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Obstetrics Flashcards

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1
Q

Gestational age (GA)

A

From day of last menstrual petiod

  • Fundal height: umbil-20wks +2-3cm/wk
  • Fetal heart tones: 10-12wks
  • Appreciat fetal mvt: 17-18wks
  • US: CRL 6-12wks; BPD/FL/AC 13wks; measur of GA most reliable in 1st trim
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2
Q

Diagnosis of pregnancy

A

Beta-hCG: by placenta; peak at 100K by 10wksGA
↓2nd trim
Double every 48h in early pgncy; ectopic if abNl doubling

US: confirm intraUt pgncy
Gestational sac on transvag US, by 5wksGA + B-hCG 1000-1500

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3
Q

Normal physiology of pregnancy

A

↑ then ↓: renal flow
↓ then ↑: BP
↑ then plateaus: GFR, SV, TV
↑: weight, HR, CO, periph venal distens*, bld volume, fibrinogen, gastric emptying time
↓: periph vasc resist, expirat reserve, Ht, sphincter tone
Unchanged: RR, vital capac, e-

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4
Q

Prenatal care (weight, nutrition, exercise)

A

-Weight gain: 1-1.5kg/mo
-Prepgncy BMI: 19.8-26 w/ gain of 11-16kg
-Nutrition: add 100-300kcal/d; add 500/day if breastfd
Folic ac 0.4mg/d; Iron 30mg/d; Calcium 1000mg/d; VitD 400IU/d; VitB12 2ug/d
-Exercise: moderate 30min/d

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5
Q

Prenatal diagnostic testing

A

Wks 0-28: /4wks
Wks 29-35: /2wks
Wks 36-birth: /1wk

CBC, ABO, Rh, UA+Cx, rubella, HBV, syphilis, gono/chlam, TB, HIV, Pap smear, HCV, varicella, …

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6
Q

Quad screening

A

MSAFP, estriol, B-hCG, inhibin A

MSAFP >2.5xNl ass w/ neural tub def, abdo wall def, multi gestat*, incorrect date, fetal death, placent abNl

MSAFP <0.5xNl ass w/ trisomy 21/18, fetal demise, incorrect date

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7
Q

Pregnancy-associated plasma protein A

A

Recomm at 9-14wks
PAPP-A + nuchal transp + free B-hCG detect trisomy 21/18

  • Screen of pgnt women (>35yo)
  • Available before CVS + less invasive
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8
Q

Chorionic villus sampling vs Amniocentesis

A

CVS: 10-12wks; transcerv/transabdo apirat of placental T.; genetic dg; earlier GA; ↑R fetal loss; limb defect if <9wks

Amniocentesis: 15-20wks; transabdo aspirat of amniot fluid; genetic dg; PROM; chorioamnionitis; fetal-maternal hge

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9
Q

Cell-free fetal DNA

A

10wks
Fetal DNA from bld of mother
Noninvasive
Limited bcz low concentration of DNA in mom

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10
Q

Amniocentesis (indications)

A

In women >35yo
If abNl quad screen
In Rh-sensitized pgncy
Eval fetal lung maturity (L/S ≥2.5)

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11
Q

Toxoplasmosis congenital infection

A 
Transplacental
Hydroceph, intracran calcif, chorioret, ring les* (MRI)
Dg: serology
ttt: pyrimethamine + sulfadiazine
Prophyl: spiramycin in 3rd trim
Prev: avoid cat feces
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12
Q

Rubella congenital infection

A

Transplacental (1st trim)
Blueb muff rash, cataract, mental retard, hear loss, PDA
Dg: serology
ttt: sympt
Prevent: immunize before pgncy; vaccin mom if ⊖ serol

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13
Q

CMV congenital infection

A 
Transplacental
Petechial rash, periventric calcif
Dg: urin Cx, PCR of amniot fluid
Postpartum ganciclovir
No prevention
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14
Q

HSV congenital infection

A 
Intrapartum if active les*
Skin, eye, mouth; life-treat CNS/systemic
Dg: serology
ttt: acyclovir
Prevent: C-section if active les*
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15
Q

HIV congenital infection

A

In utero, at delivery, via breast milk
Often asympt; failure to thrive; bact inf; up/low resp ds
Dg: ELISA, Western blot
ttt: HAART (mom); prophyl AZT (baby)
Prevent: AZT or nevirapine in pgnt W; C-section if viral >1000; No breastfeed

