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OBGYN 5 Flashcards

1
Q

Describe quad screen for Down syndrome

A

Remember that Downs is UP

  • AFP and Estriol are down in both Downs and Edwards
  • hcG and Inhibin A are UP
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2
Q

Describe quad screen for Edwards

A

Remember that Edwards is down

  • AFP and Estriol are down in both Downs and Edwards
  • hcG and Inhibin A are DOWN
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3
Q

What tests make up 1st trimester screen

A
  • US for nuchal translucency (normal <3 mm)
  • PAPP-A
  • hcG
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4
Q

What tests make up quad screen

A

o hcG
o AFP
o Estriol
o Inhibin A

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5
Q

Next step: currently pregnant woman with unknown GBS status but with previous GBS disease baby

A

Give intrapartum abx prophylaxis. No need to check GBS status because she will get abx regardless

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6
Q

Tx of umbilical cord prolapse

A

Elevate fetal head and arrange for C-section

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7
Q

Tx of baby born to meconium stained fluid

A

If newborn is depressed, intubate trachea and suction meconium from beneath the glottis

If newborn is vigorous, tracheal suctioning is not necessary - will more likely just cause damage to the vocal cords

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8
Q

Are babies of T1DM moms likely to be large or small

A

Small

Macrosomic infants are typically associated with gestational diabetes

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9
Q

Describe complications associated with a baby of mom with poorly controlled gestational DM in relation to:

  • Size
  • Sugar
  • RBC
  • Bilirubin
  • Calcium
A
  • Macrosomia
  • Stillbirth
  • Hypoglycemia
  • Polycythemia
  • Hyperbilirubinemia
  • Hypocalcemia
  • Respiratory distress
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10
Q

What is the protocol of a baby delivered by an HIV+ mother on treatment with undetectable viral load

A
  • Start AZT immediately after deliver
  • Start HIV testing at 24 hours
  • Breast feeding is contraindicated
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11
Q

Should HIV infected mom deliver vaginally or via csx

A

Depends on viral load

  • Viral load < 1000 = vaginal delivery as long as no other contraindications
  • Viral load > 1000 = csx
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12
Q

What are the 5 components of apgar scoring

A 
A = appearance/color
P = pulse
G = grimace/reaction
A = activity/muscle tone
R = respiratory effort
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13
Q

Describe scoring of appearance/color

A 
2 = completely pink
1 = acrocyanosis
0 = blue/pale
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14
Q

Describe pulse of apgar scoring

A 
2 = > 100 bpm 
1 = < 100 bpm
0 = absent
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15
Q

Describe apgar scoring of grimace/reaction

A 
2 = cough/sneeze/gag
1 = grimace
0 = no response
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16
Q

Describe apgar scoring of activity/muscle tone

A 
2 = flexed/active motion
1 = some flexion of extremities
0 = limp
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17
Q

Describe apgar scoring of respiratory effort

A 
2 = good, crying
1 = slow, irregular
0 = absent
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18
Q

Describe presentation of Sheehan synrome

A

♣ Panhypopituitarism
♣ Failure to lactate, absent menstruation, cold intolerance
♣ Slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension, and amenorrhea

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19
Q

Tx of Sheehan syndrome

A

♣ Estrogen and Progesterone replacement and supplementation with thyroid and adrenal hormones

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20
Q

Risk factors for postpartum endometritis

A

Prolonged labor, prolonged rupture of membranes, multiple vaginal examinations, internal fetal monitoring, removal of placenta manually, low SEC

21
Q

What is the tx for chorioamnionitis

A

IV abx and induction of labor

22
Q

At what gestational age should tx of PPROM be delivery

A

> 34 weeks

23
Q

At what gestational age is magnesium indicated in PROM

24
Q

What is the most common complication associated with PROM

A

Preterm labor

25
Most common organism responsible for chorioamnionitis without membrane rupture
Listeria
26
What is the most common abnormality on fetal heart rate tracing seen in PROM
Variable decelerations due to oligohydramnios causing insufficient fluid to buffer the cord
27
Management of Parvovirus in pregnant mom
- Fetal US every 1-2 weeks for 8-10 weeks after a positive IgM assay - Doppler assessment to assess for fetal anemia - If evidence of hydrops of anemia, fetal blood sampled to obtain hematocrit for fetal transfusion
28
When do you give Rhogam in Rh- mom
At 28 weeks, and again within 72 hours of delivery
29
Most common organisms of endometritis
Staph aureus and streptococcus
30
What is the difference between postpartum depression and postpartum blues
Blues < 2 weeks | Depression > 2 weeks
31
Breast feeding decreases the risk of what disease
Ovarian cancer
32
Name uterotonics
Pitocin, Cytotec, Hemabate
33
Name tocolytics
Terbutaline, Nifedipine, Nitroglycerin, Indomethacin
34
Tx of mastitis in a breast feeding mom
Antibiotics Mom can continue breast feeding
35
Why does it take a while for mothers to produce milk after delivery
Needs time for estrogen and progesterone levels to decrease in order to remove the inhibitory effect on prolactin
36
Most common organism in mastitis
Strep
37
What hormones are responsible for milk production vs. milk ejection
``` Production = prolactin Ejection = oxytocin ```
38
What progesterone level suggests a normal pregnancy
>25 ng/ml
39
At what beta-hCG level should an intrauterine pregnancy be expected to be seen on US
Discriminatory zone is >2000
40
What is the criteria for use of methotrexate to treat ectopic pregnancy
Hemodynamic stability, non-ruptured ectopic pregnancy, size of ectopic mass <4cm without a fetal heart rate or <3.5 cm with a fetal heart rate
41
What is the most common cause of spontaneous abortion in the 1st trimester
genetic abnormalities
42
What are risk factors for chorioamnioitis
♣ Prolonged rupture of membranes (>18 hours) ♣ PPROM ♣ Prolonged labor ♣ Internal fetal/uterine monitoring devices ♣ Repetitive vaginal examinations ♣ Presence of genital tract pathogens
43
How do you diagnose chorio
``` ♣ Maternal fever PLUS >/=1 of the following: • Fetal tachycardia (>160) • Maternal leukocytosis • Purulent amniotic fluid • Maternal tachycardia (>100) • Uterine fundal tenderness ```
44
Treatment of chorio
♣ Broad spectrum antibiotics | ♣ Induction of labor
45
Maternal complications of chorio
postpartum hemorrhage, endometritis
46
Neonatal complications of chorio
♣ Neonatal: preterm birth, pneumonia, encephalopathy
47
What are the components of biophysical profile (BPP)
Nonstress test plus US of the following: - Amniotic fluid volume - Fetal breathing movement - Fetal tone - Fetal movement
48
Management of delivery plan for a nonviable fetys
Vaginal delivery (has lowest risk of maternal complications)
49
Define late term vs. postterm pregnancy
Late term = 41wk - 41wk6d Postterm = >42wk

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