OBGYN Flashcards
What are the normal maternal changes?
1) HR increases 15-20
2) BP decreases 5-15 in 2nd trimester but returns to normal in 3rd trimester
3) CO increases
4) Plasma increases 40%
5) Increased clotting factors and increased risk of pulmonary embolus
6) Progesterone and Relaxin hormones relax sphincters
7) Decreased functional/residual volume because baby is taking up room in the belly
What are the pregnancy length terms?
Preterm: before 38 weeks
Full term: 38-42 weeks
Post term: after 42 weeks
What are the general treatment measures for obstetric emergencies?
1) Place patient in lateral recumbent position, ideally left because there is no resulting compression of inferior vena cava
2) Check temperature (fever can indicate sepsis, treat with ampicillin and gentamycin)
3) Check fetal heart rate which should be 120-160
4) Administer Lactated Ringers
5) Administer O2
What is DES?
Standard assessment of labor:
Dilation: 0-10 cm
Effacement: cervix thickness, normal is 2cm
Station: fetal head related to pubic bone measured in cm + or -
What are the key points of fetal monitoring?
The gold standard is internal fetal monitoring scalp transducer with uterine pressure monitor tocometer
External fetal monitoring with Doppler
Normal FHR 120-160; tachycardia commonly tied to maternal fever, bradycardia commonly tied to hypoxia
Variability is the most important indicator of fetal well being (10-15 is normal). Fetal hypoxia is the top cause of poor variability
Accelerations which are always good and decelerations which can be bad are related to uterine contractions
How do you interpret fetal heart rate and uterine contraction waveforms?
FHR mirrors Contraction: early decelerations, associated with head against cervix, benign
FHR deceleration starts mid contraction: late deceleration, associated with ureteroplacental insufficiency causing fetal hypoxic bradycardia. Commonly related with pregnancy induced hypertension, late deliveries, diabetes, pre eclampsia, and smokers. This is always a concern
V or W shaped waveform for fetal heart rate: variable deceleration due to cord compression from nuchal (wrapped around fetus’ neck) or prolapsed (cord protruding from mother’s vagina) cord
Fetal heart rate appears similar to fine Vfib: sinusoidal variations caused by accidental tap of umbilical cord during amniocentesis, placental abruption, and fetomaternal transfusion. Fetal hypovolemia, acidosis, and anemia result. Emergency C-section.
What are the signs of imminent delivery?
1) Vaginal Bleeding
2) Contractions less than 10 minutes apart with growing intensity
3) Urge to push
4) Need to have a BM
5) Crowning
What are the stages of delivery?
1) Crowning (cervix is fully dilated)
2) Delivery of body
3) Delivery of placenta
What are the indications for Emergency C-Section?
1) Multiple Decelerations with poor Rate/variability
2) Sustained Bradycardia (less than 120 for longer than 10 min)
3) Sinusoidal Waveform
What are the key points regarding pre term labor and delivery?
Regular uterine contractions with cervical change/effacement (true labor) prior to 38 weeks gestation. This is most commonly a result of hypovolemia.
Administer tocolytics (medications for stopping uterine contractions) such as Terbutaline which stops uterine contractions immediately after subcutaneous injection of 0.25mg every 15min because it does not last very long or Magnesium Sulfate which depresses the CNS and relaxes smooth muscles allowing I to stop uterine contractions when 4-6 grams are given by IV over 30 minutes or with a continuous infusion of 2 grams/hour (Mag lasts a long time but takes a long time to work).
Be aware of mag toxicity after giving magnesium sulfate. Perform a mag check to look for decreased DTRs and pulmonary edema. In a mag check deep tendon reflexes are scored (0: absent reflex, 1: trace or seen only with reinforcement, 2: normal, 3: brisk, 4: nonsustained clonus or repetitive vibratory movement, 5: sustained clonus) and respirations are evaluates. Blood levels of mag should not be relied upon because they do not correlate with levels of toxicity. Calcium Gluconate is the antidote for magnesium sulfate toxicity.
Administer steroids (Celestone or Dexamethasone) to stimulate fetal lung maturity
Prevent infection by avoiding vaginal exam and use sterile gloves if exam is needed
What are the key aspects of a Premature Rupture of Membranes? signifiesimminent
When a mother’s water breaks early, indicates imminent delivery.
Amniotic sac is what surrounds the baby and protects against infection
Administer steroids for fetal lung maturity
What are the key points regarding Anaphylactoid Syndrome of Pregnancy?
Caused by maternal exposure to fetal cells. Disseminated Intravascular Coagulopathy or DIC and Anaphylaxis occur simultaneously. Sudden pleuritic chest pain, fever, tachycardia, and tachypnea can be symptoms of this. Treatment includes increasing PEEP, fluid resuscitation, fresh frozen plasma, platelets, cryoprecipitate
What are the key aspects of umbilical cord prolapse?
Variable decelerations can occur. Elevate cord to relieve pressure and increase fetal circulation. Use a saline soaked gauze to prevent cord from drying. Put pt I trendelenburg position or knees to chest. Administer tocolytics.
What are the key points regarding Meconium?
Meconium is the baby’s defecation in the womb. It is sterile, but it makes surfactant ineffective. Deep suctioning is only indicated if baby is not vigorous. Intubation and suction before first cry
What are the important things to remember regarding Pregnancy Induced Hypertension?
New hypertension that occurs with pregnancy and can lead to placental insufficiency. PIH can be treated with Labetolol (Beta Blocker), Methyldopa (Levodopa), Hydralazine (Alpresoline)
