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A1 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is the technical definition of parity?

A

Number of pregnancies that led to a birth beyond 20 weeks gestation, or an infant weighing over 500 g

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2
Q

What is the developmental age of a fetus?

A

Time since conception–this is usually an unknown quantity

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3
Q

What is the technical definition of gestational age?

A

Number of weeks and days from LMP

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4
Q

When does the fundal height correspond to weeks gestation?

A

After 20 weeks

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5
Q

When are fetal heart tones heard?

A

10 weeks

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6
Q

When does fetal movement begin?

A

20ish weeks

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7
Q

When is the crown-rump length the determining factor for dating gestational age?

A

until 12 weeks (so only the first trimester)

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8
Q

What happens to hCG in the second and third trimester respectively?

A 
second = decrease
Third = level off
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9
Q

When can a fetus be seen on US (weeks and b-hCG levels)?

A

around 5 weeks or 1500 hcg transvaginally, or 5000 transabdominally

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10
Q

What is the acceptable amount of weight gain that a mother should gain if they are:

  • underweight
  • at weight
  • overweight
  • obese
A
  • underweight = 15 kg
  • at weight = 14 kg
  • overweight = 9 kg
  • obese = 7 kg
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11
Q

What are the definitions of excessive and inadequate rate of weight gain in pregnancy?

A 
Excessive = 1.5 kg/month
Inadequate = Less than 1 kg/month
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12
Q

What amount of folate should all women have? What about those with a h/o giving birth to a child with a NTD?

A

0.4 mg/day

4 mg/day for h/o it

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13
Q

What is the recommended amount of Fe that a pregnant women should get per day, starting at the first prenatal visit?

A

30mg/day

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14
Q

What is the recommended amount of Ca that a pregnant women should get per day, starting at the first prenatal visit?

A

1300 mg/day less than 19 years old

1000 mg/day over 19 years

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15
Q

What is the recommended amount of Vitamin D that a pregnant women should get per day, starting at the first prenatal visit?

A

10 micrograms/day

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16
Q

What is the recommended amount of vitamin B12 that a pregnant women should get per day, starting at the first prenatal visit?

A

2 micrograms/day

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17
Q

How much exercise should pregnant women get?

A

30 minutes /day

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18
Q

What happens to the following measurements in throughout the duration of pregnancy:

  • Cardiac output
  • Heart Rate
  • BP
A
  • Cardiac output = increases
  • Heart Rate = increases
  • BP = decreases
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19
Q

What happens to the following measurements in throughout the duration of pregnancy:

  • Tidal volume
  • Respiratory rate
  • Expiratory reserve
A
  • Tidal volume = increases
  • Respiratory rate = constant
  • Expiratory reserve = decreases
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20
Q

What happens to the following measurements in throughout the duration of pregnancy:

  • blood volume
  • Fibrinogen
  • Electrolytes
  • Hematocrit
A
  • blood volume = increases
  • Fibrinogen = increases
  • Electrolytes = constant
  • Hematocrit = decreases
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21
Q

How often should pregnant women have a prenatal visit throughout their pregnancy?

A

Weeks 0 - 28 = q4 weeks
Weeks 29-35 = q2 weeks
Weeks 36+ = every week

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22
Q

What are the hematological labs that should be obtained at the first prenatal visit? (3)

A

CBC
Rh
T+S

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23
Q

What are the infectious diseases should be tested for at the first prenatal visit?

A 
Rubella antibody titer
HBsAg
RPR/VDRL
Gonorrhea and chlamydia
PPD
HIV
Pap smear
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24
Q

What are the prenatal tests that are offered at 9-14 weeks gestation? (3)

A

PAPP-A
nuchal translucency
beta-hCG

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25
Q

What are the prenatal tests that are offered at 15-22 weeks gestation? (4)

A

AFP
estriol
beta-hCG
inhibin-A

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26
Q

When is the quad screen offered in pregnancy?

A

second trimester

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27
Q

When is the full anatomic screen offered in pregnancy?

A

20 weeks

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28
Q

When is the one hour glucose challenge done in pregnancy?

A

26 weeks

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29
Q

When is Rhogam given in pregnancy for an Rh - woman with an Rh + fetus?

