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OBGYN EOR > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

pts OBGYN hx is written how

A

G# Ptpal

term
premature
abortions (before 20 wks)
living

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2
Q

how often do you check pregnant moms

A

q 4 weeks undtil 32 weeks
then 2 weeks
then 36 q week

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3
Q

what dx should be done at every check

A

UA for glucosuria, ketonuria and proteinuria

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4
Q

when should you start doing vaginal exams in OB

A

at 36 weeks

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5
Q

when would you check fundal height and when FHR

A

20 wks and 10 wks

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6
Q

fetal HR should be

A

120-160

can measure from 9-12 weeks onward

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7
Q

common complaints of pregnancy inculde

A

bleeding gums
prfuse salivation
fatigue

also
variscosities
heartburn
hemorrhoids

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8
Q

first trimester screening includes

A

PAPPA and free BHCG

ULS for establishing and confirming EDC

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9
Q

What findings in a first trimester screen would indicate potential genetic disorder

A

low PAPPA and high free HCG

would suggest trisomy 21

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10
Q

dark patched on face associated with pregnancy are known as

A

malasma or cholasma

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11
Q

when can you do NT

A

10-13 weeks

screens for trisomies 13,18, adn 21 as well as for Turner

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12
Q

if positive NT then

A

amnio or CVS

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13
Q

what is the likelihood of detecting trisomy 21 with early screenign

A

NT plus PAPPA and B hcg can detect 82-87%

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14
Q

first prenatal visit need to order

A

HIV offered cystic fibrosis, sickle cell
coomb’s for irregualr aB screen

UA BRATS PAP
hep B
rubella
a CBC 
type and screen 
 syphilis

if that brat is dirty get a Chlamydia and Gonorrhea

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15
Q

in the first trimester you can do these tests

A 
PAPPA
Free beta HCG
ULS
NT
CVS
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16
Q

when exactly can you do a CVS

A

10-13

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17
Q

what tests can you do in second trimester

A 
unconjigated estriol
maternal serum AFP
inhibin A 
ULS
Amnio
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18
Q

Endometritis classically occurs ___ and is characterized by

A

2-3 days post-partum and is characterized by fever, foul-smelling lochia, abdominal and pelvic pain, abnormal vaginal bleeding, uterine tenderness and leukocytosis.

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19
Q

management of suspected endometritis

A

This is an acute bacterial infection of the endometrium commonly caused by Group B strep, S. aureus, E. coli and E. faecalis. The patient should have an ultrasound to rule out retained products of conception. She should be started on intravenous broad-spectrum antibiotics and admitted to the hospital.

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20
Q

risk factors for endometritis include

A

1 is a c section

PRIM>24 hours
stage 2 of labor >12 hours
increase in internal exams

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21
Q

when can you do a amnio

A

15-18 weeks

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22
Q

what tests can you do in the thrid trimester

A

DM gestation 24-28

In unsensitized Rh repeat Ab titers at 28 weeks

GBS 35

Hgb and Hct 35 weeks

NST

BPP

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23
Q

When do you get the results form a CVS

A

48 hours after

can not detec NT defects through AFP

risk of spontainious abortion is the same as amnio when adjusted for earlier gestational age

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24
Q

trisomy 21 would yield these results in 2nd trimester screen

A

low unconjugated ertiol
AFP LOW

inhibin A high

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25
Q

NT defects would yield these resutls in second trimester screen

A

abnormally high AFP

spina bifida and ancephaly

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26
Q

Combining first trimester screen with second trimester screen gets you this % of accuracy for trisomy 21

A

94-96%

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27
Q

indication for amnio or CVS in clude

A

> 35
previous child with abnormality
family history of chromosomal abnormality
NT defect risk (Amnio only)
abnormal first trimester or second trimester serum screening
two previous pregnancy losses
abnormal uLS

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28
Q

What is a normal NST

A

acceleration ins 20 minutes of 15 bpm from baseline heart rate for a duration of 25 seconds and the absence of decelerations

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29
Q

what is the definition of a deceleration

A

decline in fetal heart rate of 15 bpm or lasting more than 15 second or a slow return to baseline

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30
Q

persistent late deceleration

A

begin AFTER the peak of the contraction are NONreassuring and warrant intervention