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16
Q

Syphilis congenital infection

A 
Intrapartum, transplacental
Maculopap rash, LNpathy, HMG, snuffles, osteitis, late congen (saber shins, saddle nose, CNS, Hutchinson teeth, deafness)
Dg: dark-field, VDRL/RPR, FTA-ABS
ttt: penicillin
Prevent: penicillin if pgnt W is ⊕
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17
Q

Spontaneous abortion (RF)

A

<20wks; esp 1st trim
-Chrom abNl: 1st/2nd/3rd trim
-Maternal fact: inherited thrombophilias, immuno, anatomic, endocrino, other (trauma/↑age/inf/diet)
-Environm: tobacco, alcoh, caffeine, toxin, drug, radiat*
-Fetal fact: anatom malfo
-Recurr SAB: ≥2 consecut or 3SAB/1y; for cause, karyotype parents, hypercoag labs mom, uterin anatom
(<12wks esp chrom abNl) (12-20wks esp hypercoag)

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18
Q

Spontaneous abortion (types)

A 
Complete
Threatened
Incomplete
Inevitable
Missed
Septic
Intrauterine fetal demise
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19
Q

Spontaneous abortion (dg, ttt)

A

Nonviable pgncy: gestat sac >25mm w/o fetal pole of card activ
Clinic, speculum, US, serum B-hCG
US
Give RhoGAM if mom Rh⊖

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20
Q

Elective termination of pregnancy

A

Depend on GA and ptt
-First (90%): medical mngmt (mifepristone, misoprostol, methotrexate) up to 59d; surgical mngmt (MUA, D&C) up to 13wks

-Second (10%): obstetric mngmt (induct* labor w/ prostagl, oxytocin); surgical mngmt (D&E) up to 13-24wks

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21
Q

Normal obstetric examination

A

Leopold maneuvers: fetal lie + presentation

Cervical exam: dilat*, effacem, consist, station of fetal head relative to ischial spines, …
Sterile speculum exam if ROM suspected

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22
Q

Stages of labor

A

1st latent: 3-4cm dilation, 6-11h (primip), 4-8h (multip), prolong w/ excess sedation
1st active: 4-10cm dilation, 4-6h (primip), 2-3h (multip), prolong w/ cephalopelvic disprop

2nd: 10cm to deliv of NN, 0.5-3h (primip), 5-30min (multip), NN through all cardinal mvts
3rd: deliv of NN to deliv placenta, 0-30min (primip/multip), uterus contr + hemostasis

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23
Q

Recommendations for fetal heart rate monitoring

A

Electrode to fetal scalp or external monit Doppler US

  • Ptts w/o complic: 1st stage /30min; 2nd stage /15min
  • Ptts w/ complic: 1st stage /15min; 2nd stage /5min
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24
Q

Components of fetal heart rate evaluation

A

Rate (110-160bpm):

  • Brady (<110): congen heart malfo, severe hypox
  • Tachy (>160): hypox, mom fever, fetal anemia

Variability (6-25bpm):
-Absent (sev fet distress); minimal (<6; fet hypox, sleep, opioid); marked (>25; fel hypox, before ↓variab); sinusoidal (serious fet anem)

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25
Q

FHR: accelerations vs decelerations

A

Accelerations (↑>15 beats abov baseline in <30sec): reassuring

Decelerations:

  • Early (gradual ↓FHR to nadir in >30sec, then baseline): head compress by Ut contrac (Nl)
  • Late (gradual ↓FHR to nadir in >30sec, then baseline): begins after end of Ut contrac, uteroplac insuff + fet hypoxemia
  • Variable (abrupt ↓FHR 15 below baseline for ≥15sec + <2min, to nadir in <30sec): umbil cord compress
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26
Q

Antepartum fetal surveillance

A 
In pgncy w/ ↑R of antepart fet demise
Tests at 32-34wks
-Fetal mvt assessment
-Nonstress test
-Contraction stress test
-Biophysical profile
-Amniotic fluid index
-Modified biophysical profile
-Umbilical artery Doppler velocimetry
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27
Q

Obstetric analgesia and anesthesia

A
  • Visceral pain (T10-L1): ut contrac + cerv dilat*
  • Somatic pain (pudend N, S2-S4): press on vagina+perineum

Absolute CI to regional anesthesia: maternal: refract hypoTN, coagulop, LMWH in 12h, unttt bacteremia, ↑ICP

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28
Q

Hyperemesis gravidarum (PE)

A 
Persist vomit (#morning sickn that is wks 4-16)
Acute starvat*; ↓weight (≥5% of preprgncy)

