Obstetrics Flashcards
Types of Aneuploidy
- Downs 21
- Edwards 18
- Patau 13
First Trimester Aneuploidy Screening
- US-Nuchal Lucency
- PAPP-A
- hCG
Triple Screen/Quad Screen findings in Downs
hCG increased
AFP decreased
Estriol decreased
Inhibin A Increased
Triple Screen/Quad Screen Findings in Edwards
hCG decreased
AFP decreased
Estriol very decreased
Inhibin A decreased
Gestational Diabetes Screening
1 hr GTT- >140
3 hr GTT-
- >95
- >180
- >155
- >140
Risk Factors for Gestational DM
- BMI >30
- Hx GDM
- Pre-Diabetic
Maternal anemia Dx Usually caused by
Iron deficiency anemia Hgb<10 or HCT <30
Asx Bacteriuria
Presentation
Dx, Tx
(+) UA, no symptoms
Tx:
- Amoxicilin
- nitrofurantoin
- Repeat UA after treatment
Cystitis
Presentation
Dx, Tx
Pt: Urgency, frequency, dysuria
Tx:
- Amoxicillin
- Second line-nitrofurantoin
Pyelonephritis
Presentation
Dx, Tx
Pt:
- urgency,
- Frequency,
- Dysuria
- Fever and
- CVA tenderness
Tx: Ceftriaxone
Reasses after a few days
- No improvement=abscess 14 days Abx U/S for drainage
- Improvement=Pyelo 10 days Abx
Positive UA findings
- Nitrites
- Leukocyte Esterase
- Lots of WBCs
- (+) Bacteriuria
- No epithelial
- Cells >100 cfu
Transcranial doppler
- used when,
- or what,
- risk,
- Extra facts
- >20 wks Assessment of fetal anemia,
- Alloimmunization
- No risk
- Highly sensitive
Chorionic villous sampling
- Used when,
- for what,
- risk,
- extra facts
- >10wks
- Assessment of genetic disorders
- slight risk
- for early detection and early termination
Hyperthyroidism in pregnancy
Presentation
dx, tx
“overactive patient” can lead to fetal demise
Dx:
- TSH decreased,
- T4 increased
Tx:
- PTU
- Methimazole
Hypothyroidism in pregnancy
Presentation
Dx, Tx
Everything “Slowed” down leads to cretinism
Dx:
- TSH Increased,
- T4 Decreased
Tx:
- Levothyroxine,
- f/u dosing every 4 weeks larger doses required during pregnancy
What Anti-Epileptic Drugs are safe in pregnancy
Levitiracetam=Lamotrigine
Phenobarbital for active seizing
Hypertension in pregnancy
Goal
medications safe in pregnancy
- Goal is BP <140/<80
- alpha-methyldopa
- Labetalol
- hydralazine
- Screening should be tight for eclampsia
DM in pregnancy
Goals and testing
- Change oral medications to insulin before pregnancy
- use insulin during pregnancy,
- higher insulin requirement during pregnancy
Stage 1 Latent phase of labor time
- Nulliparous 20hr
- Multiparous 14hr
Stage 1 Active phase of labor time (prolonged or arrested)
- Nulliparous 4 hours or no change
- Multiparous 5 hours no change
Stage 1 Active phase of labor dilation per time
- Nulliparous 1.2cm/hr
- Multiparous 1.3 cm/hr
Stage 2 phase of labor time
- nulliparous 3 hours
- multiparous 2 hours
What are the stages of labor
Stage 1:
- 0cm to 6cm (Latent)
- 6cm to 10cm (Active)
Stage 2:
- 10cm to fetus delivery
Stage 3:
- Fetus deliver to placental delivery
Stage 3 of labor time
<30 min
Arrest of active phase of labor treatment
- prolonged-oxytocin
- arrest-c-section
- if at negative station c-section
- positive station-forceps, vacuum
Preterm Gestational age
24- 37 weeks
Term Gestation Age
37-42 weeks
Premature Rupture of Membranes
Presentation
Dx, Tx
Usually due to infection GBS
Pt: (+) ROM, (+) term, no contractions
Dx: Clx, find the GBS
Tx: Deliver
- GBS positive or unknown=give ampicillin
- GBS negative=wait and watch
Preterm Premature Rupture of Membranes
Presentation
Dx, Tx
Infection GBS
Pt: (+) ROM, not at term, no contractions
Dx: Clx
Tx: >34 wks=deliver
<24 wks=abortion
24-34wks=steroids
Prolonged Rupture of Membranes
Presentation
Dx, Tx
Ascending infection, GBS
Pt: (+)ROM, no delivery >18 hrs
Tx: Deliver
GBS (+), unknown=ampicillin
GBS negative=wait
F/u for endometritis (baby out),chorioamnionitis (baby in)=
Ampicillin + getamicin +/- clindamycin
Risk Factors for preterm labor
Cigarette smoking
young maternal age
multiple gestations
anatomical abnormalities
Preterm Labor
Presentation
Dx, Tx
Pt: (+) contractions, cervical changes, not at term
Tx >34 wks=deliver
<20 wks=abortion
20-34wks steroids and tocolytics
Mild Pre-eclampsia
BP
Timing
U/A
Sxs
Tx
F/U
BP->140/>80
Timing-sustained, after 20wks
U/A->300mg/dl, proteinuria
Sxs-none
Tx->37wks deliver
<37wks wait
F/U weekly
Pre-eclampsia with severe features