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31
Q

permateres of BPP

A 
gross movement 
breathing 
fetal tone 
amniotic fluid level 
NST

B- TANG

each parameter contains 2 points with a total of ten and the risk of asphyxia

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32
Q

teenage preganncies have a higher risk of

A

premature delivery and low fetal birth weight (poor nutritional intake)

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33
Q

the most common MATERNAL complication of multiple gestation are

A

spontaneous abortion and preterm birth

other problems that occur with greater frequency are preeclampsia and anemia

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34
Q

the most common fetal complications of mutliple gestations are

A 
IUGR
cor accidents
death of own twin
congenital anomalies
abnormal or breech presentation
placental abruption or placental previa
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35
Q

the most common cause of ectopic pregnancy is

A

occlusion of the tube secondary to adhesions

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36
Q

most common risk factors for ectopic pregnancy are

A 
previous
PID
previous abd surgery 
use of IUD 
assisted reproduction
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37
Q

most common signs and symptoms of ectopic in order

A 
pain
abnormal menstruation
tachycardia
hypotension
pelvic mass
dizziness or syncrope 
shock
GI symptoms
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38
Q

Sxs of ruptured ectopic

A

abdominal or shoulder pain associated with peritonitis
tachycardia
syncope
orthostatic hypotension

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39
Q

hcg in exctopic

A

less than expected

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40
Q

diagnoses for ectopic

A

transvaginal ULS dx in 90% of cases

should have IUP ive >1500 hcg

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41
Q

Treatment for ectopic

A

folic acid analog like methotrexate can be used for treatment in 80% of cases

critera

<3.5 cm
bhcg<5000
thrombocytes > 100,000
hemodynamically stable 
no blood disorders
no pulmonary damage
no peptic ulcer disease 
normal renal function 
normal hepatic function
compliant patient and able to return for follow up
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42
Q

surgical treatment for ectopic

A

involves laparoscopy

laprotomy is reserved for pts with known abdominal adhesions or those that are clinically unstable

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43
Q

factors that increase risk of abortion include

A 
smoking
infection
maternal systemic disease
immunological parameters 
drug use
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44
Q

diagnsotic studies for spontaious abortion

A

serial HCG
serum progesterone
serial ultrasonohrapy

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45
Q

high blood pressure during the first 20 weeks of pregancny could be a sign of

A

mole

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46
Q

dilation and curratage procedure morbidity

A

uterine perforation or cervical laceration

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47
Q

grape like or snow storm refers to complete or incomplete mole

A

complete 20% progress to malignancy .

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48
Q

what is a partial hydratiform

A

fetus present
non viable
rarely progress to malignancy

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49
Q

when would beata hcg indicate a gestational trophoblastic tumor

A

> 100,000

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50
Q

treatment of hydratiform mole

A

benign tumors can be treated with chemo
metastatic or high risk tumors can be treated with chemo and radiation and surgery

after evacuation must monito hcg and use contraception for 6 mo to a year

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51
Q

treatment for mole

A

if don’t desire fertility hysterectomy

if do than curretage

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52
Q

what percentage of pts with gestational diabetes go on to develop DM

A

50% of those that need insulin therapy will develop DM within five years

reoccurrence of GDM is common in 60-90 % of subsequent pregnancies

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53
Q

what are MATERNAL complications are associated with GDM

A

preeclampsia
hyperacceleration of general diabetic complications
traumatic birth
should dystocia

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54
Q

what are the fetal complications of GDM

A

marcosomia
prematurity
fetal demise
delayed fetal lung maturity

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55
Q

clincial features of GDM

A

patients are usually asymptomatic

RF include 
previous GDM
large for gestation infant 
obestiy
age older than 25
family hx of DM
AA
Asian
Hispanic
American indian
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56
Q

diagnostic studies for GDM

A

obtain random glucose on all pregnant women during the first week of pregnancy to check for preexisting DM
then 24-28 do glucose screening