Esp first pgncy, multiple gest, molar pgncy
↑B-hCG, ↑estradiol

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29
Q

Hyperemesis gravidarum (dg, ttt)

A

Dg: B-hCG; US; R/o molar pgncy
Ketones, Na, K, metab alkal, liv enz, bili, amyl/lipa

ttt: VitB6, doxylamine, promethazine/dimenhydrinate
If sev: metoclopra, ondenset, prochlorpera, promethaz
If dehydr: IV fluids, nutrit supplem, dimenhydrinate

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30
Q

Diabetes in pregnancy

A

-Gestational DM: during pgncy
>50% dev glu intol +/- DM2 later in life; always screen

-Pregestational: before pgncy
If RF for DM, screen w/ HbA1c or fasting glu

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31
Q

Gestational diabetes mellitus (PE, dg)

A

Usual dg 24-28wks
Asympt; may have edema, polyhydram, large infant (>90th percentile)

Dg: 1-h 50g glu chall test at 24-28wks (abNl if ≥140)
Confirm w/ 3-h 100g glu toler test (3h >140)

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32
Q

Gestational diabetes mellitus (ttt)

A

ADA diet, regular exo, strict glu monito (4/d)
Tight glu control
Insulin if diet insuff (+ intrapartum insulin+dextrose)

Periodic US + NST (fetal growth/health)
If poor glyc control, induce labor 39-40wks

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33
Q

Pregestational diabetes

A

Poorly controlled DM: ↑R congen malfo, fetal loss, mater/fet morbi

ttt mom: assess end-org damage + strict glu control (fastin ≤95 and 2-h postprand <120)
ttt fetus: 16-24wks (quad screen, US); 32-34wks (NST, CST, BPP, US); deliv-postpart (IV insulin and glu/h in labor, early deliv if RF, C-sect* if >4500g, breastfeed)

34
Q

Maternal complications of pregestational DM

A 
DKA or hyperosm nonketotic coma
Preeclampsia or eclampsia
C-section
Preterm labor
Infection
Polyhydramnios
Postpartum hge
Maternal mortality
35
Q

Fetal complications of pregestational DM

A 
Macrosomia or IUGR
Cardiac and renal defects
Neural tube defects
Hypocalcemia
Polycythemia
Hyperbilirubinemia
Hypoglycemia from hyperinsulinemia
RDS
Birth injury
Perinatal mortality
36
Q

Gestational and chronic hypertension

A
  • Gestat HTN: at >20wks; proteinuria (<300); 25% dev preeclamp
  • Chronic HTN: at <20wks and before concept*; till >12wks postpart; 33% dev preeclamp

ttt: close monitor BP
Antihypertens (methyldopa, labetalol, nifedipine)
!!! No ACEIs or diuretics

37
Q

Preeclampsia and eclampsia

A
  • Preeclam: new HTN (SBP≥140 or DBP≥90) + proteinuria (>300/d) at >20wks
  • Eclam: new grand mal seiz + preeclam

-HELLP sd: Hemolyt anem, ↑LFTs, ↓plts
Vasospasm → hge + org necros; poor pg

38
Q

Preeclampsia and eclampsia (PE, complications)

A
  • Mild: asymp; edema
  • Severe: BP>160/110; proteinuria (>5g/d) or oliguria; headac, somnol, blurred vis*, scotom, RUQ pain, HELLP
  • Eclampsia: same as severe preeclam + seiz

Compl: prematur, fet distress, stillbirth, plac abrupt, seiz, DIC, cereb hge, retin detach, hypox enceph, thromboemb, fet/mat death

39
Q

Preeclampsia and eclampsia (ttt)

A

Only cure: delivery

  • Preecla: near term (induct*); far term (bed rest); labetal/hydral; continuous MgSulfate; seiz prophyl
  • Sev preecla: same + induct* or C-section

-Eclam: !ABC; Mg; IV diazepam (if seiz); monito baby; contr BP; limit fluids+Foley; delivery if no seiz
!Seiz: antep/intrap/postpart till 48h

40
Q

UTI and pyelonephritis during pregnancy

A

Asympt bacteriuria then UTI/pyelon if unttt
Persist unttt, ↑R for preterm labor, low birth weight, perinatal mortality

Dg: ⊕Cx (esp E coli)
ttt: asympt (3-7d nitrofur, cephalexin, amoxiclav)
Follow Cx at 1wk
Pyelon: admit, IV fluids, IV C3G, AB for rest of pgncy

