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OB/GYN > Tx: Complications in Pregnancy > Flashcards

Tx: Complications in Pregnancy Flashcards

1
Q

Anemia

  • iron deficiency, severe, prevention
A
  • Iron deficiency: eat meat, leafy greens. Acidic foods to increase absorption. Iron supplements
    • Avoid tea, phytates, alkalines, tetracyclines
  • Blood transfusion if severe - shock, heart failure
  • Prevention:
    • Screening
    • Iron and folate supplements
    • Treat infections
    • Family planning
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2
Q

Placenta previa

*3rd trimester*

A

Consult OB

  1. Admit
  2. Stabilize
    • Magnesium sulfate

Management determined by state of mom & fetus

  1. Delivery:
    • nonreassuring fetal HR
    • life-threatening maternal hemorrhage,
    • >34 weeks + known fetal lung maturity
  2. Delivery when stable
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3
Q

Placental abruption

*3rd trimester*

A
  1. C/S if maternal or fetal jeopardy
  2. Vaginal delivery if term, in labor, and mom & fetus are stable
  3. Conservative tx in hospital if preterm, contractions have stopped, and mom & fetus are stable
  4. Rh (-): RhoGam
  • Hospitalized remainder of pregnancy, tx depends on size of the abruption
    • May need immediate delivery and stabilization
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4
Q

Vasa previa

*3rd trimester*

A

Immediate C/S

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5
Q

Uterine rupture (6)

*usually labor*

A
  1. Immediate C/S
  2. Left lateral decubitus position (maintain blood flow to fetus)
  3. D/C pitocin
  4. O2
  5. SQ terbutaline
  6. Emergency laparotomy if other measures fail
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6
Q

Cervical insufficiency (incompetent cervix)

*2nd Trimester*

A
  1. Cerclage (12-14 weeks if ≥2 prior 2nd trimester losses or ≥3 preterm births)
  2. US surveillance beginning at 14-16 weeks → cerclage if necessary
  3. Hydroxyprogesterone caproate prophylaxis with singleton until 36 weeks
  4. Alt: vaginal progesterone, pessary
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7
Q

Chronix/Pre-existing HTN

A
  1. A-methyldopa
  2. Labetolol
  3. Nifedipine
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8
Q

Preeclampsia

A

Resolves after delivery of placenta.

Severe:

  1. Delivery at 34 weeks
  2. Admit
  3. Betamethasone
  4. Antihypertensives
  5. IV magnesium sulfate

If <33-37 weeks give steroids, don’t delay delivery beyond maternal stabilization (when in doubt, deliver).

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9
Q

Postpartum HTN

>150/100

A
  1. Labetolol
  2. Nifedipine
  • or both
  • f/u in 3 days
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10
Q

Eclampsia

A
  1. MgSO4 IV
    • watch for Mg toxicity, treat with calcium gluconate
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11
Q

HELLP Syndrome

A

Same management as preeclampsia if HTN present.

  1. Delivery at 34 weeks
  2. Admit
  3. Betamethasone
  4. Antihypertensives
  5. IV magnesium sulfate

Goal is delivery

​

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12
Q

Gestational DM Tx

A
  1. A-1: diet controlled
  2. A-2: insulin or oral meds
    • metformin, glyburide, insulin if FBG >110
  3. Diet and exercise modification for everyone
  4. Encourage breastfeeding after delivery for glycemic control
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13
Q

Gestational DM Goals

A

Goal is strict euglycemia

  1. Fasting <95
  2. 1h Postprandial <140
  3. 2h Postprandial <120
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14
Q

Gestational DM Delivery

A
  • A-1: Up to 41 weeks
  • A-2: up to 39 weeks
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15
Q

Rh Alloimmunization

A

Prevention: RhoGam 300mg IM

  1. 28 weeks
  2. within 72 hours of delivery

If alloimmunization has occurred:

  1. Deliver at 37 weeks
  2. Future pregnancies with IVF, sperm donation, or surrogacy
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16
Q

Hydrops fetalis

A

fatal

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17
Q

Breech presentation

A
  • Close monitoring
  • Breech at 37 weeks: ECV
  • Failed ECV/not candidate: C/S at 29 weeks or later (85%)
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18
Q

Indications for C/S (12)

A
  1. Dystocia
  2. Repeat C/S
  3. Fetal distress
  4. Malpresentation (breech)
  5. Placenta previa
  6. Placenta abruption
  7. Preeclampsia/eclampsia
  8. Macrosomia
  9. Cervical cancer
  10. Active genital herpes
  11. Maternal request
  12. Fetal abnormalities (hydrocephalus)
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19
Q

Reasons to do a repeat C/S

A
  1. >1 transverse C/S
  2. Small pelvis
  3. Hx of vertical uterine incision
  4. Hx of myomectomy
20
Q

C/S incisions

A
  1. Midline vertical incision: if emergent C/S
  2. Transverse (Pfannenstiel) incision: preferred method
  • Inpt 3-4 days postprocedure
21
Q

Dystocia

22
Q

Fetal distress

A
  1. Turn mother on side (left lateral decubitous)
  2. O2
  3. Correct hypotension
  4. D/C oxytocin
  5. Exam: check for cord prolapse
23
Q

Chorioamnionitis

A
  1. Close monitoring
  2. C/S if delivery is not imminent
24
Q

Amniotic fluid embolism (in mom)

