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MS3 > OBGYN 4 > Flashcards

OBGYN 4 Flashcards

1
Q

Describe intrahepatic cholestasis of pregnancy (ICP)

A

o Intrahepatic cholestasis of unknown etiology in pregnancy whereby the patient usually complains of pruritus with or without jaundice and no skin rash

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2
Q

Describe Pruritic urticarial papules and plaques of pregnancy

A

o A common skin condition of unknown etiology unique to pregnancy characterized by intense pruritic and erythematous papules on the abdomen that spread extremities and often the buttocks

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3
Q

Treatment of intrahepatic cholestasis of pregnancy

A

♣ Ursodeoxycholic acid (UDCA) – decreases total serum bile acid levels and helps to relieve the itching
♣ Fetal testing with plan for early deliver (37-18 weeks) due to increased risk of stillbirth

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4
Q

What is considered a reactive NST

A

> /= 2 accelerations in a 20 min period

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5
Q

What are the components of a biophysical profile

A
  • NST
  • Fetal breathing
  • Fetal tone
  • Fetal movement
  • Amniotic fluid volume
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6
Q

What adverse pregnancy outcomes are associated with pruritic urticarial papules and plaques of pregnancy (PUPP)

A

None

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7
Q

What lung volume changes during pregnancy

A

Functional residual capacity decreases due to baby compressing the lungs

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8
Q

Ddx of acute onset severe dyspnea in a pregnant woman

A
  • Reactive airway disease
  • Pneumonia
  • Pulmonary edema
  • Pulmonary embolism
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9
Q

How do you diagnose pulmonary embolism

A

Spiral computed tomography or ventilation/perfusion (V/Q) imaging

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10
Q

Tx of PE in pregnant woman

A
  • Full IV anticoagulation therapy for 5-7 days
  • Then therapy is switched to subcutaneous therapy to maintain the aPTT at 1.5-2.5 times control for at least 3 months after the acute event
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11
Q

What anticoagulation meds are safe to use in pregnancy

A

Heparin and LMWH

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12
Q

Describe the two main factors of pregnancy that increase the risk of DVT

A
  • Hypercoagulable state due to increased clotting factors

- Venous stasis due to uterus pressing on the vena cava

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13
Q

Tx of DVT in pregnant woman

A

Same as tx of PE:

  • Full IV anticoagulation therapy for 5-7 days
  • Then therapy is switched to subcutaneous therapy to maintain the aPTT at 1.5-2.5 times control for at least 3 months after the acute event
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14
Q

When is an amniotic fluid embolism most likely to occur

A

During labor or immediately postpartum

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15
Q

Tx of amniotic fluid embolism

A

Mostly supportive with immediate delivery if there is rapid maternal or fetal decompensation

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16
Q

What is the most common cause of maternal mortality in pregnancy

A

Embolism of all types (thrombotic or amniotic)

Followed by cardiovascular conditions and infection

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17
Q

What is the purpose of Bishop scoring

A

o Cervical assessment system used for predicting labor outcome (vaginal vs. C-section)
♣ Basically, high score means the cervix is more ripe and baby is more ready for delivery

18
Q

What are the 5 components of bishop scoring

A
  • Station of presenting part
  • Cervical dilation
  • Cervical effacement
  • Consistency of cervix
  • Position of cervix
19
Q

What does a high Bishop score indicate (>/=8)

A

• Similar likelihood of vaginal delivery whether labor begins spontaneously or is induced

20
Q

What does a low Bishop score indicate (= 6)

A

• Induction is less likely to be successful than spontaneous labor and associated with a higher rate of cesarean section

21
Q

Diagnose: urinary incontinence in a patient with irregularly enlarged and anteverted/anteflexed uterus

A

Fibroids - diagnose via US

22
Q

What are the guidelines for pap testing

A

• First Pap test age 21
• Test every three years until age 30
• Age > 30, HPV test with Pap test every 5 years
o Almost all young women are infected with HPV, but only transiently
o Usually clear HPV around 30 y/o
o This is why we test at 30 – because if they haven’t cleared virus by then, then we start to worry

