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Shelf - Obstetrics and Gynecology > Pregnancy, Childbirth, Puerperium - antenatal testing > Flashcards

Pregnancy, Childbirth, Puerperium - antenatal testing Flashcards

1
Q

Uterotonic agent commonly used for labor induction; prevention and management of postpartum hemorrhage

A

oxytocin

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2
Q

complications of oxytocin (3)

A

tachysystole (abn frequent contrations = >5 in10min)
hyponatremia
hypotension

late decels in fetus

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3
Q

Presence of maternal fever (>100.4) and one+ of the following:

  • mom: uterine tenderness, maternal tachycardia, malodorous amnionic fluid, purulent vaginal discharge
  • fetus: tachycardia >160
A

chorioamnionitis

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4
Q

important risk factor for chorioamnionitis

A

Prolonged rupture of membranes

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5
Q

tx of chorioamnionitis

A

bs abx and then delivery

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6
Q

Risks of inadequate or excessive weight gain:
-Fetal growth restriction and preterm delivery
vs.
-GDM, macrosomia, csxn

A
  1. inadequate

2. excessive

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7
Q

tx of asx endometriosis

A

no treatment

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8
Q

tx of sx endometriosis (3)

A

NSAIDs, OCPs, progesterone IUD (not copper)

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9
Q

screening dates for syphilis

A

Universal: first prenatal visit

High risk: 3rd tri and delivery

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10
Q

tx syphilis

A

IM pen G

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11
Q

If mom is unsensitized Rh-negative pregnant patient, when do you NOT need to give ppx anti-D Ig?

A

if dad is knwn Rh negative

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12
Q

antiD Ig at what points?

A

between 28-32 weeks and then w/i 72hrs of deliver

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13
Q

MC African american.
Yellow or yellow-brown masses of large lutein cells. Solid ovarian mass on u/s (50% bl), regress spontaneously after delivery

Dx and fetal virilization risk

A

luteoma

high fetal virilization risk

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14
Q

b/l ovarian cysts n u/s. Associated with molar pregnancy and multiple gestation (dt increased beta-hCG). regress spontaneously after delivery

Dx and fetal virilization risk

A

theca lutein cyst

low fetal virilization risk

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15
Q

b/l solid ovarian masses on u/s. mets from primary GI tract cancer.

Dx and fetal virilization risk.

A

kruckenburg tumor

high fetal virilization risk

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16
Q

tx of eclampsia

A

Mg sulfate
anitHTN agent
delivery

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17
Q

preeclampsia at <20wks, think more that it’s a complication from what?

A

hydatidiform mole.

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18
Q

Major risk factor for preterm delivery

A

hx of preterm delivery dt spontaneous preterm labor or Preterm PROM

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19
Q

Pt has a hx of birth <37wks. what are three things that can be done to minimize reoccurence?

A
  1. IM progesterone in 2nd/3rd trimesters
  2. serial cervical length measurements by transvaginal u/s in 2nd trimester
  3. cerclage is shortened cervix
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20
Q

lactation issue: subareolar, mobile, well circumscribed, nontender mass. no fever

A

galactocele

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21
Q

lactation issue: tenderness/erythema + fever

A

mastitis

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22
Q

3-5 days post delivery. breast bilateral symmetric fullness, tenderness and warmth. no fever

tx

A

breast engorgement

cool compress, NSAIDs, breastfeed

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23
Q

what two procedures make uterine rupture a high risk if trial of labor?

A
  • Vertical csxn

- Abdominal myomectomy WITH uterine cavity entry (i.e. to remove intramural or submucosal fibroids)

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24
Q

Postpartum: fatigue, wt los, HYPOTENSION, INABILITY TO BREASTFEED, amenorrhea

A

sheehan - postpartum hypopituitarism due to massive obstetric hemorrhage and hypovolemic shock causing ischemic necrosis of anterior pituitary

25
Q

Increased risk for what if: previous csxn, hx of D&C, maternal age >35
Postpartum bleed

A

placenta accreta (uterine villi attach to myometrium)

26
Q

Vaginal (antepartum) bleeding, abd PAIN, tense and distended uterus, fetal hr abn
risk factors for this include: cocaine use, tobacco use, prior hx of this happening, bad trauma, maternal HTN or preeclampsia

A

placental abruption (premature detachment of placenta form uterus)

27
Q

Antepartum hemorrhage following contractions and cervical dilation

A

placenta previa

28
Q

when fetal vessels traverse amniotic membranes over internal cervical os. presents with PAINLESS antepartum bleeding and fetal HR abd just AFTER membrane rupture

A

vasa previa

29
Q

HSVrisk factors

A
  • primary maternal infection; vaginal delivery with active lesions
  • longer duration of membrane rupture
  • vaginal delivery with active lesions
  • impaired skin barrier
  • preterm birth
30
Q

pregnant with women - ppx with ___ at ___wk

A

ppx with acyclovir/vancyclovir at 36wks

31
Q

shoulder dystocia results in neuro deficit (extended wrist, hyperext MCPs, flexed IPs, abset grasp reflex) and horner syndrome (ptosis and miosis)

A

klumpke plasy - C8-T1 and sympathetic damage

32
Q

LH surge = ?