*result from C/S or precipitous labor*

A
  1. immediate resuscitation
25
Q

Peripartum hysterectomy

A

Total or supracervical approach

26
Q

Shoulder dystocia

A

*ACUTE EMERGENCY*

  1. McRoberts maneuver (maternal legs hyperflexed onto abdomen)
  2. Wood’s corkscrew maneuver
  3. Episiotomy
  4. C/S (suggested for future pregnancies)
27
Q

Umbilical cord prolapse

  • overt, funic, occult
A
  • Overt: EMERGENCY
    1. ​Stat pelvic exam - check cervix and check cord pulsations
    2. Knee-chest position (McRoberts maneuver)
    3. Continuous upward pressure on fetal presenting part (prevents cord compression)
    4. O2
    5. Emergent C/S
  • Funic: C/S prior to ROM
  • Occult:
    1. Change pt position
    2. O2
    3. Monitor closely
    4. C/S if compression
28
Q

Ectopic pregnancy

A
  • OB consult
  • Hemodynamically unstable: get to OR
  • Hemodynamically stable & ectopic <3.5cm, b-hCG <5000, & not breastfeeding:
    1. Methotrexate IM
    2. Rh (-): RhoGam
    3. Laparoscopy or surgery if not candidate for methotrexate
    4. Expectant management
29
Q

Threatened abortion

A
  • Send home
  • Nothing per vagina (tampons, intercourse)
30
Q

Missed abortion

A
  • Misoprostol
  • D&C
  • Rh (-): RhoGam
  • Pelvic rest for 2 weeks
31
Q

Incomplete/inevitable abortion

A
  • prompt D&C (stop bleeding and prevent infection)
  • Rh (-): RhoGam
  • Pelvic rest for 2 weeks
32
Q

Complete abortion

A
  • D&C
  • f/u
  • Rh (-): RhoGam
  • Pelvic rest for 2 weeks
33
Q

Nonviable fetus

A
  • Admit or D&C
  • F/u in 1 week
  • Return if heavy bleeding, pain, or fever
  • Rh (-): RhoGam
  • Pelvic rest for 2 weeks
34
Q

Septic post-abortion

A
  • Admit
  • Fluids
  • Abx
35
Q

Postpartum hemorrhage

  • med, stage 0-III
A

*EMERGENCY - CALL OB*

  • Misoprostol
  • Stage 0: uterine massage, oxytocin IV
  • Stage I: 1 IVs, Methergine, type & match, IV fluids
  • Stage II: Prostaglandins, RBC transfusion, consider OR/Epidural
  • Stage III: massive transfusion protocol, laparotomy, hysterectomy, uterine artery embolization
36
Q

Postpartum endometritis

A
  1. Call OB
  2. Broad spectrum abx
    • clindamycin + gentamicin or ampicillin + gentamicin if vaginal delivery
37
Q

Premature Rupture of Membranes (PROM)

A
  1. Call OB
  2. Admit for delivery
  3. Expectant management
    • betamethasone (corticosteroids)
    • Abx to prevent strep B infection
    • activity restriction
    • Removal of cerclage
    • Try to manage until 34 weeks
  4. Prophylactic abx
38
Q

Preterm Premature Rupture of Membranes (PPROM)

A
  • No sign of fetal distress: admit, fetal monitoring, wait for spontaneous labor
    • <34 weeks: betamethasone
  • Tocolytics
  • Abx: Ampicillin + Azithromycin
  • Maternal or fetal distress: Prompt delivery
39
Q

Premature labor

A
  1. Call OB
  2. Tocolytics to suppres contractions
    • Terbutaline
    • Magnesium sulfate
  3. Antenatal corticosteroids = betamethasone
  4. Abx prophylaxis
40
Q

Placenta accreta

A
  1. C/S, leave placenta for later D&C
  2. consider Hysterectomy
41
Q

Gestational Trophoblastic Disease

A
  • D&C with pathology
  • Hysterectomy if done having kids
  • Follow weekly b-hCG for 3 weeks, then monthly for 3-6 months (make sure trending down)
    • if not trending down → malignant → methotrexate and chemo
  • Use contraception and do not get pregnant for 6 months (allows us to follow b-hCG to r/o malignancy)
42
Q

Recurrent Pregnancy Loss

A
  • Low weight molecular heparin (LWMH) /Lovenox
  • Aspirin
  • IVIg
  • Corticosteroids
  • Prophylactic heparin and ASA if antiphospholipid antibody syndrome
43
Q

Induced abortion

A
  • Counseling and informed consent
  • Discuss future contraception
  • <10-11 weeks: Misoprostol
  • Surgery
44
Q

Baby blues

A
  • Resolve within 2 weeks
  • Consider counseling/therapist
45
Q

Postpartum depression

A
  1. CBT 1st line
  2. Antidepressants
    • sertraline if breastfeeding
    • Paroxetine
  3. ​Refractory: consider ECT (safe during breastfeeding)
  4. Prophylactic antidepressants if hx of MDD
46
Q

Postpartum psychosis

A
  • Immediate referral to ED and mental health specialist
47
Q

Multiple gestation delivery

A
  1. Adequate staff - extra nurses, anesthesia, peds, neonatologist
  2. Fetal monitoring
  3. Pain control: epidural
  4. Informed consent if need for C/S
  5. IV access
  6. Pitocin
  7. Aggressive management of 3rd stage of labor (delivery of placenta)

OB/GYN (7 decks)

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