A

30 weeks

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30
Q

When is a GBS culture obtains in pregnancy?

A

35-37 weeks gestation

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31
Q

What are the quad screen results for trisomy 18?

A

Decreased everything (AFP, estriol, hcg, inhibin A)

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32
Q

What are the quad screen results for Down syndrome?

A 
("2 up, 2 DOWN")
Decreased AFP
Decreased estriol
Increased beta hCG
Increased inhibition A
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33
Q

What is elevated maternal serum AFP associated with?

A

NTDs
Abdominal wall defects
Multiple gestations
Fetal death

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34
Q

When is the triple screen performed?

A

10 weeks-ish gestation (end of first trimester)

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35
Q

What are the indications for amniocentesis? (4)

A
  • Women over 35
  • Abnormal quad screen
  • Rh sensitized mother to detect fetal hemolysis
  • Evaluate fetal lung maturity
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36
Q

What are the TORCHeS infections?

A 
Toxo
Other
Rubella
CMV
Herpes / HIV / hepatitis
Syphilis
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37
Q

What is the definition of spontaneous abortion?

A

Loss of POC prior to 20 weeks gestation

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38
Q

What is the definition of recurrent spontaneous abortions?

A

Two or more consecutive SABs or three in 1 year

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39
Q

What are the likely causes of spontaneous abortions early and late in the pregnancy?

A 
Early = chromosomal abnormalities
Late = Hypercoagulable states
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40
Q

What are the fetal effects of maternal use of: ACEIs?

A

fetal renal tubular dysplasia

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41
Q

What are the fetal effects of maternal use of: androgens

A

Virilization of female fetuses, and genital developmental defects in boys

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42
Q

What are the fetal effects of maternal use of: cocaine?

A

Bowel atresia
Heart or limb malformations
Microcephaly / IUGR

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43
Q

What are the fetal effects of maternal use of: carbamazepine

A

NTDs

Microcephaly

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44
Q

What are the fetal effects of maternal use of: DES

A

Clear cell adenocarcinoma of the vagina or cerix

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45
Q

What are the fetal effects of maternal use of: lead

A

Increased SABs

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46
Q

What are the fetal effects of maternal use of: Li

A

Ebstein anomaly

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47
Q

What are the fetal effects of maternal use of: methotrexate

A

SABs

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48
Q

What are the fetal effects of maternal use of: organic Hg

A

SABs

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49
Q

What are the fetal effects of maternal use of: phenytoin

A

IUGR
MR
microcephaly

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50
Q

What are the fetal effects of maternal use of: radiation

A

microcephaly

MR

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51
Q

What are the fetal effects of maternal use of: streptomycin and kanamycin

A

CN VIII damage

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52
Q

What are the fetal effects of maternal use of: tetracyclines

A

Yellow discoloration of teeth

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53
Q

What are the fetal effects of maternal use of: thalidomide

A

bilateral limb deficiencies

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54
Q

What are the fetal effects of maternal use of: valproic acid

A

NTDs

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55
Q

What are the fetal effects of maternal use of: vitamin A and derivatives

A

SABs

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56
Q

What are the symptoms of congenital infection with: toxo

A

Hydrocephalus
Chorioretinitis
Intracranial calcifications

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57
Q

What are the symptoms of congenital infection with: rubella

A 
Blueberry muffin
cataracts
MR
Hearing loss
PDA
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58
Q

What are the symptoms of congenital infection with: CMV

A

Petechial rash and periventricular calcifications

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59
Q

What are the symptoms of congenital infection with: HSV

A

CNS/systemic infections

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60
Q

What are the symptoms of congenital infection with: HIV

A

FTT and immunodeficiency

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61
Q

What are the symptoms of congenital infection with: syphilis

A

Maculopapular rash
SNuffles
Saber shins
Saddle nose

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62
Q

What are the components of the Hutchinson triad of congenital syphilis infection?

