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OB MTB Flashcards

1
Q

embryo is considered fetus at how many weeks gestation?

how long infant for?

A

8 weeks

infant for 1 year after birthNagele rule

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2
Q

Nagele rule

A

EDD : LMP - 3 months + 7 days

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3
Q

gestational age?

trimester breakdown

A

number of days since LMP

1st: 0-12 weeks (14 gestational age)
2nd: 12-24 weeks
3rd: 24-delivery

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4
Q

screening based on trimesters

A

1st: FHTs with Doppler
2nd: triple/quad screen, movement at 16-20 wks, u/s at 18-20 wks GA
3rd: frequent visits, monitor labs

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5
Q

Gs and Ps of female who presents with her 6th pregnancy, has had 2 abortions, 2 children born at term, and set of twins born preterm

A

G6P2124
G TPAL
(twins born preterm count as 1 pregnancy)

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6
Q

one of first signs of pregnancy on PE

A

Goodell sign: softening of cervix, may be felt at 4 weeks

in contrast, quickening is first time mother feels fetal movement

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7
Q

other signs of pregnancy
Ladin:
Chadwick:
chloasma:

A

Ladin: softening of midline uterus (6 wks)
Chadwick: blue discoloration of vagin and cervix (6-8 wks)
chloasma: “mask of pregnancy” (16 wks)

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8
Q

how rapidly is B-hCG produced in 1st trimester?

when does it peak?

A

doubles every 48 hrs in 1st 4 wks
peaks at 10 wks
drop in 2nd trimester, and rise slowly again in 3rd trimester to levels of 20-30,000 IU/mL

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9
Q

when/what B-hCG level should a gestational sac be seen on ultrasound?

A

at 5 wks or B-hCG of 1000-1500 IU/mL

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10
Q

changes in CO, HR, BP

A

^CO, ^HR, decreased BP (lowest 24-28 wks)

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11
Q

changes in coagulation

A

hypercoagulable, ^fibrinogen

but no increase in PT, PTT, INR

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12
Q

1st trimester tests

A

see every 4-6 wks
11-14 wks: u/s for GA and nuchal translucency
blood tests, pap smear, Gc/Clamydia
1st trimester screening for chrom. abn.

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13
Q

most accurate test to establish gestational age in 1st trimester

A

U/S, esp. 11-14 wks

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14
Q

2nd trimester screening

A

triple/quad screen 15-20 wks

ultrasound 18-20 wks for fetal malformations

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15
Q

3rd trimester visits

A

q2-3 wks until wk 36 then qwk
27: CBC (iron if hgb less than 11)
24-28: glucose load (140+ 3 hr gtt)
36: cerv. cx for Gc/Chl, recvag cx for GBS

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16
Q

when to get CVS

amniocentesis

A

CVS: 10-13 wks in AMA or known genetic disease
amniocentesis: 11-14 wks

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17
Q

most common site of ectopic

risk factors?

A

ampulla of fallopian tube

PID, IUD, previous ectopic

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18
Q

ectopic pregnancy:

presentation and tests

A

u/l low abdominal or pelvic pain, vaginal bleeding, hypotensive with peritoneal signs if ruptured
tests: B-hCG, U/S, laparoscopy (tx)

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19
Q

unstable ruptured ectopic pts

A

need IV fluids, +/- blood products, +/- dopamine to stabilize BEFORE surgery
stable ruptured can go straight to sx

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20
Q

medical tx of non-ruptured ectopic

A 
MTX
labs: B-hCG, CBC, t/s, LFTs
look for 15% drop in hCG in 4-7 days
if not, 2nd dose MTX
if still not decreasing, resort to surgery
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21
Q

exclusion criteria for MTX

A

immunodeficiency, noncompliant, hepatotoxicity, 3.5cm+, FH beat auscultated (^risk failure)

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22
Q

ectopic surgical tx

A

salpingostomy (cutting hole in tube, preserves)
salpingectomy (remove whole tube)
give RhoGAM if Rh negative

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23
Q

etiologies of abortion

A

*chromosomal abnormalities
anatomic abnormalities, infection (STDs), immune (aPL syndrome), endocrine (HTN, DM), malnutrition, trauma, Rh isoimmunization

