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Ob/Gyn Dreams > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

dx: appendicitis in preggers

A

graded compression u/s

if U/S not diagnostic you can MRI

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2
Q

tx: DVT in preggers

A

LWMH

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3
Q

when can you get sheehan syndrome

A

right after childbirth or even months/years later

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4
Q

tx for acute sheenhan syndrome

A

IV dexamethasone

then MRI the head to r/o other crap

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5
Q

tx: hyperthyroid for preggers

A

propylthiouracil 1st trimester

methimazole 2nd, 3rd

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6
Q

tx: lyme in preggers

A

amoxicillin

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7
Q

why do preggers get GDM?

A

human placental lactogen (aka chorionic somatomammotropin) increases insulin resistance

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8
Q

how much folic acid for preggers

A

normal: 0.4 mg

high risk: 4 mg

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9
Q

cord compression tx

A

corticosteroids

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10
Q

quad screen

A

triple screen + inhibin A

hCG, unconjugated estriol, AFP, inhibin A

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11
Q

quad screen results: + for Downs

A

decreased AFP
decreased estriol
increased inhibin
increased hCG

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12
Q

management: screening for downs

A

low risk can get triple screen
high risk (>35, late prenatal) get quad
if + –> genetic counseling
then offer amniocentesis

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13
Q

pregger: fever, abd pain and sausage shaped mass near umbilicus

A

septic pelvic pain thrombophlebitis

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14
Q

pregger/laboring: fever, tachy, tender uterus, foul smelling amniotic fluid

A

chorioamnionitis

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15
Q

post partum pelvic pain, foul smelling lochia

A

endometritis

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16
Q

vag bleeding 20+ weeks: painless vs painful

A 
painless = placenta previa or vasa previa
painful = placental abruption
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17
Q

possible problems with babies from DM moms

A 
resp distress syndrome
hypertrophic CM (elevated insulin)
hypoglycemia (elevated insulin)
hypocalcemia (low PTH)
polycythemia (hi EPO)
hypomagnesemia (Mg excreted by mom kidneys)
hyperbilirubinemia (increased hemolysis)
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18
Q

normal fetal HR

A

110 - 160

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19
Q

tx for GDM

A
  1. lifestyle

2. + insulin or glyburide

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20
Q

most effective dating method first TM

A

transvaginal sonogram: crown-rump length

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21
Q

diff btwn incomplete and inevitable abortion

A

inevitable is before passage of tissue , incomplete has some or all tissue passed (both have open os)

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22
Q

management: placenta previa

A

< 36 wks: conservative, repeat U/S before delivery

> 36 wks: U/S, most –> C-section, ant-marginal –> can try vaginal

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23
Q

diff btwn gestational HTN and preeclampsia

A

preeclampsia has proteinuria or signs of end organ damage

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24
Q

MC breech

A

frank (butt presents, hips flexed, knees extended)

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25
Q

tx: low breast milk production

A
  1. increase feedings
  2. metoclopramide (D2 antag)
    also make sure shes not on combined OCPs
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26
Q

latent phase of labor

A

effacement and dilation up to 4 cm

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27
Q

prolonged latent phase

A

null: > 20
multi: > 14

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28
Q

active phase of labor

A

eff/dil from 4 - 10 cm

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29
Q

prolonged active phase

A

null: < 1.2 cm/hr
multi: < 1.5 cm/hr

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30
Q

arrested active phase

A

no dilation in 2 hrs in active phase

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31
Q

second phase of labor

A

from 10 cm to delivery

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32
Q

prolonged second phase

A

null: 2 hrs
multi: 1 hr

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33
Q

third stage of labor

A

baby out to placenta out

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34
Q

prolonged third stage

A

> 30 min

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35
Q

shiny, peeling areola (breastfeeding)

A

candidiasis of nipple

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36
Q

tx: nipple candadiasis

A

-azole cream on nipple

oral azole for baby (thrush)

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37
Q

MCC mastitis

A

staph aureus

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38
Q

when can you see a gestational sac (BhCG)

A

transvag: > 1,500
abdominal: > 6,500

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39
Q

BhCG growth: normal vs ectopic

A

normal: double/48 - 72 hrs
ectopic: lower

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40
Q

dx: ectopic pregnancy

A

transvag U/S and serial BhCGs

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41
Q

mgmt: ectopic pregnancy

A

methotrexate

unstable: surgery

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42
Q

mgmt: preterm labor by dates

A

34 - 36.6: +/- corticosteroids (betamethasone), PCN if GBS(+)/unknown
32 - 33.6: add tocolytics (indomethacin, nifedipine)
< 32: add magnesium sulfate

