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152 Cards in this Set

  • Front
  • Back
What encompasses obstetrics?
pregnancy, childbirth, & puerperium(see Taber's)
What the hell is puerperium?
post-partum, period of time shortly after childbirth
What is abruptio placentae?
premature separation of a placenta from the uterus
Signs & sxs of abruptio placentae?
(name 4)
1.vaginal bleeding
2.uterine pain
3.hemorrhagic shock
4. DIC
Cause of & explanation of severity of sxs for abruptio placentae?
cause unknown
severity depends on degree of separation & blood loss
Abruptio placentae:
Risk to fetus?
fetal ischemia
Abruptio placentae:
What must you r/o when suspecting this BEFORE doing pelvis exam?
placenta previa
Abruptio placentae:
evaluation of includes what 3 things?
1. fetal heart monitoring
2. CBC measurement of serum fibrinogen
3. fibrin-split products
Abruptio placentae:
bed rest or prompt delivery
Cervical Incompetence:
What is it and what does it result in?
painless cervical dilation resulting in delivery of live fetus between 16 & 22 weeks
Cervical Incompetence:
suturing/reinforcing of cervical ring (cerciage)
Cervical Incompetence:
causes of ?
(name 4)
1. congenital ex: Ehlers-Danlos syn
2. deep cervical lacerations
3. induction of ovulation
4. more than 3 fetal losses during 2nd trimester
What is it & when does it happen?
infxn of chorion & amnion
occurs near term
Results from?
an infxn which climbs through genital tract
Consequences of?
(name 5)
1. premature rupture of membranes (Know this)
2. premature labor(Know this)
3. neonatal pneumonia
4. bacterimia
5. meningitis
broad-spectrum abx & delivery
Ectopic pregnancy:
Where do they occur?
(name 6)
1.fallopian tube(most common)
3.uterine interstitium(2nd most common)
5.abdominal cavity
6.pelvic cavity
Ectopic pregnancy:
What is there alternate fate instead of coming to term?
rupture or involute
Ectopic pregnancy:
Early sxs without rupture?
(name 3)
2.vaginal bleed
3.cervical motion tenderness
Ectopic pregnancy:
Sxs post rupture?
(name 2)
2.hemorrhagic shock
Ectopic pregnancy:
Dx by?
(name 2)
1.beta-human chorionic gonadotropin measurement (beta-hCG)
Ectopic pregnancy:
Risk factors?
(name 6)
1.increasing maternal age (Know this)
2.prior PID(pelvic inflam dz)(particularly from Chlamydia trachomatic)
3.prior ectopic preg
4.prior tubal surgery
5.cigarette smoking
6.prior induced abortion
Ectopic pregnancy:
Bleeding from where results in what kind of inflammation?
intraperitoneal blood causes peritonitis
Ectopic pregnancy:
Where are b-hCG levels measured from?
(name 2)
2.serum (x<5mlIU/mL)would actually r/o ectopic preg
Ectopic pregnancy:
What 2 keynotes suggest?
1.ABSENCE of intrauterine sac
2.b-hCG x>2000mlIU/mL
Ectopic pregnancy:
What prodcedure is used for supplementatal confirmation?
Ectopic pregnancy:
if dx unclear, what levels measured?
Ectopic pregnancy:
name & describe the surgery technique for tx?
surgical removal of the fallopian tubes
Erythroblastosis Fetalis:
What is it & what is it d/t?
hemolytic anemia in fetus d/t transmission of maternal abs to fetal RBCs
Erythroblastosis Fetalis:
How would you describe the blood groups of mom & baby?
Erythroblastosis Fetalis:
Remember Waks, what is the Rh for mom and for baby, who is - and who +?
mom: Rh-
baby: Rh+
Erythroblastosis Fetalis:
Dx begins with?
prenatal maternal antigenic and ab screening
may require paternal screening also
Erythroblastosis Fetalis:
How do ABO bloodtypes cause this?
they don't!
