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
