OB OME Flashcards
how long should stage 2 of labor last?
3h null
2h muli
*anything -1 is protracted(2h null, 1h multi)
managment of ROM & PROM?
delivery! they are at term so induce PROM and deliver be sure ot test PROM for GBS and give Ampicillin if needed
Transverse vs longitudinal cephalic v breech
Transverse = perpendicular to mom longitudinal = parallel with mon cephalic = head @ cervix breech = ass @ cervix
what should you always do when you find a prego women with HTN?
urinalysis for protein + if actual HTN and not transient = do U/S for IUGR
Preeclampsia
> 140/90 + protinuria = >37 deliver if <37 rest!
*eclampsia, severe preeclampsia, HELLP deliver all these!
what causes hypercoagulability in prego?
increase clotting factors, decrease PC/S and INCREASED FIBRINOGEN
*if you ever see normal fibrinogen in prego especially close to term think DIC.
complete breech
baby cris-cross apple sauce folded in a ball!
Post date baby date?
> 42wks
what do you give for seizure in a prego women with epilepsy?
phenobarbitol
what happens to TV, FEV1, FRC in prego?
tidal volume increases, FEV1 doesnt change, Functional residual capacity decreases
define premature rupture of membranes
ROM w/o contraction between 37-42 wks
what is required for an adequate CST?
3 contractions every 10 min
Precutaneous Umbilical Blood Sampling(PUBS)/Cordocentesis. why do you do this? when?
anytime between 20-32 wks to confirm fetal anemia & treat w/transfusion.
*if >32 wks = deliver baby!
when do you check for anemia during pregnancy? what is normal? how do you F/U & tx?
1st and 3rd!
28-30 wks = nadir of Hg/Hct: 10/30
*if less than this do iron studies and tx w/iron supplimentation!
define preterm premature rupture of membranes
Management?
ROM w/o contractions between 24-36 wks
- > 34 wks deliver
- <24 wks deliver/abort
- 24-26wks = steroids + expected managment –>risk for prolonged rupture of membranes
CST late decelerations
utero-placental insufficiency
how long shoudl stage 3 of labor last?
30 min. no matter how long the other stages were its always 30 min!
What are the rules for a reactive NST?
> 32wks = 15x15; 2x20
*increase via 15 bpm for 15 sec w/2 of these occuring within 20 min
<32wks = 10x10; 2x20
what bonds are broken when cervix dilates?
DISULFIDE BONDS
tx of hyperthyroid in prego? what will you see for TSH & T4:?
dec TSH, inc T4
tx: CANNOT DO RADIO I! tx w/PTU and if needed can do surgery in 2nd trimester
incomplete breech
aka footling = one leg curled up the other leg sticking out!
what defines arrested active labor?
stage 1 active labor….
> 4h w/good contractions
6h w/o contractions
what do you do to check for Mg tox?
check DTR! these will go before respiratory depression!
Tx of epilepsy in prego?
all epilepsy drugs are teratogens!
tx: L drugs are safest!
* Leviteracetan & Lemotrigine
dnt forget to add FOLIC ACID
tx of GBS?
ampicillin or Clindamycin if pcn allergy
tx of diabetes in prego?
insulin > metformin > glyburide
How long till active labor? nulli v multi?
20h in null; 14 multi
*active labor is 6cm
how long should it take to progress through active stage 1 labor?
1.2 cm/h null
- 5 cm/h multi
* if slower = protracted labor
Misoprostole vs Mifepristone?
- Misoprostole(PGE1) = causes uterus to contract ad expel products
- Mifepristone(–|PG) = causes trophoblast to be removed from the decidua = terminates prego
what do you test for in the 3rd trimester?
as you begin 3rd u check for 3 big things!
- Gestational Diabetes
- Alloimmunizatoin
- Anemia
tx of hypothyroid in prego? what labs will you see for tsh and t4?
dec T4 & inc TSH
tx: frequent TSH assesment and give levothyroxine
**if already on levo you will need to increase the dose for prego
Whats Cell-Free DNA screen? when can this be done?
ID genetic shit from babys cells that are in moms blood as early as 10 wks!
CST early decelerations
normal or head compression
antenatal testing hierarchy…
NST > BPP then if 0-2BPP = fetal demise = deliver now! if 8-10BPP = normal, if 4-6 BPP:
- > 36wks = delivery
- <36wks –> contraction stress test
CST: no late decel, no brady = stop inducing contraction leav baby in!
CST: late decelerations, brady = fetal demise deliver!
whats the target BP in prego women?
BP <140/80
what happens in prego with renal shit?
increase in GFR, decrease in Cr
How do you test for gestational DM? when?
third trimester.
-1h glucose: +>140
-3h glucose: + if
fasting >95, 1h>180 2h>155 3h>140
Define Preterm delivery
management?
20-34 wks
<20 = abort
>34 deliver
20-34 depends! as long as no C/I = steroids + Tocolytics to help lungs mature! *will only last a day or so
Preeclampsia with severe features
> 160/110 + Proteinuria + any 1 of: Cr>1.1, Plt<100, elevated liver enzymes, RUQ pain, Pulmonary edema, HA or visual disturbances
- basically its gonna look like help but its missing all aspects of help
- *can sometimes induce for vag delivery with this but often do C-section
what is prolonged rupture of membranes? managment?
