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U World Step 2 > Pregnancy, Childbirth, & Puerperium > Flashcards

Pregnancy, Childbirth, & Puerperium Flashcards

1
Q

First stage of labor

Definition

Phases

A

Latent: Gradual cervical change from 0 cm to 6 cm dilation

Active: Rapid cervical change from 6 cm to 10 cm dilation

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2
Q

Disorders of the active phase of labor

  1. Diagnosis
  2. Clinical features
  3. Treatment
A
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3
Q

Neural tube detects

  1. Types
  2. Risk factors
  3. Prenatal screening
  4. Prevention
A
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4
Q

Infants of diabetic mothers – general risks

A

Respiratory distress syndrome

Preterm delivery

Fetal macrosomia

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5
Q

Infant of diabetic mother – complications

  1. 1st trimester
  2. 2nd and 3rd trimester
A
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6
Q

Placenta previa

  1. Risk factors
  2. Clinical features
  3. Diagnosis/management
A
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7
Q

Fetal fibronectin

A

Found on the choriodecidual interface

Presence in vaginal secretions at 24-34 gestation is predictive of preterm delivery

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8
Q

Kleihauer-Betke test

A

Determines the necessary dose of Rh(D) anti-D immunoglobulin after delivery of an Rh-positive fetus to an Rh-negative mother

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9
Q

Tocolytics

  1. Drug
  2. Mechanism
  3. Indication
  4. Side effects
A
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10
Q

Preterm labor (<37 weeks)

  1. Gestational age
  2. Management
A
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11
Q

Eclampsia

  1. Clinical features
  2. Management
A
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12
Q

Types of abortion (pregnancy loss at <20 weeks of pregnancy)

  1. Missed
  2. Threatened
  3. Inevitable
  4. Incomplete
  5. Complete
A
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13
Q

Antepartum fetal surveillance

Purpose

Frequency

A

Evaluates for fetal hypoxia in pregnancies with a high risk of fetal demise due to maternal or fetal factors.

Maternal factors: Hypertension, diabetes mellitus

Fetal factors: post-term pregnancy, growth-restriction

Weekly testing starting at 32 weeks

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14
Q

Normal non-stress test (NST)

A

>=2 heart rate accelerations that are >= 15 beats/min above baseline and >=15 seconds long within a 20 minute period

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15
Q

Antepartum fetal surveillance (Description, normal result, abnormal result)

  1. Nonstress test
  2. Biophysical profile
  3. Contracction stress test
  4. Doppler sonography of the umbilical artery
A
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16
Q

Placenta accreta

Risk factors

A

Occurs when uterine villi attach directly to the myometrium instead of the decidua.

Risk factors:

Prior cesarean delivery

History of D&C

Maternal age > 35

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17
Q
A

Placental abruption

Premature detachment of the placenta from the uterus

Vaginal bleeding

Abdominal pain

Tense and distended uterus

Fetal heart rate abnormalities

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18
Q
A

Placenta previa

Occurs when the placenta implants over the internal cervical os

Contractions and cervical dilation typically cause antepartum hemorrhage

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19
Q
A

Vasa previa

Fetal vessels traverse the amniotic membranes over the cervical os

Painless antepartum bleeding and fetal heart rate abnormalities just after the rupture of membranes

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20
Q

Breastfeeding contraindications

  1. Maternal
  2. Infant
A
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21
Q

Biophysical profile (Component, normal finding)

A
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22
Q

Nuchal cord

A

Associated with variable decelerations

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23
Q

Intrauterine fetal demise

  1. Definition
  2. Diagnosis
  3. Management
  4. Complication
A

Risk factors for intrauterine fetal demise: nulliparity, obesity, hypertension, and diabetes mellitus

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24
Q

Kleihauer-Betke test

A

Confirm or rule out fetomaternal hemorrhage

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25
Q

Evaluation of fetal demise

  1. Fetal
  2. Maternal
A
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26
Q

Postpartum urinary retention

  1. Risk factors
  2. Clinical features
  3. Management
A
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27
Q

Preeclampsia

  1. Definition
  2. Severe Features
  3. Management
  4. Fetal complications
A
  1. Fetal complications: Oligoydramnios and fetal growth restriction/small for gestational age infants due to chronic uteroplacental insufficiency
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28
Q

Management of patients >=37 weeks gestation with breech presentation

A

External cephalic version

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29
Q

Internal podalic version

A

Used for breech extraction of a malpresenting second twin

Breech delivery of a second twin has a lower risk of asphyxia than Cesarean and is not contraindicated

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30
Q

Pubic symphysis diastasis

  1. Risk factors
  2. Presentation
  3. Management
A
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31
Q

Femoral nerve damage

A

Can occur during delivery as a result of hyperfelxion of the thigh

Numbness over anterior and medial thigh, inability to extend the leg or flex the thigh, and diminished patellar reflexes

32
Q

Risk factors for fetal macroscomia (Weight > 4 kg)

  1. Maternal
  2. Fetal
A
33
Q

Low back pain during pregnancy

  1. Etiology
  2. Risk factors
  3. Imaging
  4. Mangement
A
34
Q

Intrapartum fetal heart rate monitoring

  1. Early decelerations
  2. Late decelerations
  3. Variable decelerations
A
35
Q

Chorioamnionitis

A

Maternal fever

Fetal tachycardia (baseline FHR > 160 bpm)

36
Q

Fetal anemia

A

Sinusoidal fetal heart rate tracing

37
Q

Recurrent variable decelerations

A

Occur with >50% of contractions

Require treatment to prevent fetal acidosis

  1. Maternal repositioning (to left lateral) - 1st line
  2. Amnioinfusion - 2nd line
38
Q

Normal physiological changes during pregnancy (system, clinical finding, mechanism)

