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152 Cards in this Set
- Front
- Back
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What encompasses obstetrics?
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pregnancy, childbirth, & puerperium(see Taber's)
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What the hell is puerperium?
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post-partum, period of time shortly after childbirth
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What is abruptio placentae?
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premature separation of a placenta from the uterus
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Signs & sxs of abruptio placentae?
(name 4) |
1.vaginal bleeding
2.uterine pain 3.hemorrhagic shock 4. DIC |
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Cause of & explanation of severity of sxs for abruptio placentae?
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cause unknown
severity depends on degree of separation & blood loss |
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Abruptio placentae:
Risk to fetus? |
fetal ischemia
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Abruptio placentae:
What must you r/o when suspecting this BEFORE doing pelvis exam? |
placenta previa
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Abruptio placentae:
evaluation of includes what 3 things? |
1. fetal heart monitoring
2. CBC measurement of serum fibrinogen 3. fibrin-split products |
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Abruptio placentae:
tx? |
bed rest or prompt delivery
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Cervical Incompetence:
What is it and what does it result in? |
painless cervical dilation resulting in delivery of live fetus between 16 & 22 weeks
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Cervical Incompetence:
tx? |
suturing/reinforcing of cervical ring (cerciage)
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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 |
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Chorioamnionitis:
What is it & when does it happen? |
infxn of chorion & amnion
occurs near term |
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Chorioamnionitis:
Results from? |
an infxn which climbs through genital tract
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Chorioamnionitis:
Consequences of? (name 5) |
1. premature rupture of membranes (Know this)
2. premature labor(Know this) 3. neonatal pneumonia 4. bacterimia 5. meningitis |
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Chorioamnionitis:
keynote? |
TACHYCARDIA PERSISTING WITHOUT FEVER
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Chorioamnionitis:
tx? |
broad-spectrum abx & delivery
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Ectopic pregnancy:
Where do they occur? (name 6) |
1.fallopian tube(most common)
2.cervix 3.uterine interstitium(2nd most common) 4.overy 5.abdominal cavity 6.pelvic cavity |
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Ectopic pregnancy:
What is there alternate fate instead of coming to term? |
rupture or involute
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Ectopic pregnancy:
Early sxs without rupture? (name 3) |
1.PELVIC PAIN
2.vaginal bleed 3.cervical motion tenderness |
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Ectopic pregnancy:
Sxs post rupture? (name 2) |
1.syncope
2.hemorrhagic shock |
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Ectopic pregnancy:
Dx by? (name 2) |
1.beta-human chorionic gonadotropin measurement (beta-hCG)
2.ultrasound |
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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 |
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Ectopic pregnancy:
Bleeding from where results in what kind of inflammation? |
intraperitoneal blood causes peritonitis
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Ectopic pregnancy:
Where are b-hCG levels measured from? (name 2) |
1.urine
2.serum (x<5mlIU/mL)would actually r/o ectopic preg |
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Ectopic pregnancy:
What 2 keynotes suggest? |
1.ABSENCE of intrauterine sac
2.b-hCG x>2000mlIU/mL |
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Ectopic pregnancy:
What prodcedure is used for supplementatal confirmation? |
laparoscopy
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Ectopic pregnancy:
if dx unclear, what levels measured? |
progesterone
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Ectopic pregnancy:
name & describe the surgery technique for tx? |
salpingectomy
surgical removal of the fallopian tubes |
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Erythroblastosis Fetalis:
What is it & what is it d/t? |
hemolytic anemia in fetus d/t transmission of maternal abs to fetal RBCs
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Erythroblastosis Fetalis:
How would you describe the blood groups of mom & baby? |
incompatible
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Erythroblastosis Fetalis:
Remember Waks, ...now what is the Rh for mom and for baby, who is - and who +? |
mom: Rh-
baby: Rh+ |
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Erythroblastosis Fetalis:
Dx begins with? |
prenatal maternal antigenic and ab screening
may require paternal screening also |
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Erythroblastosis Fetalis:
How do ABO bloodtypes cause this? |
they don't!
(admit it, you were scared b/c you had no clue) |
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Erythroblastosis Fetalis:
Can other fetomaternal incompatibilities cause this? |
yes.