A1c is NOT recommended for screening

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57
Q

screening for GDM

A

24-28 weeks administer 50 g of glucose challenege test followed by serum glucose level 1 hour later

if the 1 hour serum glucose value is >130 THEN NEED 3 HOUR

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58
Q

What is the 3 hour glucose test

A

if 1 hour is over 130 need it

give 100 g glucose load in the morning after an overnight fast serum glucose levels are taken at fasting and then 1, 2, and 3 hours after the glucose load

fasting /<95
1 hour<180
2 hour<155
4 hour <140

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59
Q

what is the management of GDM

A

careful management of diet and exercise

need to check blood sugars daily after fasting overnight and after each meal
need to review fbg

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60
Q

When would a mom with GDM require insulin

A

FBG >105 or

2 hour PP> 120

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61
Q

when should you screen women for post partum diabetes if they have GDM

A

at 6 weeks postpartum visit and at yearly intervals after

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62
Q

labor management of pt with GDM

A

if glucose is in control and no signs of macrosomia then induction at 40 weeks

if glucose is poorly controlled and there are signs of macrosomia then induction will occur at 38 weeks gestation

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63
Q

to helo avoid GDM moms can

A

mainatin ideal body weight

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64
Q

preterm labor and delivery is defined as

A

infant before 37 weeks

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65
Q

MCC of neonatal deaths is

A

preterm

those that do survive have significant developmental delays
cerebral palsy
and lung disease

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66
Q

RF for preterm labor

A 
smoking
cocaine 
uterine malformations
cervical incompetence 
infection (vaginal group B strep or urinary infection)
and low prepregnancy weight
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67
Q

clincial features of preterm labor include

A

> 4 uterine contractions between 20-36 weeks of gestation and the presence of one or more of the following

cervical dilation >2cm at presentation
cervical dilation of 1 cm or greater on serial examinations cervical effacement at 80%

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68
Q

late symptoms of preterm labor

A 
painless contractions
pressure
menstrual like cramps
watery or bloody discharge 
low back pain
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69
Q

diagnsotic studies for preterm labor

A

ultrasonography can be used to exam the lenght of the cervix
normal length is 4 cm

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70
Q

what cervical length increases the risk of a premature delivery

A

2cm or less at 24 weeks

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71
Q

how do you evaluate cervicovaginal secretions for possible premature delivery

A

fetal fibronectin
(glycoprotein)

absence means low risk of dilvery in the next 2 weeks

72
Q

management of premature delivery

A

IV
anbx for subclincal infection
steroids for fetal lung maturity
tocolytics if indicated

73
Q

what tocolytics are used

A

Mag sulfate inhibits myometrial contractions mediated by Ca

74
Q

side effects of CCB as tocolytics

A

maternal hypotension and tachycardia

75
Q

why are beta mimetic adrenergic agents infrequently used and what are they

A

beta mimetic adrenergic agents are used as tocolytics they include
terbutaline

they are infrequently used because of the potentially ftal maternal heart complications

76
Q

How do CCB work as tocolytics

A

they inhibit smooth muscle contraction by decreasing calcium ions intracellularly

—> relaxes uterine muscle

77
Q

side effects of CCB as tocolytics

A

maternal hypotension and tachycardia

78
Q

prevention of preterm labor

A

for those women with a history of preterm delivery weekly injections of 17 alpha hydroxyprogesterone from 16-36weeks gestation can sometimes reduce the rate of reoccurrent preterm birth

79
Q

PROM

A

rupture of the amniotic membrane before the onset of labor or beyond 37 weeks gestation and it occurs approximately 8% of all pregnancies

most women (90%) will go into spontanious labor afterwords

80
Q

Major risk with PPROM and PROM

A

infection (chorioamnionitis and endometritis

cord prolapse can also occur with ruptured membranes if the head is not well engaged

81
Q

when is a digital exam permissible with PPROM

A

if delivery is imminent

82
Q

what is the management of PROM

A

the patietn should be hospitalized and monitored for expectant management

labor induced if it does not occur withhin 18 hours of rupture

83
Q

management of PPROM

A

20-36 weeks

if there is no sign of distress pt should be admitted to the hospital for bed rest

84
Q

when should steroids be administered for a patient in PPROM

A

before 34 weeks

85
Q

use of antibiotics in PPROM

A

have been administered to prevent infection and help prolong pregnancy because thye have been shown to reducinfant mortality

