OB/GYN Emergencies Flashcards
A patient who is over 20 weeks pregnant presents with painless vaginal bleeding. What should be deferred until placenta previa can be ruled out?
pelvic exam
What are clinical signs of PCOS?
obesity, hirsutism, dysmenorrhea, acne
Symptomatic patients with what HCG level are more likely to have an ectopic pregnancy?
> 1000 mIU/mL
Appropriate STI test for suspected PID
NAAT
How would you distinguish between vulvovaginitis and foreign body in a prepubertal patient with bloody vaginal discharge?
vulvovaginitis would itch and foreign body would smell
What would be your top two diagnoses for a premenopausal patient who is not pregnant but presents with vaginal bleeding?
ruptured ovarian cyst and ovarian torsion
What is your primary concern in a peri- or post-menopausal woman who presents with vaginal bleeding?
endometrial cancer
What do women who are Rh neg need after ANY bleeding episode while pregnant?
Rhogam
What type of miscarriage is characterized by a closed cervix, positive fetal cardiac activity, and no cramping?
threatened miscarriage
What type of miscarriage is characterized by an open cervical os, no fetal cardiac activity, bleeding, and cramping?
inevitable miscarriage
What is your suspected diagnosis for a pregnant patient who has moderate/severe cramps, bleeding, open cervical os and a boggy uterus?
incomplete miscarriage
What are the following conditions risk factors for: previous ectopic pregnancy, tubal surgery, hx of PID, fertilization treatment
ectopic pregnancy
Most common symptom of ectopic pregnancy
abdominal pain
What is the most helpful imaging technique to determine if an intrauterin pregnancy is present?
transvaginal US
Where is the most common location of an ectopic pregnancy?
fallopian tubes
What is your next step in a suspected ectopic pregnancy is the TUS is inconclusive and the patient is stable?
follow serial quantitative hCG’s
What is the appropriate treatment for a patient with a hetertopic pregnancy (an intrauterine & an extrauterine gestation are concomitant) if the mother is stable?
consider methotrexate and an OB consult
What is the abx treatment for cervicitis secondary to infection?
rocephin 250mg IM and 1 g PO azithromycin
Name two antenatal corticosteroids that enhance lung maturation lung and induce lung enzymes in preterm fetus
betamethasone 12mg IM 2 doses 24 hrs apart or dexamethasone 6mg IM 4 doses 12 hrs apart
Why are coag studies and 4 units of typed and cross-matched blood needed for management of placenta previa if patient is acutely bleeding?
can develop DIC
What tocolytic agent can be given to manage a stable patient with placenta previa if they are having contractions?
magnesium sulfate
What are indications of fetal distress?
lack of variability, late decelerations, sinusoidal pattern, and HR <120 bpm
Should be discontinued in situations of fetal distress and tocolytics should be considered for continued distress with contractions
utertonic drugs
Pregnant patient presents with uterine bleeding, abdominal pain/contractions, and fetal distress
placental abruption
2 BP measurements 6 hrs apart >140/90 and usually proteinurea >0.1 g/L on urine dipstick or > 300 mg protein 24 hr
mild pre-eclampsia
2 BP measurements 6 hrs apart > 160/110, proteinurea > 5 g/L, and oliguria <500 ml in 24 hrs
severe pre-eclampsia
How many weeks should a baby be before considering delivery of mild pre-eclampsia?
at least 37 weeks
First sign of hypermagnesemia after delivering magnesium sulfate to woman with severe pre-eclampsia for the prevention of seizures
loss of reflexes
The occurrence of 1 or more general tonic-clonic seizures or coma in a preeclamptic woman
ecclampsia
Medications used to lower blood pressure and stop seizures in ecclamptic patient
hydralazine or labetolol to lower BP. lorazepam or diazepam to stop seizures
What is a patient who experiences a death in utero during the 2nd and 3rd trimesters at greater risk if they’ve had a prior c-section?
uterine rupture with induction of labor
During a breech delivery, what is checked in addition to pulling down a small loop to prevent traction after the trunk has been delivered up to the scapula?
cord pulsation
What position should a babies head be during a breech delivery and can be maintained by applying suprpubic pressure?
flexion
Manuever done for shoulder dystocia where two assistants sharply flex the maternal thighs back against the abdomen. suprapubic pressure is applied with palm or fist
McRoberts maneuver
Manuever done for shoulder dystocia where clinician places one hand in vagina behind poterior shoulder rotates it antior toward fetal face.
Rubin maneuver