BP
Timing
U/A
Sxs
Tx
BP->160/>110
Timing-Sustained, after 20wks
U/A->5g/dl, proteinuria
Sxs- severe features
Tx-Mg and deliver (induction)
What are the severe features of Eclampsia
decreased platelets
increased LFTs
RUQ abdominal pain
increased Cr (1.1, or 2x)
Pulmonary edema
Headaches, Vision Changes
BP->160/>110
HELLP Syndrome
Hemolysis
Elevated LFTs
Low Platelets
Antidote for magnesium toxicity
Calcium
decreased deep tendon reflexes leading to decreased respiratory rate
Twinning with different genders
Di-zygotic, Di-chorionic, Di-Amniotic
Risks: Preterm labor, malpresentation, PPH
2 placentas, same gender
Monozygotic, Di-chorionic, Di-amniotic
same gender, (+) septum, 2 sacs
Monozygotic, Monochorionic, Di-amniotic
Twin Twin transfusion (skinny twin will do better)
same gender, no septum, 1 sac
Monoygotic, monochorionic, monoamniotic
Conjoined twins, cord entanglement
PPH definition
500cc vaginal delivery
1000cc c-section
Uterine Atony
Presentation
Dx, Tx
Pt: Atonic uterus, PPH and boggy uterus
Tx: Massage
oxytocin
Surgery
Uterine Inversion
Presentation
Dx, Tx
“Births itself”, can be caused by traction or oxytocin
Pt: PPH and absent uterus
Tx: Tocylytics-then put it back
Placenta Accreta
burrows a little deeper
Placenta Increta
invades the myometrium
Placenta Percreta
Invades all the way though the endometrium
Retained Placenta
Presentation
Dx, Tx
Pt: PPH and firm uterus
Tx: Dilation and curretage leading to TAG
Normal Fetal Heart Rate
between 110-160
High risk pregnancy or decreased fetal movement
antenatal testing
Non stress test
NST after vibroacoustic stimulation
biophysical profile between 3-8
gestational age <37 weeks =contraction stress test
Describe early Decels, and what causes them
Heart rate deceleration in line with the peak of contraction
head compression
Describe variable decelerations and what causes them
Heart rate deceleration without relation to contractions
cord compression
Describe late decelerations and what causes them
Heart rate deceleration occuring after the peak of contraction
utero-placental insufficiency
Placenta Previa
Presentation
Dx, Tx
placenta lies across the cervical os
presents with painless bleeding
Dx: U/S= Transverse lie
NST/CST=Fetal Distress
Tx: Urgent C-Section
Vasa Previa
Presentation
Dx, Tx
Accessory lobe lies across the cervical os
Blood vessels tear when the cervix dilates
Presents with painless bleeding
Dx: NST/CST=fetal distress
Tx: Urgent C-Section
Uterine Rupture
Presentation
Dx, Tx
Vaginal Birth after C-section
Presentation: Painful, “absent” uterus
Loss of fetal station
Tx: Crash Section
Placental Abruption
Presentation
Dx, Tx
Usually due to HTN or cocaine use, MVA
Presentation: Painful Bleeding
Dx: U/S, Vitals, HgB, AMS, CST/NST
Tx: C-section
Group B Strep Infection
Presentation
Dx, Tx
Screening should occur at week 10 and again at week 35
there will be a healthy delivery but toxic baby
Dx: Risk Factors-Any previous positive
prolong ROM, Intrapartum Fever
Tx: Ampicillin
Cefazolin
Clindamycin
Vancomycin
HIV infection during pregnancy and delivery
Dx, Tx
ELISA confirm with western blot
if for baby Viral load
Tx: 2+1
2 NRTI (Tenofovir +Emtricitabine) or (Zidovudine+Lanivudine)
NNRTI (Nevirapine)
Toxoplasmosis
Presentation
Dx, Tx
Presentation-Mom=Mono like illness
Baby=Brain calcifications, Ventriculomegaly, Seizure Disorder
Dx: Toxo Ab (+)=do nothing
Toxo Ab(-)=avoidance
Syphilis
Presentation
Dx, Tx
Presentation
- Painless chancre
- targetoid lesions affecting the palms and soles
- Neuro Sxs
Dx
- Darkfield microscopy
- RPR—FTA-Abs
- CSF VDRL, RPR
Tx= Penicillin
Rubella Congenital Infection
Presentation
Dx, Tx
Presentation: Baby-Blueberry muffin baby, Cataracts, Congenital heart defects, deafenss
Tx: Vaccinate three months prior to pregnancy, avoidance
Herpes congenital Infection
Presentation
Dx, Tx
Painful burning prodrome, vesicels on an erythematous base
Dx: PCR
Tx: (val)acyclovir
follow uup for blindness, preterm, IUGR
When do you use the Forceps or vaccum during delivery
Fetal distress or prolonged or arrested labor plus
Full effacment and 2+ station
When do you use cervical cerclage
When there have been multiple second trimester losses
ROM around week 14
Be sure to remove the cerclage at week 36