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43
Q

why do you give mg sulfate for preterm labor

A

fetal neuroprotection (eg cerebral palsy)

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44
Q

when to cervical cerclage

A

cervix < 2.5 cm

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45
Q

mgmt: uterine inversion

A 
immediate manual replacement 
if can't replace, try uterotonics
uterotonics once it's replaced
(remove placenta after it's replaced if still attached)
if nothing works -- laparotomy
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46
Q

baby complications of DM mom (1st TM)

A

congenital heart dz
NTD
small L colon
spontaneous abortion

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47
Q

baby complications of DM mom (2/3 TM)

A 
hyperinsulinemia
polycythemia (up met demand --> hypoxia)
organomegaly
hypoglycemia
brachial plexopathy, clavicle frx, perinatal asphyxia (macrosomia, shoulder dystocia)
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48
Q

preeclampsia: baby risks

A

chronic uteroplacental insuff –> growth restriction/LBW

not hypoxia, which is due to acute UPI

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49
Q

preeclampsia: mom risks

A

placental abruption
DIC
eclampsia

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50
Q

fetal non-stress test: what is a reactive result?

A 
110 - 160 bpm
mod variability (6 - 25/min)
2+ accelerations in 20 min (each 15+ high and 15+ s long)
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51
Q

causes of non-reactive non-stress test

A

fetal sleep (MC)
fetal hypoxia (from UPI)
fetal cardiac abnormalities
fetal neuro abnormalities

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52
Q

mgmt: nonstress test

A

reactive? great, 20 min is good
nonreactive? extend to 40 - 120 min (feti only sleep 40 min at a time)
all nonreactive need follow up biophysical profile or contraction stress test

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53
Q

causes of fetal tachycardia

A

maternal fever
maternal hyperTh
meds (terbutaline)
placental abruption

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54
Q

definition of fetal growth restriction

A

U/S estimated weight < 10th percentile for gestational age

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55
Q

symmetric vs asymmetric fetal growth restriction

A

symmetric: see it 1st TM; global growth lag
asymmetric: see in 2nd/3rd; head-sparing growth lag

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56
Q

causes of fetal growth restriction

A

symmetric: chromosome abnorm, congenital infection
asymmetric: UPI, maternal malnutrition

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57
Q

normal preg physio: kidneys

A

up renal blood flow, GFR, BM permeability –>
down serum BUN, Cr
up renal protein excretion

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58
Q

normal preg physio: heart

A

fill

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59
Q

normal preg physio: lungs

A

fill

60
Q

normal preg physio: blood

A

fill

61
Q

normal preg physio: endo

A

fill

62
Q

recommended preggo vaccines

A

Tdap
inactivated flu
Rho(D)

63
Q

preggo vaccines (for high risk pts)

A 
Hep A/B
pneumococcus
H flu
Meningococcal
Varicella-zoster Ig
64
Q

RFs for uterine atony

A

prolonged labor
induction of labor
operative delivery
fetal weight > 4000 g

65
Q

spontaneous abortions with closed os

A

missed
threatened
complete

66
Q

empty sac = which spontaneous abortion

A

missed

67
Q

Tx: asx bacteriuria in pregnancy

A

cephalexin
amox-clav
nitrofurantoin
NO cipro/TMP-SMX

68
Q

when can you quad screen

A

15 - 22 wks

69
Q

what preg screening can you do @ 10 wks

A

cell-free fetal DNA
CVS
PaPP, beta HCG, nuchal translucency

70
Q

when do you give rhogam

A 
28 - 32 wks
< 72 hrs after delivery
< 72 hrs after abortion
2nd/3rd TM bleeding
CVS/amnio
71
Q

biggest RF for preterm birth

A

previous preterm birth

72
Q

cervix things that increase risk of preterm birth

A

short cervix
cold knife conization
LEEP (maybe)
laser ablation DOES NOT

73
Q

mgmt: short cervix (with no previous preterm)

A

vaginal progesterone

74
Q

mgmt: short cervix (with previous preterm)

A

IM progesterone @ 2nd TM
serial TVUS to check for short
short –> cerclage

75
Q

whats on the biophysical profile (+norm)

