OBs / Gyn Flashcards
when to give Rogham
- 28 wk GA
- w.i 72 hour of birth of a Rh positive fetus
- if Kiehauer Betke test positive
- with invasive procedure CVS amniocentesis
- ectopic procedure
- miscarriage or therapeutic aborption
- antepartum haemorrhage
Medications termination of pregnancy
<9 week - MTX and misoprostol
>12 weeks - prostaglandin (intra or extra amniotic ally or IM) or misoprostol
surgery to terminate pregnancy
< 12 weeks - Dilation and vacuum aspiration +/- curettage
> 12 weeks - dilation and evacuation , early induction of labour
DDX of decreased fetal movement
DASH death amniotic fluid decreased Sleep cycle of fetus Hunger and thirst
indications for BPP
- abnormal or atypical NST
- post term pregnancy
- decreased fetal movement
- uroplacental insufficiency
what is looked at in BPP
AFV - 2X2
Breathing - one episode in 30 sec
Limb movement - 3 movements
fetal tone - one episode of extension followed by flexion
score BPP
8 - good
6 - try again in 24 hours
0-4 - delivery
adverse fetal outcomes in HTN with pregnancy
IUGR
oligohydramnios
Absent / reversed umbilical artery end diastolic flow
if severe hypertension in pregnancy
> 160/ 110
- lebatolol
- nifedipine
- hydrazine
magnesium sulfate toxicity
- flushing
- hyporeflexia
- Somnolence
- Respiratory and cardiac depression
- weakness
- increased risk of toxicity if using CCB or renal disease
Tx - STOP MgS
GIVE calcium gluconate
eclampsia before 20 weeks
think antiphospholipid syndrome
blood test for APS
1lupus anticoagulant
- anti cardiolipin
- anti B2 glycoprotein
threatened abortion
PVB and cramps
Cervic is soft and closed
US - viable fetus
Tx - watch and wait
inevitable abortion
PVB and cramps Cervix closed until product begin to expel US shows nonviable fetus Tx - watch and wait 2. misoprostol 3. D and C +- oxytocin
incomplete
PVR VERY heavy Cervic is open US - products of conception Tx: 1. 2. 3. watch and wait, misoprostol or D and C
Complete
Bleeding and passage of sac and placenta
Cervic open
US - no products of conception
Tx- expectant management - no D and C needed
Missed abortion
No bleeding ( fetal death in utero)
Cervix closed
US - SGA with no fetal heart activity , nonviable fetus
Tx watch and wait, misoprostol, D and C
Recurrent abortiopn
> 3 consecutive spontaneous abortion
- evaluate mechanical genetic and environmental
Septic abortion
contents of uterus - infected
Treatment - DC and antiobitocs
methotextrate indication for ectopic pregnancy
- < 3.5 cm unreputure extompic
- no hepatic , renal or hematologic disease
- B HcG < 5000
- no fetal heart rate
- Willing to follow up
twin twin transfusion
- monochromic twins
- material blood from donor twin passes through placenta into vein of recipient twin
treatment of TTT syndrome
amniocentesis - decompress polyhydraminios of recipient town and decrease pressure in cavity on placenta
- intrauterine transfusion to donor if necessary
polyhydramnios
idiopathic MOM - Type 1 DM Maternal - fetal - multiple gestation - choriangiomas FETUS - chromosomal anomaly - malformation lung - anencaphly, hydrocephalus - TEF , duodenal atresia, fascial clefts
oligohydramnios
-idiopathy MOM - UPI, MEDS (ACE inhibitor ) FETUS - renal agenesis - Demise / chronic hypoxemia ( blood shunt away from kidney to perfuse brain) - IUGR - Ruptured membrane - Amniotic fluid normally decrease 35K
complicated variable decelerations
< 70bpm and <60s
- loss of variability or decrease in baseline after decelerations
- biphasic deceleration
- slow return to baseline
- baseline tachycardia or bradycardia
early decelerations
benign - head compressions
later deceleration
usually a sign of uretoplacenta insufficiency
- fetal hypoxia and academia
maternal hypotension
- uterine hypertonus
use of tocolytics
- absence of maternal or fetal contraindications
- preterm labour
- cervical dilaitation <4cm
c/i tocolytics
mom - bleeding, maternal disease , preeclampsia or eclampsia
Fetus - fetal demise , IUGR , severe congenital abnormalities
most common RF for preterm labour
- previous preterm labour
criteria for EVC
- < 37 weeks
- singleton
- unengaged presenting part
- reactive NST
criteria for vaginal breach delivery
> 36 weeks complete or frank breech EFW 2500 - 3800 g continuous fetal monitoring 2 obstetrician ability to perform emergency C/s if necessary
when do you do a CS during vaginal breech delivery
fetus not descending to the perineum in the second stage of labour after 2 hours in absence of active pushing or vaginal delivery
c/i to vaginal breech delivery
cord compression
clinically inadequate maternal; [e;vis
detal factors affecting delivery
obstetrical causes of DIC
Abruption
Gestation HTN
Fetal demise
PPH
risk factors for Umbilical cord prolapse
- prematurity / PROM
- fetal malpositio
- low lying placenta
- polyhydraminos
- multiple gestation
risk factor for uterine rupture
uterine scarring
excessive uterine stimulation - prolonged oxytocin
uterine trauma - operative equipment , ECV
uterine abnormalities
Multiparty
complications of uterine rupture
maternal mortality , hemorrhage
fetal distress
Amniotic fluid ambles
hysterectomy - if excess and uncontrolled haemorrhage
risk factors for amniotic fluid embolus
- placental abruption
- rapid labour
- multiparty
- uterine rupture
- uterine manipulation
clinical Amniotic fluid embolism
- sudden onset SOB
- Cardiovascular collapse (hypotension, hypoemia
- Seizure - 10%
- ARDS or Left ventricular dysfunction
uterine atony
- labour
- uterus
- placenta
- maternal factors
- halothane anesthesia
