OBGYN Flashcards
Placenta previa
painless third trimester bleeding
implantation across cervical os
increased risk with multiple c-sections
Placentia abruptio
sudden onset PAINful 3rd trimester bleeding
uterine rupture
can feel fetal parts - painful with or without bleeding
contraction and sudden fetal distress followed by loss of contractions and loss of fetal station
vasa previa
painless 3rd trimester bleeding - fetal bradycardia after ROM
gestational Diabetes
24-28wks
1 hr glucose challenge
3 hr GTT (need 2+)
Normal latent phase
20hrs - nulliparity
14hrs - multiparity
how to augment labor
oxytocin misoprostol dinoprostone amniotomy balloon to stimulate engagement
prolonged and arrested active phase
no cervical change after 4hrs of adequate contractions or 6hrs of inadequate contractions
prolonged 2nd stage
2hrs pushing in multi
3hrs pushing in a nulli
test to monitor for fetal anemia
MCA Doppler showing increased flow
timeline of amniocentesis
15-20 wks
timeline of chorionic villous sampling
10-13wks
what test allows access for transfusion
Percutaneous Umbilical cord sampling only do if <32wks
rhogram timelines
28wks and 72hrs of fetal maternal mixing (including abortions)
accelerations on a NST
increased HR of 15 bpm that is sustained for 15 seconds that occurs twice in 20 min
VEAL
CHOP
variable decelerations- cord compression
Early decelerations - head compression
Late decelerations - placental insufficiency
NST categories
cat 1 - normal
cat 2 - variability but some minimal abnormal
cat 3 - absent variability get baby out
IUD types
levonorgestrel (initial spotting)
copper (best one - but can increase bleeding and cramping)
plan B pill
levonorgestrel within 72hrs of intercourse - delays ovulation until sperm are gone - will not harm existing pregnancy
depo shot
3 months
absence of periods or abnormal bleeding
chronic HTN in pregnant women
bp >140 / >90 before 20 wks
control with alpha methyldopa
gestational HTN
elevated BP after 20wks in the absence of proteinuria
pre eclampsia without severe features
BP >140/>90 after 20wks
proteinuria >300mg
deliver at 37wks
pre eclampsia with severe features
BP >160/>110 creatine >1.1 or 2x baseline platelets < 100 increased AST or ALT RUQ or epigastric pain pulmonary edema
eclampsia =
pre eclampsia with seizures
treatment of eclampsia
HTN - labetolol, hydralazine
Sz- Magnesium and possibly benzos
ultimate tx = deliver baby
down syndrome - hcg and inhibin A
increased hcg
increased inhibin A
elevated AFP
neural tube defects
abdominal wall defects
cell free DNA
10wks noninvasive
ROM
speculum exam - pool of fluid in the posterior vagina
nitrazine test - turns blue
ferning pattern when dry
premature ROM
> 37wks prior to onset of labor in the absence of contractions
(make sure to know GBS status)
preterm ROM
<37wks
- if >34 wks - deliver
- if <34 wks - corticosteroids and delay as much as you can
- if <24wks nonviable
chorioamnionitis and endometritis
same (1 with baby in and other baby out)
- maternal fever
- maternal and/or fetal tachy
- uterine tenderness
- purulent amniotic fluid
treatment of chorioamnionitis and/or endometritis
IV ampicillin, gentamicin, and clindamycin
tocolytics
Magnesium - <32 wks neuroprotection
Ca channel block - nifedipine
PGE-i - not in >32 weeks (closes ductus)
B-agonists - for tachysystole only
congenital hypothyroidism
low birth weight
neuropsychological impairment
hypothyroid patients
High TSH low T4
infertile secondary to annovulation
tx - levothyroxine
hyperthyroidism
low TSH high t4
prior to preg - surgical resection or radioactive ablation
during preg - PTU (blocks T4 –> t3) or methimazole
valproate (pregnancy class)
teratgenic
- cardiac abnormalities
- neural tube defects
- craniofacial abnormalities
epilepsy drugs to avoid in pregnancy
valproate
phenytoin
carbamzepine
epilepsy drug thats OK for pregnancy
levetiracetam
First line Tx of UTI and backup
amoxicillin and nitrofurantoin backup
1st line IV = ceftriaxone
other teratogenic meds
ACE-I ARBS lithium retinoic acid MTX
diagnosis of twins
Uterus is large for dates
AFP is high on quad screen
US = Dx
twins are at increased risk for
C-section
prematurity
dizygotic dichorionic diamnitotic
2 placentas
2 sacs
2 eggs = 2 genders
monozygotic dichorionic diamniotic
2 placentas
2 sacs
1 egg = 1 gender
monozygotic monochorionic diamnotic
increased risk for
1 placenta
2 sacs
1 egg = 1 gender
twin twin transfusion (bigger twin at risk - small twin does better)
monozygotic monochorionic monoamniotic
increased risk for
1 placenta
1 sac
1 egg = 1 gender
conjoined twins, cord entanglement
all multi gestations are at increased risk for
