin + azithro
- anaphylaxis risk - clindamycin + azithro
third trimester vaginal bleeding? imaging and digital exam
digital vaginal exam is C/I in 3rd trimester vaginal bleeding, do transabdominal U/S first (may do TVUS after)
tx of placenta previa
strict pelvic rest (no sex, nothing in the vagina)
placenta previa presents with pain_ vaginal bleeding
placental abruption presents with pain_ vaginal bleeding
placenta previa presents with painLESS vaginal bleeding
placental abruption presents with painFULL vaginal bleeding
mgmt of Rh incompatibility
at initial prenatal visit, do Rh ab screen –> if negative, check titers –> if unsensitized, repeat test again at 28 weeks and if patient continues to be unsensitized, we try to keep her unsensitized by given her RhoGAM (which binds any fetal Rh that may enter mother’s circulation and keeps her from mounting immune response) –> if at any point sensitized and titers are high (>1:16), do amniocentesis at 16-20 weeks to look at fetal Rh and bilirubin levels –> if bili levels are high, check fetal Hct and if low do intrauterine transfusion
how does U/S confirm gestational age?
femur length, abdominal circumference, and head diameter
tx of hyperemesis gravidarum
1st non pharmacological (diet, avoid triggers, etc) then diphenhydramine (H1) then metoclopramide (DA) finally ondansetron (H2)
asx bacteriuria in pregnancy
we treat it, other can result in preterm birth, low birth weight, and perinatal morbidity
acute pyelo in pregnancy warrants
hospitalization and IV ceftriaxone
antibiotics to avoid in pregnancy
TMP-SMX in first trimester (folic acid antagonism)
Aminoglycosides (amikacin, gentamicin, kanamycin, streptomycin, tobramycin) - ototoxicity
Tetracyclines and fluoroquinolones
Tx of pruritic urticarial papule and plaques of pregnancy
topical steroids
severe preeclampsia <20 weeks gestation
can be a manifestation of hydatiform mole
HTN during pregnancy with edema, joint pain, malar rash, and proteinuria and RBC casts likely
SLE complicated by nephritis
fetal nonstress test
detection of 2 fetal movements and acceleration of HR >15 bmp lasting 12-20 seconds in a 20 minute period
biophysical profile
B - breathing (chest expansions) A - amniotic fluid index (volume) T - fetal Tone (flexing) M - movement (3 in 30 mins) A ------------------------------------- N - Nonstress test
each one is assigned 2 points
8-10 = normal
4-8 = inconclusive
<4 = abnormal
do not give _ to asthma patients
prostaglandins (e.g. for cervical ripening or to stop bleeding)
most common cause of prolonged or arrested 2nd stage of labor is
fetal malposition (head not engaged with pelvis properly; optima = occiput anterior)
arrest of cervical dilation is when …
there is no dilation for more than 2 hours
causes of protracted dilation (i.e. cervix is too slow to dilate during the active phase)
the 3 P’s: power, passenger, and passage (–> cephalopelvic disproportion)
Leopold maneuver does what?
set of 4 maneuvers that estimate the fetal wight and presenting part of the fetus