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 |
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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
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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)
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Erythroblastosis Fetalis:
What is isoimmunization? |
fetal RBCs stimulating maternal ab production
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Erythroblastosis Fetalis:
Hemolysis of RBCs will elevate levels of what in neonates? |
indirect bilirubin
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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 |
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Erythroblastosis Fetalis:
If fetus is high-risk, how long are transfusions performed until? |
until fetal lung maturity
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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
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Erythroblastosis Fetalis:
How long do the anti-Rh abs persist for after injection? |
x>3 months from one dose
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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
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Herpes Gestationis
(Pemphigoid Gestationis): dx how? |
skin biopsy
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Herpes Gestationis
(Pemphigoid Gestationis): What category of dz is this believed to be? |
auto-immune
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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) |
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Herpes Gestationis
(Pemphigoid Gestationis): Tx? |
corticosteroids
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Hyperemesis Gravidarum:
What is it and what does it result in? |
uncontrollable vomitting during pregnancy resulting in dehydration and ketosis
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Hyperemesis Gravidarum:
Dx via? (name 3) |
1.measurement of urine ketones
2.serum electrolytes 3.renal function |
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Hyperemesis Gravidarum:
Pregnancy usually causes n/v d/t what 2 elevating levels? |
1.estrogens
2.b-hCG (beta-human chorionic gonadotropin |
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Hyperemesis Gravidarum:
Most cases are? |
morning sickness which is NOT ASSOCIATED WITH weight loss, dehydration, or ketoacidosis
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Hyperemesis Gravidarum:
May be triggered by psychologic events, true or false? |
true
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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
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Hyperemesis Gravidarum:
What 2 things must be r/o and by using what? |
1.hyatidirom mole
2.multi-fetal pregnancy r/o via ultrasound |
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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
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Hyperemesis Gravidarum:
Tx? |
IV electrolytes, nothing by mouth for a while
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Placenta Previa:
What is it? |
when placenta is found over or near the INTERNAL OS of the cervix
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Placenta Previa:
Sxs and when? |
painless bright red vaginal bleed late in pregnancy
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Placenta Previa:
Dx? |
ULTRASOUND
(must know) |
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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* |
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Placenta Previa:
Risk factors? (name 5) |
1.multiparity
2.prior cesarean 3.uterine abnormalities that inhibit implantation like fibroids 4.smoking 5.multifetal pregnancy |
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Placenta Previa:
If occurs in early pregnancy, by what week does it resolve usually? |
by 20th week
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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
so DO ULTRASOUND |
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Placenta Previa:
DDX? |
abruptio placentea
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Placenta Previa:
Tx? |
if major bleeding, c-section
if minor bleeding, hospitalization with bed rest and abstinance |
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Preeclampsia & Eclampsia:
What are they? |
Pre: Preg-induced HTN + proteinuria
Ecl: unexplained generalized seizures in above pts |
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Preeclampsia & Eclampsia:
When do they develop? |
between the 20th week and end of 1st week puerperium
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Preeclampsia & Eclampsia:
Women usually affected are either? |
primigravidas (1st pregnancy)
or with preexisting vascular disorder |
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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 |
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Preeclampsia & Eclampsia:
Untreated preeclampsia will progress to eclampsia slowly or rapidly? |
rapidly
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Preeclampsia & Eclampsia:
Etiology and pathophysiology? (name 2 possible mechanisms) |
unknown but may include poorly developed uterine placental arterioles or lipid peroxidation
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Preeclampsia & Eclampsia:
Vasospasm would result in? (name 3 organs affected) |
ischemia
affecting brain, kidneys, and liver particularly |
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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) |
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Preeclampsia & Eclampsia:
Sxs? (name 4) |
1. nondependent edema (edema not necessarily found below heart) (Know this)
2. increased reflex reactivity 3. petechiae 4. asymptomatic |
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Preeclampsia & Eclampsia:
Dx? |
via sxs of HTN, especially sudden onset HTN (Know this)
urinalysis, CBC & plts, liver fxn tests, & HELLP syn |
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Preeclampsia & Eclampsia:
HELLP stands for? |
Hemolysis
Elevated Liver fxn tests & Low Plts |
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Preeclampsia & Eclampsia:
Tx? |
delivery
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 |
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Preeclampsia & Eclampsia:
Standard IV medication to pts with severe preeclampsia? |
Mg sulfate
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Preeclampsia & Eclampsia:
if pt with eclampsia, what 2 conditions must be controlled prior to delivery? |
seizures & HTN
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Preeclampsia & Eclampsia:
If not resolved before delivery, how long until they do? |
6-12 hours puerperium
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What is Pruritic Urticarial Papules and Plaques of Pregnancy(PUPPP)?