41
Q

Antepartum hemorrhage

A

Bleeding at >20wks
Esp placental abrupt* and placenta previa
Other: placenta accreta, ruptured uterus, genit tract les, trauma
!cervical cancer, cerv/vagin les, fetal bleeding

42
Q

Placental abruption (RF, PE, dg, comlications)

A

Premature separat* of placenta
RF: HTN, trauma, tobacco/cocaine, previous abr, …
Painful dark bleed, uter hypertonicity, fetal distress

Dg: clinic, TA/TV US (retroplac clot; r/o previa)
Compl: hgic shock; DIC; recurr; fetal hypoxia

43
Q

Placental abruption (ttt)

A

Mild: stabilize ptt w/ hospit, IV, fetal monito, bed rest

Mod-sev: immed delivery (vag if mom/baby stable; C-section if 1 in distress)

44
Q

Placenta previa (RF, PE)

A

AbNl implantat*: total (covers os); marginal (margin of os); low lying (close to os)
RF: prior C-sec; multipar; adv age; multip gest; prior previa

Painless bright red bleed, stops in 1-2h; +/- contract*
No fetal distress

45
Q

Placenta previa (dg, complications, ttt)

A

Dg: TA/TV US (abNl posit*)
Compl: ↑R placenta accreta; vasa previa; preterm; PROM; IUGR; congen anomal; recurr

ttt: NO vag exam; stabilize ptt; tocolytics; serial US; betamethasone (28-32wks, lung matur)
C-sect*: if labor, life-threat bld, fet distress, ⊕lung matur, 36wks GA

46
Q

Vasa previa (RF, PE, dg)

A

Velamentous umb cord insert* +/or bilobed placenta
RF: multi gest, IVF, 1 umb artery, plac previa, low-lying plac

Painless bleed at rupture of membranes + fet bradycard
Dg: TV US w/ Doppler

47
Q

Vasa previa (complications, ttt)

A

Compl: fetal exsanguinat*

ttt: acute bld = emerg C-sect*
If dg before bld: steroids at 28-32wks, hospit 30-32wks, close monito + C-sect* at 35wks

48
Q

Ectopic pregnancy (PE, #dg)

A

dg: abort, ov tors, PID, ruptured ov cyst

Esp tubal
Abdo pain + vag bleed; or asympt
Ass w/ causes of scarring (Hx of PID, pelv surg, DES, endometriosis)

49
Q

Ectopic pregnancy (dg, complications, ttt)

A

Dg: W of reprod-age + abdo pain = ruptured ectop pgncy until proven otherwise
⊕pgncy test, TV US (empty ut), serial B-hCG w/o doubling

Complic: tubal rupture, hemoperitoneum
ttt: methotrexate (if small + unruptured); surg is rupt or unstable (salpingectomy/salpingostomy w/ evacuat*)

50
Q

Intrauterine growth restriction (RF, dg, complications)

A

EFW < 10th percentile for GA
RF: mat system ds w/ uteroplac insuff (An, HTN, ut inf); mat subst abuse; plac previa; multi gest

Dg: US (serial fundal height measur + EFW)
Compl: ↑perinatal morbi/morta

51
Q

Intrauterine growth restriction (ttt)

A

Underl cause
If near term, give steroids (48h before delivery)
Fetal monito w/ NST, CST, BPP, umbil art Doppler

52
Q

Fetal macrosomia

A

Birth weight > 95th percentile
Sequela of gest diabetes
Prenatal dg imprecise
Compl: ↑R should dystocia (brach plex injury + Erb-Duchenne palsy)

ttt: C-sect* if >5000g + no DM or if >4500g + DM

53
Q

Polyhydramnios

A

AFI ≥25; asympt
Nl pgncy; fetal chromosom dev abNl
Causes: mat DM; multi gestat*; isoimmuniz; pulm abNl; fet anomalies; tw-twin transfu sd

Dg: fundal height > expect; US (fet anom); gluc; Rh
ttt: underl cause
Compl: preterm labor; fet malpresent; cord prolapse

54
Q

Oligohydramnios

A

AFI <5; asympt or IUGR/fet distress
Causes: fet urin tract abNl; chron uteroplac insuff; ROM
Dg: US

ttt: r/o inaccur gest date; ttt underl cause
Compl: ass w/ ↑x40 perinat morta; MSK abNl; pulm hypopl; umbil cord compress*; IUGR

55
Q

Rhesus isoimmunization (RF, dg, ttt)

