OBG 2 Flashcards
magnesium should be monitored for signs of toxicity (somnolence, areflexia, respiratory suppression).
What pts are at increased risk for toxicity?
renal insufficiency
(bc magnesium is excreted by the kidneys)
Hypocalcemia is a potential adverse effect
Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Solid unilateral ovarian mass
Sertoli-Leydig Tumor
Surgery required (2nd trimester or postpartum)
*High fetal virilization risk
Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Cystic, bilateral ovarian masses
Theca lutein cyst
Spontaneous regression of masses after delivery (observe)
*Low fetal virilization risk
Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Solid, unilateral/bilateral ovarian masses
Luteoma
Spontaneous regression of masses after delivery (observe)
*High fetal virilization risk
Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
No ovarian mass on exam
Placental Aromatase Deficiency
Resolution of maternal symptoms after delivery (observe)
*High fetal virilization risk
Used to monitor fetal status in pregnancies complicated by maternal hypertension or fetal growth restriction.
Umbilical artery Doppler ultrasound
Low/↓ Maternal serum α-fetoprotein on quad screen indicates what?
Aneuploidies (eg, trisomy 18 & 21)
High/↑ Maternal serum α-fetoprotein on quad screen indicates what(3)?
Neural tube defects (anencephaly, open spina bifida)
Ventral wall defects (omphalocele, gastroschisis)
Multiple gestation
(these pts require fetal ultrasound)
Anti-D immune globulin (RhoGAM) is indicated in unsensitized, Rh-negative women at __ weeks gestation or within 72 hours of any procedure or incident in which there is any possibility of feto-maternal blood mixing.
28
Pruritus that is most severe on the palms with no associated rash occuring in the third trimester is consistent with what diagnosis?
Intrahepatic cholestasis of pregnancy (ICP)
s/t ↑ estrogen & progesterone levels causing hepatobiliary tract stasis and decreased bile excretion HENCE elevated total bile acids (≥10 µmol/L) which is diagnostic.
Management of Intrahepatic cholestasis of pregnancy (ICP) includes:
Antihistamines
Delivery at 37 weeks gestation
and what medication?
Ursodeoxycholic acid
cx: IUFD, Preterm delivery, Meconium-stained amniotic fluid, NRDS
Significant postpartum hemorrhage can cause _____.
Typically presents with bleeding and/or thrombosis (acute pulmonary embolus), thrombocytopenia, & prolonged PT & PTT
disseminated intravascular coagulation (DIC)
Prophylactic latency antibiotics (erythromycin, ampicillin) are indicated in patients at __ weeks gestation with preterm prelabor rupture of membranes to prevent fetal infection
<34
magnesium sulfate is administered for fetal neural protection to patients at __ weeks gestation
<32
A rare obstetrical emergency causing rapid hemodynamic instability and pulmonary edema.
Amniotic fluid embolism
A rare obstetrical emergency that can present with a vaginal mass, massive hemorrhage, and hemodynamic instability. Uterus is not palpable post-partum.
Uterine Inversion
A rare obstetrical emergency that can present with a vaginal mass, Rectal or vaginal pressure, massive hemorrhage (can be concealed bleeding), ± hemodynamic instability.
Risk factors include: Operative vaginal delivery (obstetric trauma), Infant ≥ 4kg (8.8 lb)
Vaginal hematoma
Nonexpanding: observation
Expanding: embolization, surgery
Preeclampsia can present up to __ weeks postpartum with headache and hypertension.
6
(if pt has a focal neurologic deficits a CT head is indicated)
Patients with ___ in their current pregnancy or those who delivered a prior infant with early-onset GBS infection are high risk and require intrapartum antibiotic prophylaxis.
GBS bacteriuria
Digital Cervical Exam may be insufficient for determining fetal presentation in patients with a bulging bag (which may be a normal finding s/t contractions tensing the sac).
If fetal presentation is indeterminate (no palpable presenting fetal part) on cervical exam, what is performed to confirm presentation and help determine route of delivery?
transabdominal ultrasound
Cephalic fetal presentation → managed expectantly
Non-cephalic (breech, transverse, funic/cord first) fetal presentations → cesarean delivery
Presents with acute abdominal pain; a rigid, tender uterus; and high-frequency contractions.
Risk factors include cocaine and tobacco use, which cause placental vasoconstriction.
Placental Abruption
(20% have a concealed abruption w/ no visible bleeding. Usually have severe focal pain at the location of the placenta that progresses to diffuse uterine tenderness)
Uncomplicated perineal lacerations (no fever or purulence) are managed how?
conservatively
(NSAIDs, sitz baths)
Management of Placenta Accreta refractory to uterine massage, uterotonic meds, and manual extraction/ sharp uterine curettage of retained placenta.
Cesarean hysterectomy with placenta in situ
Management of uterine inversion
- manual replacement (stop uterotonics)
- If refractory, uterine relaxants and laparotomy
Neuraxial anesthesia (epidural) can cause maternal hypotension and decreased placental perfusion. FHT will show recurrent late fetal heart rate decelerations with every contraction.
Management is with what three interventions?
Left lateral patient positioning
IVF bolus
vasopressors (phenylephrine, vasopressin)
Neuraxial anesthesia (epidural) can cause maternal hypotension and decreased placental perfusion. FHT will show recurrent late fetal heart rate decelerations with every contraction.
Management is with what three interventions?
Left lateral patient positioning
IVF bolus
vasopressors (phenylephrine, vasopressin)
Presents with severe abdominal pain; uterine tenderness; a palpable, firm & tender mass; and signs of inflammation (eg, leukocytosis).
Uterine fibroid degeneration
(Leiomyomata uteri become an infarcted, degenerating uterine fibroid during pregnancy)
Category 3 FHT (very bad) are defined by
1. Sinusoidal pattern
or
2. Absent variability PLUS one of what 3 FHT findings?
recurrent late decelerations (slow after every contraction)
recurrent variable decelerations (fast not always after every contraction)
bradycardia (Less than 100 bpm baseline)
Management of Category 3 FHTs
Initial management is with intrauterine resuscitative interventions (maternal repositioning, Oxygen, IVFs)
If no improvement with initial management and are far from delivery require immediate cesarean delivery.
Inevitable abortion presents with heavy vaginal bleeding, cramping, and a dilated cervix without passage of gestational tissue. ____ management is indicated for patients whose condition is hemodynamically unstable or has signs of infection?
suction curettage (surgical management)
In Inevitable abortion where the pt is hemodynamically stable with minimal bleeding what 2 types of management are appropriate?
Medical induction (Misoprostol) or expectant management
Persistently absent or minimal variability on fetal heart rate monitoring typically indicates fetal metabolic acidosis. However, certain ___ can also cause decreased variability (fetal CNS depression).
medications (opioids/narcotics)
Indomethacin tocolysis (inhibit contractions) is indicated in patients with preterm labor at __ weeks gestation.
*can cause oligohydramnios and premature closure of the fetal ductus arteriosus (benefits > risks)
<32
Pregnancy complicated by chronic hypertension confers an elevated risk of ___ & ___ due to uteroplacental insufficiency.
fetal growth restriction (<10th percentile)
oligohydramnios (amniotic fluid index [AFI] ≤5 cm)
Obesity in pregnancy (prepregnancy BMI ≥30 kg/m²) increases risks of ___ & ___
Intrauterine fetal demise
fetal macrosomia (>90th percentile)
Diabetes mellitus in pregnancy increases the risk for ___ & ___
macrosomia (>90th percentile)
polyhydramnios (AFI ≥24 cm)
