Pregnancy, Childbirth, Puerperium - antenatal testing Flashcards
Uterotonic agent commonly used for labor induction; prevention and management of postpartum hemorrhage
oxytocin
complications of oxytocin (3)
tachysystole (abn frequent contrations = >5 in10min)
hyponatremia
hypotension
late decels in fetus
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
chorioamnionitis
important risk factor for chorioamnionitis
Prolonged rupture of membranes
tx of chorioamnionitis
bs abx and then delivery
Risks of inadequate or excessive weight gain:
-Fetal growth restriction and preterm delivery
vs.
-GDM, macrosomia, csxn
- inadequate
2. excessive
tx of asx endometriosis
no treatment
tx of sx endometriosis (3)
NSAIDs, OCPs, progesterone IUD (not copper)
screening dates for syphilis
Universal: first prenatal visit
High risk: 3rd tri and delivery
tx syphilis
IM pen G
If mom is unsensitized Rh-negative pregnant patient, when do you NOT need to give ppx anti-D Ig?
if dad is knwn Rh negative
antiD Ig at what points?
between 28-32 weeks and then w/i 72hrs of deliver
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
luteoma
high fetal virilization risk
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
theca lutein cyst
low fetal virilization risk
b/l solid ovarian masses on u/s. mets from primary GI tract cancer.
Dx and fetal virilization risk.
kruckenburg tumor
high fetal virilization risk
tx of eclampsia
Mg sulfate
anitHTN agent
delivery
preeclampsia at <20wks, think more that it’s a complication from what?
hydatidiform mole.
Major risk factor for preterm delivery
hx of preterm delivery dt spontaneous preterm labor or Preterm PROM
Pt has a hx of birth <37wks. what are three things that can be done to minimize reoccurence?
- IM progesterone in 2nd/3rd trimesters
- serial cervical length measurements by transvaginal u/s in 2nd trimester
- cerclage is shortened cervix
lactation issue: subareolar, mobile, well circumscribed, nontender mass. no fever
galactocele
lactation issue: tenderness/erythema + fever
mastitis
3-5 days post delivery. breast bilateral symmetric fullness, tenderness and warmth. no fever
tx
breast engorgement
cool compress, NSAIDs, breastfeed
what two procedures make uterine rupture a high risk if trial of labor?
- Vertical csxn
- Abdominal myomectomy WITH uterine cavity entry (i.e. to remove intramural or submucosal fibroids)
Postpartum: fatigue, wt los, HYPOTENSION, INABILITY TO BREASTFEED, amenorrhea
sheehan - postpartum hypopituitarism due to massive obstetric hemorrhage and hypovolemic shock causing ischemic necrosis of anterior pituitary
Increased risk for what if: previous csxn, hx of D&C, maternal age >35
Postpartum bleed
placenta accreta (uterine villi attach to myometrium)
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
placental abruption (premature detachment of placenta form uterus)
Antepartum hemorrhage following contractions and cervical dilation
placenta previa
when fetal vessels traverse amniotic membranes over internal cervical os. presents with PAINLESS antepartum bleeding and fetal HR abd just AFTER membrane rupture
vasa previa
HSVrisk factors
- primary maternal infection; vaginal delivery with active lesions
- longer duration of membrane rupture
- vaginal delivery with active lesions
- impaired skin barrier
- preterm birth
pregnant with women - ppx with ___ at ___wk
ppx with acyclovir/vancyclovir at 36wks
shoulder dystocia results in neuro deficit (extended wrist, hyperext MCPs, flexed IPs, abset grasp reflex) and horner syndrome (ptosis and miosis)
klumpke plasy - C8-T1 and sympathetic damage
LH surge = ?
menstruation
prior to conception until 20wks:
>or= 140/ >or=90
chronic HTN
> or= 20wks
new onset HTN, no proteinuria or end organ damage
gestational htn
> or= 20wks
new onset HTN AND proteinuria OR signs of end organ damage
preeclampsia
> or= 20wks
new onset HTN AND proteinuria OR signs of end organ damage AND new onset grand mal seizure
eclampsia
chronic HTN and 1+: new onset proteinuria or worsening of existing proteinuria at >or= 20wks; sudden worsening HTN; signs of end organ damage
chronic HTN superimposed on preeclampsia
test performed for pregnancies at risk for fetal hypoxia or fetal demise
nonstress test
- performed when decreased detal movements and fetal compromise is expected
Be aware of giving mag to a mom with what problem?
renal insufficiency bc mag is renally excreted
increased Maternal Serum AFP - thing what three things
open neural tube defects, ventral wall defects, multiple gestation
decreased Maternal Serum AFP - thing what
aneuploidy (tri18,21)
Post partym hemorrhage tx
bimanual uterine massage, IVF, O2, uterotonic meds (oxytocin, methylergonovine, carboprost, misoprostol)
Renal physiologic changes in preg:
RBF
GFR
Renal basement permeability
all increase
Renal lab changes in preg:
BUN
Cr
Renal protein excretion
BUN DECR
Cr DECR
Renal protein excretion INCR
tx of preeclampsia:
- BP
- Seizure
- BP: hydralazine IV, nifedipine po, labetalol IV (will also lower HR)
- Seizure - mag sulfate IV or IM
indications for prophylactic anti-D Ig admin for unsensitized Rh-neg pregnant pt
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
Give what 3 vaccines during pregnancy
Tdap
Inactivated influenza
RhoD
DO NOT give any pregnant pt what four vaccines?
MMR (safe for breastfeeding moms, give immediately postpartum)
Varicella
Live influenza
HPV
Woman with hyperemesis gravidum has horizontal nystagmus and bilateral abducens palsy (oculomotor dysfunciton), encephalopathy (confusion, incoherence), and ataxis.
Dx and tx
Dx: wernicke encephalopathy
Tx: thiamine IV and glucose (dt hypoglycemia in Hyperemesis Gravidum)
False v latent labor:
- Contractions irregular, infrequent, weak, no-mild pain, no cervical change
- Contractions regular and increasing frequency, increasing intensity, painful, and cervical change
- false
2. latent
no vainal bleeding, closed vervical os, no fetal activity or empty sac
missed abortion (fetus dead, still attached inside uterus)
vaginal bleeding, closed cervical os, fetal cardiac activity
threatened abortion (fetus alive, still attached inside uterus)
vaginal bleeding, open cervical os, products of conception seen/felt at or above cervical os
inevitable abortion (fetus not still attached inside uterus, not expelled)
vaingal bleeding, cervical os open, some products of conception expelled/some remain
incomplete abortion (fetus not still attached inside uterus, may/may not be expelled)
vaingal bleeding or non, closed os, products completely expelled
complete abortion (fetus completely expelled)
post csxn/surgery: fever unresponsive to abx, no localizing sx except possible BL LQ tenderness, negative infectious evaluation, dx of exclusion
septic pelvic thrombophlebitis - thrombosis of deep pelvic or ovarian viens
tx of septic pelvic thrombophlebitis
anticoagulation and bs-abx
fever, lower abd pain, heavy vaginal bleeding, malodorous purulent vaginal discharge, uterine tenderness
after (MC) elective abortion.
dx
septic abortion
medical induciton of aboriton
MTX or misoprostol (SAB)
