UW3 (14 Ob) Flashcards
PreTerm Labor (management)
- GA < 32w
- GA 32-33w
- GA > 34w
- Betamethasone
- Penicillin @ GBS
- Indomethacin
- MgSO4
- Betamethasone
- Penicillin @ GBS
- Nifedipine
- Betamethasone
- Penicillin @ GBS
Appendicitis @ pregnancy
- Complications? 2
- Management?
- Spontaneous abortion
- Preterm labor & delivery
• Surgery (no Ob complications)
PylePhelebitis
- Risks?
- Cause / Mechanism?
- Untreated Appendicitis, IA / Pelvic infections
* Portal vein thrombosis
Ob epidural (contraindication) 2
- Plt < 70
* Rapid Plt ↓
Pregnancy (skin changes)
Diagnosis & Treatment?
- Focal pruritus
- No rash
- Bile = n + LFT = n
- General pruritus
- No rash
- Bile ↑ + LFT ↑
Normal change
• Oatmeal bath
• UV light
• Anti histamine
IntraHepatic Cholestasis
• Ursodeoxycholic acid
• Anti histamine
Start @ Periumbilical
Urticarial papule & plaque
Vesicle / Bullae
- Diagnosis?
- Treatment? 3
Pemphigoid Gestationis
- Steroid topical
- Anti histamine PO
- Resolve after Delivery
PreEclampsia (prevention)
Aspirin low dose @ GA 12w
Exercise contraindication @ pregnancy
- Preterm Delivery risk? 3
- Bleeding risk? 2
- Medical conditions? 4
- Cervical insufficiency
- Preterm labor at current pregnancy
- PPROM
- Placenta previa
- Persistent bleeding @ T2-3
- Anemia
- PIH / Pre-eclampsia
- Restrictive lung disease
- Heart disease
Fetal Fibronectin (indication) When does it show false positive?
- GA < 34w
- Preterm contraction / delivery
• False ⊕ @ bleeding
Bariatric surgery @ pregnancy
- Indication? 2
- Benefits? 2
- Management?
- BMI > 35 + comorbitidy
- BMI > 40
• Reduce Ob complications (↓ Pre eclampsia & ↓ GDM)
- Delay pregnancy 1y after surgery
- Stabilize weight loss & nutrition
Seizure Medication (pregnancy)
- Before ⊕ preg test?
- After ⊕ preg test?
• Change medication > 6m
- Keep same meds
- Folic acid (high dose)
- Termination counsel before Screen (AFP/US)
SubChorionic Hematoma
- US findings?
- Course?
- Cresent
- HypoEchoic
- Normal
- Serial US
Labor management
- Prolong active labor?
- Arrest of labor?
- Dilation > 6cm + Progress < 1cm/2h
- Oxytocin / Amniotomy
- No fetal descent
- > 3h normal
- > 4h w/ epidural
- CS
Septic Abortion
- Risk? 2
- Symptom? 2
- Management? 4
- Elective abortion
- Spontaneous apportion
- Purulent vaginal discharge
- Boggy/Tender uterus
1) Culture (blood & endometrium)
2) Gentamicin + Clindamycin
3) Suction curettage
4) Hysterectomy
AFI (amniotic fluid index)
- Oligo?
- Poly?
- AFI < 5
- Pre-eclampsia
- Placental abruption
- UteroPlacental insufficiency
- Renal anomaly
- NSAID
- AFI > 24
- EsophageoDuodenal atresia
- Anencephaly
- Multiple gestation
- Congenital infection
- DM
Painless bleeding
GA > 20w
- Diagnosis?
- Diagnostic? Avoid?
- Treatment?
• Placenta Previa
- Speculum exam ok
- US-TV
- No digital vag/cerv exam
- Avoid instrument
- CS
Amniotic Fluid Embolism
Treatment?
Supportive
Cyst/Mass @ pregnancy
Surgery indication? 4
- Complex / Septations
- Growing
- Malignancy potential
- Size > 10cm
Epithelial Ovarian Carcinoma @ pregnancy
- Complications? 3
- Surgery indication? 3
- US findings?
- Treatment?
- Torsion
- Rupture
- Labor obstruction
- Complex
- Septations
- Size > 10cm
- Solid
- Complex
- Thick Septation
- Ascities
• Surgery @ early T2
Painless Cervical dilation
Pelvic pressure
Vaginal discharge/bleed
Amniotic bulge/prolapse
- Diagnosis?
- Treatment? Contraindication?
• Cervical Insufficiency
- Cerclage @ GA 12-14w
- CI @ membrane prolapse
Breech management
1) Before 37w
2) After 37w
1) rescan @ 37w
2) ECV
ECV contraindications? 4
- Herpes
- Placenta Previa
- Multiple gestation
- IUGR
Exercise @ pregnancy
- Goal?
- Benefits? Reduce risk of? 3
- 30min
- Mod intense aerobic
- most days of week
- GDM
- PreEclampsia
- CS
Cervical Cancer
Symptoms & PE?
- Irregular vaginal bleed
- Post coital bleed
- Vaginal discharge (Watery, Mucoid)
- Cervical mass (Friable, Exophytic)
Adolescent Pregnancy < 19y
- Maternal complications? 4
- Fetal complications? 4
- Hydatidiform mole
- Pre-eclampsia
- Anemia
- PP depression
- Gastrochisis
- Omphalocele
- Preterm birth
- SGA
PCOS
- Main treatment?