(admit it, you were scared b/c you had no clue)
Erythroblastosis Fetalis:
Can other fetomaternal incompatibilities cause this?
some are names like Duffy, Diego, and Kidd (not kidding)
some are religions like Lutheran
some are random letter that you'll never remember like Xg, P, Ee, MNSs
Erythroblastosis Fetalis:
Back to our Rh mom & baby.
Is this pregnancy at less of a risk than subsequent pregnancies?
yes. maternal abs will cross placenta in subsequent pregnancies and lyse fetal RBCs resulting in anemia
Erythroblastosis Fetalis:
How does the anemia affect fetal bone marrow and circulatory RBCs?
the bone marrow is forced to create immature RBCs (erythroblasts) in the circulation (erythroblastosis fetalis)
Erythroblastosis Fetalis:
What is isoimmunization?
fetal RBCs stimulating maternal ab production
Erythroblastosis Fetalis:
Hemolysis of RBCs will elevate levels of what in neonates?
indirect bilirubin
Erythroblastosis Fetalis:
If amniotic fluid cells were required b/c the father is heterozygous for RhO(D), any of what 3 things would allow pregnancy to continue untreated?
1.fetal blood Rh -
2.middle cerebral artery blood flow remains normal
3.amniotic bilirubin levels remain normal
Erythroblastosis Fetalis:
If fetus is high-risk, how long are transfusions performed until?
until fetal lung maturity
Erythroblastosis Fetalis:
Prevention performed how?
giving mother RhO(D) immunoglobulin injection which neutralizes Rh + fetal RBCs so as to avoid maternal ab production, which may eventually attack subsequent children
Erythroblastosis Fetalis:
How long do the anti-Rh abs persist for after injection?
x>3 months from one dose
Herpes Gestationis
(Pemphigoid Gestationis):
What is it and what strain of Herpes causes it?
this polymorphic vesicobullous eruption occurs during pregnancy or postpartum and is NOT caused by any Herpes virus
Herpes Gestationis
(Pemphigoid Gestationis):
dx how?
skin biopsy
Herpes Gestationis
(Pemphigoid Gestationis):
What category of dz is this believed to be?
Herpes Gestationis
(Pemphigoid Gestationis):
Describe the rash?
Hint: PALS
Pruritic (itchy)
Abdominal onset
Labor makes it worse
Shape is greatly varied (papules & plques widespread with vesicles and bullae on outer border)
Herpes Gestationis
(Pemphigoid Gestationis):
Hyperemesis Gravidarum:
What is it and what does it result in?
uncontrollable vomitting during pregnancy resulting in dehydration and ketosis
Hyperemesis Gravidarum:
Dx via?
(name 3)
1.measurement of urine ketones
2.serum electrolytes
3.renal function
Hyperemesis Gravidarum:
Pregnancy usually causes n/v d/t what 2 elevating levels?
2.b-hCG (beta-human chorionic gonadotropin
Hyperemesis Gravidarum:
Most cases are?
morning sickness which is NOT ASSOCIATED WITH weight loss, dehydration, or ketoacidosis
Hyperemesis Gravidarum:
May be triggered by psychologic events, true or false?
Hyperemesis Gravidarum:
What serum and liver markers are evaluated?
(name some of 9 things)
urine ketones, TSH, serum electrolytes, AST, ALT, BUN, serum creatinine, Mg, P, and sometimes weight
Hyperemesis Gravidarum:
What 2 things must be r/o and by using what?
1.hyatidirom mole
2.multi-fetal pregnancy
r/o via ultrasound
Hyperemesis Gravidarum:
Other dzs to r/o?
(name some of 8)
hepatitis, pyelonephritis, pancreatitis, intestinal obstruction, GI tract lesions, hyperthyroidism, gestational trophoblastic dz, & increased intracrania
Hyperemesis Gravidarum:
IV electrolytes, nothing by mouth for a while
Placenta Previa:
What is it?
when placenta is found over or near the INTERNAL OS of the cervix
Placenta Previa:
Sxs and when?
painless bright red vaginal bleed late in pregnancy
Placenta Previa:
(must know)
Placenta Previa:
What varieties of this exist?
