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Womens Health EOR > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What does APGAR stand for?

A
  • Apperance
  • Pulse
  • Frimace (reflex irritability)
  • Activity
  • Respiration
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2
Q

When is APGAR given?

A

1 minute after birth and again at 5 minutes

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3
Q

What is a normal, low, and critically low APGAR score?

A
  • Normal: = to or greater than 7
  • Low: 4-6
  • Critically low: = to or less than 3
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4
Q

What are the APGAR categories for appearance?

A
  • 0: blue, pale
  • 1: pink body, blue extremities
  • 2: pink
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5
Q

What are the APGAR categories for pulse?

A
  • 0: absent
  • 1: below 100 bpm
  • 2: over 100 bpm
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6
Q

What are the APGAR categories for grimace?

A
  • 0: floppy
  • 1: minimal response to stimulation
  • 2: prompt response to stimulation
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7
Q

What are the APGAR categories for activity?

A
  • 0: absent
  • 1: flexed arms and legs
  • 2: active
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8
Q

What are the APGAR categories for respiration?

A
  • 0: absent
  • 2: slow and irregular
  • 3: vigorous cry
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9
Q

What are dizygotic or fraternal twins?

A
  • 2/3 of multiple gestations
  • fertilized 2 ova by 2 different sperms
  • not the same genetic material
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10
Q

What are monozygotic or identical twins?

A
  • 1/3 of multiple gestations
  • fertilization of 1 ova that splits
  • same genetic material
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11
Q

How much weight can a patient gain with multiple gestations?

A

37-54 lbs

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12
Q

How are multiple gestations diagnosed?

A

US + elevated hCG + AFP

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13
Q

What are monochorionic monoamniotic (mo/mo) twins?

A

single placenta, one chorion, one amnion

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14
Q

What are monochorionic diamniotic (mo-di) twins?

A

Single placenta, single chorion, two sacks

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15
Q

What are dichorionic diamniotic (di-di) twins?

A

two placentae, two chorion, two sacs

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16
Q

What are management recommendations for multiple gestations?

A
  • 2 prenatal vitamine with iron
  • 1 mg folate and 1000 mg of vitamin D daily
  • More frequent US & visits
  • Sleep on the left side
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17
Q

What are the 7 cardinal movements of labor & delivery?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
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18
Q

What is engagement?

A

fetal head enters into pelvis

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19
Q

What is descent?

A

Fetal head descends into pelvis

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20
Q

What is flexion?

A

head flexes to smallest diameter to present to the pelvis

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21
Q

What is internal rotation?

A

fetal vertex rotates from the transverse position to the anterioposterior position

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22
Q

What is extension?

A

vertex extends beyond pubic symphysis

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23
Q

What is external rotation?

A

after the head is delivered, baby externally rotates to allow for babys shoulders to pass

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24
Q

What is stage 1 of labor?

A
  • onset of true regular contractions until full dilation/effacement of cervix
  • 10-12 hrs
  • latent phase: onset until 2-4 cm dilated
  • active phase: extends until >9 cm
  • deceleration/transition phase: cervix completes dilation
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25
Q

What is stage 3 of labor?

A
  • from delivery of infant until delivery of placenta
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25
Q

What is stage 2 of labor?

A
  • time of full dilation until delivery
  • 1-2 hours
  • early/variable decelerations common
  • passive and active phases
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26
Q

What are fetal stations?

A

a measurement of how high ot low the baby is
* -3: above ischial spines
* 0: at ischial spines
* 3: below ischial spines (time to push)

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27
Q

What is the first trimester screen and when is it done?

A
  • Plasma hCG, PAPP-A, nuchal translucency
  • 11-13 wks
  • CVS sampling if indicated
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28
Q

What chromosome abnormalities does the 1st trimester sceen look for?

A
  • Downs (21): ↑↑ NT, ↓↓ PAPP-A, ↑ hCG
  • Edwards (18): ↑↑ NT, ↓↓ PAPP-A & hCG
  • Pataus (13): ↑ NT, ↓↓ PAPP-A & ↓ hCG
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29
Q

What is the QUAD screen and when is it done?

A
  • AFP + inhibin-A + estriol + BhCG
  • 15-20 weeks
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30
Q

What chromosome abormalities does the QUAD screen look for?

