OBGYN 5 Flashcards
Describe quad screen for Down syndrome
Remember that Downs is UP
- AFP and Estriol are down in both Downs and Edwards
- hcG and Inhibin A are UP
Describe quad screen for Edwards
Remember that Edwards is down
- AFP and Estriol are down in both Downs and Edwards
- hcG and Inhibin A are DOWN
What tests make up 1st trimester screen
- US for nuchal translucency (normal <3 mm)
- PAPP-A
- hcG
What tests make up quad screen
o hcG
o AFP
o Estriol
o Inhibin A
Next step: currently pregnant woman with unknown GBS status but with previous GBS disease baby
Give intrapartum abx prophylaxis. No need to check GBS status because she will get abx regardless
Tx of umbilical cord prolapse
Elevate fetal head and arrange for C-section
Tx of baby born to meconium stained fluid
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
Are babies of T1DM moms likely to be large or small
Small
Macrosomic infants are typically associated with gestational diabetes
Describe complications associated with a baby of mom with poorly controlled gestational DM in relation to:
- Size
- Sugar
- RBC
- Bilirubin
- Calcium
- Macrosomia
- Stillbirth
- Hypoglycemia
- Polycythemia
- Hyperbilirubinemia
- Hypocalcemia
- Respiratory distress
What is the protocol of a baby delivered by an HIV+ mother on treatment with undetectable viral load
- Start AZT immediately after deliver
- Start HIV testing at 24 hours
- Breast feeding is contraindicated
Should HIV infected mom deliver vaginally or via csx
Depends on viral load
- Viral load < 1000 = vaginal delivery as long as no other contraindications
- Viral load > 1000 = csx
What are the 5 components of apgar scoring
A = appearance/color P = pulse G = grimace/reaction A = activity/muscle tone R = respiratory effort
Describe scoring of appearance/color
2 = completely pink 1 = acrocyanosis 0 = blue/pale
Describe pulse of apgar scoring
2 = > 100 bpm 1 = < 100 bpm 0 = absent
Describe apgar scoring of grimace/reaction
2 = cough/sneeze/gag 1 = grimace 0 = no response
Describe apgar scoring of activity/muscle tone
2 = flexed/active motion 1 = some flexion of extremities 0 = limp
Describe apgar scoring of respiratory effort
2 = good, crying 1 = slow, irregular 0 = absent
Describe presentation of Sheehan synrome
♣ Panhypopituitarism
♣ Failure to lactate, absent menstruation, cold intolerance
♣ Slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension, and amenorrhea
Tx of Sheehan syndrome
♣ Estrogen and Progesterone replacement and supplementation with thyroid and adrenal hormones
Risk factors for postpartum endometritis
Prolonged labor, prolonged rupture of membranes, multiple vaginal examinations, internal fetal monitoring, removal of placenta manually, low SEC
What is the tx for chorioamnionitis
IV abx and induction of labor
At what gestational age should tx of PPROM be delivery
> 34 weeks
At what gestational age is magnesium indicated in PROM
<32 weeks
What is the most common complication associated with PROM
Preterm labor
Most common organism responsible for chorioamnionitis without membrane rupture
Listeria
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
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
When do you give Rhogam in Rh- mom
At 28 weeks, and again within 72 hours of delivery
Most common organisms of endometritis
Staph aureus and streptococcus
What is the difference between postpartum depression and postpartum blues
Blues < 2 weeks
Depression > 2 weeks
Breast feeding decreases the risk of what disease
Ovarian cancer
Name uterotonics
Pitocin, Cytotec, Hemabate
Name tocolytics
Terbutaline, Nifedipine, Nitroglycerin, Indomethacin
Tx of mastitis in a breast feeding mom
Antibiotics
Mom can continue breast feeding
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
Most common organism in mastitis
Strep
What hormones are responsible for milk production vs. milk ejection
Production = prolactin Ejection = oxytocin
What progesterone level suggests a normal pregnancy
> 25 ng/ml
At what beta-hCG level should an intrauterine pregnancy be expected to be seen on US
Discriminatory zone is >2000
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
What is the most common cause of spontaneous abortion in the 1st trimester
genetic abnormalities
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
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
Treatment of chorio
♣ Broad spectrum antibiotics
♣ Induction of labor
Maternal complications of chorio
postpartum hemorrhage, endometritis
Neonatal complications of chorio
♣ Neonatal: preterm birth, pneumonia, encephalopathy
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
Management of delivery plan for a nonviable fetys
Vaginal delivery (has lowest risk of maternal complications)
Define late term vs. postterm pregnancy
Late term = 41wk - 41wk6d
Postterm = >42wk