(name 4)
1. total
2. partial
3. marginal
4. low-lying
*all titles are in regard to the os*
Placenta Previa:
Risk factors?
(name 5)
2.prior cesarean
3.uterine abnormalities that inhibit implantation like fibroids
5.multifetal pregnancy
Placenta Previa:
If occurs in early pregnancy, by what week does it resolve usually?
by 20th week
Placenta Previa:
What kind of exams are forbidden in vaginal bleeds post-20th week and why?
PELVIC EXAMS b/c may increase bleeding if pt has a placenta previa
Placenta Previa:
abruptio placentea
Placenta Previa:
if major bleeding, c-section
if minor bleeding, hospitalization with bed rest and abstinance
Preeclampsia & Eclampsia:
What are they?
Pre: Preg-induced HTN + proteinuria
Ecl: unexplained generalized seizures in above pts
Preeclampsia & Eclampsia:
When do they develop?
between the 20th week and end of 1st week puerperium
Preeclampsia & Eclampsia:
Women usually affected are either?
primigravidas (1st pregnancy)
or with preexisting vascular disorder
Preeclampsia & Eclampsia:
Other risk factors?
(name 6)
1. previous preclampsia pregnancies
2. maternal age x<20 y/o
3. family history
4. multifetal pregnancy
5. thrombotic disorders
6. obesity
Preeclampsia & Eclampsia:
Untreated preeclampsia will progress to eclampsia slowly or rapidly?
Preeclampsia & Eclampsia:
Etiology and pathophysiology?
(name 2 possible mechanisms)
unknown but may include poorly developed uterine placental arterioles or lipid peroxidation
Preeclampsia & Eclampsia:
Vasospasm would result in?
(name 3 organs affected)
affecting brain, kidneys, and liver particularly
Preeclampsia & Eclampsia:
Contributors to vasospasm include?
(name 3)
1. decreased prostacyclin (vasodilator)
2. increased endothelin (vasoconstrictor)
3. increased soluble Flt-1 (a receptor for vascular endothelial growth factor)
Preeclampsia & Eclampsia:
(name 4)
1. nondependent edema (edema not necessarily found below heart) (Know this)
2. increased reflex reactivity
3. petechiae
4. asymptomatic
Preeclampsia & Eclampsia:
via sxs of HTN, especially sudden onset HTN (Know this)
urinalysis, CBC & plts, liver fxn tests, & HELLP syn
Preeclampsia & Eclampsia:
HELLP stands for?
Liver fxn tests &
Preeclampsia & Eclampsia:
but if pt not severe, outpatient tx is strict bedrest, lying on side whenever possible, massage
of edematous areas, increase fluids, and maintain normal salt intake
Preeclampsia & Eclampsia:
Standard IV medication to pts with severe preeclampsia?
Mg sulfate
Preeclampsia & Eclampsia:
if pt with eclampsia, what 2 conditions must be controlled prior to delivery?
seizures & HTN
Preeclampsia & Eclampsia:
If not resolved before delivery, how long until they do?
6-12 hours puerperium
What is Pruritic Urticarial Papules and Plaques of Pregnancy(PUPPP)?
-common pruritic eruption of pregnancy of unknown etiology
-1 in every 160~300 pregnancies
PUPPP Sx and Symptoms?
-intensely pruritic, erythematous, solid, superficial, and elevated urticaria-like papules and plaques
-some with minute vesicles in center
-some surrounded by blanching
PUPPP-where does lesions start?
-on abdomen
-frequently on striae atrophicae(stretch marks)
PUPPP-other places?
-can spread to thighs, buttocks, occasionally arms
PUPPP-When develop?
-during 3rd trimester
-most often in the last 2~3wk
PUPPP-when resolve?