A
  • Downs (21): ↑ hCG & ↑ inhibin-A
  • Edwards (18): ↓ estriol, ↓↓ hCG
  • Pataus (13): ↑ AFP
  • Turners (X/0): ↑↑ hCG & inhibin-A
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31
Q

What is the MCC of spontanous abortion?

A

chromosomal abnormalities

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32
Q

What is a threatened abortion?

A
  • cervical os: closed
  • POC: retained
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33
Q

What is an inevitable abortion?

A
  • cervical os: open
  • POC: retained
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34
Q

What is an incomplete abortion?

A
  • cervical os: open
  • POC: some passed
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35
Q

What is a complete abortion?

A
  • cervical os: closed
  • POC: completly passed
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36
Q

What is an ectopic pregnancy?

A
  • implantation anywhere but the endometrium
  • MC: fallopian tube
  • MCC: occlusion of tube due to adhesions
  • typically presents 6-8 weeks after LMP
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37
Q

What are risk factors for an ectopic pregnancy?

A
  • strongest RF: previous ectopic
  • hx PID, IUD
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38
Q

What are symptoms of an ectopic pregnancy?

A

Unilateral/lower abd pain + bleeding/spotting + amenorrhea
* ruptured: severe abdominal or shoulder pain (kehr sign), syncope, hypotension

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39
Q

How is an ectopic pregnancy diagnosed?

A

hCG less than expected
* > 1500 should show up on TVUS

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40
Q

How do you treat an ectopic pregnancy?

A
  • hCG < 5000 without fetal activity: methotrexate
  • emergent: laparoscopy
  • trend BhCG until levels return to normal
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41
Q

How is gestational diabeties diagnosed?

A

GTT screening at 24-28 weeks
* 50g 1 hr glucose test: > 140
* 100g 3 hr test: fasting > 90, 1 hr > 180, 2 hr > 155, 3 hr > 140

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42
Q

How is gestational diabeties treated?

A
  • Diet & exercise
  • Severe: insulin
  • Alt. glyburtide or metformin
  • Comp.: polyhydramnios
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42
Q

What are symptoms of gestational trophoblastic disease?

A

painless vaginal bleeding, uterine size greater than gestational age, hyperemesis gravidarum, preclampsia 6-16 weeks

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43
Q

What is gestational trophoblastic disease?

A

neoplasm due to abnormal placental development with trophoblastic tissue proliferation arising from gestational tissue
* 2 types: complete (MC), partial
* complete: empty, no viable fetus
* partial: some fetal tissue + trohoblastic hyperplasia

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44
Q

How is gestational trophoblastic disease diagnosed?

A
  • earilest it can be dx: 8 wks
  • hCG > 100,000
  • US: snowstorm pattern and grapelike vesicles
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45
Q

How is gestational trophoblastic disease treated?

A
  • benign/low risk: chemo (methotrexate)
  • high risk: chemo + surgery/radiation
  • surgical: suction curettage/hysterectomy
  • Monitor weekly hCG until return to baseline
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46
Q

What is cervical insufficiency?

A

inability of the cervix to retain a pregnancy through the 2nd trimester due to premature cervical dilation in the absense of uterine contractions

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47
Q

What are risk factors for cervical insufficency?

A

ehlers-donlos syndrome, cervical trauma during labor/delivery, cervical dilations

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48
Q

What are symptoms and physical exam findings of cervical insufficency?

A
  • Sx: ASX or pelvic pressure & vaginal discharge
  • PE: soft, effaced, dilated cervix with grossly prolapsed or ruptured membranes
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49
Q

How is cervical insufficency diagnosed?

A
  • 2 consecutive 2nd trimester losses or early premature births
  • TVUS: cervical length less than 25 mm before 24 wks
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50
Q

How is cervical insufficency treated?

A

cerclage placement at 12-14 weeks

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51
Q
A
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52
Q

What is placenta abruptio?

A
  • premature separation of normally implanted placenta from the uterine wall after 20 weeks resulting in hemorrhage
  • most occur before labor and after 30 wks
  • MCC of third trimester bleeding
53
Q

What are risk factors for placenta abruptio?

A

HTN, cocaine, smoking

54
Q

What are symptoms of placenta abruptio?

A

3rd trimester painful vaginal bleeding +/- severe contraction, firm/tender uterus

55
Q

How is placenta abruptio diagnosed?