> 18 hr ROM *risk for GBS, Chorioamnitis(baby still in infect), endometritis(baby out inf)
tx: Ampicillin + Erythromycin
Tx of chorioamnionitis and endomeritis
clindamycin +gentamicin + ampicillin
define rupture of membranes
ROM + contraction between 37-42 weeks
If you have arrest of labor in stage 2 and you ahve already given oxytocin what do you do?
operation vaginal delivery > c-section
*vacuum assited or forcepts
If you have labor arrest in stage 1 active and they tell u contractions are adequate….what do you do?
C-section! if not adequate give oxytocin!
whats the thinking behind a NST?
baby moves = increase in baby hr! –> you want to see accelerations & variability
when can you do amniocentesis? why?
> 16 wks to look for genetic defects. low risk to baby but not really done anymore bc if defects you basically only get 2-3 weeks to decided if u wanna keep it or not =/ been replaced with CVS and quad
HTN in prego?
140/80
when measuring fetal station what is 0?
ischial spine
frank breech
legs up in air
Nuchal Translucency(NT) When is this done? whats normal?
1st trimester(10-13w) - should be <3mm if more could indicate trisomy defect
when do you do MCA doppler? what does this telll u about the baby?
> 20 wks. “water flows faster than ketchup”
*high diastolic = anemia
Triple Screen Vs Quad screen when are they done? why?
both in 2nd trimester(15-22wks) to id genetic disorder esp trisomies.
- x3 = AFP, hcg, Estriol
- x4 =AFP, Estriol, INHIBIN, Bhcg
**18 all down, 21 has h*I up!
What is an adequate contraction? how can you tell?
use IUPC –> 200 mV in 10 min or 3 in 10 min that feel strong!
tx of HTN in prego?
alpha methyl dopa, labetalol, hydralazine,
CVS. when do you do this? why?
10-13 wks(1st trimester), checks for genetic abnormalites! = good bc can be done early = make decision earlier. 0.22% loss
what causes effacemnt of the cervix?
prostaglandins E2 *can use topically to ripen cervix
*this is why indomethacin can be a tocolytic
CST variable decelerations
cord compression
Tx of UTI in prego
alwasy treat!!! even if asymtomatic!
1st = amoxicillin or`nitrofurantoin 2nd = IV ceftriaxone
2 painfull 3rd trimester bleeding sc?
Placenta abruption & uterine rupture!
2 painless 3rd trimester bleeding sc?
Placenta previa & Vasa Previa
explain the Lewis, Kelly & Duffy antibodies when it comes to alloimmunization. How much will cause a prob?
3 antibody types!
- lewis = IgM(cold agglutinins) = Lewis Lives! –> this wont cross the placenta. If shes lewis positive you dnt need to do anything!
- Duffy & Kelly = IgG = Duffy Dies & Kelly Kills –> this will cross the placenta
*>1:8-1:32
What do you do if you dnt know the Rh type of the baby? i.e. dad is unknown!
amniotic fluid PCR
tx of anemia in baby
*determined via Precutaneous Ubilical Blood Sampling(PUBS) if…
> 32 wks = deliver
<32 wks = transfuse!
when do you give RhoGam in Rh- mom?
@28 wks and 72 hrs before fetal maternal mixing(birth)
Mom is Hep B +. How do you tx baby?
C-section to reduce risk of transmission +IVIg Hep B + HBV on day of delivery
What are the TORCH Infections?
Toxo, Other(Syphilis), Rubella, Cytomegalo, Herpes(HSV)
Sx of Toxo in mom?
mono-like illness in prego = baby will have brain calcifications, ventriculomegaly & seizures
sx of congential syphilis
1 trimester = dead baby
2-3 trimester:saddle nose, saber skins, hutchinsons teeth(teeth w/pacman bites out of them), nasal discharge, generalized lymphadenopathy, hepatosplenomegaly.
sx of congential rubella
*when soudl mom get vac?
1 trimester = IUGR or Abortion
3 trimester: “blue-berry muffin baby”, petechia & purpura + 3Cs(Cataracts, Congenital Heart, Cdeafness)
*MMR vac 3 months prior to prego or after + avoid unvac babies
sx of CMV in mom + baby
mom: looks like the flu
baby: jaundice, petechial, LP, IUGR, hearing loss, hepatosplenomeagly
*prob be a distractor
sx of HSV in mom
PAINFUL BURING PRODROM then appearance of vesicles!
Dx of HSV? Tx in prego?
PCR, (Val)acyclovir from 36-delivery
sx of HSV in baby?
IUGR, preterm birth, Blindness
Criteria for VBAC?
< 2 C-sections; Low Transverse incision on previous C-section
When can you use Vacuum Delivery or Forceps?
- baby is almost out = below +2
2. Mom is ready to delivery = fully dilated and completely effaced.
when do you often do Cervial Cerclage? When do you remove?
done @ week 14 (careful you dnt rupture membranes)….removed at week 36 = dnt want baby to rip sutures if it tries to deliver
OB - where does the pain in stage 1 come from? stage 2?
Stage 1 = T10-12
Stage 2 = S2-4
sx of paracervical block in baby
fetal bradycardia
*cannot use for C-section!
sx of pudendal block in baby
none! other than you can miss ur mark and mom will have pain =(
sx of epidural in mom?
if you get it inot CSF accidently = hypotension
