OBGYN: Reno questions/answers Flashcards
Differentiate b/w placenta previa and abrupto placentae
- Placenta Previa
* placenta covers part or all of cervical os
* PAINLESS bleeding
* during 3rd tri MC - Abrupto Placentae
* placenta detaches from uterus
* PAINFUL bleeding (seen or unseen)
* MC during 3rd tri
define pre term
delivery before 37 week
list two diagnostic criteria for per term labor
- regular uterine contraction <4-6/hour
2. cervical change: effacement of 80% or dilation of 3+CM
explain management of preterm labor after 34 weeks and before 34 weeks
-when can u discharge?
BEFORE 34 WEEKS
- admit
- fetal monitoring
- give betamethasone
- attempt to delay delivery for 48 hrs using MAG SULFATE
- ABX prophylaxis for GBS
AFTER 34 WEEKS
- admit
- monitor
- deliver
**if 4-6 hours pass with no progression of cervical effacement or dilation—- can discharge
4 RF for PROM
- vaginal/cervical infection
- smoking
- multiple gestations
- prior pre-term delivery
list two methods used to diagnose PROM
- check for FERNING under microscope
2. use nitrazine paper to check for alkalinity– turns blue if +amniotic fluid
what should we never put inside a vagina in a woman with PROM
anything that is NOT sterile—she is already at incr risk of infection
explain difference b/w PROM and PPROM
PROM=rupture of mem at 37+ weeks
PPROM= rupture of mem prior 37 weeks
management for PROM and PPROM
PROM
- admit
- fetal monitoring
- monitor mom for infection
- induce labor if no spontaneous labor after 18 hours
PPROM
- admit
- fetal monitor
- if 34 weeks or less–>bethamethasone
- ABX +/-
- induce labor–> if after 48 hours OR earlier if signs of distress
Describe dystocia, 3 reasons, and its tx
Dystocia=labor that does not progress normally
management based off which of the three problems are causing it
- POWERS (intensity of contractions)–>give IV Oxytocin
- PASSENGER (fetus too big)–>c section
- PASSAGE (maternal pelvis too small)–>c section
what constitues arrest of labor
no change in cervical dilation or effacement despite 4 hours of adequate contractions (>200 montevideo units)
describe shoulder dystocia and its management
shoulders wont come out—- managed by different maneuvers
*if they dont work— break fetus clavicles
describe breech presentation and its management
butt coming out first
-managed based on experience of the OB and if they feel confident to deliver a breech vaginally
describe umbilical cord prolapse and its management
umbilical cord extends beyond the presenting fetal part
-managed by trying to release pressure on cord from baby’s head
list four MC indications for c-section
- dystocia
- prior c section
- breech presentation
- fetal distress
list absolute indication for a c-section
prior non-transverse uterine incision
describe uterine rupture
- list signs/symps (4)
- RF (5)
*when all muscle layers of uterus tear apart
S/S
- extreme pain (worse than labor)
- absent contractions
- bleeding
- fetal bradycardia*****
RF=previous uterine rupture, prior c-section, induction of labor with oxytocin, trauma, previous myomectomy
define PP hemorrhage
loss of blood >500 mL vaginal delivery, >1,000 mL C-section
four main causes of PP hemorrahge
- tone (uterine atony)
- tissue (retained placental tissue)
- trauma/lacerations
- thrombin (coag disorder)
RF for uterine atony (6)
- multiple gestations
- fetal macrosomia
- prolonged labor
- IV oxytocin
- Mag Sulfate to manage preeclampsia
- uterine leiomyomas/fibroids
tx for uterine atony
- uterine massage
- oxytocin
- if oxytocin doesnt work–>Methylergonovine
tx for refractory PP hemorrahge
tamponade
surgical ligation or cauterization of arteries
hysterectomy
3 causes of PP pain and how to manage it
- afterpains
- episiotomy
- lacerations
- breast engorgement
- post-epidural HA
- *tx=
- acetaminophen–NOT NSAIDS
- ASA
- codeine
describe colostrum and its purpose
yellow thick substance–secreted thru breast in first weeks PP–carries extra minerals, AAs and immunoglobulins (IgA) to protect baby from GI infections