A

clinically - NO VAGINAL EXAM

56
Q

How is placenta abruptio treated?

A

stabilize patient, prepare for hemorrhage
* < 34 wks: tocolytics + steriods + bed rest
* > 34 wks: delivery

57
Q

What is placenta previa?

A

when the placenta attaches low in the uterus
* complete: covers all of interal os
* partial: covers portion of internal os
* marginal: covers edge of internal os

58
Q

What are symptoms of placenta previa?

A

sudden onset of painless vaginal bleeding after 28 weeks
* absense of abfominal pain ot uterine tenderness

59
Q

How is placenta previa diagnosed?

A

NO VAGINAL EXAM
* transabdominal US: to screen
* TVUS: to confirm
* Kleihaver-betke test for all Rh - women

60
Q

How is placenta previa treated?

A

strict pelvic rest and bed rest
* planned c-section at 34-37 weeks + hysterectomy

61
Q

What are the guidelines for elective abortions?

A

> 8 weeks gestation: medical abortion
* methotrexate/misoprostol

> 12 weeks gestation: surgical abortion
* 4-12 wks: suction curettage (D&C)
* greater than 12 wks: D&E

62
Q

What is preclampsia?

A

TRIAD: nondependent edema, HTN, proteinuria

63
Q

How is preclampsia diagnosed?

A

BP >140/90 on 2 seperate occasions after 20 wks + proteinuria
* >300 mg per 24hr collection
* protein:creatinin > 0.3

OR in the absence of proteinuria
* thrombocytopenia: platelets < 100,000
* creatinine > 1.1
* RUQ or epigastric pain unresponsive to tx
* pulmonary edema
* visual disturbances/headaches

64
Q

How is preclampsia treated?

A

prevent eclampsia + BP control + delivery
* seizure prophylaxis: magnesium sulfate (monitor patellar reflex - calcium gluconate if mag toxicity)
* BP: hydralazing, labetalol, nifedipine
* >32 wks: deliver w/ induction
* Future pregnancies: low dose ASA

65
Q

What is eclampsia?

A

elevated BP + proteinuria + seizures

66
Q

What are symptoms of eclampsia?

A

HTN after 20 wks gestation + protinuria + evidence of end-organ dysfunction (visual changes, AMS, pulmonary edema, seizures)

67
Q

How is eclampsia diagnosed?

A

Control BP + delivery
* magnesium sulfate: 4-6g over 15-20 min followed by 1-2g per hour (monitor patellar reflex)
* BP: hydralazine, contuine for 12-24 hrs after delivery

68
Q

What is HELLP syndrome?

A
  • Hemolytic anemia: bite cells, schistocytes, high lactate & bilirubin, low Hgb
  • Elevated Liver enzymes
  • Low Platelets: < 100k
69
Q

When to suspect HELLP syndrome?

A

epigastric pain + headache + HTN
Tx: delivery

70
Q

What is augmentation?

A

induction of labor, increases contractions
* prostaglandins, oxytocin, mechanical dilation, artifical ROM

71
Q

What induction agent would you give a patient with a Bishop score greater than 6?

A

Favorable for success of induction
* IV oxytocin, aminotomy (artifical ROM)

72
Q

What induction agent would you give for a patient with a Bishop score less than 6?

A

Unfavorable for successful induction
* prostaglandin gel or transcervical balloon catheter

73
Q

How is hyperemesis gravidarum diagnosed?

A
  • weight loss of > 5 % of pre-pregnancy body weight
  • UA: ketonuria
  • hypokalemia, hypochloremic metabolic alkalosis
74
Q

How is hyperemesis gravidarum treated?

A
  • Inital: lifestyle modification
  • 1st line: pyridoxine +/- doxylamine
  • 2nd line: phenergan, zofran or metoclopramide
75
Q

What is the leading cause of neonatal sepsis?

A

GBS

76
Q

How is pyelonephritis treated in a pregnant patient?

A

IV ceftriaxone

77
Q

What is intrahepatic cholestasis?

A

liver disease that occurs during pregnancy characterized by increased serum bile acids and elevated LFTs
* MC in 3rd trimester
* recurs in 1/2 of pregnancies

78
Q

What are symptoms of intrahepatic cholestasis?

A

purititis on plams and soles

79
Q

How is intrahepatic cholestasis treated?