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-common pruritic eruption of pregnancy of unknown etiology
-1 in every 160~300 pregnancies |
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PUPPP Sx and Symptoms?
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-intensely pruritic, erythematous, solid, superficial, and elevated urticaria-like papules and plaques
-some with minute vesicles in center -some surrounded by blanching |
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PUPPP-where does lesions start?
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-on abdomen
-frequently on striae atrophicae(stretch marks) |
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PUPPP-other places?
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-can spread to thighs, buttocks, occasionally arms
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PUPPP-When develop?
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-during 3rd trimester
-most often in the last 2~3wk |
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PUPPP-when resolve?
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-usu. w/in 15days after delivery
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PUPPP-recur?
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-only upto 5% of subsequent pregnancies
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PUPPP-Tx?
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-mile symptoms: topical corticosteroids(0.1% triamcinolone acetonide cream upto 6x/day
-severe symptoms:systemic corticosteroids(predisone 40mg by mouth/day)=rare |
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Spontaneous Abortion(miscarriage)-definition?
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noninduced embryonic or fetal death or passage of products of conception b/f the 20th wk of pregnancy
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Spontaneous abortions-What are the 4 different type of spontaneous abortions?
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1. threatened
2. inevitable 3. incomplete 4. complete |
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Threatened abortion-definition?
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any bleeding or cramping of uterus in the 1st 20wk of pregnancy
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What's definition of abortion?
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deathof the fetus or passage of products of conception(fetus & placenta) b/f 20wk of prgnancy
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Induced abortion definition?
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done for medical or elective reasons
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Inevitable abortion definition?
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intolerable pain or bleeding that threatens the woman's well-being
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Incomplete abortion under Spontaneous abortion classification?
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if part of products of conception is passed or if the membrances are ruptured
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Complete abortion?
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if all the products of conception are passed, uterus contracted toward normal size, and cervix has closed, abortion is complete
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How to Dx Threatened abortion?
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by clinical criteria and ultrasonography
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Threatened abortion-Tx?
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-usu. bed rest
-if spontaneous abortion occured or unavoidable(empty sac, absent of cardiac activity) evacuation of uterine |
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Stillbirth definition?
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fetal death after 20wk with delivery
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Late fetal death definition?
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Fetal death after 20wk
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Preterm(preterm birth) definition?
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passage(delivery) of a live fetus b/t 20 and 37wk
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Early abortion?
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b/f 12wk of pregnancy
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Late abortion?
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b/t 12 and 20wk
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What is the term for abortions performed to save the pregnant woman's life or health?
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therapeutic
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What is the term for the occurrence of 3 or more consecutive spontaneous abortions?
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habitual abortion
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What is the term for fetus has died but has been retained in utero 4wk or longer?
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Missed abortion
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What is septic abortion?
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develops when the contents of the uterus become infected before, during or after an abortion
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When do you suspect missed abortion?
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-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) |
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Incidence of Spontaneous abortion?
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~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 |
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Etioloy of spontaneous abortions?
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1. viruses
-cytomegalovirus -herpesvirus -parvovirus -rubella virus 2. disorders cause sporadic or recurrent abortion -chromosomal or mendelian abnomalities -luteal phase defects 3. immunologic abnomalities 4. major trauma |
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Signs and Symptoms of spontaneous abortion?
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crampy pelvic pain, bleeding, eventual expulsion of tissue
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Signs and Symptoms of late spontaneous abortion?
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-may begin w/ gush of fluid when membrances rupture
-hemorrage is rarely massive -if dilated cervix=innevitable abortion |
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What might be the cause of abortions after 10 or greater than 10wk?
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acquried and hereditary thrombophilias
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Ultrasonograhy and quantitative measurement of serum beta subunite of human chrorionic gonadotropin(beta-HCG) tells us?
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-to rule outectopic pregnancy
-DDx tool to different types of abortion |
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Which one does not cause vaginal bleeding?
a. threatened b. inevitable c. incomplete d. missed |
D. missed
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What symptoms do you expect if products of conception remain in uterus after spontaneous abortion?
