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OBGYN > OB OME > Flashcards

OB OME Flashcards

1
Q

how long should stage 2 of labor last?

A

3h null

2h muli

*anything -1 is protracted(2h null, 1h multi)

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2
Q

managment of ROM & PROM?

A

delivery! they are at term so induce PROM and deliver be sure ot test PROM for GBS and give Ampicillin if needed

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3
Q

Transverse vs longitudinal cephalic v breech

A 
Transverse = perpendicular to mom
longitudinal = parallel with mon
cephalic = head @ cervix
breech = ass @ cervix
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4
Q

what should you always do when you find a prego women with HTN?

A

urinalysis for protein + if actual HTN and not transient = do U/S for IUGR

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5
Q

Preeclampsia

A

> 140/90 + protinuria = >37 deliver if <37 rest!

*eclampsia, severe preeclampsia, HELLP deliver all these!

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6
Q

what causes hypercoagulability in prego?

A

increase clotting factors, decrease PC/S and INCREASED FIBRINOGEN

*if you ever see normal fibrinogen in prego especially close to term think DIC.

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7
Q

complete breech

A

baby cris-cross apple sauce folded in a ball!

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8
Q

Post date baby date?

A

> 42wks

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9
Q

what do you give for seizure in a prego women with epilepsy?

A

phenobarbitol

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10
Q

what happens to TV, FEV1, FRC in prego?

A

tidal volume increases, FEV1 doesnt change, Functional residual capacity decreases

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11
Q

define premature rupture of membranes

A

ROM w/o contraction between 37-42 wks

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12
Q

what is required for an adequate CST?

A

3 contractions every 10 min

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13
Q

Precutaneous Umbilical Blood Sampling(PUBS)/Cordocentesis. why do you do this? when?

A

anytime between 20-32 wks to confirm fetal anemia & treat w/transfusion.
*if >32 wks = deliver baby!

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14
Q

when do you check for anemia during pregnancy? what is normal? how do you F/U & tx?

A

1st and 3rd!
28-30 wks = nadir of Hg/Hct: 10/30
*if less than this do iron studies and tx w/iron supplimentation!

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15
Q

define preterm premature rupture of membranes

Management?

A

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
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16
Q

CST late decelerations

A

utero-placental insufficiency

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17
Q

how long shoudl stage 3 of labor last?

A

30 min. no matter how long the other stages were its always 30 min!

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18
Q

What are the rules for a reactive NST?

A

> 32wks = 15x15; 2x20
*increase via 15 bpm for 15 sec w/2 of these occuring within 20 min
<32wks = 10x10; 2x20

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19
Q

what bonds are broken when cervix dilates?

A

DISULFIDE BONDS

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20
Q

tx of hyperthyroid in prego? what will you see for TSH & T4:?

A

dec TSH, inc T4

tx: CANNOT DO RADIO I! tx w/PTU and if needed can do surgery in 2nd trimester

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21
Q

incomplete breech

A

aka footling = one leg curled up the other leg sticking out!

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22
Q

what defines arrested active labor?

A

stage 1 active labor….

> 4h w/good contractions
6h w/o contractions

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23
Q

what do you do to check for Mg tox?

A

check DTR! these will go before respiratory depression!

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24
Q

Tx of epilepsy in prego?

A

all epilepsy drugs are teratogens!

tx: L drugs are safest!
* Leviteracetan & Lemotrigine

dnt forget to add FOLIC ACID

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25
Q

tx of GBS?

A

ampicillin or Clindamycin if pcn allergy

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26
Q

tx of diabetes in prego?

A

insulin > metformin > glyburide

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27
Q

How long till active labor? nulli v multi?

A

20h in null; 14 multi

*active labor is 6cm

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28
Q

how long should it take to progress through active stage 1 labor?

A

1.2 cm/h null

  1. 5 cm/h multi
    * if slower = protracted labor
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29
Q

Misoprostole vs Mifepristone?

A
  • Misoprostole(PGE1) = causes uterus to contract ad expel products
  • Mifepristone(–|PG) = causes trophoblast to be removed from the decidua = terminates prego
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30
Q

what do you test for in the 3rd trimester?

A

as you begin 3rd u check for 3 big things!

  1. Gestational Diabetes
  2. Alloimmunizatoin
  3. Anemia
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31
Q

tx of hypothyroid in prego? what labs will you see for tsh and t4?

A

dec T4 & inc TSH
tx: frequent TSH assesment and give levothyroxine

**if already on levo you will need to increase the dose for prego

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32
Q

Whats Cell-Free DNA screen? when can this be done?

A

ID genetic shit from babys cells that are in moms blood as early as 10 wks!

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33
Q

CST early decelerations

A

normal or head compression

34
Q

antenatal testing hierarchy…

A

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!

35
Q

whats the target BP in prego women?

A

BP <140/80

36
Q

what happens in prego with renal shit?

A

increase in GFR, decrease in Cr

37
Q

How do you test for gestational DM? when?

A

third trimester.
-1h glucose: +>140
-3h glucose: + if
fasting >95, 1h>180 2h>155 3h>140

38
Q

Define Preterm delivery

management?