A

ursodexyxholic acid to ↑ hepatic bile flor
* Induce labor at 36-37 weeks gestation

80
Q

How should seizures be managed in pregnancy?

A
  • taper to lowest effective dose
  • if no seixure in 2 years, stop meds
  • no depakote or valproic acid
81
Q

How should DVT be managed in pregnancy?

A

heparin

82
Q

How should thyroid disorders be managed in pregnancy?

A
  • hyper: PTU (1st trimester), methimazole
  • hypo: levothyoxine
83
Q

How should SLE be treated in preganancy?

A

ASA, heparin, steriods
* NO methotrexate

84
Q

What is intraamniotic infection (chorioamnionitis)?

A

serious complication of pregnancy due to infection or inflammation of the fetal amnion membrane and chorion membrane
* caused by upward migration of vaginal flora

85
Q

What are symptoms of IAI (chorioamionitis)?

A

fever > 100.4, leukocytosis (>15,000), purulent cervical os fluid, baseline fetal tachycardia
* maternal tachycardia, uterine tenderness, ill/toxic appearing, hypotension, diaphoresis

86
Q

How is IAI (chorioamnionitis) diagnosed?

A

Clinical
* fever + leukocytosis + fetal tachycardia OR purulent fluid from cervical os
* Confirm: needle aspiration & analysis of amniotic fluid

87
Q

How is IAI treated?

A

ABX + quick delivery
* IV ampicillin + gentamycin
* + clindamycin or metronidazole if c-section

88
Q

What is the frank breech presentation?

A

MC
* hips flexed & knees extended
* feet adjacent to head

89
Q

What is complete breech presentaion?

A
  • both hips flexed
  • both knees flexed
90
Q

What is incomplete (footling) breech presentation?

A
  • one or both hips not completely flexed
  • presenting part may be buttock or one or both feet
91
Q

What is McRoberts maneuver?

A
  • hyperflexion and abduction of maternal hips towars the abdomen without pressure then with suprapubic pressure
  • for shoulder dystocia
92
Q

What is Rubin maneuver?

A
  • for shoulder dystocia
  • pressure on accessible shoulder towards anterior chest of fetus to decrease diameter
93
Q

What is Woods corkscrew maneuver?

A
  • for shoulder dystocia
  • rotation fo the fetal shoulder 180°
94
Q

What is Zavenilli maneuver?

A
  • for a true emergency of shoulder dystocia
  • place head back into pelvis and perform c-section
95
Q

What is normal acceleration of fetal heart rate?

A
  • ≥ 32 weeks gestation
  • HR peak of ≥ 15 bpm above baseline with a duration of 15sec-2min from onset to return
96
Q

What is reactive accleratino of fetal heart rate?

A

Two normal accelerations within 20 minutes

97
Q

What is an early deceleration?

A
  • lowest fetal HR at the SAME TIME as peak contraction
  • due to vagal tone and head compression during contraction
98
Q

What is a variable deceleration?

A
  • ↓ in fetal HR ≥ 15 bpm for 15 sec-2 min
  • due to cord entrapment under fetal shoulder
99
Q

What are late decelerations?

A
  • lowest fetal HR AFTER the peak of the contraction
  • due to uteroplacental insufficency
100
Q

What is category I of fetal distress?

A
  • Normal fetal HR
  • normal baseline
  • moderate variability
  • no late decelerations
101
Q

What is category II of fetal distress?

A
  • indeterminate fetal HR
  • anything that doesnt fall into categories I or II and warrents further investigation
102
Q

What is category III of fetal distress?

A

abnormal fetal HR + atleast 1 of the following
* abseent variability
* recurrent late declerations
* bradycardia
* sinusoidal pattern (fetal anemia)

103
Q

What is VEALCHOP?

A
  • Variable: Cord compression
  • Early: Head compression
  • Accelerations: Ok
  • Late: Placenta insufficency
104
Q

What is premature rupture of membranes (PROM)?

A

membrane rupture before the onset of labor or refular uterine contraction ≥ 37 weeks

105
Q

What are symptoms and physical exam findings of PROM?

A
  • Sx: sudden gush of clear or pale yellow fluid from the vagina
  • PE: pooling of amniotic fluid in vaginal fornix
106
Q

How is PROM diagnosed?

A

Clinical - avoid digital exam!
To confirm:
* + nitrazine paper test
* microscopic ferning
* US: absent or very low levels of amniotic fluid

107
Q

How is PROM treated?