A 
continuous observation for 30 min
non stress test (reactive)
amniotic fluid vol (> 2 x 1 cm)
fetal mvmts (> 3)
fetal tone (> 1 flex/ext)
fetal breathing mvmts (> 1 for > 30 s)
76
Q

when do you deliver based on biophysical profile

A

4 or less

77
Q

fetal demise with limb fractures, hypoplastic thoracic cavity

A

osteogenesis imperfecta (II)

78
Q

when can you turn a breech baby

A

37 weeks to onset of labor

79
Q

who can’t breastfeed

A 
active TB
HIV
HSV breast lesions
varicella
meds/chemo/drugs
80
Q

preterm labor definition

A

contractions (making cervical change!) before 37 wks

81
Q

chorioamnionitis aka

A

intraamniotic infection

82
Q

criteria for chorioamnionitis

A

maternal fever plus 1:

  • uterine tenderness
  • maternal or fetal tachycardia
  • malodorous amniotic fluid
  • purulent vaginal discharge
83
Q

tx: chorioamnionitis

A

broad spectrum Abx
deliver (accelerate w/ oxytocin)
antipyretics

84
Q

lactation suppression

A

avoid nipple stimulation
ice packs
NSAIDs
no binding (mastitis) no bromocriptine

85
Q

prenatal care: when do you type and screen

A

initial visit

86
Q

prenatal care: when do you do the 1 hr GTTT

A

24 - 28 wks

87
Q

prenatal care: when do you do HIV/HBsAg/RPR/Chlamydia

A

initial visit

88
Q

prenatal care: when do you get the GBS culture

A

35 - 37 wks

89
Q

prenatal care: when do you get the Ab screen if shes Rh negative

A

24 - 29 wks

90
Q

prenatal care: when do you check her rubella/varicella immunity

A

initial visit

91
Q

prenatal care: when do you do a UA

A

initial visit

92
Q

pregnancy liver d/os

A

intrahepatic cholestasis of pregnancy
HELLP
acute fatty liver of pregnancy

93
Q

3rd TM: itchy papular rash around umbilicus

A

pruritic urticarial papules and plaques of pregnancy

94
Q

pregnancy: general pruritus, worse at night, worse on palms/soles

A

intrahepatic cholestasis of pregnancy

95
Q

definition of preeclampsia

A

new onset HTN (>140/+/- >90) @ > 20wks +/-
proteinuria (> 0.3 g in 24 hr or protein/Cr ratio >0.3 or dipstick >/= 1+)
plt < 100,000
Cr > 1.1 or doubling Cr
LFT 2x ULN
Pulm edema
Cerebral/visual sx

96
Q

McRoberts maneuver complication

A

mom femoral nerve damage

97
Q

where is 0 station

A

midway btwn ischial spines

98
Q

quick loss of fetal station

A

think uterine rupture

99
Q

painless vaginal bleeding upon rupture of membranes

A

think vasa previa

100
Q

contraindications for exercise in preg

A 
amniotic fluid leak
cervical incompetence
multis
placenta abruption/previa
preeclampsia/gest HTN
severe heart/lung dz
also no hot yoga
101
Q

mgmt: eclampsia

A

mg sulfate
anti-HTN (hydralazine, labetalol…)
deliver

102
Q

when do you treat moms for GBS

A

+ test: during labor

unknown and < 37 wks: during labor

103
Q

mgmt: inevitable abortion

A

hemo stable: misoprostol, nothing or D+C

hemo unstable: D+C

104
Q

why can’t you use oxytocin for 1 TM/2 TM abortions

A

there aren’t many oxytocin receptors on uterus yet

105
Q

pregnancy: thyroid changes

A

TG up
thyroxine up –> total thyroid hormone up
free T4 only up a little or none
TSH down (suppressed by hcg and increased T4)

106
Q

tx: hypothyroidism in preg

A

up levo 30% when find out pregnant

adjust q month

107
Q

path: HELLP syndrome

A

abnormal placentation –> systemic inflammation –> activate coags and complement –> platelet consumption and microangio hemolytic anemia –> liver problems

108
Q

tx: HELLP

A

delivery
magnesium (seizure prophylaxis)
anti-HTN

109
Q

when do you do amnioinfusion

A

variable decels from cord compression in labor

110
Q

things that cause up AFP in maternal serum

A

NTDs
abdominal wall defects (omphalocele, gastroschisis)
multiple gestations
rare: congenital nephrosis or obstructive uropathy

