OBGYN 2 Flashcards
Tx of inverted uterus
Try to manually reduce. If that fails then . . .
Uterine relaxing agent (e.g. Terbutaline, Magnesium sulfate, Halothane)
Then either replacement with gloved hand or surgery
Also TREAT THE HEMORRHAGE (fluids!)
What do you do if placenta has not delivered after 30 min
Attempt manual extraction of the placenta
^ Do this instead of attempting uterotonics
What is the cause of massive hemorrhage involved in uterus inversions
Inverted uterus leads to inability for an adequate myometrial contraction effect
What is shoulder dystocia
Inability of the fetal shoulders to deliver spontaneously, usually due to the impaction of the anterior should behind the maternal pubic symphysis
3 major risk factors for shoulder dystocia
(1) Prior shoulder dystocia
(2) Fetal macrosomia
(3) Maternal gestational DM
Tx of shoulder dystocia
McRoberts maneuver
- Maternal thighs are sharply flexed against the maternal abdomen to straighten the sacrum relative to the lumbar spine and rotate the symphysis pubis anteriorly toward the maternal head
What part of the brachial plexus is damaged in Erb-Duchenne palsy
Superior trunk (C5-C6)
Describe deficits in Erb palsy
Weakness of:
- Deltoid (cannot abduct - arm hangs by side)
- Infraspinatous (cannot abduct - arm hangs by side)
- Flexors (cannot flex/supinate - arm extended and internally rotated)
What is the danger of rupturing membranes with an unengaged fetal presentation
Umbilical cord prolapse
Tx of umbilical cord prolapse
Immediate C-section
Trendelenburg in the meantime + keep hand in vagina to keep pressure off the cord
First step in dealing with fetal bradycardia
Must distinguish fetal HR from maternal via US or fetal scalp electrode
Describe symptoms of pre-eclampsia
- Headache*
- Vision changes*
- Shortness of breath (pulmonary edema)*
- Epigastric/RUQ pain*
Describe signs of pre-eclampsia
- Hypertension >140/90, >160/110*, two measurements 4 hours apart
- Proteinuria (>300 mg on a 24 hour urine, P:C >0.3)
- Elevated hematocrit
- Hemolysis (elevated LDH)
- Thrombocytopenia (<100,000)*
- Elevated liver enzymes (AST/ALT twice normal)*
- Renal insufficiency (Cr>1.1 or twice baseline)*
How do pre-eclampsia and HELLP syndrome compare
HELLP = preeclampsia + hemolytic anemia
Which vaccinations are recommended during pregnancy
Tdap, inactivated influenza virus, Rho(D) immunoglobulin
Management for pt >37 wk gestation with breech presentation
External cephalic version (ECV)
If that fails - C-section
How can you tell the difference between placenta previa and placenta abruption
Placenta abruption = painful bleeding
Placenta previa = painless bleeding
What is considered a reactive nonstress test
NST = External fetal heart rate monitoring for 20-40 minutes
Normal results: Reactive: >/= 2 accelerations in a 20 min period
What is a biophysical profile
• Nonstress test plus US assessment of the following:
o Amniotic fluid volume
o Fetal breathing movement
o Fetal movement
o Fetal tone
• 2 point per category if normal and 0 points if abnormal (max 10/10)
What is a contraction stress test
♣ Description
• External fetal heart rate monitoring during spontaneous or induced (e.g. oxytocin, nipple stimulation) uterine contractions
♣ Normal result
• No late or recurrent variable decelerations
What does a BPP of <6/10 indicate?
Fetal hypoxia due to placental dysfunction
Common side effect of depo provera (Medroxyprogesterone) shot?
Weight gain
Management of recurrent variable decelerations
♣ Maternal repositioning to reduce cord compression
♣ Amnioinfusion
♣ C-section if there is loss of FHR variability
What is septic pelvic thrombophlebitis
o Is a thrombosis of the deep pelvic or ovarian veins that becomes infected
Presentation of septic pelvic thrombophlebitis
♣ Fever unresponsive to abx
♣ No localizing signs/symptoms
♣ Negative infectious evaluation
♣ Diagnosis of exclusion
Tx of septic pelvic thrombophlebitis
♣ Anticoagulation
♣ Broad-spectrum antibiotics
Next step in management of decreased fetal movement
NST
Most common cause of postpartum hemorrhage in vaginal delivery
Uterine atony
Definition of postpartum hemorrhage in vaginal
and Csx delivery
Vaginal = Loss of 500 mL or more
C-sx = loss of 1000 mL or more
Tx of uterine atony
First line:
- Dilute IV oxytocin + bedside uterine massage
If first line is ineffective:
- Prostaglandin F2-alpha (Hemabate)
- Rectal misoprostol
What is the most common cause of late postpartum hemorrhage (after the first 24 hours)
♣ Subinvolution of the uterus
• Occurs when the placental implantation site does not decrease in size as expected, thus when the eschar overlying the placental site falls off (7-10 days after deliver)
• Tx = uterotonic agents such as ergot alkaloids or misoprostol
Describe alpha fetoprotein levels in neural tube defects
o AFP is a glycoprotein made by the fetal liver
• AFP will be elevated when there is an opening in the fetus not covered by skin (e.g. NTD)
Describe AFP levels in chromosomal trisomies
Decreased AFP
Describe b-hCG, estriol, and Inhibin A levels in Down syndrome
♣ Decreased alpha-fetoprotein
♣ Increased b-hCG
♣ Decreased estriol
♣ Increased Inhibin A
Describe b-hCG, estriol, and Inhibin A levels in Trisomy 18
♣ Decreased alpha-fetoprotein
♣ Decreased b-hCG
♣ Decreased estriol
♣ Normal Inhibin A
ALL LEVELS ARE LOW
Normal HbA1C
Normal = 4-5.6% Pre-DM = 5.7-6.4% DM = <6.5%
DM Class A1
♣ Gestational, no medication
DM Class A2
♣ Gestational, medication
DM Class B
♣ Onset >20 y/o; duration <10 years
DM Class C
♣ Onset 10-19 y/o; duration 10-19 years
DM Class D
♣ Onset <10 y/o; duration >20 years
DM Class R
♣ Proliferative retinopathy
DM Class F
♣ Nephropathy (>500 mg/day)
DM Class H
♣ Atherosclerotic heart disease
DM Class T
♣ Prior renal transplant