A

Prompt induction of labor with oxytocin
* Complications: IAI or endometritis if prolonged

108
Q

What is preterm premature rupture of membranes (pPROM)?

A
  • membrane rupture before 37 weeks
109
Q

How is pPROM treated?

A
  • 20-36wks: steriods + ABX (ampicillin, erythromycin) + tocolysis + bethamethosone
  • daily BPP, NST, aminocentesis
  • prompt delivey if sxs of maternal/fetal infection or distress
110
Q

What is preterm labor?

A
  • before 37 weeks gestation
  • regular uterine contraction ~5 min apart that occur with cervical dilation, effacement or both
  • MCC of infant morbidity/mortality
111
Q
A
112
Q

What are the 4 main causes of preterm labor?

A
  1. pathologic uterine distension: multiple gestation, polyhydramnios
  2. blood vessel hemorrahe & abruption: maternal HTN
  3. exaggerated response to inflammation or infection: activation of TNF
  4. premature activation of HPA
113
Q

Howis preterm labor diagnosed?

A

regular uterine contractions + 1 of the following
* cervical dilation ≥ 3 cm
* cervical length < 20 mm on TVUS
* cervical length 20-29mm on TVUS + positive fetal fibronectin

114
Q

How is preterm labor treated?

A
  • > 34 wks: deliver
  • <34 wks: ABX + steriods + tocolytics
115
Q

What are tocolysis?

A

Its Not My Time!
* Indomethacin: before 32 weeks
* Nifedipine: after 32 weeks
* Magnesium sulfate: neuroprotective
* Terbutaline: BBW may cause maternal death and cardiac events

116
Q

How can preterm labor be prevented?

A

weekly injections of 17 alpha hydrocyprogesterone caproate from 16-36 weeks

117
Q

What is oligohydramnios?

A
  • too little amniotic fluid
  • ↑ in perinatal mortality
  • AFI < 5 on US
118
Q

How is oligohydramnios treated?

A
  • induce labor
  • dilure meconium in amniotic fluid to decrease aspiration risk
119
Q

What is polyhydramnios?

A
  • too much amniotic fluid
  • MCC chromosome abnormalities
  • AFI > 20-25 on US
  • Tx: ROM
120
Q

What is a prolapsed umbilical cord?

A
  • umbilical cord presents outside the cervix before fetus is delivered
  • emergency! inhibits blood flow and can lead to fetal demise
  • RF: breech position
121
Q

What are symptoms of a prolapsed umbilical cord?

A

changes on fetal HR tracings, variable late decelerations or prolonged bradycardia

122
Q

How is a prolapsed umbilical cord treated?

A
  • cord decompression (manual)
  • standard: emergent C-section
  • if delay: terbutaline 0.25mg to decrease contractions and alleviate pressure on cord
123
Q

What is endometritis?

A

infection of the decidua (pregnancy endometrium)
* MC after c-section
* MCC: anaerobic streptococci

124
Q

What are symptoms of endometritis?

A
  • 5-10 days after delivery
  • Classic: lower abdominal pain + fever + tachycardia + uterine tenderness
  • foul smelling lochia
125
Q

How is endometritis diagnosed?

A

WBC > 20K, UA

126
Q

How is endometritis treated?

A

**IV clindamycin + gentamycin **
* may add ampicillin or metro if no response in 24-48 hrs
* suspect septic pelvic thrombophlebitis if no imporvment after 3-5 days (palpable cord-like mass)
* Prophylaxis: ceftazolin within 60min of c-section

127
Q

What is a 1st degree perineal laceration?

A

involves only the perineal skin

128
Q

What is a second-degree perineal laceration?

A

involves the perineal body and deeper tissues (bulbospongious muscle, superficial transverse perineal muscle)

129
Q

What is a third-degree perineal laceration?

A

extends into the capsule and muscle of the rectal sphincter
* 3a <50%
* 3b >50%
* 3c: both external and internal anal sphincter

130
Q

What is a 4th degree perineal laceration?

A

extends through the spincter and into the rectal mucosa

131
Q

What is a episiotomy?

A

surgical incision from vaginal opening to anus to assit with vaginal delivery
* reserved for when 3rd/4th degree lacerations are likely
* MC mediolateral

Womens Health EOR (2 decks)

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