Obstetrics Flashcards
What is Goodell sign?
Softening of the cervix in early pregnancy
What is Chadwick sign?
Dark bluish-red discoloration of the vaginal mucosa in the 1st trimester
What are Hegar and Ladin signs?
Softening of the uterus in 1st trimester
What is Chloasma?
Skin hyper pigmentation of the face, often in sun-exposed areas in the 2nd trimester
What is Linea nigra?
Skin hyperpidmentation along the midline of the anterior abdominal wall in the 2nd trimester
What is Naegele’s rule?
- To determine expected date of delivery
- Take 1st day of LMP and add 7 days. Then subtract 3 months. then add 1 year
When can beta HCG be detected in the urine? In the serum?
- Urine=2 weeks after fertilization
- serum=1 week after fertilization
Which teratogen is associated with Ebstein anomaly?
Lithium
Which teratogen is associated with yellow-brown discoloration of teeth?
Tetracyclines
Which teratogen is associated with phocomelia (shortened limbs)?
Thalidomide
Which teratogen is associated with nasal hypoplasia and epiphyseal stippling?
Warfarin
When should a preggo be screened for syphilis?
first visit
-3rd trimester too if high risk
When should a preggo get the quadruple screen?
15-20 weeks
When should a preggo be screened for gestational DM?
24-28 week s
when should a preggo get RhoGAM if Rh(D) negative?
- 28 weeks
- after delivery
- anytime there is potential hemorrhage
When should a preggo be screened for group B streptococcus?
35-37 weeks
What is an elevated AFP associated with?
- neural tube defects
- abdominal wall defects
- multiple gestations
- incorrect dating
Dec AFP, inc beta hCG, dec estradiol, inc inhibin?
Trisomy 21
Decreased AFP, estriol and beta hCG?
Trisomy 18 (Edwards)
When can chorionic villus sampling be done?
10-13 weeks
When can amniocentesis be done?
15-20 weeks
1st line pharmacotherapy for n/v in pregnancy?
pyridoxine (vitamin B6) and doxylamine (antihistamine)
What is hyperemesis gravidarum?
weight loss >5% of pre-pregnancy weight due to n/v
- dehydration, ketosis, and abnormal labs
- get US to r/o gestational trophoblastic disease and multiple gestations
What is the difference between an A1 and an A2 gestational diabetic?
A1=good control of BG with diet and exercise
A2=requires insulin
What ABX are good for asymptomatic bacteruria in preggos?
- nitrofurantoin
- amoxicillin
- caphalexin
- bactrim
- fosfomycin
What is the treatment for a preggo with pyelonephritis?
-IV ABX (amp +gent, ceftriaxone, meropenem, zosyn)
Who should be treated with antibiotics for the duration of the pregnancy?
- women with asymptomatic bacteriuria who failed treatment 2 times
- Women with pyelonephritis x 1.
- Give Nitrofurantoin for the duration of the pregnancy
What conditions are associated with p-ANCA?
- Pauci-immune glomerulonephritis
- microscopic polyangitis
- Churg-strauss
- Ulcerative colitis
- Primary sclerosing cholangitis
Which antihypertensives are good for preggos?
“Hypertensive Mothers Love Nifedipine”
- Hydralazine
- Methyldopa
- Labetalol
- Nifedipine
What is the diagnostic criteria for pre-eclampsia?
-elevated BP >140/90 after 20 weeks gestation
AND
-proteinuria >300mg/24 hours
OR
-end organ dysfunction (renal insufficiency, thrombocytopenia, inc LFTs, HA, vision changes)
Woman in labor develops hypotension, respiratory failure, unresponsiveness and DIC?
amniotic fluid embolism
Choriorentinitis, diffuse intracranial calcifications and hydrocephalus in an infant? Tx?
- Toxoplasmosis
- Tx: mom: spiramycin
- fetus: pyrimethamine + sulfadiazine + folinic acid
Infant with sensorineural hearing loss, periventricular intracranial calcifications and microcephaly?