A

Fetal RBCs leak to mat bld (Rh⊖) → mat form anti-Rh IgG → Ab cross plac + fet hemolysis (2nd pgncy)
↑R w/ prev SAB or TAB or delivery w/o RhoGAM

Dg: monito sensitized Rh⊖ moms w/ serial US + amniocent
ttt: sev (preterm deliv when lungs mature) +/- intraut bld transfu (if low fet Ht)

56
Q

Rhesus isoimmunization (prevention, complications)

A

Prev: if mom Rh⊖ + dad ⊕/unk, give RhoGAM
If bb ⊕, give mom RhoGAM
If mom ⊖ and abort, Hx ectop pgncy, amniocent, vag bld, plac prev/abrup → type + screen + prev pgncy for 1y

Compl: hydrops fetalis if bb Hb <7; fet hypox + acidosis, kernict, prematur, death

57
Q

Gestational trophoblastic disease (benign vs malignant)

A

-Benign: complete (sperm+empty ov; 46XX; no fet tiss) or incomplete (Nl ov+2 sperm; 69XXY; fet tiss) molar pgncy

-Malign: molar pgncy progr to invasive mole or choriocarcinoma
W/ complic: pulm or CNS meta, trophobl pulm emboli

58
Q

Gestational trophoblastic disease (PE, dg)

A

1st trim ut bleed; hyperem gravid; preecl/ecl <24wks; ↑ut size
RF: <20 or >40yo; def folate or B-carotene

Dg: no heartbeat; large ovaries; grapelike molar in vagina
↑↑B-hCG (>100K); US (snowstorm, no gest sac/fetus); CXR (lung meta)

59
Q

Gestational trophoblastic disease (ttt)

A

Evacuate uterus + follow B-hCG/week
Malign: methotrexate or dactinomycin (chemoth)
Residual: hysterectomy
Meta: chemoth + irradiation

60
Q

Multiple gestations

A

Monozy (ident) or dizygot (fratern)
Rapid ut growth; excess ↑weight; palpat* of ≥3 large fet parts

Dg: US; B-hCG; human plac lactogen; MSAFP (all ↑)
ttt: surveill for IUGR
Compl: hospit ↑x6; ↑R plac prev + C-sect*; tw-twin transfu sd; IUGR; preterm; ↑R congen malfo

61
Q

Shoulder dystocia

A

RF: obes, DM, macrosomic bb, Hx of prior dystocia
Dg: prolong 2nd stage of labor, recoil of perineum, No spontan restitut*

ttt: HELPER (Help reposit, Episiotomy, Leg elevat, Pressure suprapub, Enter vagina+rotation, Reach fetal arm

62
Q

Failure to progess with labor/delivery (dg, complications)

A

Ass w/ chorioamnionitis, occiput post posit*, nullipar, ↑birth weight

  • 1st stage: fail adequate progr cervic chang
  • 2nd stage: arrest fetal descent

Compl: chorioamnionitis, fet inf, permanent injury, postpart hge, lacerat*

63
Q

Failure to progess with labor/delivery (ttt)

A
  • 1st stage: latent (parenteral analgesia, oxytocin, amniotomy, cervical ripening); active (amniotomy, oxytocin, C-sect*)
  • 2nd stage: observ w/ ↓epidural rate and oxytocin; assisted vagin deliv (forceps/vacuum); C-sect*
64
Q

Rupture of membranes (4 types)

A
  • Spontan: after or at onset of labor
  • Premat: >1h before onset of labor
  • Preterm premat: <37wks gest
  • Prolong: >18h before deliv
65
Q

Rupture of membranes (dg, ttt, complications)

A

Dg: sterile spec exam; nitrazine paper test (blue); fern test; US
No digit vag exam (if no plan for labor)
Monito fetal HR, mat T*C, WBCs, ut tendern

ttt: dep on GA+lung matur (rest or induct)
AB (prophyl or ttt); CS (betameth or dexameth x48h
Compl: perterm, chorioamnionitis, plac abrupt, cord prolapse

66
Q

Preterm labor (RF, PE)

A 
Labor betw/ 20-37wks gestat*
#1 cause of neonat morbi/morta

RF: multi gest; inf; PROM; ut anomalies; prev preterm; polyhydram; plac abrupt; poor mat nutrit*; low SES
PE: cramps, low back pain, pelv press, new vag disch/bld

67
Q

Preterm labor (dg)

A

Dg: regular ut contrac (≥3 each 30sec over 30min) AND concurr cerv chang at <37wks