A

Teeth
Deafness
Interstitial keratitis

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63
Q

What is the treatment for congenital infection with: toxo

A

Pyrimethamine

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64
Q

What is the treatment for congenital infection with: rubella

A

Symptomatic

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65
Q

What is the treatment for congenital infection with: CMV

A

Ganciclovir

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66
Q

What is the treatment for congenital infection with: HSV

A

Acyclovir

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67
Q

What is the treatment for congenital infection with: HIV

A

HAART

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68
Q

What is the treatment for congenital infection with: syphilis

A

PCN

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69
Q

What are the s/sx, PE findings, and treatment for complete spontaneous abortions?

A
  • Bleeding and cramping stopped, POC expelled
  • Closed OS
  • no treatment
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70
Q

What are the s/sx, PE findings, and treatment for threatened spontaneous abortions?

A
  • Uterine bleeding + abd pain
  • Closed OS with NO POC passed
  • Pelvic rest, f/u US
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71
Q

What are the s/sx, PE findings, and treatment for an Incomplete spontaneous abortions?

A
  • Partial POC expulsion
  • Open OS
  • Manual uterine aspiration
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72
Q

What are the s/sx, PE findings, and treatment for inevitable spontaneous abortions?

A
  • Uterine bleeding, No POC expulsion

- Open OS

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73
Q

What are the s/sx, PE findings, and treatment for missed spontaneous abortions?

A
  • Cramping, loss of early pregnancy s/sx

- Closed OS, w/o fetal cardiac activity

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74
Q

What are the s/sx, PE findings, and treatment for septic spontaneous abortions?

A
  • Fever, foul smelling d/c
  • Fever, hypotension
  • D+C and Abx
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75
Q

What is the defintion and treatment for intrauterine demise?

A

Absence of fetal cardiac activity over 20 weeks gestation

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76
Q

When in the pregnancy can methotrexate be used to end a pregnancy?

A

49 days

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77
Q

When in the pregnancy can mifepristone and misoprostol be used to end a pregnancy?

A

49 days

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78
Q

When in the pregnancy can vaginal or SL misoprostol (high dose, repeated) be used to end a pregnancy?

A

59 days

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79
Q

When in the pregnancy can manual D+C (w/wo suction) be used to end a pregnancy?

A

up to 13 weeks

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80
Q

When in the pregnancy can induction of labor through prostaglandins / oxytocin be used to end a pregnancy?

A

13-24 weeks GA

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81
Q

When in the pregnancy can D+E be used to end a pregnancy?

A

Up to 24 weeks GA

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82
Q

What are the leopold maneuvers used for?

A

Determine fetal lie and presentation to determine if the pregnancy will be complicated

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83
Q

If ROM is suspected in a women, what exam should be performed?

A

Sterile speculum examination

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84
Q

What are the aspects of the cervix that are evaluated just prior to Labor? (4)

A

Dilation
Effacement
Station
Cervical station/consistency

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85
Q

What are the stages of labor?

A 
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
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86
Q

How often should FHR be obtained in the first and second stages of labor assuming there are no complications?

A 
First = q30 minutes
Second = q15 minutes
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87
Q

What defines the latent and active parts of the first stage of labor?

A 
Latent = Onset to 4 cm dilation
Active = 4 cm dilation to full (10cm) dilation
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88
Q

What is the average time for the latent and active phases of labor for primiparous and multiparous women respectively?

A 
Primiparous = 9 hours, 6 hours
Multiparous = 5 hours, 2.5 hours
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89
Q

What is the average time for the second phase of labor for primiparous and multiparous women respectively?

A

0.5 - 3 hours for primiparous

5 - 30 mins for multiparous

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90
Q

What is the average time for the third phase of labor for primiparous and multiparous women respectively?

A

0 - 0.5 hours for both

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91
Q

How often should FHR be obtained in the first and second stages of labor if there are complications?

A

First stage = q15 minutes

Second stage - q5 minutes

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92
Q

What is the normal fetal heart rate range?

A

110-160 bpm

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93
Q

What does absent variability of the fetal HR mean?

A

Indicates severe fetal distress

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94
Q

What does minimal variability of the fetal HR mean?

A

Less than 6 bpm change, indicates fetal hypoxia Mg, or sleep cycle

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95
Q

What does normal variability of the fetal HR mean?

A

6-25 bpm

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96
Q

What does marked variability of the fetal HR mean?

