Obstetrics Flashcards
threatened vs inevitebale abortion
threatened: bleeding in early pregnancy
inevitable: patient presents with bleeding, cramping and open cerivcal OS.
patient presents after passing tissue, bleeding slowed, cramping slowed, closed os= suspect complete abotion
diagnosing miscarriage
size of mean sac diameter: >25mm with no fetal pol
CRL >7mm with NO fetal cardiac activity or falling beta HCG.
if MSD <25mm or CRL <7mm= pregnancy of undetermined viability.
management of missed abortion
often expectant management
medical; misoprostol 800micrograms vaginally.
surgical :DandC: often if incomplete abortion or missed or unstable patient.
definition of infertility
inability to conceive after 1 year of regular unprotexted intercourse.
in someone with a 36 day cycle, when does ovulation occur?
22 days. the follicular phase is day 1 -ovulation and variable in length. luteal phase is ovulation to onset of menses, fixed at 14 days for most women.
fertile window:
highest chance of success from 5 days before to day of ovulation
how do you evaluate fertility including ovulation, sperm, fallopian tubes and uterus?
Hysterosalpinogram
pelvic US
sperm analysis
day 21 progesterone
menstrual history: progesterone, bbt, LH surge(urine testing)
Note:
luteal phase progesterone (21)
basal body temperature (after ovulation your temperature goes up .5 degrees
estradiol (ovarian reserve– if its low, then really early in cycle)
first line fertility treatment for a woman with PCOS
- weight loss and cycle regulation via birth control
- ovulation induction with clomid/clomiphene citrate (SERM, risk of twins), or aromatase inhibitors like letrozole.
if you have bilateral tube obstructions, what therapy is best for fertility
IVF
IUI would put the sperm in the uterus but it would not allow them to fertilize the egg in the tube since its still blocked. You need to fertilize the egg prior to insertion, and then implant it in the uterus wihtout going through the tube. aka IVF.
definition of labour
regular cramping and cervical change through time.
BPP
The BPP checks your baby’s heart rate, muscle tone, movement, and breathing. It also measures the amount of amniotic fluid around your baby. Looking at these five areas helps your doctor know how well your baby is doing
6cm dilated, 100% efface, station is -1. what stage is she in?
first stage.
early- cramping to 4-5cm
active- 5cm to pushing to delivery
3- placental delivery
prior to starting oxytocin, what should you make sure you do?
amniotomy prior to starting labour.
ALARMER
alert
leg and hip hyper extension McRoberts
anterior shoulder rotation through suprapubic pressure
rotational maneuvers
manual delivery of posterior arm
evaluate for episiotomy
roll on all fours
potentially can break the clavicle.
differential for PPH
Tone: things that prevent uterine contraction–fibroids, infection, retained products of conception
tissue: placenta
trauma: tears, cervix, uterine rupture
thrombin: coagulopathy, being on anticoagulation, DIC.
meds for pph
hemabate (no asthma)
TXA
misoprostol
oxytocin
methylmergovine /ergot (not for those with hypertension because it causes vasoconstriction)
uterine compression
acute drop in consciousness and blood pressure after delivery– what to consider?
amniotic fluid embolism:
Shortness of breath or difficulty breathing.
Sudden drop in blood pressure.
Pulmonary edema (fluid in your lungs).
Abnormal heart rate.
Bleeding from your uterus, C-section incision or IV (intravenous) sites.
Fetal distress.
Agitation, confusion or sudden anxiety.
Chills.
when do you give rH- patient rhogam
15 weeks, 28 week, 35 week, post partum.
tocolysis
nifedipine or indomethacin to slow down premature delivery to allow transfer. usually done at 24-34 weeks in labour.
what type of twin is at risk of twin-twin transfusion
mono/di twin: 1 placenta, 2 sacs– one gets more nutrition than the other. therefore one is growth restricted+ oligohydramnios and the other is macro+polyhydramnios.
twins at risk for cord entanglement
mono/mono twins: two cords in the same sac and placenta.