86
Q

what tests should be done while mom is hospitalized wtih PPROM

A

NST
BPP

both should be monitored daily

amnio can be performed to check for lung matuirty

if distress–> deliver

87
Q

management of PIH and chronic HTN

A

monthly ULS to check for IUGR

Serial BP and urine protein

weekly NST during the third trimester

88
Q

medication for chronic HTN and PIN

A

methlydopa

labetelol is the alternative

89
Q

preeclampsia and eclampsia

triad

A

HTN
edema
proteinuria but edema is NOT necessary for the dx

90
Q

most common risk factor for preeclampsia is

A

nulliparity

91
Q

other RF for preeclampsia include

A

multiple gestations
dm
Preexisting renal disease
chronic HTN

92
Q

what is the difference between mild and severe preeclampsia

BP measurements

A

mild is >140/90 where severe is 160-180/110 on twooccasions 6 hours apart

if the pt has an increase of 30 S or 15 D then that is also milkd preeclampsia

93
Q

what is the difference in protein b/w preeclampsia mild and severe

A

mild is 300 mg/24hrs but less than 5g and hour

severe is >5g in 24 hours

or 4+ urine on dip

94
Q

uric acid in mild vs severe pre e

A

mild >4.5

severe much greater than 4.5

95
Q

liver enzymes would be elevated in severe or mild preeclampsia

A

severe

96
Q

what are the symptoms of mild Pre E

A

hyperreflexia

97
Q

what re the symptoms of severe pre e

A 
HA
Blurred vision
scotomas
clonus 
RUQ pain
98
Q

scotomas

A

a partial loss of vision or blind spot in an otherwise normal visual field.

99
Q

complications of pre E

A 
HELLP
Abruptio placente
renal failure
cerebral hemorrhage
pulmonary edema 
disseminated intravascular coagulation
100
Q

Syphilis may cause

A

Syphilis may cause stillbirth, late term abortions, transplacental infection and congenital syphilis.
All women should be tested for syphilis during prenatal visits

101
Q

fetal complications if PRE E

A

hypoxia
low birth weight
preterm delivery
perinatal death

102
Q

when do you give Rh immunoglobulin

A

28 to 29 weeks

after delivery if baby is Rh positive then the mother recieves Rhogam again to protect against subsequent pregnancies

when rhogham is given it helps reduce incidence by 99%

103
Q

what is the management of mild pre e

A

inpatient management is magnesium sulfate until 24 hours after birth

outpatient management would be just close f/u

urine output should be monitored as magnesium sulfate is cleared through the kidney which leads to an increase risk of Mg SO4 toxcity

betamethazone prior to 34 weeks

severe pre E ALWAYS DELIVER regardless of age

104
Q

what is the drug of choice for managing pre e in addition to mg sulfate

A

hydralizine or labetelol is given for the acute management of high blood pressure

105
Q

what are the diagnostic studies for Rh incompatibility

A

routine blood type and cross
Rh factor
coombs test for Ab

Ab titiers of less than 1:16 probably will not adversely affect the pregnancy

106
Q

in a sensitized pregnancy what do you do

A

you need to do a coomb’s test
amnio
and ultrasound to follow the developing fetus for evidence of distress or hydrops

107
Q

what is the maangement of Rh incompatability

A

rhogam 300mg to Rh negatice nonimmunized 28 weeks of gestation AND within 72 hours of delivering an Rh positive infant

108
Q

other than the aformentioned when would you give Rhogam

A

at amnio or possible uterine bleeding

109
Q

when would you need a larger dose of rhogam

A

if massive maternal hemorrhage

110
Q

abrupto placenete happens

A

after the 20th week

MOST COMMON CAUSE OF THIRD TRIMESTER BLEEDING

111
Q

what are the risk factors for placental abruption

A 
trauma
smoking
HTN
decrease folic acid
alcohol (>14 weeks)
cocoaine
uterine anomalies 
high parity
previous abruption (recurrence rate os 10% to 17%) 
and advance maternal age

think party mom with hypertension and not taking vitamins

112
Q

which one is painless vaginal bleeding

A

previa

113
Q

what is the characteristic of pain experienced with placental abruption

A

searing back pain or uterine cramps

114
Q

what are the risk factors for placental previa

A

advanced age
smoking
multiple gestations
previous scarring on endometrium

think old whethered mom with twins smoking on the porch

115
Q

difference between external abruption and canceled abruptiom

A

external is more common and less severe
this is where blood escapes from the uterus and vaginal bleeding occurs

with conceled abruption is is more severe because the blood is retained. if the bleeding is canceled back pain uterine or abdominal pain may be the only symptom