A

Over 25 bpm variations

Indicates fetal hypoxia

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97
Q

What does sinusoidal variability of the fetal HR mean?

A

Points to serious fetal anemia

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98
Q

What are accelerations in fetal HR? What are the significance of these?

A

Onset of an increase in FHR over 15 bpm to a peak in less than 30 seconds

Reassuring because the indicate fetal ability to appropriately respond to the environment

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99
Q

When is antepartum fetal surveillance indicated (indications, timeframe)?

A

IN pregnancies in which the risk of antepartum fetal demise is increased, usually at 32-34 weeks

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100
Q

What is assessed in the antepartum fetal surveillance?

A
  • Number of fetal movements over 1 hour (avg is 10/ 2 hours)

- Less than this is an indication for further workup

101
Q

What are early decelerations, and what causes them?

A

Gradual onset of deceleration in FHR, with the nadir occurring less than 30 seconds after the contraction.

Indicates fetal head compression, and is a normal finding

102
Q

What are late decelerations, and what causes them?

A

Gradual onset of FHR deceleration with the onset to the nadir over 30 seconds with gradual return to baseline

Indicates placental insufficiency and fetal hypoxemia

103
Q

What are variable decelerations, and what causes them?

A

Abrupt decrease in FHR with onset to nadir less than 30 seconds after contraction, with quick return to baseline.

Indicates cord compression, and should be followed with infusion of NS

104
Q

What is the fetal non-stress test?

A

Mother resting on left lateral tilt position, and FHR assessed as well as a tocometer. Acoustic stimulation may be used

105
Q

What characterizes a “reactive” fetal nonstress test?

A

Normal response–Two accelerations over 15 bpm above baseline lasting for at least 15 seconds, over a 20 minute period

106
Q

What characterizes a “non-reactive” fetal nonstress test?

A

Insufficient accelerations over a 40 minute period

This indicates the need for further evaluation with biophysical profile

107
Q

What is the contraction stress test?

A

Performed in the lateral recumbent position, with FHR monitored during spontaneous or induced contractions.

Reactivity is determined from FHR monitoring, as in the NST

108
Q

What conditions are contraindications to the contraction stress test?

A

Placenta previa

PPROM

109
Q

What defines a “positive” contraction stress test? What is the significance of this?

A

Late decelerations following 50% or more of contraction in a 10 minute period

Raises concerns about fetal compromise

110
Q

What defines a “negative” contraction stress test? What is the significance of this?

A

NO late or significant variable decelerations within 10 minutes, and at least 3 contractions

Highly predictive of fetal wellbeing in conjunction with a normal NST

111
Q

What defines an “equivocal” contraction stress test? What is the significance of this?

A

Intermittent late decelerations or significant variable decelerations

112
Q

What is a biophysical profile? What are the 5 components of this?

A

Real time US to assign a score of 2 (normal) or 0 (abnormal) to five parameters:

  • Fetal tone
  • breathing
  • movement
  • amniotic fluid volume
  • NST
113
Q

What is an amniotic fluid index?

A

Sum of the measurements of the deepest cord-free amniotic fluid measured in each of the 4 abdominal quadrants

114
Q

What are the scores of the Biophysical profile that are:

  • Reassuring
  • Equivocal
  • Worrisome
A
  • Reassuring = 8+
  • Equivocal = 6
  • Worrisome 0-4
115
Q

What is the only major indication to perform umbilical artery doppler velocimetry?

A

IUGR suspected

116
Q

What level of amniotic fluid is diagnostic of oligohydramnios?

A

Less than 5 cm

117
Q

Uterine contractions and cervical dilation result in visceral pain at what spinal levels?

118
Q

Descent of the fetal head and pressure on the vagina and perineum results in somatic pain at what spinal levels?

A

S2-S4 (pudendal nerve)

119
Q

What are the absolute contraindications to regional anesthesia (epidural, spinal, or combo) for pregnant women? (6)

A
  • Refractory hypotension
  • Coagulopathy
  • Use of once daily dose of LMWH with 12 hours
  • Untreated bacteremia
  • Skin infx at site of placement
  • Increased ICP 2/2 mass lesion
120
Q

How long does morning sickness usually last?