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1. vaginal bleeding(usu. after delay)
2. fever, pain, sepsis d/t infection |
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Dx of threatened, inevitable, incomplete, or complete abortion is often possible based on?
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1. clinical criteria
2. positive urine pregnancy test |
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Tx of inevitable, incomplete, or missed abortions?
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1. uterine evacuation
2. at less than 10wk, wait for spontaneous passage of products of conception |
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Evacuation?
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at less or equal to 12wk of pregnancy
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Dilation and evacuation?
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at 12~23wk
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medical induction?
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(for women w/o prior uterine surgery)
at greater than 16~23wk |
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Recurrent abortion usually result from disorders that cause what?
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intrauterine fetal damage
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What causes 50% of recurrent abortions?
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chromosomal abnormalities
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other common casues of recurrent abortions?
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-maternal luteal phase defects(usu @ less then 6wk)
-overt endocrine disorders(polycystic ovary syndrome, hypothyroidism, hyperthyroidism, poorly controlled DM) |
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What is septic abortion?
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serious uterine infection during or shortly b/f or after an abortion
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Septic abortion usually result from?
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indued abortions done by untrained practitioners uning nonsterile techniques
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Causative organisms of septic aboriton?
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E. coli
Enterobacter aerogenes Proteus vulgaris hemolytic streptococci Staph |
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Signs and Symptoms of septic abortion?
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-similar to pelvic inflammatory dz
-septic shock may result(hypothermia, hypotension, oliguria, respiratory dz) -Sepsis d/t C. perfringens |
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Definition of stillbirth?
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delivery of a dead fetus whose gestational age is older than 20wk
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Most common cause of stillbirth?
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abruptio placentae
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Contraindications for forceps delivery and vacuum extraction?
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-fetal head larger than pelvic opening
-incomplete dilation of the cervix -absence of engagement -indeterminate fetal presentation or position |
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Incuction of labor?
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-stimulation of uterine contractions usu w/oxytocin
-fetal lung must be assessed |
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What is cesarean section?
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-delivery by incision into the uterus
-15%~20% of deliveries are cesarean section in US(much lower in most other countries) |
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Most common specific indications of cesarean section?
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1. previous cesarean section
2. protracted labor 3. fetal dystocia(breech presentation) 4. nonreassuring fetal heart rate |
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What is amniotic fluid embolism?
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-entrance of amniotic fluid and fetal cells into the maternal pulmonary circulation
-rare ostetric ER |
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autopsy of women showed fetal squamous cells and hair in the pulmonary circulation. What do you suspect?
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Amniotic Fluid Embolism
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Tx of Amniotic fluid Embolism?
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transfusion of RBCs and fresh forzen plasma, clotting factors, inotropic drugs
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What is Fetal Dystocia?
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abnormal fetal size or position resulting in difficult delivery
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Tx of fetal dystocia?
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with physical maneuvers to reposition the fetus, forceps delivery, or cesarean section
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Fetopelvic disproportion?
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-fetus is too large for the pelvic opening
-one of the cause of fetal dystocia |
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Occiput posterior presentation?
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-1st most common abnormal presentation
-larger diameter needed d/t deflexed fetal neck -(many cases forceps delivery or C section require) |
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Face presentation?
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hyperextended head and chin may be posterior
-(if chin posterior= C section) |
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Brow presentation?
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-usu converts spontaneously to occiput or face presentation
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Breech presentation?
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-2nd most common abnormal presentation
-buttocks b/f the head -can casue head to be trapped during delivery, w/umbilical cord compressing |
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2types of breech presentation?
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1. frank breech=fetal hips are flexed, knees extended
2. complete breech=fetus seems to be sitting with hips and knees flexed |
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Single/double footing presentation?
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-single or both legs are completely extended and present b/f buttocks
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Breech presentation increases risk of?
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-preterm delivery
-fetal brachial plexus -spinal cord birth trauma -prenatal death |
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External version maneuver?
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gently pressing on the maternal abdomen at 37~38wk to move fetus into vertex presentation b/f labor
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Transverse lie?
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-transverse position fetus w/fetal long axis oblique or perpendicular to maternal long axis
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shoulder dystocia?
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-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 |
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Risk factor of shoulder dystocia?
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-large fetus
-maternal obesity -maternal diabetes mellitus |
