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88 Cards in this Set
- Front
- Back
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What are the 5 Cs?
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Compassion: pt needs to feel safe
Communication Competence Charting Confession |
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Define preeclampsia
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New onset HTN after 20 weeks with proteinuria
HTN > 140/90 Proteinuria (>1 or >300mg/24 hr) |
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What are the risk factors for preeclampsia
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Nulliparity
Maternal age greater than 40 Twin gestation Preeclampsia in prior pregnancy Chronic htn Chronic renal dz Anti phospholipid syndrome Elevated BMI DM |
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BP for severe preeclampsia?
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SBP > 160
DBP> 110 |
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Treatment for severe preeclampsia?
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Expedite delivery
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Preferred anticonvulsant for eclampsia
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Magnesium Sulfate
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What effect does Mg sulfate have on BP
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No significant effect
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Anti hypertension drugs for severe preeclampsia?
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Labetalol: initial dose 20mg IV bolus. If bp not controlled within 10 minutes--> give 40mg then 80 mg IV Q 10 min for 2 additional doses. Max dose: 220
Hydralazine: dose 5-10 mg IV q 20 min |
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Dosages for the 2 HTN drugs used in severe pre eclampsia
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Labetalol: initial dose 20mg IV bolus. If bp not controlled within 10 minutes--> give 40mg then 80 mg IV Q 10 min for 2 additional doses. Max dose: 220
Hydralazine: dose 5-10 mg IV q 20 min |
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What is HELLP syndrome?
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Hemolysis
Elevated Liver enzymes Low Platelets |
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What are the risk factors for VTE?
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Thrombophillic disorders
Multiparity (>4) Age>35 Weight>80 kg Severe varicose veins Hyperemesis Preeclampsia Prolonged bed rest or immobility |
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Where do the majority of DVT in pregnant ladies occur?
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90% in left leg
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If you have a pregnant woman with significant vaginal bleeding, what PE should be avoided? Why?
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Digital vag exams
Don want to worsen placenta previa Only do this if you know the placental location |
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Pt has painless bleeding in second trimester. What are you thinking is the diagnosis?
You do an ultrasound that appears positive. What is the next step? |
Placenta Previa
Do a transvaginal scan |
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Hallmark of placental abruption?
Discuss concealed bleeding |
Pain
concealed bleeding: visible bleeding may not reflect amount of blood loss. Occurs in 20-60% |
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Most common etiology of uterine rupture?
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Previous c section
Especially a classic through muscle with vertical incision |
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Given the following menstrual age, give the embryologic event that corresponds (*?*):
3-4 weeks |
Implantation site
lab finding: decidual thickening |
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Given the following menstrual age, give the embryologic event that corresponds (*?*):
4 weeks |
Trophoblast
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Given the following menstrual age, give the embryologic event that corresponds (*?*):
4-5 weeks |
Gestational sack
bhCG>1500-2000 |
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Given the following menstrual age, give the embryologic event that corresponds (*?*):
5-6 weeks |
Yolk Sac and Embryo and cardiac activity
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progesterone less than ___ is morel likely to be associated with spontaneous abortion or ectopic preg
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5 ng/ml
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Number one reason for miscarriage?
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genetic anomaly
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She said something about the different types of spontaneous abortion but didn't really go into details
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Incomplete
Complete Septic Inevitable Missed these are the types |
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What is the second most common cause of maternal mortality?
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Ectopic pregnancy
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Risk factors for ectopic pregnancy?
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Hx of previous ectopic
prior tubal surgery prior tubal infection progestin only contraception contraceptive IUD in utero DES exposure note: Many occur in women with no risk factors |
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What size ectopic mass is treatable with Methotrexate?