A

first trimester

121
Q

What are the diagnostic criteria for hyperemesis gravidarum?

A
  • Ketonuria/ketonemia
  • hyponatremia/hypokalemia
  • Hypochloremic metabolic alkalosis
122
Q

What is the treatment for hyperemesis gravidarum?

A
  • Vit b6
  • Doxylamine (antihistamine)
  • Diphenhydramine PO
  • IVFs PRN
123
Q

What needs to be r/o in cases of suspected hyperemesis gravidarum?

A

Molar pregnancy

124
Q

What is the suspected cause of hyperemesis gravidarum?

A

Increased hCG and estradiol causes it, maybe

125
Q

When is the screening for gestational DM done? What is done?

A

25 weeks-ish

1 hour 50g glucose challenge

126
Q

How many measurements of abnormal BG are needed to diagnose G-DM?

127
Q

What are the fasting, 1 hour, 2 hour, and 3 hour BG cutoff values for the 50g glucose tolerance test?

A

Fasting = less than 95
1 hour = over 180
2 hours = over 155
3 hours = over 140

128
Q

What is the diet that is recommended that mothers with G-DM be started on?

129
Q

What are the tests that should be performed on the fetus in cases of maternal G-DM?

A

Periodic US and NST

130
Q

In mothers who had G-DM, when should f/u testing be done to assess for DM-II?

A

6-12 weeks postpartum

131
Q

What level of HbA1c indicates a risk for congenital malformations?

A

Greater than 8, investigate!

132
Q

What are the fasting and postprandial goals of G-DM?

A

Fasting goal under 95 mg/dL

Postprandial under 120 mg/dL

133
Q

True or false: glucosuria on a UA in a woman before 20 weeks gestation is an indication of G-DM

A

False-indicates pregestational DM

134
Q

What are the three major tests that are performed on a fetus at 16-24 weeks in a mother who has G-DM?

A
  • Quad screen
  • US
  • Fetal echo
135
Q

What are the three major tests that are performed on a fetus at 32-34 weeks in a mother who has G-DM?

A
  • close fetal surveillance
  • Admit if poorly controlled
  • Serial US
136
Q

True or false: maternal BG levels should be tightly regulated during delivery

137
Q

When is pregnancy does gestational HTN develop?

A

After 20 weeks

138
Q

What level of proteinuria is diagnostic of eclampsia?

A

Over 300 mg/L

139
Q

What is the treatment for gestational HTN? What is NOT?

A

Monitor closely, and give methyldopa, labetalol PRN.

NOT ACEIs

140
Q

What is the classic triad of preeclampsia?

A

HTN
Proteinuria
Edema

141
Q

What are the components of HELLP syndrome?

A 
Hemolysis
Elevated
LFTs
Low
Platelets
142
Q

What BP defines mild preeclampsia? Severe?

A 
Mild = 140/90 or more
Severe = 160/110
143
Q

What are the features of severe preeclampsia?

A
  • 160/110
  • Proteinuria
  • Cerebral changes
  • Visual changes
  • RUQ pain (and other HELLP syndrome s/sx)
144
Q

What level of proteinuria is diagnostic of severe preeclampsia?

A

Over 5g/day, oor 3-4 + urien dipsticks

145
Q

What is the treatment for eclampsia that is far from term?

A

Modified bed rest and expectant management

146
Q

What are the three major treatments that are done with eclamptic women?

A
  • IV Mg
  • Labetalol or hydralazine
  • Delivery if possible
147
Q

What is the treatment for Mg toxicity?

A

Calcium gluconate

148
Q

How long should seizure prophylaxis (Mg) be continued in eclamptic women postpartum?

149
Q

What is the treatment for an uncomplicated UTI and pyelonephritis respectively in pregnancy?

A 
UTI = Macrobid
Pyelo = 3rd gen cephalosporins
150
Q

What are the two most common causes of antepartum hemorrhage?

A

Placental abruption

Placenta previa

151
Q

What are the four major causes of bleeding in the third trimester?