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24
Q

tests to do in abortion

A

CBC, type/screen, U/S

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25
if no products of conception found on u/s ? if some POCs found ? if intact POCs but bleeding and cervix dilated? if intact POCs, no cervical dilation but bleeding? if intact POCs but fetal death? infection of uterus/surrounding areas?
complete abortion (f/u) some: incomplete (D&C/medical) bleeding/dilated: inevitable (D&C/medical) bleeding/no dilation: threatened (bed/pelvic rest) fetal death: missed (D&C/medical) infection: septic abortion (D&C and IV abx (levaquin, metronidazole)
26
medical treatment of abortions (incomplete, inevitable, missed)
misoprostol (PGE1 analog): help open cervix and expulse fetus if Rh- give RhoGAM
27
complications of multiple gestations
spontaneous abortion of 1 fetus, premature L+D, placenta previa, anemia
28
preterm contractions with cervical dilations called ?
preterm labor if "gush of fluids" consider PROM if just preterm contractions will not lead to cervical change
29
risk factors for preterm labor
PROM, multiple gestations, previous hx of preterm labor, placental abruption, maternal factors (anatomy, infection, pre-E, intra-abd. sx)
30
when NOT to stop preterm labor
pre-E/eclampsia, cardiac disease, cervical dilation of +4cm, maternal hemorrhage (placental abruption, DIC), fetal death, chorioamnionitis, between 34-37 wks, greater than 2500g
31
most commonly used tocolytic | SEs?
Mg+: decreases uterine tone and contractions SEs: flushing, HA, diplopia, fatigue also, check DTRs and look out for respiratory depression and cardiac arrest others: CCBs, terbutaline (B-agonist) Do NOT use indomethacin
32
PROM may lead to ?
preterm labor, cord prolapse, placental abruption, chorioamnionitis (do fewer pelvic exams to reduce risk of chorio)
33
treatment of PROM
if chorioamnionitis: deliver NOW | if term and no chorio: wait 6-12 hrs for spontaneous delivery, than induce
34
P-PROM treatment (preterm premature ROM) if no chorioamnionitis
betamethasone, tocolytics, ampicillin, 1 dose azithromycin (decrease risk of dev. chorio) if PCN allergic: cefazolin and azithromycin if high risk anaphylaxis: clindamycin and azithromycin
35
PAINLESS vaginal bleeding
placenta previa abnormal implantation over internal os cause of 20% of hemorrhages ^risk with previous C-section, uterine sx, gestations, placenta previas in past
36
types of placenta previa
complete, partial, marginal (adjacent, touching edge), vasa previa (fetal vessels over os), low-lying placenta (between 0-2 cm away)
37
treatment of placenta previa
strict pelvic rest immediate C-section if: cervix dilated +4cm (unstoppable labor), severe hemorrhage, fetal distress get type/screen, CBC, PTT
38
PAINFUL vaginal bleeding
placental abruption may occur before, during, after labor (most commonly in 3rd trimester) may present with contractions and possible fetal distress
39
risk factors for placental abruption
HTN, prior abruption, cocaine use, external trauma, smoking during pregnancy
40
types of placenta previa
concealed (blood in uterine cavity) and external
41
risks with placenta abruption (most likely concealed type)
premature delivery, uterine tetany, DIC, hypovolemic shock, fetal hypoxia/death, Sheehan syndrome (postpartum hypopituitarism
42
sudden onset EXTREME abdominal pain
uterine rupture typically occurs during labor +/- abnormal bump in abdomen, no contractions, regression of fetus tx: immediate laparotomy and delivery
43
what ^risk of uterine rupture
previous C-section with classic (longitudinal) incision OR low transverse (current) trauma (MVAs), myomectomy, overdistension (polyhydramnios, twins), percreta
44
hemolytic disease of newborn
fetal anemia and extramedullary production of RBCs ^heme and bilirubin in plasma (bili may be toxic) can lead to erythroblastosis fetalis (^fetal cardiac output (CHF))
45
Rh screening done when?
initial prenatal visit, if Rh- get Ab titers no Abs: unsensitized done again at 28 and 35 wks, if still unsensitized, give RhoGAM at 28 wks and at delivery
46
Rh- mother is considered sensitized if Ab titers are more than ?
1:4 if the titer is less than 1:16 no further treatment if more than 1:16: amniocentesis at 16-20 wks to evaluate fetal Rh status if Rh+ then serial amniocentesis (evaluation of fetal bilirubin level)
47
eclampsia treatment
(pre-E + tonic-clonic seizure) stabilize mom then deliver Mg+ sulfate and hydralazine
48
complications of pregestational DM
^risk: pre-E, spontaneous abortion, rate of infection, PPH, congenital anomalies, macrosomia