  • CI tocolysis: inf, nonreassu fet test, plac abrupt
  • Sterile spec: r/o PROM
  • US: r/o anomalies, verigy GA, fet present, fluid volume
  • Cx chlam/gororr/GBS; UA, ur Cx
68
Q

Preterm labor (ttt, complications)

A

ttt: hydrat* + bed rest; tocolyt unless CI; steroids; GBS prophyl (peni/ampic)

Compl: RDS; intravent hge; PDA; necrot enterocolitis; retinopathy; bronchopulm dyspl; death

69
Q

Fetal malpresentation

A

Other than vertex
RF: premat; prior breech deliv; ut anomal; poly/oligohydr; multi gest; PPROM; hydroceph; anenceph; plac previa

Esp breech (LE/butt)
ttt: 75% chang by wk38; external vers*; C-sect*
70
Q

Indications for cesarean section

A
  • Mat fact: prior C-sec; activ gen herpes; cerv carcinoma; mat trauma; HIV
  • Fet + mat fact: cephalopelvic disprop; plac previa/abrupt; failed vag deliv; postterm pgncy
  • Fet fact: malposit*; distress; cord compr/prolap; erythroblastosis fetalis (Rh incomp)
71
Q

Episiotomy

A

Median or mediolateral

Compl: extens* to anal sphinct or rectum; bleed; inf; dyspareunia; rectovag fistula; mat death

72
Q

Postpartum hemorrhage (complications, ttt)

A

> 500mL for vag deliv or >1000mL for C-sect*
Before, during, after deliv of placenta

Compl: acute bld loss (fatal); chronic loss (anemia, ↑R inf); Sheehan sd
ttt: if severe, uter art emboliz

73
Q

Uterine atony

A

RF: ut overdist (multi gest, macrosom, polyhydr); exhausted myomet (prolong labor, oxytocin); ut inf; condit* interfer w/ contrac (anesth, myoma, MgSO4)

Dg: soft enlarg boggy ut; #1 cause of postpart hge
ttt: biman ut massage; oxytocin; methergine if no HTN; PGF2a

74
Q

Genital tract trauma

A

RF: precipit labor; operat vag deliv; large bb; inadeq episiot repair
Dg: manual/visual inspect* of lacerat* >2cm; postpart hge

ttt: surg repair

75
Q

Retained placental tissue

A

RF: plac accr/incr/percreta/previa; ut leiomyoma; preterm deliv; previous C-sec/curett
Dg: manual/visual inspect* of cotyled; US

ttt: manual removal; curettage w/ suct*

76
Q

Postpartum infections (PE, RF)

A

≥38*C for ≥2 of the first 10 days postpart (w/o first 24h)
Ut tendern, malodor lochia

RF for endometritis: emerg C-sec; PROM; prolong labor; multi intrapart vag exams; intraut manip; deliv; low SES; young W; prolong rupt membr; bact coloniz; CS

77
Q

Postpartum infections (ttt, complications)

A

ttt: broad AB IV (clinda/genta) until afeb x48h; add ampi if complic

Compl: septic pelvic thrombophlebitis (abdo/back pain; fev up to 41*C; bld Cx; CT (absc); ttt w/ broad AB and anticoag heparin x7-10d)

78
Q

Sheehan syndrome (postpartum pituitary necrosis)

A

Massive obstet hge/shock → pituit ischem + necros → ant pit insuff (#1 in adult W)
PE: esp failure to lactate (↓ prolact); other sympt

Dg: provocative hormo test, MRI of hypoth/pitui (r/o other cause)
ttt: replac all def hormo

79
Q

7 W’s of postpartum fever (10 days)

A 
Womb (endometritis)
Wind (atelectasis, pneumonia)
Water (UTI)
Walk (DVT, PE)
Wound (incision, episiotomy)
Weaning (breast engorgement, abscess, mastitis)
Wonder drugs (drug fever)
80
Q

Lactation and breastfeeding

A

In pgncy: ↑estro+progest → brst hypertrop + inhib prolact
After deliv: ↓hormo, prolac stimul alveol epith cells (↑milk)
Periodic suckling: ↑prolact/oxytocin → milk eject*
Colostrum: prot, fat, secret IgA, minerals
In 1wk: mature milk w/ prot, fat, lactose, water

81
Q

Lactation and breastfeeding (benefits, CI)

A

↓ incid of allergies
↓ incid of early URIs and GI inf
Facilit mom-bb bonding
Maternal weight loss

CI: HIV; active HBV and HCV; medic (tetracyc, chloramph)

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