-usu. w/in 15days after delivery
-only upto 5% of subsequent pregnancies
-mile symptoms: topical corticosteroids(0.1% triamcinolone acetonide cream upto 6x/day
-severe symptoms:systemic corticosteroids(predisone 40mg by mouth/day)=rare
Spontaneous Abortion(miscarriage)-definition?
noninduced embryonic or fetal death or passage of products of conception b/f the 20th wk of pregnancy
Spontaneous abortions-What are the 4 different type of spontaneous abortions?
1. threatened
2. inevitable
3. incomplete
4. complete
Threatened abortion-definition?
any bleeding or cramping of uterus in the 1st 20wk of pregnancy
What's definition of abortion?
deathof the fetus or passage of products of conception(fetus & placenta) b/f 20wk of prgnancy
Induced abortion definition?
done for medical or elective reasons
Inevitable abortion definition?
intolerable pain or bleeding that threatens the woman's well-being
Incomplete abortion under Spontaneous abortion classification?
if part of products of conception is passed or if the membrances are ruptured
Complete abortion?
if all the products of conception are passed, uterus contracted toward normal size, and cervix has closed, abortion is complete
How to Dx Threatened abortion?
by clinical criteria and ultrasonography
Threatened abortion-Tx?
-usu. bed rest
-if spontaneous abortion occured or unavoidable(empty sac, absent of cardiac activity) evacuation of uterine
Stillbirth definition?
fetal death after 20wk with delivery
Late fetal death definition?
Fetal death after 20wk
Preterm(preterm birth) definition?
passage(delivery) of a live fetus b/t 20 and 37wk
Early abortion?
b/f 12wk of pregnancy
Late abortion?
b/t 12 and 20wk
What is the term for abortions performed to save the pregnant woman's life or health?
What is the term for the occurrence of 3 or more consecutive spontaneous abortions?
habitual abortion
What is the term for fetus has died but has been retained in utero 4wk or longer?
Missed abortion
What is septic abortion?
develops when the contents of the uterus become infected before, during or after an abortion
When do you suspect missed abortion?
-if uterus fails to grow
-fetal heart is not heard at the appropriate time w/Doppler ultrasonography
-absent heart sound(that was there b/f)
-serum or urine test for beta-subunit of HCF becomes negative earlier than expected(low for gestational age or not double w/in 48~72hrs)
Incidence of Spontaneous abortion?
~20 to 30% of women bleed or cramping during 1st 20wk of prgnancy;1/2(10~15%) of these women spontaneously abort
-probably higher # of incidence since every early abortions are mistaken for a late menstrual period
Etioloy of spontaneous abortions?
1. viruses
-rubella virus
2. disorders cause sporadic or recurrent abortion
-chromosomal or mendelian abnomalities
-luteal phase defects
3. immunologic abnomalities
4. major trauma
Signs and Symptoms of spontaneous abortion?
crampy pelvic pain, bleeding, eventual expulsion of tissue
Signs and Symptoms of late spontaneous abortion?
-may begin w/ gush of fluid when membrances rupture
-hemorrage is rarely massive
-if dilated cervix=innevitable abortion
What might be the cause of abortions after 10 or greater than 10wk?
acquried and hereditary thrombophilias
Ultrasonograhy and quantitative measurement of serum beta subunite of human chrorionic gonadotropin(beta-HCG) tells us?
-to rule outectopic pregnancy
-DDx tool to different types of abortion
Which one does not cause vaginal bleeding?
a. threatened
b. inevitable
c. incomplete
d. missed
D. missed
What symptoms do you expect if products of conception remain in uterus after spontaneous abortion?
1. vaginal bleeding(usu. after delay)
2. fever, pain, sepsis d/t infection
Dx of threatened, inevitable, incomplete, or complete abortion is often possible based on?
1. clinical criteria
2. positive urine pregnancy test
Tx of inevitable, incomplete, or missed abortions?