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<4 cm
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In incomplete miscarriage, ________ treatment has a high likelihood for success
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non-surgical
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***FROM THE CARD***
Give the ABCs... of Forceps Application |
A: Address the Patient
Ask for Help Anesthesia adequate? B: Bladder empty C: Cervix must be completely dilated D: Determine position of head (think of shoulder dystocia) E: Equipment ready G: Gental traction H: handle elevated to follow the "J" shaped pelvic curve I: Incision evaluation for episiotomy J: remove forceps when the Jaw is reachable |
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***FROM THE CARD***
Give the HELPERR mnemonic for shoulder dystocia *** |
H: call for Help
E: Evaluate for Episiotomy L: Legs elevated P: suprapubic Pressure E: Enter (rotational maneuvers) R: Remove posterior arm R: Roll the pt on her hands/knees |
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***FROM THE CARD***
What are the "Enter" maneuvers for shoulder dystocia |
Rubin II: rotate baby toward nose on anterior shoulder
Rbun II + Woods screw: rotate baby putting pressure in both directions Reverse woods: rotate towards nose pressure on posterior shoulder |
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• Define Lie
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o Relationship of long axis of fetus to mother
o Longitudinal, transverse, oblique (examples) |
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• Define Presentation
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o Portion of fetus foremost in birth canal
o Vertex, breech, face, brow, shoulder (examples) |
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• Define position
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o Reference point on presenting part
o LOA/ROA/LOP (examples) |
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• What is occiput posterior?
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o “Back labor”
asymmetric dilation, persistent anterior lip o Ease of palpation of anterior fontanel on vaginal exam o Palpation of ear |
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• What is the most common malpresentation?
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o Occiput posterior
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• What are the 3 types of breech presentation? Describe them
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o Frank: Hips flexed, legs extended
o Complete: Hips and legs flexed o Footling: One hip extended (foot out) |
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• He said there may be a question on rapid response to prolapsed (flip to read what was on the slide)
*** |
o Recognize non-reassuring tracing
o Visually inspect/palpate cord to diagnose o Assess fetal status (FHT, US) o Do not attempt to replace the cord o Hold presenting part off cord Foley cath Position change (trendelenburg, knee chest) o Tocolysis |
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• Shoulder dystocia occurs in >50% of what weight infants?
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o It occurs in greater than 50% of NORMAL WEIGHT infants
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• What is “turtle sign”
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o It is when a baby has shoulder dystocia and after the head pops out, it sucks back in because the shoulder is stuck on the pubic bone
o It retracts against the perineum o And the baby will look like an angry little sumo wrestler (credit: Tyler) |
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• What is the McRobert’s maneuver? What does this help with?
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o Flex maternal hips so that the thighs are just on sides of abdomen
o Resolves >40% of shoulder dystocias *** (I think this is the TQ) |
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What will occur in 20-63% of patients with placental abruption?
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Concealed bleeding
visible bleeding may no reflect amount of blood remember the hallmark is that this is painful bleeding |
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***FROM THE CARD***
Give the ABCs for vacuum application *** |
A: Address the Patient
Ask for Help Anesthesia adequate? B: Bladder empty C: Cervix must be completely dilated D: Determine position of head (think of shoulder dystocia) E: Equipment ready F: Place cup in proper relation to Fontanelles on Flexion point H: Halt traction between contractions Halt procedure if cup disengages 3 times Halt if no progress in 3 pulls Halt procedure after 20 min of use I: Incision evaluation for episiotomy J: remove vacuum when the Jaw is reachable |
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Evidence supports the use of labor assistants, decreases the amount of cesareans
*** |
he said this would be a test question...
not sure how to write it deal with it! *A LABOR COMPANION*, not an employee, not husband |
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What is the H in the ABCs of Vacuum application?
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H: Halt traction between contractions
Halt procedure if cup disengages 3 times Halt if no progress in 3 pulls Halt procedure after 20 min of use |
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Maternal request for pain relief is indication enough for what?
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Epidural
make sure to get an informed consent women should not expect nor should clinicians require a "routine epidural" |
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most common indication for primary c-section delivery?
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Labor dystocia
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the following are benefits from continuous support from what?
Less analgesia use Lower rates of operative vaginal/c-section Fewer reports of dissatisfaction with childbirth experience less dystocia |
Labor companion (doula)
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prevention of preterm deliver includes using abx to treat bacterial vaginosis. 2 drugs you can use?