A
  • Vagina-bloody show, trauma
  • Cervical lesions/CA
  • Placental bleeding
  • Fetal bleeding
152
Q

What is placental abruption?

A

Premature separation of normally implanted uterus

153
Q

What is a “low lying” placenta previa?

A

Placenta is in close proximity to the OS

154
Q

What is vasa previa?

A

Velamentous umbilical cord insertion and/or bilobed placenta causing vessels to pass over the internal os.

155
Q

What are the major risk factors for placental abruption? (3)

A

HTN
Abdominal/pelvic trauma
Tobacco/cocaine abuse

156
Q

What are the major risk factors for placenta previa? (3)

A

Prior C-sections
Multiparity
Advanced maternal age

157
Q

What are the major risk factors for vasa previa (3)?

A

Multiple gestations
IVF
Single umbilical artery

158
Q

What are the s/sx of placental abruption?

A

Painful, dark vaginal bleeding that does not spontaneously cease

159
Q

What are the s/sx of placenta previa?

A

Painless bright red bleeding that often ceases in 1-2 hours w/wo uterine contractions

160
Q

How do you diagnose:

  • Placental abruption
  • Placenta previa
  • Vasa previa
A
  • Placental abruption = Clinical
  • Placenta previa = TV / TA US
  • Vasa previa = TVUS
161
Q

What are the s/sx of vasa previa?

A

Painless bleeding at rupture of membranes with fetal bradycardia

162
Q

How do you manage placental abruption?

A

Expectant/stabilize if mild

Immediate delivery if severe and expected delivery soon

163
Q

How do you manage placenta previa?

A

Do NOT perform vaginal exam
Serial US to see if resolves
Deliver by C-section if not resolved by

164
Q

How do you manage vasa previa?

A
  • Acute bleeding = emergency C-section

- Before labor = Steroids at 30 weeks, and scheduled c-section

165
Q

What is the classic triad for an ectopic pregnancy?

A

Pain
Amenorrhea
Vaginal bleeding

166
Q

What does the workup of a suspected ectopic pregnancy involve?

A 
bhCG measurements (will not double appropriately)
US w/o intrauterine pregnancy
\+ prego test
167
Q

What is the medical treatment for an ectopic pregnancy?

A

Methotrexate

168
Q

What is the technical definition of IUGR?

A

EFW less than 10th percentile

169
Q

What are the risk factors for IUGR?

A

■ Maternal systemic disease leading to uteroplacental insufficiency (intrauterine infection, hypertension, anemia).
■ Maternal substance abuse.
■ Placenta previa.
■ Multiple gestations.

170
Q

What is the treatment for IUGR that is near delivery date?

A

Administer steroids to accelerate fetal lung maturity (48 hours)

171
Q

What is the technical definition of fetal macrosomia?

A

Birth weight over the 95th percentile

172
Q

What is the treatment for fetal macrosomia?

A

-Planned c-section if over 5000g

173
Q

What is the technical defintion of polyhydramnios?

A

AFI over 25 on US

174
Q

How do you diagnose polyhydramnios?

A

Fundal height greater than expected.

US

175
Q

What are the complications associated with polyhydramnios?

A

Preterm labor
Fetal malpresentation
Cord prolapse

176
Q

What is the technical definition of oligohydramnios?

A

AFI less than 5

177
Q

What must always be r/o prior to diagnosing oligohydramnios?

A

Inaccurate dating

178
Q

What is erythroblastosis fetalis?

A

Rh problems

179
Q

What are the two major malignant types of gestational trophoblastic disease?

A

Invasive moles

Choriocarcinoma

180
Q

What are the usual s/sx of gestational trophoblastic disease?

A

Uterine bleeding and uterine sizes greater than expected for dates

181
Q

What is the mechanism behind complete and incomplete moles?

A 
Complete = sperm fertilization of an empty ovum
Incomplete = normal ovum fertilized by two sperm
182
Q

What are the karyotypes of complete and incomplete hydatidiform moles?

A

Complete =46, XX or YY

Incomplete = 69 XXY or XYY

183
Q

Which contains fetal tissue: complete or incomplete moles?

A

Incomplete

184
Q

What are the dietary deficiencies that have been associated with the development of moles?