breech birth
pre term
placenta previa
PPH
delivery decisions for
cephalic - cephalic
cephalic - breech
breech - breech
vaginal
clinical judgment
c section
latent phase definition
cervix dilatioin up to 6cms
active phase of labor
6-10cm cervical dilation
cervical changes during labor
and mechanism
changes from thick (nose) and firm to thin a short structure (lip)
mechanism - breaking of disulfide bonds between collagen = collagen ripening
effacement of cervix
shortening
cervical changes can be stimulated by:
fetal head engagement and by the production of prostaglandin E2
fetal station numbers
-5 (uterus)
0 (ischial spine)
+5 (out of vagina)
frank breech
knees extended
hips flexed
complete breech
knees flexed
hips flexed
footling breech
knees in any position
hips extended
external version
attempted 37wks
GPA
TPAL
term
preterm
abortions
living
1st trimester labs
ABO type rh Ag hgb/hct rubella titers varicella titers HIV RPR Hep B gonorrhea chlamydia
C section incision name
pfannestiel incision
bikini cut
vertical (classic or emergent)
transverse (planned)
risks of vacuum delivery
denuding vagina (inside out)
cephalohematoma
facial lacerations
risks of forcep delivery
maternal lacerations or hemorrhage
facial nerve palsy
skull fx
intracranial hemorrhage
cervical insufficiency
she may begin to dilate very early in pregnancy
anesthesia
stage I pain -
stage II pain -
T10-T12 visceral pain
S2-S4 somatic pain
pudendal nerve block
block the somatic pain stage II
performed by palpating the ischial tuberosity and injection is made towards the pudendal nerve near the sacrospinous ligament
epidural (DOC)
should be no pop
no CSF return
pain of contractions removed but not the pressure
excess epidural anesthesia risks
vasodilation and hypotension
paralysis of the diaphragm if its too high
cardio physiology of pregnancy
plasma volume increases
RBC mass increases
dilutional anemia
increased CO
coagulation state of pregnant women
hypercoagulability
clotting factor increase
increased fibrinogen
increased D-dimer
pulmonary changes of pregnancy
increased minute ventilation
increased tidal volume
decreased FRC
genitourinary changes
increased GFR
creatine will be lower
definition of PPH
500cc vaginal delivery
1000cc c-section
uterine atony
MCC of pph
tired uterus fails to contract - feels BOGGY
(saturated oxytocin receptors)
tx of uterine atony
1) uterine massage
2) uterotonics (methlergonovine, oxytocin, carboprost)
3) mechanical tamponade with bakri baloon
4) sx
carboprost (hemabate) moa
PGF2alpha - smooth muscle contractions????
C/I - in asthma
uterine inversion
- uterus cant be felt may come out of the vagina
- increased risk with oxytocin and umbilical cord traction
placenta accreta, increta, percreta
acreta - endometrium
increta - myometrium
percreta - serosa
hepatitis B exposed baby
Hep B vaccine
IV Ig hep B
HIV tx for a baby
AZT (zidovudine)
toxoplasmosis
mono like syndrome cat feces - uncooked meat exposure brain calcifications ventriculomegaly seizures
CMV
- jaundice
- petechial - low platelets
- intrauterine growth restriction
- hearing loss
- hepatosplenomegaly
herpes
- painful burning prodrome
- vesicles on an erythematous base
- PCR
- c-section to avoid exposure
- prophylaxis with acyclovir
diagnosis of rectovaginal fistula
dark red velvety (rectal mucosa) on the posterior vaginal wall
granulosa cell tumors
malignant stromal cord tumors large >10cm complex post menopausal bleeding juvenile - precocious puberty estrogen secreting
cause of granulosa cell tumors
endometrial hyperplasia from chronic unopposed estrogen exposure
candida on microscope
pseudohyphae
treatment of candida
fluconazole
HELLP syndrome
hemolytic anemia
elevated LFTs
low platelets
due to systemic inflammation and platelet consumption
acute abdomen signs
guarding with decreased bowel sounds
implantation site of a gestational sac
upper fundal region
abnormal = outer quadrants (corneal arcus)
chadwick sign
blue discoloration of vagina and cervix (6-8wks)
hcg timeline
the 1st (4wks) doubles every 4hrs
peaks at 10wks
drops in 2nd trimester
BP lowest peak
23-28wks
virchow triad
hypercoagulability (increased fibrinogen)
stasis (venous)
endothelial damage
MCC of increased AFP
dating error
braxton hicks contractions
3rd trimister
sporadic
no cervical dilation
presentation of ectopic pregnancy
unilateral lower abdominal or pelvic pain
vaginal bleeding
if ruptured can be hypotensive with peritoneal irritation
exclusion criteria for MTX for ectopic
immunodeficiency non compliant liver disease (ADR - hepatotoxicity) greater >3.5cm fetal heart auscultated breast feeding coexisting viable pregnancy