111
Q

EMB: complex endometrial hyperplasia

A

think about unopposed estrogen

112
Q

best emergency contraceptive

A

copper IUD

113
Q

which emergency contraceptives can be given > 72 hrs after

A

copper IUD
ulipristal - less effective than IUD
both up to 120 hrs after

114
Q

tx: essential HTN during pregnancy

A

labetalol or methyldopa (1st line)

nifedipine and hydralazine good alternatives

115
Q

mgmt: prego pt on lithium

A

taper lithium

116
Q

tx: recurrent variable decels

A 
maternal repositioning (L lat)
amnioinfusion if doesnt work
117
Q

infertility by age

A

< 35 you get a year to try

> 35, 6 months

118
Q

what does hCG do

A

preserves corpus luteum so that progesterone stays up

119
Q

mgmt: PPROM

A

34 - 37 wks: abx, +/- corticosteroids, delivery

< 34 wks, no fetal compromise: abx, corticosteroids, fetal surveillance

< 34 wks, fetal compromise: abx, corticosteroids, delivery

< 32 wks, fetal compromise: above + Mg

120
Q

time frame: post partum blues

A

2 wks

121
Q

late term vs postterm pregnancies

A

late term: 41 wks

post term: 42+ wks

122
Q

fetal risks a/w late/post term pregnancies

A 
oligohydramnios
meconium aspiration
stillbirth
macrosomia
convulsions
123
Q

maternal risks a/w late/post term pregnancies

A

c-section
infection
postpartum hemorrhage
perineal trauma

124
Q

what to do when you can’t find fetal HR w/ doppler

A

need absence of fetal cardiac activity on abdominal U/S to confirm fetal demise

125
Q

what has to be done after a fetal demise

A

fetal: autopsy; examine placenta/membranes/cord; karyotype/genetics
maternal: Kleihauer-Betke test for fetomaternal hemorrhage; antiphospholipid abs; coag studies

126
Q

c-section: how long after can you give anti-coags if need

A

6 - 12 hrs

127
Q

arrest of active labor

A

no cervical change for > 4 hrs w/ adequate contractions

no cervical change for > 6 w/o adequate contractions

128
Q

tocolytics

A

< 32 wks: indomethacin

32 - 34 wks: nifedipine

129
Q

why do women get hTN post epidural (+ppx)

A

block sympathetic nerves –> vasodilation (give IVF before)

130
Q

fetal malposition vs malpresentation

A

malposition: relation of presenting part to pelvis
malpresentation: presenting part

131
Q

optimal fetal position

A

occiput anterior

132
Q

optimal fetal presentation

A

vertex

133
Q

MCC of arrested 2nd stage

A

fetal malposition

134
Q

possible nerve stuff with preeclampsia with severe features

A

hyperreflexia

135
Q

RFs shoulder dystocia

A

macrosomia
maternal obesity/excess weight gained in pregnancy
GDM
post-term

136
Q

Hep C preggo

A

give hep A/B vaccines if hasn’t had them
don’t treat (teratogens)
breastfeeding is fine
c-section won’t help

137
Q

RFs for vertical hep C transmission

A

HIV co-infection

high viral load

138
Q

oxytocin toxicity

A

similar to ADH –> hNa, hTN, tachysystole

hNa –> HA, n/v, seizures

139
Q

amphetamines in pregnancy risks

A

FGR, fetal demise
preterm labor
placental abruption
preeclampsia

140
Q

GDM sugar goals

A

fasting < 95
1 hr postprandial < 140
2 hr postprandial < 120

141
Q

mgmt: shoulder dystocia

A

BE CALM

  1. Breathe, don’t push
  2. Elevate hips against abdomen (McRoberts)
  3. Call for help
  4. Apply suprpubic pressure
  5. enLarge vaginal opening (episiotomy)
  6. Maneuvers
142
Q

shoulder dystocia maneuvers

A

deliver posterior arm
rotate 180 (Wood’s corkscrew)
collapse ant shoulder (Rubin)
replace fetal head for c-section (Zavanelli)

143
Q

wtf is pseudocyesis

A

psych pregnancy
pregnancy sx, thinks test is +
usually following loss or infertility

144
Q

contraindications to amnioinfusion

A

hx of uterine surgery

145
Q

birth plan with hx of vertical c section or open myomectomy

A

planned c section @ 36 - 37 wks

laparotomy + hysterotomy if labor earlier

Ob/Gyn Dreams (2 decks)

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