Uwise - Unit 2: Obstetric Pathology Flashcards
Pt with suspected ruptured ectopic pregnancy - tx?
Surgery
Criteria for giving methotrexate for ectopic pregnancy?
- Hemodynamic stability
- Nonruptured
- Less than 4 cm in size without heart rate or less than 3.5 cm with heart rate.
- Normal liver enzymes, renal function, WBC count
Medical conditions that cause first trimester abortions?
Diabetes, SLE, chronic renal disease
Treatment for spontaneous loss of pregnancy due to cervical incompetence?
Cervical cerclage
Missed abortion – treatment?
First trimester – nothing needs to be done (at least for a couple of weeks)
Second trimester – D & E
Highest risk for mortality in pregnancy?
Maternal mortality over 25%
Screening for gestational diabetes?
Without hx of glucose intolerance - 24-28 weeks
With hx (obesity, family hx), screen ASAP
Bronchial breath sounds suggest?
Consolidation
Antidepressant contraindicated in pregnancy?
Paroxetine (fetal cardiac malformations)
Management of nephrolithiasis in pregnancy?
- Aggressive hydration
- Antimicrobials
- If no resolution in 72 hours, double-J stent
- If need long term stenting, do percutaneous nephrostomy
When to emergency deliver from a preeclampsia mother?
Thrombocytopenia, elevated LFTs, CNS symptoms, Oliguria
Mag levels and related toxicity?
4-7 normal
7-10 loss of DTR
12+ respiratory depression
(Pulmonary edema is a side effect, not a toxicity)
Zone 3 Liley curve tx?
Severe hemolytic Rh disease (risk of hydrops and fetal death in next week)
Give fetal transfusion (plasmapheresis is transfusion not possible)
Non-invasive test to determine fetal anemia?
Middle cerebral artery Doppler
G1 pt with unexpected fetal demise. Chronic condition that could be the cause?
Diabetes
Pt undergoing suction D&C when bowel comes out - next step?
Laparoscopy
Premenstrual dysphoric disorder?
Depressive symptoms in the luteal phase (absent and beginning of follicular phase)
Pregnant pt with suspected IUGR - monitoring?
- Amniotic fluid measurement (for oligohydramnios)
- Systolic/diastolic ratio (increase suggests increased vascular resistance seen in IUGR)
- NST
Process that can lead to IUGR and poor neurological outcome?
Severe vascular resistance
Cause of asymmetric growth restriction versus symmetric growth restriction?
Uteroplacental insufficiency versus intrinsic growth failure/early event (organ system anomaly, aneuploidy, infection)
Organisms that cause growth restriction? Organisms that do not call cause growth restriction?
Viral – CMV, rubella, Syphilis, varicella
Protozoa – toxoplasmosis
No bacterial causes of growth restriction
Vaginal tears – classification?
1 – vaginal mucosa
2 – vaginal fascia and perineum
3 – rectal sphincter
4 – external anal sphincter, internal anal sphincter, rectal mucosa
Gynecologic factor that indicates C-section?
Fibroids
advantage of vacuum assisted delivery versus forceps for mother?
Less incidence of maternal lacerations
When is external cephalic version contraindicated? Do instead?
Acting labor; C-section
Non-Contraceptive health benefits of female sterilization?
Of OCP?
Reduced risk of ovarian cancer
Reduced breast cancer, ovarian cancer, endometrial cancer
Patient progressing during labor – steps before considering C-section?
- Ptosin
2. IUPC
Patient with close cervix who wishes induction of labor – use?
Cytotec (cervdil)
Patient with uterine fibroids – potential labor complication?
Breech presentation
When to rupture membranes artificially?
Arrest in the active phase of labor
Effect of smoking on baby?
Small sick baby peeing blood
IUGR, infection, preeclampsia, placental abruption, placenta previa
Friable cervix without dilation?
Friable cervix with dilation?
Cervicitis
Bloody show
4 effects of steroids during pregnancy?
- Lung maturity
- Decreased respiratory distress syndrome
- Decreased intraventricular hemorrhage
- Decreased necrotizing enterocolitis
Management of the patient over 34 weeks with spontaneous rupture of membranes without labor?
Induce labor
Physical finding that is an indication for delivery?
Tender uterine fundus
Patients with uterine atony – most appropriate next step?
Prostaglandin F2-Alpha
Patients with chronic asthma – contraindicated uteroonic agent?
Prostaglandin F2
Most serious type of postpartum bleeding?
placenta accreta
Newly breast-feeding mother develops a low-grade fever – cause?
Breast engorgement
Classic presentation of septic thrombophlebitis? Tx?
Postpartum fever unresponsive to antibiotics
Heparin