  1. Renal/urinary
  2. Heme
  3. Cardiovascular
  4. Pulmonary
A
39
Q

Syphilis in pregnancy

  1. Screening
  2. Serologic tests
  3. Treatment
  4. Pregnancy effects
  5. Fetal efects
A
40
Q

Timing of screening for Group B strep

A

35-37 weeks

41
Q

Causes of hyperandrogenism in pregnancy

  1. Diagnosis
  2. Maternal clinical features
  3. Fetal virilization
A
42
Q
A

Neonatal clavicular fracture

No intervention needed

Heals rapidly without intervention

43
Q

Neonatal displaced clavicular fracture

  1. Risk factors
  2. Clinical features
  3. Diagnosis
  4. Treatment
A
44
Q

Treatment of preeclampsia

  1. Drug
  2. Indication
A
45
Q

Maternal cardiopulmonary adaptations to pregnancy

  1. Maternal adaptations
  2. Clinical manifestations
A
46
Q

Ectopic pregnancy locations

A
47
Q

Managment of a hemodynamically unstable patient with hemoperitoneum (bloiod in pelvis)

A

Emergency surgical exploration

48
Q

Gestational diabetes mellitus

  1. Target blood glucose levels
  2. Treatment
A
49
Q

Brachial plexus injuries

A
50
Q

Management of shoulder dystocia (BE CALM)

A
51
Q

Chorioamnionitis (intraamniotic infection)

  1. Risk factors
  2. Diagnosis
A
52
Q

Late-term and postterm pregnancy complications

  1. Fetal
  2. Maternal
A
53
Q
A

Uterine rupture

Presents with severe pain, antepartum bleeding, and loss of fetal status.

Uterine rupture rarely occurs in patients who have no had uterine surgery.

54
Q

Uterine inversion

  1. Etiology
  2. Presentation

3. Management

A

If the placenta is still attached to the uterus, it should not be removed until after the uterus is replaced due to risk of massive hemorrhage.

55
Q

Routine prenatal laboratory tests

  1. Initial prenatal visit
  2. 24-28 weeks
  3. 35-37 weeks
A
56
Q

Montevedo units

A

Measure adequacy of contractions

of uterine contactions in 10 min x contraction strength

Adequate labor: 200 Montevideo units

57
Q

Treatment of pyelonephritis in pregnancy

A

Ceftriaxone

58
Q

Treatment of acute cervicitis

A

Ceftriaxone + azithromycin

(Covers gonorrhea and chlamydia)

59
Q

Treatment of lactational mastitis

A

Dicloxacillin

Narrow spectrum penicillin that coers the two most frequent pathogens: MSSA and Group A Strep

60
Q

Treatment of breast abscesses

A

Vancomycin

61
Q

Postpartum endometritis

  1. Risk factors
  2. Clinical features
  3. Etiology

4. Treatment

A
62
Q

Fetal position

A

Relatinship of the fetal presenting part to the maternal pelvis

Optimal feal position: occiput anterior (facilitates the cardinal movements of labor)

Deviations: Occiput transverse, occiput posterior

63
Q

Fetal presentation

A

Lowest part of the fetus in the maternal pelvis

Most common: Vertex

Nonvertex presentations: breech, face

64
Q

Fetal station

A

Measures the descent of the presenting part through the pelvis

65
Q

Second stage arrest of labor

  1. Definition
  2. Risk factors
  3. Etiology
  4. Management
A

Second stage begins when the cervix is 10 cm dilated and ends with delivery

66
Q

Fetal growth restriction (Symmetric versus Asymmetric)

  1. Definition
  2. Onset
  3. Etiology
  4. Clinical features
  5. Managment
A
67
Q

Vaccines during pregnancy

  1. Recommended
  2. Indicated for high-risk patients
  3. Contraindicated
A
68
Q

Management of pregnant patients exposed to varicella

A

If a patient lacks evidence of immunity (negative IgG serologic testing, no history of childhood infection), she is treated with postexposure prophylaxis.

Varicella-zoster immunoglobulin administration.

Varicella vaccine is contraindicated in pregnancy.

69
Q

Magnesium toxicity

  1. Clinical features
  2. Treatment
  3. Common risk factor
A
  1. Common risk factor: Renal insufficiency, because magnesium is excreted solely by the kidneys
70
Q

Preventing neonatal group B Streptococcus infection

  1. Universal screening
  2. Indications
  3. Prophylaxis
A
71
Q

Preterm birth prevention

A
72
Q

Risks associated with being Small for Gestational Age (SGA)

A

Hypoxia

Polycythemia

Hypoglycemia

Hypothermia

Hypocalcemia

73
Q
A

Hydatidiform mole

Anechoic, cystic spaces (“snowstorm” on ultrasound)

74
Q

Hydatidiform mole

  1. Clinical presentation
  2. Risk factors
  3. Diagnosis
  4. Management
A

Preeclampsia with severe features at <20 weeks gestation

75
Q

Ectopic pregnancy

  1. RIsk factors
  2. Clinical features
  3. Diagnosis
  4. Management
A
76
Q

Indications for prophylactic anti-D immune globulin administration for Rh(D)-negative patients

A

Anti-D immune globulin (RhoGAM) is indicate in unsensitized, Rh-negative women at 28 weeks gestation or within 72 hours of any procedure or incident in which there is any possibility of feto-maternal blood mixing.

77
Q

Antiphospholipid antibody syndrome

A

False positive VDRL (FTA-ABS negative)

Prolonged PTT

Thrombocytopenia

Prophylaxis with low dose aspirin and LMWH

U World Step 2 (22 decks)

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