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Clindamycin
Metronidazole |
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what test has a 99% negative predictive value to tell you if a woman will deliver in 7-14 days
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Fetal fibronectin (fFN)
(A positive test doesn't tell you much) |
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what type of exam must be done FIRST in a preterm patient?
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always put a speculm in before your fingers
gel messes up testing of fFN test |
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options to prevent preterm labor? (4)
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Steroids (betamethasone)
Tocolysis (Mg Sulfate) Transfer care GBS prophylaxis |
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2 side effects of giving indomethacin for a tocolytic
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closure of ductus arteriosis
oligohyraminos |
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when is GBS screening done?
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35-37 weeks gestation
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women with negative vaginal and rectal GBS screening cultures within ____ weeks of delivery do NOT require intrapartum antimicrobial prophylaxis for GBS even if obstetric risk factors develop
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5 weeks
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Give indications for GBS prophyhlaxis
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GBS bacteriuria in any concentration during current pregnancy
previously birth of an infant with GBS dz +GBS vaginal rectal screening culture in late gestation during current pregnancy unknown GBS status at the onset of labor AND GBS risk factors |
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Flip to read about risk factors for GBS
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delivery at <37 weeks
duration of membrane rupture >18 hrs Temp>100.4 + intrapartum GBS nucleic acid amplification tests (NAAT) |
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what two antibiotics can be given in PPROM? (24-34 weeks)
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Ampicillin
Erythromycin |
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At how many weeks can you NO LONGER use VACUUM assisted delivery?
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<34 weeks
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list the risk factors for pre-term delivery (6)
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Hx of preterm delivery
Multiple gestation Interpregnancy interval<6 mo Hx of cervix surgery Short cervical length on endovaginal US (<25 mm at 22 to 25 weeks) Infection (bacteriuria, UTI, vaginosis) |
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What endovaginal cervical length indicates a risk factor for pre-term delivery? when is this done
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<25 mm
at 22 to 25 weeks |
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Remember that transfer is an option for preterm labor
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he said there could be a question about this
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***FROM THE CARD***
What should you do for the "head" when managing massive PPH? (5) |
check the airway
check breathing administer O2 lie flat note time of relevant events |
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***FROM THE CARD***
What should you do for the "arms" when managing massive PPH? (5) |
Check pulse and BP
Establish large bore IV x 2 Check blood counts, clotting and crossmatch 4-6 units Start fluid resuscitation if required with 2 liters crystalloid Drugs: Oxytocin/syntocinon Methylergonovine/Ergometrine Prostaglandin F2alpha (consider surgery if > 2 doses required) |
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***FROM THE CARD***
What should you do for the "uterus" when managing massive PPH? (6) |
Massage uterus to stimulate contraction
COORDINATE: Helper 1 at "head" Helper 2 at "arms" if bladder full or palpable, empty with cath if atony persists, apply bimanual compression review other causes (4 T's: Tone, Trauma, Tissue, Thrombin) move to surgery early if bleeding persists |
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***FROM THE CARD***
Give 2 emergency treatments of uterine atony (manual maneuvers) |
Bimanual massage and compression
intramyometrial prostaglandin injection |
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***FROM THE CARD***
what are the 3 steps in correction of uterine inversion? |
Recognition
Replacement Restitution |
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***FROM THE CARD***
What are the 4 T's of postpartum hemorrhage? |
Tone: Uterine Atony
Trauma: Cervix or Vagina Tissue: retained placenta Thrombin: Coagulopathy |
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***FROM THE CARD***
