Obstetrics Flashcards by Dana Chemali

How often to bHCG levels double?

48 hours

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At what bHCG value is gestational sac seen and at what week?

5 weeks

1000-1500

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What are the nutritional supplements recommended for pregnant women?

Folic acid: 0.4 or 4 if woman has hx of NTD
Iron 30 mg
Calcium
Complete vegetarians: vitamin D, vitamin B12

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Which disease should be detected at first visit?

rubella 
HbSAg
Syphillis 
HIV 
Pap smear
Hep B 
Hep C

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At what week does FTCS happen?

What is in the FTCS

9-14 weeks

PAPP-A, NT, free bHCG

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When is second trimester combined screening happen?

What is in it?

15-22 weeks 
Alpha feto protein 
AFP
Estrodiol
bHCG 
inhibin A

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When does U/S happen for anatomic screening?

18-20 weeks

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When does the glucose challenge happen?

24-23 weeks

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What is elevated alpha AFP associated with?

Open neural tube defects (anencephaly, spina bifida)
Abdominal wall defects
Multiple gestation
Incorrect gestational dating

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What is associated with low alpha AFP?

Trisomy 18
Trisomy 21
Fetal demise
Incorrect gestational dating

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What is high/low in the quad screen for trisomy 21?

AFP low
Estriol low
Inhibin high
bHCG high

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When can CVS be done?

10-12 weeks

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When can Amniocentesis be done?

15-20 weeks

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What are the risks of CVS?

Risk of fetal loss high

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What are the risks of amniocentesis?

PROM
Chorioamnionitis
Fetal maternal hemorrhage

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When can free cell DNA be done?

10 weeks

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What is the management of termination of pregnancy in the first trimester?

up to 49 days: mifepristone + oral misoprostol OR IM methotrexate + oral/vaginal miso

surgical up to 13 weeks

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What is the management of termination of pregnancy in the second trimester?

D&E

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How long is First stage of labour?

6-18

2-10

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How long is the second stage of labour?

0.5-3 hours

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How long is the 3rd stage of labour?

0-0.5

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Late deceleration causes

Uteroplacental insufficiency

Fetal hypoxemia

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Early deceleration causes?

Head compression from uterine contraction

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Causes of variable deceleration?

Umbilical cord compression

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Treatment of hyperemesis gravidum?

Vitamin B6 Doxylamine PO Promethazine or dimenhydrinate PO or rectal administration If severe: metoclopramide, ondansetron If dehydrated: IV fluids, IV nutritional supplementation...

What are the complications of pregestational diabetes for mom?

``` PE Macrosomia leading to need for C-section Preterm labour Infection Polyhydramnios PPH Maternal mortality ```

What are the complications of pregestational diabetes for bb?

``` Macrosomia or IUGR Cardiac and renal defects NTD Hypocalcemia Polycythemia Hyperbilirubinaemia Hyperglycaemia RBS Birth injury ```

What is contraindicated for treatment of gestational or chronic HTN?

ACE | Diuretic

What is the classic triad of Pre-eclampsia?

HTN (140/90) Proteinuria Edema occurring at > 20 weeks gestation

What is HELLP syndrome?

Hemolysis Elevated LFT Low Platelet

What are the symptoms of severe PE?

``` Headache Blurred vision Hyperactive reflexes Clonus RUQ pain ```

What are the symptoms of Magnesium toxicity?

Respiratory paralysis Coma Loss of deep tendon reflex

How to control BP of severe PE?

Labetalol Hydralazine Continuous Mag sulfate Delivery

What is the treatment of asymptomatic bacteriuria in pregnancy?

3-7 days nitrofurantoin

What is the treatment of asymptomatic bacteriuria in pregnancy?

IV fluids Hospital admonition IV 3rd generation cephalosporin

Is placental Abruption painful or painless?

Painful

In what kind of APH do you never perform a VE?

Placental previa

Definition of IUGR?

EFW less 10th percentile for gestational age

Causes of polyhydramnios?

``` Maternal DM Multiple gestation Isoimmunization Pulmonary abnormality Fetal anomaly ```

What is the definition of polyhydramnios?

AFI > 25

What is the definition of oligohydramnions

AFI < 5

Causes of oligohydramnios?

Fetal urinary tract abnormality Uteroplacental insufficiency Rupture of membranes

What is the titre that suggest monitoring for mom for Rh -ve status?

1:16

How to prevent RH isoimmmunisation?

28 weeks give RhoGAM

What is the karyotype of a complete mole?

46 XX

What is the karyotype of an incomplete mole?

69 XXY

Definition complete mole

Sperm enters an egg that has no ovum

Definition incompletely mole

Normal ovum touched by 2 sperm

What is the presentation of molar pregnancy?

Uterine bleeding Hyperemesis PE < 4 weeks Large uterine size

What is diagnosis of molar pregnancy?

Very high betaHCG > 100000 D&C shows cluster of grapes Snowstorm appearance on U/S

Treatment molar pregnancy

Evacuate | Monitor bHCG

What are the complications of multiple pregnancy?

Placenta praaevia | ....

What are the complications of twin pregnancy for bb?

TTT IUGR Preterm labour Congenital malforamtion

What are the risk factors of shoulder dystocia?

Macrosomia Obese mom Diabetes Hx previous shoulder dystocia

Treatment of shoulder dystocia?

``` Help reposition Episiotomy Leg elevation Pressure suprapubic Enter the vagina and help rotate Reach fetal arm ```

What are the hours for failure to progress in first stage?

Latent - Prima > 20 - Multi > 14 Active - Prima > 2 - Multi > 2 after reaching 3-4 cm

What are the hours for failure to progress in second stage?

Primary > 2, > 3 with epidural | Multi > 1, > 2 with epidural

What is premature ROM?

> 1 hour before onset of labour

What is preterm premature ROM?

ROM < 37 weeks gestation

What is prolonged ROM?

> 18s prior to delivery

How is ROM diagnosed?

Nitrazine paper test turns blue | Fern test +ve

Treatment of preterm premature ROM?

``` Abx CSC is < 32 w Term: check GBS and observe labour 34-36 w: Induce labour < 32 w: bed and pelvic rest ```

Treatment of preterm labour?

Steroids Tocolysis : Beta-mimetic, MgSO4, CCB, PGI Abx : penicillin or ampicillin for GBS prophylaxis Transfer and admit Intrapartum Care Neuroprotection if < 30 w

Definition of preterm labour?

Onset of labour between 20-37 w

How do you diagnose preterm labour?

Regular uterine contractions | Concurrent cervical changes

Complications of preterm labour

PDA NEC RDS...

Definition PPH

Loss of blood > 500 mL

Causes of PPH

Tone (commonest ) Tissue Trauma Thrombin

6 W's of postpartum delivery

``` Womb (endometritis) Wind Water (UTI Walk (DVT) Wound (incision infection ) Weaning (mastitis) ```

What is Sheehan's syndrome?

Pituitary ischemia secondary to obstetric hemorrhageand shock

What is the presentation of Sheehan's Syndrome?

Failure to lactate

What does colostrum contain?

Protein Fat Secretory IgA Minerals

What is the treatment of mastitis?

``` dicloxacillin cephalexin amoxycillin azythromycin clyndamycin ```