A

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

39
Q

Preeclampsia with severe features

A

> 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
40
Q

what is prolonged rupture of membranes? managment?

A

> 18 hr ROM *risk for GBS, Chorioamnitis(baby still in infect), endometritis(baby out inf)

tx: Ampicillin + Erythromycin

41
Q

Tx of chorioamnionitis and endomeritis

A

clindamycin +gentamicin + ampicillin

42
Q

define rupture of membranes

A

ROM + contraction between 37-42 weeks

43
Q

If you have arrest of labor in stage 2 and you ahve already given oxytocin what do you do?

A

operation vaginal delivery > c-section

*vacuum assited or forcepts

44
Q

If you have labor arrest in stage 1 active and they tell u contractions are adequate….what do you do?

A

C-section! if not adequate give oxytocin!

45
Q

whats the thinking behind a NST?

A

baby moves = increase in baby hr! –> you want to see accelerations & variability

46
Q

when can you do amniocentesis? why?

A

> 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

47
Q

HTN in prego?

A

140/80

48
Q

when measuring fetal station what is 0?

A

ischial spine

49
Q

frank breech

A

legs up in air

50
Q

Nuchal Translucency(NT) When is this done? whats normal?

A

1st trimester(10-13w) - should be <3mm if more could indicate trisomy defect

51
Q

when do you do MCA doppler? what does this telll u about the baby?

A

> 20 wks. “water flows faster than ketchup”

*high diastolic = anemia

52
Q

Triple Screen Vs Quad screen when are they done? why?

A

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!

53
Q

What is an adequate contraction? how can you tell?

A

use IUPC –> 200 mV in 10 min or 3 in 10 min that feel strong!

54
Q

tx of HTN in prego?

A

alpha methyl dopa, labetalol, hydralazine,

55
Q

CVS. when do you do this? why?

A

10-13 wks(1st trimester), checks for genetic abnormalites! = good bc can be done early = make decision earlier. 0.22% loss

56
Q

what causes effacemnt of the cervix?

A

prostaglandins E2 *can use topically to ripen cervix

*this is why indomethacin can be a tocolytic

57
Q

CST variable decelerations

A

cord compression

58
Q

Tx of UTI in prego

A

alwasy treat!!! even if asymtomatic!

1st = amoxicillin or`nitrofurantoin
2nd = IV ceftriaxone
59
Q

2 painfull 3rd trimester bleeding sc?

A

Placenta abruption & uterine rupture!

60
Q

2 painless 3rd trimester bleeding sc?

A

Placenta previa & Vasa Previa

61
Q

explain the Lewis, Kelly & Duffy antibodies when it comes to alloimmunization. How much will cause a prob?

A

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

62
Q

What do you do if you dnt know the Rh type of the baby? i.e. dad is unknown!

A

amniotic fluid PCR

63
Q

tx of anemia in baby

A

*determined via Precutaneous Ubilical Blood Sampling(PUBS) if…

> 32 wks = deliver
<32 wks = transfuse!

64
Q

when do you give RhoGam in Rh- mom?

A

@28 wks and 72 hrs before fetal maternal mixing(birth)

65
Q

Mom is Hep B +. How do you tx baby?

A

C-section to reduce risk of transmission +IVIg Hep B + HBV on day of delivery

66
Q

What are the TORCH Infections?

A

Toxo, Other(Syphilis), Rubella, Cytomegalo, Herpes(HSV)

67
Q

Sx of Toxo in mom?

A

mono-like illness in prego = baby will have brain calcifications, ventriculomegaly & seizures

68
Q

sx of congential syphilis

A

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.

69
Q

sx of congential rubella

*when soudl mom get vac?

A

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

70
Q

sx of CMV in mom + baby

A

mom: looks like the flu
baby: jaundice, petechial, LP, IUGR, hearing loss, hepatosplenomeagly

*prob be a distractor

71
Q

sx of HSV in mom

A

PAINFUL BURING PRODROM then appearance of vesicles!

72
Q

Dx of HSV? Tx in prego?

A

PCR, (Val)acyclovir from 36-delivery

73
Q

sx of HSV in baby?

A

IUGR, preterm birth, Blindness

74
Q

Criteria for VBAC?

A

< 2 C-sections; Low Transverse incision on previous C-section

75
Q

When can you use Vacuum Delivery or Forceps?

A
  1. baby is almost out = below +2

2. Mom is ready to delivery = fully dilated and completely effaced.

76
Q

when do you often do Cervial Cerclage? When do you remove?

A

done @ week 14 (careful you dnt rupture membranes)….removed at week 36 = dnt want baby to rip sutures if it tries to deliver

77
Q

OB - where does the pain in stage 1 come from? stage 2?

A

Stage 1 = T10-12

Stage 2 = S2-4

78
Q

sx of paracervical block in baby

A

fetal bradycardia

*cannot use for C-section!

79
Q

sx of pudendal block in baby

A

none! other than you can miss ur mark and mom will have pain =(

80
Q

sx of epidural in mom?

A

if you get it inot CSF accidently = hypotension

OBGYN (25 decks)

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