49
fetal testing in pregestational DM
32-36 wks: weekly NST (FWB) and U/S (fetal size) 36+ wks: 2x weekly (1 NST and 1 BPP (for amniotic fluid amount, FWB) 37 wks: L/S ratio, if mature, deliver 38-39 wks: deliver
50
GDM complications
preterm birth, macrosomia (dystocia), neonatal hypoglycemia (increased glucose in utero raises insulin levels), DM persisting after delivery
51
testing for GDM
glucose load test at 24-28 wks: 50g glucose, measure 1 hr later + if +140 mg/dL, then do glucose tolerance test: 100g glucose, measure fasting, 1,2,3 hrs if 2/4+ : GDM
52
when to do more than diet and exercise for GDM
if uncontrolled: fasting +95 mg/dL and 1 hr postprandial greater than 140 mg/dL tx: insulin: NPH before bed and aspart before meals
53
if GDM pts don't want insulin
metformin and glyburide
54
types if IUGR (bottom 10%)
symmetric: before 20 wks asymmetric: brain weight NOT decreased, abdomen smaller than head, occurs after 20 wks
55
etiologies of IUGR
chromosomal abn, NTDs, infection, multiple gestations, maternal HTN, renal disease, malnutrition, substance abuse (*smoking)
56
complications of IUGR
premature labor, stillbirth, hypoxia, lower IQ, seizures, mental retardation
57
macrosomic if how big, what to do next? | risk factors?
over 4500g, fundal height at lease 3 cm more than age, get an U/S to estimate weight by femur length, abd. circumference, head diameter DM or obesity, AMA, postterm
58
reactive NST defined by
detection of 2 fetal movements | 2 accelerations of FHR greater than 15 bpm lasting 15-20 seconds over 20-min period
59
BPP consists of
NST fetal chest expansion (1+ in 30 min) fetal muscle tone amniotic fluid index (AFI) based on sonogram each worth 2 pts, 8-10 is normal, 4-8 inconclusive, below 4 is abnormal
60
normal FHR
110-160 bpm
61
early decelerations
decrease in HR occurs with contractions due to head compression
62
variable decelerations
decrease in HR and return to baseline with NO RELATIONSHIP to contractions implies umbilical cord compression
63
mnemonic for accels/decels
``` VEAL CHOP Variable - Cord compression Early - Head compression Accel - OK Late - Placental insufficiency ```
64
late decelerations
decrease in HR AFTER contraction started, no return to baseline until contraction ends implies fetal hypoxia/placental insufficiency
65
stage 2 steps
1. engagement 2. descent 3. flexion 4. internal rotation 5. extension 6. external rotation 7. delivery of anterior shoulder 8. delivery of posterior shoulder
66
How to induce labor
Prostaglandin E2: cervical ripening (do not give to asthmatics) Oxytocin: exaggerates uterine contractions Amniotomy: puncture sac with hook, but inspect for a prolapsed cord first!
67
prolonged latent stage caused by ? how to treat ?
longer than 20 hours for primi and 14 hrs for multi causes: sedation, unfavorable cervix, uterine dysfunction with irregular/wk contractions tx: rest and hydration, most convert to spontaneous delivery in 6-12 hrs
68
protracted cervical dilation cause? treatment?
less than 1.2 cm/hr in primi, less than 1.5 in multi causes: power, passenger, pelvis tx: oxytocin or C-section
69
arrest disorders
no cervical dilation for 2 hrs or no fetal descent for 1 hr | causes: cephalopelvic disproportion (tx: C-section), malpresentation, excessive sedation/analgesia
70
breech positions: frank complete footling
frank- hips flex knees extended ("frank hot dogs") complete -both hips and knees flexed footling - feet first, single or double
71
what to do if shoulder dystocia
1. McRobert's maneuver: mom flexes knees into abdomen with suprapubic pressure (Mc = Mom) 2. Rubin maneuver: rotation of fetal shoulders by pushing posterior shoulder toward fetal back (Rubin = rotate) 3. Woods: same as Rubin but towards fetal head 4. deliver posterior arm 5. deliberate fx of fetal clavicle! 6. Zavanelli maneuver: push head back and C-section, last resort!
72
80% of postpartum hemorrhage due to ? | other causes
``` uterine atony (inadequate compression of uterine blood vessels) others: laceration, retained parts, coagulopathy ```
73
risk factors for atony
anesthesia, uterine overdistension (twins, polyhydr.), prolonged labor, laceration, retained placenta (accreta), coagulopathy
74
what to do if PPH
assure no uterine rupture or retained placental with bimanual exam, then bimanual compression and massage (controls most cases) administer oxytocin if does not work (will constrict BVs)
75
if inability to breastfeed after PPH, think ?
Sheehan syndrome

OBGYN Step 2 (5 decks)

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