1. uterine evacuation
2. at less than 10wk, wait for spontaneous passage of products of conception
at less or equal to 12wk of pregnancy
Dilation and evacuation?
at 12~23wk
medical induction?
(for women w/o prior uterine surgery)
at greater than 16~23wk
Recurrent abortion usually result from disorders that cause what?
intrauterine fetal damage
What causes 50% of recurrent abortions?
chromosomal abnormalities
other common casues of recurrent abortions?
-maternal luteal phase defects(usu @ less then 6wk)
-overt endocrine disorders(polycystic ovary syndrome, hypothyroidism, hyperthyroidism, poorly controlled DM)
What is septic abortion?
serious uterine infection during or shortly b/f or after an abortion
Septic abortion usually result from?
indued abortions done by untrained practitioners uning nonsterile techniques
Causative organisms of septic aboriton?
E. coli
Enterobacter aerogenes
Proteus vulgaris
hemolytic streptococci
Signs and Symptoms of septic abortion?
-similar to pelvic inflammatory dz
-septic shock may result(hypothermia, hypotension, oliguria, respiratory dz)
-Sepsis d/t C. perfringens
Definition of stillbirth?
delivery of a dead fetus whose gestational age is older than 20wk
Most common cause of stillbirth?
abruptio placentae
Contraindications for forceps delivery and vacuum extraction?
-fetal head larger than pelvic opening
-incomplete dilation of the cervix
-absence of engagement
-indeterminate fetal presentation or position
Incuction of labor?
-stimulation of uterine contractions usu w/oxytocin
-fetal lung must be assessed
What is cesarean section?
-delivery by incision into the uterus
-15%~20% of deliveries are cesarean section in US(much lower in most other countries)
Most common specific indications of cesarean section?
1. previous cesarean section
2. protracted labor
3. fetal dystocia(breech presentation)
4. nonreassuring fetal heart rate
What is amniotic fluid embolism?
-entrance of amniotic fluid and fetal cells into the maternal pulmonary circulation
-rare ostetric ER
autopsy of women showed fetal squamous cells and hair in the pulmonary circulation. What do you suspect?
Amniotic Fluid Embolism
Tx of Amniotic fluid Embolism?
transfusion of RBCs and fresh forzen plasma, clotting factors, inotropic drugs
What is Fetal Dystocia?
abnormal fetal size or position resulting in difficult delivery
Tx of fetal dystocia?
with physical maneuvers to reposition the fetus, forceps delivery, or cesarean section
Fetopelvic disproportion?
-fetus is too large for the pelvic opening
-one of the cause of fetal dystocia
Occiput posterior presentation?
-1st most common abnormal presentation
-larger diameter needed d/t deflexed fetal neck
-(many cases forceps delivery or C section require)
Face presentation?
hyperextended head and chin may be posterior
-(if chin posterior= C section)
Brow presentation?
-usu converts spontaneously to occiput or face presentation
Breech presentation?
-2nd most common abnormal presentation
-buttocks b/f the head
-can casue head to be trapped during delivery, w/umbilical cord compressing
2types of breech presentation?
1. frank breech=fetal hips are flexed, knees extended
2. complete breech=fetus seems to be sitting with hips and knees flexed
Single/double footing presentation?
-single or both legs are completely extended and present b/f buttocks
Breech presentation increases risk of?
-preterm delivery
-fetal brachial plexus
-spinal cord birth trauma
-prenatal death
External version maneuver?
gently pressing on the maternal abdomen at 37~38wk to move fetus into vertex presentation b/f labor
Transverse lie?
-transverse position fetus w/fetal long axis oblique or perpendicular to maternal long axis
shoulder dystocia?
-rare, vertex presentation but anterior fetal shoulder is lodged behind the symphysis pubis
-id by turtle sign=head pulled back tightly against the vulva after passing through the cervix
-asphyxiation of fetus can occur
Risk factor of shoulder dystocia?
-large fetus
-maternal obesity
-maternal diabetes mellitus