Obstetrics Flashcards
6 types of spontaneous “abortion”
Threatened: cervix closed, bleed +/- pain, fetus OK
Inevitable: cervix open, no products passed
Incomplete: cervix open, some retained products
Complete: cervix open, no retained products
Missed: cervix closed, no bleed, no FHR
Septic: abortion + uterine infection
Meds for medical abortion
Rh immunoglobulin: if Rh neg and 7w GA, give 24h before the abortion.
Day 1: mifepristone
Days 2-3: misoprostol
Contra-indications to medical abortion
Absolute: ectopic, adrenal failure, porphyria, uncontrolled asthma.
Relative: unconfirmed GA (MA effective until 10w), IUD, concurrent steroids, bleeding disorder or a/c.
When to give prophylactic Abx for GBS
(3 cases)
- PROM/labour at 37+ weeks and GBS+, previous child with GBS, or GBS bacteriuria.
- ROM >18h at 37+ weeks and GBS unknown.
- ROM/labour at <37 weeks and GBS+ or unknown.
Management of premature rupture of membranes
GBS: if positive or unknown, give Abx + IOL.
Celestone: if preterm.
Induction: if GBS neg, can wait 24h.
Name 2 tocolytic medications
nifedipine, indomethacin
4 stages of labour
1: regular contractions causing dilation
- latent: until 4cm in nulliparous, 4-5cm in parous
- active: until 10cm
2: from full dilation until delivery
- passive: no puching
- active: pushing
3: from baby until placenta
4: from placenta until 1hour postpartum
Meds for PPH
oxytocin
ergotamine
Hemabate (carboprost)
Empiric Abx for postpartum fever
clinda + genta
Difference between baby blues and PP depression
baby blues self-limited, doesn’t last more than 2 weeks.
6 B’s of postpartum history
Brain (blues, depression, psychosis, sleep, substances…)
Breasts (breastfeeding, concerns)
BP (if gestational HTN)
Bladder/Bowel (incontinence, UTI, flatus)
Bleeding (colour, smell, clots, quantity)
Baby (bonding, feeding, concerns)
RhoGAM: when to give
In RhD-negative mothers:
Antepartum:
- If risk of hemorrhage, give first dose.
- If not given sooner, give at 28 weeks.
- Repeat q 12 weeks until delivery.
Postpartum:
- If baby is RhD-positive, give dose within 72h postpartum
(If delivery occurs within 3 weeks after the last antepartum dose, a postpartum dose may be withheld, but testing for fetal-maternal hemorrhage of >15 mL should be performed.)
Options for postpartum contraception
OCP:
- start 3 weeks PP if not breastfeeding
- if breastfeeding, wait until pt introduces supplemental feeding, or wait 3 months if breastfeeding exclusively.
Micronor: start 6 weeks PP in breastfeeding pts
IUD: can insert 6 weeks PP.
What to do with Synthroid if patient becomes pregnant
Increase dose by 30%
Vaccine recommended for every woman in every pregnancy
Adacel (Tetanus / Diphtheria / Pertussis)
between 21 32 weeks
How to screen for GDM
All pts between 24-28 weeks GA.
OGTT 50g:
- if <7.8, no further test
- if >11, GDM
- if between 7.8-11, do 75g OGTT
Basic treatment algorithm for N/V in pregnancy
Diclectin or pyridoxine (vit B6)
then
Add Gravol
then
Maxeran
then
Zofran
then
Methylprednisolone
Maternal complications of pre-eclampsia
Convulsion
Retinal detachment
Stroke/TIA
Thrombocytopenia
DIC
HELLP
Pulmonary edema
Oliguria
What is HELLP
Hemolysis, Elevated Liver enzymes, Low Platelets
It probably represents a severe form of preeclampsia, but the relationship between the two disorders remains controversial. HELLP may be a separate disorder from preeclampsia because as many as 15 to 20 percent of patients with HELLP do not have antecedent hypertension or proteinuria.
Timing of delivery for pts with HTN
Severe pre-eclampsia: now
Non-severe pre-eclampsia: 37w
Pre-eclampsia + hemolysis + LFT elevation: consider 35w
Gestational HTN: 37w
Pre-existing HTN: between 38w and 39+6/7w
To treat or prevent eclampsia.
Magnesium sulfate
1st-line treatment for severe and non-severe gestational HTN
severe (160/110): treat in hospital
- Labetalol IV
- Nifedipine PO
- Hydralazine IV
non-severe:
- Labetalol PO
- Nifedipine PO
- Methyldopa
- Other beta-blockers
TORCH infections
Toxoplasmosis
Others (VZV, syphilis, Zika)
Rubella
CMV
HSV
Also consider parvovirus B19
Options for prenatal screening
eFTS (11-14 w)
IPS (2 steps, 11-14w and 15-18w)
MSS (15-18w, not as good, use for late screening)
Cell-free DNA / NIPT (as early as 9w, for 40+ yo, positive screen, or patient preference (self-pay))
If positive screen: CVS (11-13w) or amnio (15+ weeks)
Timing of Obs U/S
Dating: 8-12w (use the earliest U/S done at 7+ weeks)
Anatomy: 18-20w (consider 20-22 for obese)
Others: as indicated