- Med for menstrual regulation?
- Med for ovulation?
- Weight ↓
- OCP (menst regulation)
- Letrozole (ovulation)
Uterus = tender / boggy
Vaginal discharge / bleed
PostPartum Endometritis
Treatment? 4
1) Clindamycin + Gentamicin
2) Unasyn
3) Cefotetan / Cefoxitin / Ceftaoxin
4) Zosyn
Cerebral Venous Sinus Thrombosis
- Symptoms?
- Treatment?
- Gradually Worsening headache @ Wakening / Valsalva
* Heparin
Contraction high freq low intensity Uterus = rigid + tender FHR = Late deceleration
- Diagnosis?
- Management for Rh-? 2
- Delivery indication?
• Placenta Abruption
- Kleihauer-Betke test
- RhoGam
• Abruption ⊕ + Active bleeding
AFP > 2.5 indication?
Management? 3
- NTD
- Ventral wall defect
1) Repeat AFP ↑
2) US
3) Amniocentesis
AFP ↑ + Acetylcholine esterase ↑
Vaginal bleeding FHR deceleration IntraAbd bleeding BP ↓ / HR ↑ Fetal station loss
Diagnosis?
Uterine Rupture
Neonatal HyperBilirubin
Exchange transfusion indication?
- Bilirubin > 20-25
* Kerniecterus
GBS Prophylaxis (management)
- UA & UC ⊕ / GBS test ⊕ ? 4
- GBS Unknown + GA < 37w, + fever, + ROM > 18h
1) Amoxicillin / Cephalexin
2) Repeat UC 1w
3) No repeat GBS test
4) Penicillin @ delivery
Penicillin @ delivery
RUQ pain / Headache / Hypertension
LFT ↑ / Plt ↓ / Hb ↓ / U-protein ↑
- Diagnosis?
- Management? 3
HELLP
1) MgSO4 / Hydralazine
2) Delivery
3) Plasma exchange @ AST > 2000 or LDH > 3000
Neonatal head finding (types)
- Boggy / Pitting edema / Poorly defined
- Present at birth
- Across suture line
- Not cross suture line
- Transient Bili ↑
- Vacuum delivery
- Hb ↓ / Shock
- Caput Succedaneum
- Resolve in days
- CephaloHematoma
- Weeks to resolve
- SubGaleal Bleed
- Monitor: Hb + Coag
- IVF
Pregnancy Contraindication (7)
- LV EF < 40%
- NYHA HF 3-4
- Peripartum cardiomyopathy
- Severe obstructive cardiac lesions
- Severe pulmonary hypertension
- (Eisenmenger)
- Aortic dilation > 4cm
Bipolar 1 (pregnancy)
- Treatment? 4
- Medications to avoid?
1) Haloperidol (acute)
2) Quetiapine / Risperidone / Olanzapine
3) Lithium
4) ECT
Valproate / Carbamazepine
Upper extremity Adduction Internal rotation Pronated forearm Asymmetric Moro reflex
- Diagnosis?
- Pathology?
- Erb Duchenne Palsy
* Brachial plexus injury @ C5-7
Vaginal problems (differential & treatment)
- Discharge = think / odor
- Stippled epithelium
- Discharge = purulent
- Cervix = friable / easy bleed
• Vesicular / Ulcerative
- Discharge = thick / white
- Pruritus
- Bacterial Vaginosis
- Metronidazole
- Clindamycin
- Symptomatic tx @ preg
- Chlamydia
- Azithromycin
- Herpes Simplex
- Acyclovir
- Candida
- Fluconazole
GBS⊕ management after delivery for neonate
1) Abx > 4h before delivery
2) All GBS ⊕
3) Inadequate treatment + Preterm < 37w / Prolong ROM > 18h
1) No treatment if treated
2) Obs 48h (Infection symptoms / Lethargy / Poor feed)
3) CBC / BC
Pre-Eclampsia
- Definition?
- Severe indication? 7
- Treatment? 4
- BP 140/70 after 20w
- Proteinuria / Organ damage
- BP > 160/110 x2 q4h
- Plt ↓ / Cr ↑ / LFT ↑
- Pulmonary edema
- Visual symptoms
- Neuro symptoms
1) MgSO4
2) BP meds
3) No severe = delivery @ 37w
Severe = delivery > 34w
Shoulder Dystocia Maneuvers
1) McRoberts
2) Woods Screw
3) Rubin
4) Gaskin
5) Zavanelli
1) Leg elevation & Hip HyperFlexion
2) Posterior shoulder rotation
3) Posterior shoulder adduction
4) Mother on hands & knees
5) Push head back then CS
IUGR
• Definition?
Occurrence, Cause, presentation
• Symmetric?
• Asymmetric?
• Fetal weight < 10th %
- T1
- Chromosomal abnormality
- Congenital infection
- Global growth lag
- T2-3
- UteroPlacental insufficiency
- Maternal malnutrition
- Head spared growth lag
placental insufficiency
- Diagnosis / Monitor? 3
- Delivery indication?
1) Umbilical artery doppler US
2) BPP
3) Growth reassement
• Umbilical artery end diastolic flow = Absent/Reverse