A

menstruation

33
Q

prior to conception until 20wks:

>or= 140/ >or=90

A

chronic HTN

34
Q

> or= 20wks

new onset HTN, no proteinuria or end organ damage

A

gestational htn

35
Q

> or= 20wks

new onset HTN AND proteinuria OR signs of end organ damage

A

preeclampsia

36
Q

> or= 20wks

new onset HTN AND proteinuria OR signs of end organ damage AND new onset grand mal seizure

A

eclampsia

37
Q

chronic HTN and 1+: new onset proteinuria or worsening of existing proteinuria at >or= 20wks; sudden worsening HTN; signs of end organ damage

A

chronic HTN superimposed on preeclampsia

38
Q

test performed for pregnancies at risk for fetal hypoxia or fetal demise

A

nonstress test

- performed when decreased detal movements and fetal compromise is expected

39
Q

Be aware of giving mag to a mom with what problem?

A

renal insufficiency bc mag is renally excreted

40
Q

increased Maternal Serum AFP - thing what three things

A

open neural tube defects, ventral wall defects, multiple gestation

41
Q

decreased Maternal Serum AFP - thing what

A

aneuploidy (tri18,21)

42
Q

Post partym hemorrhage tx

A

bimanual uterine massage, IVF, O2, uterotonic meds (oxytocin, methylergonovine, carboprost, misoprostol)

43
Q

Renal physiologic changes in preg:
RBF
GFR
Renal basement permeability

A

all increase

44
Q

Renal lab changes in preg:
BUN
Cr
Renal protein excretion

A

BUN DECR
Cr DECR
Renal protein excretion INCR

45
Q

tx of preeclampsia:

  • BP
  • Seizure
A
  • BP: hydralazine IV, nifedipine po, labetalol IV (will also lower HR)
  • Seizure - mag sulfate IV or IM
46
Q

indications for prophylactic anti-D Ig admin for unsensitized Rh-neg pregnant pt

A 
28-32wk gestation
w/i 72h of Rh+ infant birth, threatened, or induced abortion
ectopic
trauma to abd
hydatidiform mole
amniocentesis
external cephalic version
2nd/3rd tri bleed
47
Q

Give what 3 vaccines during pregnancy

A

Tdap
Inactivated influenza
RhoD

48
Q

DO NOT give any pregnant pt what four vaccines?

A

MMR (safe for breastfeeding moms, give immediately postpartum)
Varicella
Live influenza
HPV

49
Q

Woman with hyperemesis gravidum has horizontal nystagmus and bilateral abducens palsy (oculomotor dysfunciton), encephalopathy (confusion, incoherence), and ataxis.

Dx and tx

A

Dx: wernicke encephalopathy

Tx: thiamine IV and glucose (dt hypoglycemia in Hyperemesis Gravidum)

50
Q

False v latent labor:

  1. Contractions irregular, infrequent, weak, no-mild pain, no cervical change
  2. Contractions regular and increasing frequency, increasing intensity, painful, and cervical change
A
  1. false

2. latent

51
Q

no vainal bleeding, closed vervical os, no fetal activity or empty sac

A

missed abortion (fetus dead, still attached inside uterus)

52
Q

vaginal bleeding, closed cervical os, fetal cardiac activity

A

threatened abortion (fetus alive, still attached inside uterus)

53
Q

vaginal bleeding, open cervical os, products of conception seen/felt at or above cervical os

A

inevitable abortion (fetus not still attached inside uterus, not expelled)

54
Q

vaingal bleeding, cervical os open, some products of conception expelled/some remain

A

incomplete abortion (fetus not still attached inside uterus, may/may not be expelled)

55
Q

vaingal bleeding or non, closed os, products completely expelled

A

complete abortion (fetus completely expelled)

56
Q

post csxn/surgery: fever unresponsive to abx, no localizing sx except possible BL LQ tenderness, negative infectious evaluation, dx of exclusion

A

septic pelvic thrombophlebitis - thrombosis of deep pelvic or ovarian viens

57
Q

tx of septic pelvic thrombophlebitis

A

anticoagulation and bs-abx

58
Q

fever, lower abd pain, heavy vaginal bleeding, malodorous purulent vaginal discharge, uterine tenderness
after (MC) elective abortion.

dx

A

septic abortion

59
Q

medical induciton of aboriton

A

MTX or misoprostol (SAB)

Shelf - Obstetrics and Gynecology (10 decks)

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