CMV
Scarring of the skin and limb hypoplasia?
HSV
Infant with anemia and hydrops fetalis?
Parvovirus B19
Infant with PDA, cataracts and deafness?
Congenital Rubella (may also have blueberry muffin rash)
Saddle nose, snuffles Hutchinson teeth and saber shins?
Syphilis
Treatment for syphilis in a pregnant patient with a penicillin allergy?
Desensitization and PCN G
Management of a susceptible pregnant woman who is exposed to someone with chickenpox?
Varicella immune globulin
Management of a pregnant woman with chickenpox rash early in pregnancy?
acyclovir
Management of a pregnant woman with a chickenpox rash around delivery?
Mom: acyclovir
Infant: varicella immune globulin
Pt with HSV lesions or prodromal symptoms?
C-section
At what beta hCG should you be able to see an IUP?
> 1500
What patients are eligible for medical management of an ectopic pregnancy?
- stable pt with normal renal and liver fxn
- Beta-hCG
What is macrosomia?
Estimated fetal weight >4500 g
What are some risk factors associated with IUGR?
- Smoking
- cocaine use
- Low uteroplacental blood flow (HTN, DM, SLE)
When is c-section offered to moms? Why?
- estimated fetal weight >5000g (or >4500g in Diabetic mom)
- to reduce shoulder dystocia
What is a normal (reactive) non-stress test?
-2 accelerations (>15bpm above baseline lasting 15 seconds) in 20 minutes
What are the components of a biophysical profile? What is a reassuring score?
-NST
-amniotic fluid volume
-fetal breathing
-fetal movement
-fetal tone
(10 points total, 8+=reassuring)
Which fetal heart tracing can result from fetal head compression? What does this look like?
Early decelerations (mirrors contractions –> starts when contraction starts and peaks with contraction peak)
Which fetal heart tracing is a result of umbilical cord compression? What does it look like?
- Variable decelerations
- Abrupt decrease and increase, not always in relation to the contractions
What fetal heart tracing is a result of uteroplacental insufficiency? What does this look like?
- Late decels
- U-shaped with gradual decals and gradual return, beginning AFTER the contraction peaks
What can a sinusoidal pattern on FHT indicate?
severe fetal anemia
Which type of hydatidiform mole has a higher risk for choriocarcinoma?
Complete
Where does choriocarcinoma most commonly spread to?
Lung (be suspicious in postpartum patient with pulmonary symptoms)
What is the karyotype in a partial mole?
69xxx/xxy/xyy
What is the karyotype in a complete mole?
46xx/xy
If a pregnant woman is Rh negative with anti-D antibodies, what is the next step?
indirect coombs-> if +, test paternal blood
What should be monitored in an Rh - mom with Rh antibodies and an Rh+ fetus?
Maternal titers
-if >1:16 or 1:32 then you should test for fetal anemia using a MCA doppler (increased flow with anemia)or fetal blood sampling
Painless vaginal bleeding late in pregnancy?
placenta previa
Bleeding following ROM with non-reassuring FHTs?
Vasa previa
Sudden-onset painful vaginal bleeding late in pregnancy?
Placental abruption
What medication can be given in the setting of premature labor to be neuroprotective (dec risk of cerebral palsy?
-Magnesium sulfate IV
What agents are used for tocolysis?
- magnesium sulfate
- indomethacin
- terbutaline
- nifedipine
What are the stages of labor?
- Stage 1 latent: onset of labor –> 6cm dilated
- Stage 1 active: 6 cm –> 10 cm
- Stage 2: 10cm–> baby out
- Stage 3: baby out –> placenta out
Big, soft, boggy uterus after deliver? Tx?
Uterine atony
-Fundal or bimanual massage, examine uterus for placental fragments, uterotonic agent (oxytocin, methylergonovine, carboprost, misoprostol)
Tx for postpartum endometritis?
-broad spectrum ABX (gent and Clinda)
Tx of mastitis?
- Dicloxacillin
- if MRSA suspected: Vanco, linda or Bactrim
- US to check for an abscess