23
Q

When is it okay to stop getting pap tests

A

• No more testing after hysterectomy or age 65 (with negative Pap history)

24
Q

What antihypertensives are okay to use in pregnancy

A

Labetalol, Nifedipine, Hydralazine

25
Q

Why don’t you use Augmentin in pregnancy

A

Increased risk of necrotizing enterocolitis

26
Q

When is it safe to do an amniocentesis

A
  • Earliest is around 15 weeks

- Can do it til the end of pregnancy as long as there is a clear fluid pocket

27
Q

Risk factors for PPROM

A 
♣	History of PROM/PPROM
♣	Short cervical length
♣	Smoking, drug use, low BMI
- Overextended uterus (e.g. twins)
- African American
28
Q

Complications of PPROM

A

♣ Chorioamnionitis
♣ Preterm labor
♣ Abruption – separation of placenta from the uterus
♣ Cord complications – compression or prolapse
♣ Complications associated with preterm birth (e.g. pulmonary hypoplasia, necrotizing enterocolitis, sepsis)

29
Q

What meds should you give to mothers with PPROM

A
  • steroids
  • antibiotics
  • magnesium
30
Q

At what gestational age should you deliver PPROM babies

A

34 weeks

31
Q

What are the key labs to draw with a pre-eclamptic patient

A

CBC with platelet cont, LFTs, and serum creatinine

32
Q

Define chronic HTN in pregnancy

A
  • Prepregnancy diagnosis
  • Documented hypertension prior to 20 weeks
  • Hypertension that starts in pregnancy but persists >12 weeks postpartum
33
Q

Define hypertensive emergency in prengancy

A
  • Two severe values (>160/11) taken 15-60 minutes apart

* Severe values do not need to be consecutive

34
Q

Management of gestational HTN

A
  • Rule out preeclampsia
  • Growth ultrasounds/NSTs
  • BPP once a week for fetal well being
  • Delivery at 37 weeks
35
Q

Management of pre-eclampsia without severe features

A
  • Monitor closely for severe disease
  • Growth ultrasounds/NSTs
  • Delivery at 37 weeks
  • BPP once a week for fetal well being
  • Typically does not require magnesium sulfate (seizure prophylaxis)
36
Q

Management of pre-eclampsia with severe features

A

• Maintain sufficient oxygen saturation
• If >34 weeks, deliver
• Administer MgSO4 for seizure prophylaxis
• If severe HTN (>160/110), therapy should be initiated to prevent stroke
o Labetalol, Hydralazine, or Nifedipine
• If <34 weeks, evaluate if expectant management is appropriate
o If deciding to deliver, give antenatal corticosteroid (for lung maturity) and GBS prophylaxis

37
Q

Management of chronic HTN without severely elevated BP

A

• Delivery 38-39 weeks

38
Q

What is the most common cause of maternal death due to eclampsia

A

Intracerebral hemorrhage

39
Q

What test of the vaginal fluid prior to digital exam may indicate risk for preterm delivery

A

• Swab posterior vaginal fornix for fetal fibronectin (fFN)
o If positive, may indicate risk of preterm birth
o Negative fFN is strongly associated with no delivery within 1 week

40
Q

Management of preterm labor

A

♣ Antenatal corticosteroids to enhance fetal lung maturity
♣ Tocolysis: attempts to stop preterm contractions
♣ Magnesium sulfate for neuroprophylaxis (protection against cerebral palsy)
♣ GBS prophylaxis

41
Q

What are the most commonly used tocolytic agents

A

Indomethacin, Nifedipine, Terbutaline, Ritodrine, Magnesium sulfate

Review study guide for method of action and contraindications

42
Q

What antenatal steroids are used to enhance fetal lung maturity

A

Betamethasone and Dexamethasone

MS3 (88 decks)

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