116
Q

what happens to the uterus with placental abruption

A

it becomes irritable
tender
HYPERtonic

117
Q

what is used to diagnose placental abruption

A

not a whole lot apparently

ULS is not routinely reliable

118
Q

what is the management with abruption

A

depends on the degree of seperation and the biability of the fetus

blood type
cross and math
coagulation studies are indicated in the unstable patient
need large IV bore line

C-section

119
Q

placenta previa is more common in

A

smokers
previous c -section (unlike TOA)
advanced age
high parity

120
Q

what effects does placenta previa have on the uterus

A

lower uterus contracts poorly may continue to have blleding after delivery

121
Q

test of choice for placenta previa

A

ULTRASOUND (unlike abruption)

122
Q

management of placent aprevia

A

watch and wait

may need blood transfusion

if diagnosed prior to 20 weeks 50% migrate
should abstain from vaginal penetration

C section is the preferred method of choice for delivery

123
Q

what is the first stage of labor and the typical length

A

usually 6-20 hours in a primiparous woman

in a multiparous woman anywhere from 2-14 hours

usually theis is just defined by the onset of true contractions until the patient is fully dilated

124
Q

second stage

A

begins at full dilation and ends with the delivery of the infant

usually 30 minutes to 3 hours with an average of an hour in a primiparous woman

multiparous woman anywhere from 5-60 minutes (average 20 minutes)

125
Q

thirs stage of labor

A

delivery of the fetus to the delivery of the placenta

usually under 30 mintues with average being 5

126
Q

what is the fourth stage of labor

A

monitoring and laceration/hemorrhage management

127
Q

bloody show

A

often precedes labor and is the passage of a small amount of blood tinged mucus

128
Q

what should you get (diagnostic tests) when a woman is admitted for labor

A

protein
glucose
hematocrit

129
Q

when would you use and internal vs external fetal heart rate monitor

A

external is used when first in labor and that is attached to the abdomen transmitted via sound waves

an internal monitor is attached to the infant’s head and the mom must be at least 2 cm dilated and membranes must be ruptured

transmitted via R waves

130
Q

early decels

A

mirror the image of a contraction and denote fetal head compression

Variable decelerations → Cord compression/prolapse
Early decelerations → Head compression
Accelerations → OK
Late decelerations → Placental insufficiency/Problem

often present as a woman approaches second stage and are considered to be benign

131
Q

when do late decels occur

A

when the fetal heart rate drops during the SECOND HALF of the contractions

they denote Placental insufficiency

132
Q

what is the course of action when fetus appears to have late decels

A

STOP oxytocin
change maternal position
administer oxygen via a face mask
measure fetal scalp

133
Q

why do you assess the placenta

A

should have entire placenta membrane and contina three vessels arteries and vein

134
Q

why would you use oxytocin in the third or fourth stage of labor

A

to reduce blood loss by stimulating contractions

135
Q

what does pelvis power passage refer to

A

common causes of abnormalities

pelvis refers to the cephalopelvic disproportion where the maternal pelvis is not large enough to allow the infant to pass through

power refers to the contractions that are needed to dilate and expel the infant if inadequate sometimes oxytocin (pitocin) is needed to enhance labor

passanger reders to the baby where if it is too big the likelihood of cephalopelvic disproprotion

136
Q

APGAR

A 
ACTIVITY 
PULSE
GRIMACE
APPEARANCE
RESPIRATION
137
Q

ACTIVITY scoring

A

arms and legs flexed is a 1 and active movement is a 2

138
Q

pulse scorign APGAR

A

<100 is a 1 and >100 is a 2

139
Q

grimace or reflex irritability scoring

A

grimace is 1

sneezes coughs or pulls away is 2

140
Q

appearance

A

pink except extremities is 1 and pink all over is 2

141
Q

respiration rating

A

slow and irregular is 1 where good and crying is 2

142
Q

what is the marker of true dystocia

A

inability to deliver vaginally after full cervical dilation

143
Q

if maternal pushing is inadequate

A

rest or assisted delivery with vacuum extraction or forceps may be used to shorten the second stage