A

Low in folate or beta-carotene

185
Q

What are the gross exam findings of a mole?

A

Grapelike molar clusters

186
Q

What are the beta-hCG findings of a mole?

A

Markedly increased hCG

187
Q

What is the treatment for a mole?

A

D+C and trend b-hCG downward to ensure resolution

188
Q

What is the chemotherapy of choriocarcinomas?

A

Methotrexate and dactinomycin

189
Q

True or false: beta-hCG is elevated with multiple gestations

190
Q

What must multiple gestations be monitored for throughout the course of the pregnancy?

A

IUGR (twin-twin transfusion syndrome)

191
Q

What is the treatment for potential shoulder dystocia during delivery of a large infant?

A 
Help reposition
Episiotomy
Leg elevated
Pressure (suprapubic)
Enter the vagina and attempt to rotate
Reach for fetal arm

(“HELPER”)

192
Q

What is first stage protraction/arrest?

A

Labor that fails to produce adequate rates of progressive cervical change.

193
Q

What is prolonged second-stage arrest?

A

Arrest of fetal descent

194
Q

What are the complications associated with failure to progress?

A

Chorioamnionitis

Postpartum hemorrhage

195
Q

What is the definition of PROM?

A

ROM that occurs more than 1 hour before the onset of labor.

196
Q

What is the defintion of failure to progress in the latent stage of labor for primiparous and multiparous women respectively?

A 
Prima = over 20 hours
Multi = over 14 hours
197
Q

What is the defintion of failure to progress in the active stage of labor for primiparous and multiparous women respectively?

A 
Prima = over 2 hours
multi = over 1 hour

(add an hour to either if epidural present)

198
Q

What is the defintion of failure to progress in the second stage of labor for primiparous and multiparous women respectively?

A 
Prima = over 2 hours
Multi = over 1 hour
199
Q

What is the treatment for arrest in the latent phase of labor? Active? Second stage?

A 
Latent = therapeutic rest and analgesia
Active = Amniotomy, oxytocin
Second = C section or assisted vaginal
200
Q

What is the definition of PPROM?

A

ROM occurring at less than 37 weeks gestation

201
Q

What is the defintion of prolonged ROM?

A

ROM occurring ver 18 hours prior to delivery

202
Q

What is the basis of the nitrazine paper test in diagnosing ROM?

A

If amniotic fluid present, then the paper will turn blue to indicate alkaline fluid

203
Q

What is the Fern test used to diagnose ROM?

A

A ferning pattern is seen under a microscope after amniotic fluids dries on a glass slide

204
Q

What are the unequivocal tests that can be performed to definitively diagnose ROM?

A

US guided transabdominal installation of indigo carmine dye to check for leakage

205
Q

What is the treatment for PPROM if less than 32 weeks?

A

Expectant management with bed rest and pelvic rest

206
Q

What is the treatment for PPROM if between 34-36 weeks?

A

Labor induction

207
Q

What should be given to preterm fetuses less than 32 weeks gestation prior to inducing delivery?

A

Betamethasone or dexamethasone x48 hours

208
Q

What should be done if PPROM is complicated by infection?

209
Q

What is the technical definition of preterm labor?

A

Preterm labor = regular uterine contractions + concurrent cervical change at < 37 weeks’ gestation.

210
Q

True or false: most patient who go into preterm labor have identifiable risk factors

211
Q

What are the diagnostic criteria for preterm labor?

A
  • Regular uterine contractions- (three or more contractions of 30 seconds each over a 30-minute period)
  • Concurrent cervical changes at less than 37 weeks
212
Q

What should be done with a suspected preterm labor?

A
  • R/o contraindications for tocolysis
  • Sterile speculum exam to r/o ROM
  • US to r/o uterine anomalies
213
Q

What is the treatment for Preterm labor?

A

Tocolytic therapy
Steroids to accelerate fetal lungs
PCN for GBS prophylaxis

214
Q

What are the drugs that are used for tocolysis?

A
  • MgSO4
  • Beta-mimetics
  • CCBs
  • Prostaglandin inhibitors
215
Q

What is the major complication associated with preterm labor for the fetus?