Which "T" of post partum hemorrhage does the following describe: 70% of cases Perform uterine massage Perform bimanual compression Oxytocin/syntocinon (10 units IV or IM. 10-40 units in 1000cc saline at 250 cc/hr) Methylergonovine (0.2mg IM or ergometrine 0.5mg IM)- use with caution in hypertensives Prostaglandin F2alpha 0.25 mg IM or intramyometrial; may repeat every 15 min up to 8 doeses but consider surgery after 2 doses |
Tone: uterine atony
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***FROM THE CARD***
Which "T" of post partum hemorrhage does the following describe: 20% of PPH Examine and repair |
Trauma: cervix or vaginia
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***FROM THE CARD***
Which "T" of post partum hemorrhage does the following describe: most common cause of PPH |
Uterine atony (tone)
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***FROM THE CARD***
Which "T" of post partum hemorrhage does the following describe: prevent with active 3rd stage management 10% of PPH manual removal explore for fragments |
Tissue: retained placenta
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***FROM THE CARD***
Which "T" of post partum hemorrhage does the following describe: 1% of cases confirm with beside clot test replace blood products |
Thrombin: coagulopathy
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***FROM THE CARD***
What term does the following define with respect to forceps-- Fetal skull on pelvic floor; scalp visible between contractions |
Outlet
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***FROM THE CARD***
What term does the following define with respect to forceps-- Fetal skull at, or below, +2 station |
Low
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***FROM THE CARD***
What term does the following define with respect to forceps-- Head engaged, bu above +2 station |
Mid
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***FROM THE CARD***
with respect to forceps-- posterior fontanelle mid way between shanks, ___ cm above plane of shanks |
1 cm
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***FROM THE CARD***
with respect to forceps-- Fenestrations admit no more than ___ fingertip |
one
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***FROM THE CARD***
with respect to forceps-- Sutures: lamboidal above, and equidstant from, upper surface of each blade; sagittal suture is _____ |
midline
I KNOW THESE CARDS ARE GARBAGE |
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***FROM THE CARD***
with respect to forceps-- What is Pajot's Maneuver? |
axis traction follows pelvic curve
initial traction downward, then sweeping in large J-shaped arch opposite hand exerts downward traction, causing two vectors of force: HORIZONTAL OUTWARD and VERTICAL DOWNWARD |
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***FROM THE CARD***
vacuum extraction must be performed to promote _______ of the fetal head. This reduces the diameter of the head that must pass through the pelvic outlet |
Flexion
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***FROM THE CARD***
the suction cup is positioned where and over what suture? |
close to the posterior fontanelle
over the sagittal suture |
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***FROM THE CARD***
what is the DR C BRAVADO for the interpretation of FHR tracings? |
DR: Define Risk (low or high)
C: Contractions (comment on frequency etc) BRa: Basline Rate (brady, normal [110-160], or tachy) V: Variability (at least 10-15 bpm [persistent, reduced variability is a particularly ominous sign]) A: Accelerations present or absent (at least greater than or equal to a 15 beat change from the baseline lasting greater than or equal to 15 seconds) D: Decelerations (early, variable, or late) O: Overall (assessment category I/II/III and plan of management |
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***FROM THE CARD***
Describe an early deceleration, the cause, and the intervention |
as contraction occurs, decrease in HR coincides and returns to normal as contraction stops
cause: head compression intervention: none |
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***FROM THE CARD***
Describe an variable deceleration, the cause, and the intervention |
as contraction occurs, decrease in HR happens randomly
cause: cord compression intervention: Amnioinfusion, reposition mother |
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***FROM THE CARD***
Describe an late deceleration, the cause, and the intervention |
as contraction occurs, decrease in HR happens after the contraction, and ends shortly after the contraction
cause: uteroplacental insufficiency intervention: stop oxytocin, give O2 |
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***FROM THE CARD***
flip to read amnioinfusion for variable decels (I will likely not memorize this) |
infuse 250 to 500 cc warm saline through intrauterine pressure cath and follow with 50-60 cc per hour drip
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***FROM THE CARD***
What is the Gaskin maneuver? |
this is the Roll the patient in the HELPERR for shoulder dystocia
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***FROM THE CARD***
How do you remove the posterior arm? |
1. Follow posterior arm to the elbow
2. flex arm at the elbow 3. sweep forearm across the chest without pulling directly on the hand |