144
Q

when can you use forcep extractors

A

only when the head is engaged and the cervix is fully dilated for fetal distress or maternal indications

145
Q

leading indication for cesarean section

A

dystocia

146
Q

if the baby is non vertex presentation you can do

A

external version with ultrasound guidance can be attempted after 37 weeks

147
Q

when is VBAC the least successful

A

when dystocia was the indicator for previous cysarian

148
Q

risks of cesarian sections

A

greater likelihood of thromboembolic events
increased bleeding
development of infection

149
Q

management of c section

A

prophylactic antibiotics are often used after C section to prevent infection
low transverse incision is usually made because of the decreased blood loss associated with it’s use
recovery time is longer following a c-section and breast feeding may be difficult secondary to abdominal pain

150
Q

induction of labor-early

A

with minimal dilation or effacement
initiated with prostaglandin gel applied to the cervix and repeated every 12 hours
this helps soften the cervix and additionally a balloon catheter or laminaria can also be used

151
Q

later induction of labor

A

once the cervix is dilated more than 1 cm and there is some effacement pitocin can be given IB
with systemic increases in oxytocin q 3 minutes

152
Q

what is the name for artifically rupturing the membranes

A

amniotomy

153
Q

what decrease in hematocrit constitues as pp hemorrhage

A

10%

154
Q

what are the most frequent causes of late pp hemorrhage

A

occurs more than 24 hours after deivery as is usually because of subinvolution of the uterus
retained products of conception
or
endometriitis

155
Q

how do you differentiate a subinvoluted uterus

A

it will feel enlarged and soft on examination and the patient may present with increased bleeding
pain
fever
foul-smelling lochia

156
Q

management of pp hemorrhage

A

initial management should be uterine massage and comrpession

establish IV access and prepare blood compoennets

157
Q

after you have massaged the uterus and established IV access and blood compoennets what should be done to manage pp hemorrhage

A

use IV oxytocin ergonovine, methylergonovine, or protoglandins

158
Q

subinvolution of the uterus will often respond to

A

oral agents that increase uterine contraction like

methylergonovine maleate

ergonovine maleate

antibiotic treatment may also be necessary

159
Q

endometritis characteristic

A

commonly presents 2-3 days postpartum \fever higher than 38.3 or 101 and uterine tenderness are highlighy suspicious

160
Q

other than uterine tenderness and high fever what other symptoms would be concerning for endometritis

A

adnexal tenderness
peritoneal irritiation
decreased bowel sounds

161
Q

diagnostic studies for endometritis

A

WBC commonly more than 20,000

causative bacteria vary wildly but anaerobic steptoccoci
UA should be performed

162
Q

management of endometritis

A

should be administered until afebrile for 24 hours

clindamycin plus gentamicin is the first line

163
Q

what would you add if clindamycin and gentamycin didn’t work for endometritis

A

ampicillin is the first line if no response in the first 24 to 48 hours

164
Q

when would you add metronidazole to a pt with endometritis

A

if sepsis was present

165
Q

what is lochia

A

bleeding that occurs after delivery and can represent a sloughing off of decidual tissue

can last for 4-5 weeks pospartum

166
Q

when does period return for non breast feeding mothers

A

6-8 weeks

167
Q

what is common in lactating mothers

A

atrophic vaginitis

treat with vaginal cream

168
Q

when does the uterus shrink or involute

A

2 days after delivery

169
Q

when does the uterus descend into the pelvic cavity

A

2 weeks afte

170
Q

when is the uterus back to its normal size

A

by 6 weeks

171
Q

when should a pt be further worked up for PP depression

A

if they score greater than a 10 on the edinburgh postnatal depression scale

172
Q

start at the peak of contraction into the second half of the contraction

A

late

worrisome
placental insufficiency

urgent care

173
Q

mirror the contraction

A

early decels

ok

174
Q

rapid droos of fetal heart rate with variable returnt to baseline

A

fetal head comrpession

benign

175
Q

3 hr GTT

A

FASTING >90

1HR >180
2HR >155
3 HR >140

just need 2 of these

OBGYN EOR (2 decks)

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