216
Q

What is the common malpresentation of a fetus?

217
Q

What is the major risk factor for the development of fetal malpresentation?

A

Prematurity

218
Q

What are:

  • Frank breech
  • Footling breech
  • Complete breech
A
  • Frank breech = The thighs are flexed and the knees are extended.
  • Footling breech = One or both legs are extended below the buttocks.
  • Complete breech = The thighs and knees are flexed.
219
Q

What is the treatment for breech presentation? (4)

A
  • Follow, since most resolve by 38 weeks
  • External version
  • Trial of breech vaginal delivery (if imminent)
  • Elective c-section
220
Q

What type of uterine incision predisposes to uterine rupture with vaginal delivery?

221
Q

What maternal infection is an indication for a c-section?

222
Q

What is the most common cause of primary c-section?

A

Cephalopelvic disproportion

223
Q

What is puerperium?

A

the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original nonpregnant condition.

224
Q

What amount of blood is classified as postpartum hemorrhage?

A

More than 500 mL if vaginal delivery

More than 1 L if C-section

225
Q

What are the three key features of postpartum endometritis?

A
  • Fever over 38 C within 36 hours
  • Uterine TTP
  • Malodorous lochia
226
Q

What is the treatment for severe postpartum hemorrhage?

A

Uterine artery embolization

227
Q

What are the causes of uterine atony?

A
  • Uterine overdistention
  • Exhausted myometrium
  • Uterine infx
  • Conditions interfering with contractions
228
Q

What are the four T’s of postpartum hemorrhage?

A
  • Tone
  • Trauma
  • Thrombin
  • Tissue (retained)
229
Q

What are the causes of retained placental tissue?

A
  • Placenta accreta/increta/percreta
  • placenta previa
  • Uterine leiomyomas
230
Q

How do you diagnose retained placental tissue?

A

Manual and visual inspection of the placenta and uterine cavity for missing cotyledons. Ultrasound may also be used to inspect the uterus.

231
Q

What is the treatment for uterine atony? (4)

A
  • Bimanual uterine massage (usually successful).
  • Oxytocin infusion
  • Methergine (methylergonovine) if not hypertensive.
  • PGF2a.
232
Q

What is the treatment for retained placental tissue?

A

Manual removal or Curettage

233
Q

What timeframe is needed for a fever to diagnose postpartum infection?

A

Over 38 C for at least 2 of the first 10 postpartum days, not including the first 24 hours

234
Q

What are the 7 W’s of post op fever?

A 
Womb
Wind
Water
Wound
Weaning (breast abscess or mastitis)
Wonder drugs
235
Q

How long should broad spectrum abx be used for in treating postpartum fever?

A

So that pt has been afebrile for at least 48 hours

236
Q

What causes septic pelvic thrombophlebitis?

A

Pelvic infection leads to infection of the vein wall and intimal damage, leading in turn to thrombogenesis. The clot is then invaded by microorganisms.

237
Q

What are the classic s/sx of septic pelvic thrombophlebitis?

A

Presents with abdominal and back pain and a “picket-fence” fever curve (“hectic” fevers) with wide swings from normal to as high as 41°C (105.8°F).

238
Q

What is the treatment for septic pelvic thrombophlebitis?

A

Abx and anticoagulation

239
Q

What is the most common presenting symptom of SHeehan syndrome?

A

Inability to lactate

240
Q

How do you dx sheehan syndrome?

A

Provocative hormonal testing and MRI of pituitary

241
Q

What is the treatment for sheehan syndrome?

A

Replace all lost hormones

242
Q

What happens after delivery to stimulate milk production?

A

Loss of placenta leads to increased prolactin levels

243
Q

What is the immune component of colostrum?

244
Q

What are the contraindications to breastfeeding?

A
  • HIV infx
  • HSV/varicella infx
  • Certain meds
245
Q

What is the most common causative organism of mastitis?

A

Staph aureus

246
Q

True or false: mastitis is usually bilateral

A

False-unilateral

247
Q

When does mastitis typically present?

A

2-4 weeks postpartum

248
Q

Why continue breastfeeding with mastitis?

A

to prevent the accumulation of infected material

A1 (32 decks)

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