OB Uworld Flashcards
causes of asymmetric fetal growth restrictions
vascular disease like HTN and preeclampsia and DM antiphospholipids Ab autoimmune cyanotic cardiac disease substance abuse
causes of symmetric fetal growth restrictions
genetic
congenital heart disease
intrauterine infections: malaria CMV, rubella, toxo, varicella)
causes of variable heart decelerations
cord compression
oligohydramnios
cord prolapse
Tx variable decelerations
maternal repositioning to left lateral then if fail to improve do amnioinfusion
PPROM and fetus has bilateral renal agenesis
next step
allow spontaneous vaginal delivery because baby wont survive anyway
when to do C section no matter what
prior classic cesarean (vertical)
myomectomies
postpartum endometritis
fever greater than 100.4 outside first 24 hours postpartum
risk factors postpartum endometritis
prolonged rupture of membranes
prolonged labor >12 hours
C section
use of intrauterine pressure catheters or fetal scalp electrodes
signs Sx of endometritis postpratum
fever, uterine tenderness foul smelling lochia and leukocytosis
pathogens in postpartum enodmetritis
polymicrobial
Antibiotics for postpartum endometritis
clinda and genta IV
low grade fever and leukocytosis in first 24 hours postpartum
normal
management of missed spontaneous abortion
D and C
indication for induction labor for fetal demise
when coagulation studies are low normal range
impending DIC
chorioamninitis
prolonged rupture of membranes
>18 hours
Dx chorioamnionitis
maternal fever and 1+:
- uterine tenderness
- maternal or fetal tachy
- malodorous amniotic fluid
- purulent vaginal discharge
risk factor for chorioamnionitis
prolonged rupture of membranes
management chorioamnionitis
broad spec antibiotics and delivery
Dx intrauterine fetal demise
US
patient has confirmed intrauterine fetal demise and passes baby. next step to address?
autopsy to determine cause and if can prevent for future pregnancies
when is serial bhCG monitoring required post delivery
for molar pregnancies
what can you give patient if want to pass their spontaneous abortion at home
misoprostol
when to give anti D Ig or rhogam
28-32 weeks in Rh negative patient within 72 hours of delivery ectopic molar CSV or amniocentesis abdominal trauma 2nd and 3rd trimester bleeding external cephalic version
management for preterm labor
tocolytics, NSAIDs
corticosteroids and MgSO4 for neuroprotection
risk for fetus if mom has Hx of anorexia nervosa
higher risk for baby small for gestational age
common findings in anorexic patients
osteoporosis elevated cholesterol and carotene cardiac arrythmias like long QT euthyroid sick syndrome HPA dysfunction hyponatremia from drinking excess water
very high AFP is associated with what
open NT defects
ventral wall defects
multiple gestation
placenta previa with bleeding at 37 weeks
hemodynamically stable
C section
greatest risk placental abruption
DIC
risk factors for placental abruption
tobacco use and preeclampsia
tonic clonic seziure in pregnancy and now has arm adducted and internally rotated
normal DTR and strength
posterior shoulder dislocation
contraindications to external cephalic version
indications for c sextion placental abnormalities oligohydramnios ruptured membranes hyperextended fetal head fetal or uterine anomaly multiple gestation
what vaccines can be given during pregnancy
Tdap and inactivated influenza
avoid conception for how long after live attentuated vaccines
4 weeks
severe features preeclampsia
proteinuria or end organ damage BP >160 ?110 on 2 occasions more than 4 hours apart thrombocytopenia Cr >1.1 inc LFTs Pulmonary edema new onset visual or cerebral Sx
Tx preeclampsia
delivery if term
MgSO4 and hydralazine or labetolol or nifedipine PO
most comon cause postpartum hemorrhage
uterine atony
Tx uterine atony
bimanual uterine massage
IV fluids, oxygen
Uterotonic medications (oxytocin, methylergonovine, carboprost, misoprostol)
risk factors uterine rupture
prior uterine surgery
induction labor or prolonged
congenital uterine anomalies
fetal macrosomia
presentation uterine rupture
vaginal bleeding intra abdominal bleeding (hypotension) fetal deceleartions loss of fetal station loss of intrauterine pressure
suspect ectopic, and transabominal US shows no implant in uterus
next step
transvaginal US
when do majority breech presentation self correct by
37 weeks
risk factors placental abruption
cocaine and HTN
is there pain with problems with vasa previa
no
management threatened abortion
reassurance and US one week later
bed rest and no sex
lumpke palsy presentation
extended wrist
hyperextened MCP join with flexed ICP joints
absent grasp reflex
can also get ptosis and miosis
injury to C8 and T1
erb duchenne
decreased moro and biceps reflexes
waiters tip
intact grasp
risk for chorioamnionitis
protracted labor and prolonged membrane rupture
pain RUQ with HELPP
distention liver capsule
hard to breath with preeclampsia is from what
pulmonary edema from increased pulmonary capillary pressure from increased afterlod from generalized arterial vasoaspasms
screen all women at first visit for what
syphilis Hep B and HIV
when to screen for Hep C in pregnant women
HIV patients and those at high risk
risk for uterine inversion
nulliparity, fetal macrosomia
placenta acreta and rapid labor and delivery
management uterine inversion
aggressive fluid replacement
manual replacement uterus
placental removala nd uterotonic durgs after replacement
greates risk for pregnancy in someone with primary HTN
preterm labor
US of placental abruption can show what
retroperitoneal hemorrhage
first step placental abruption
aggressive fluid resuscitation with crystalloids and put in L lateral decubitus
old patient with vulvar atrophy and urinary Sx
cause of urinary problems
estrogen deficiency
if patient quad screen shows low AFP and estriol with high bhCG and inhibin A
at 18 weeks
next step
US to look for endocardial cushion defects, duodenal atresia, cystic hygroma
PPROM with unknown GBS status
give penicillin
Tx septic abortion
suction curretage
preterm labor and many late declerations
next step
C section
problem with dribbling urinary Sx post partum
urinary retention because of epidural
risk uterine rupture
previous C section
scar!!
loss of fetal station, fetus retracts
uterine rupture
contraindication to breastfeeding
active substance abuse unTx active TB maternal HIB herpetic lesions varicella infection
lab findings in hyperemesis gravidarum
severe persistent vomiting
fluid and electrolyte abnormalities
ketones!!! in urine
>5% body weight loss
