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51 Cards in this Set
- Front
- Back
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Q200. Gestational Trophoblastic Dis- History/PE
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A200. History - 1st trimester uterine bleeding; hyperemesis gravidarum; preeclampsia-eclampsia <24 weeks; excessive uterine enlargement; hyperthyroidism; PE - no fetal heartbeat, enlarged ovaries with b/l theca-lutein cysts, expulsion of grapelike cluster, blood in cervical os
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Q201. Gestational Trophoblastic Dis- Dx
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A201. High B-hCG (> 100,000 mlU/mL); "snowstorm" on pelvic US; no fetus; CXR - may have lung mets
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Q202. Gestational Trophoblastic Dis- Tx
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A202. D&C; monitor B-hCG; no pregnancy for 1 yr; if malignant – methotrexate, dactinomycin; residual uterine disease - hysterectomy
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Q203. Gestational Trophoblastic Dis- Complications
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A203. Malignant GTD; pulmonary or CNS mets; trophoblastic PE, acute respiratory insufficiency
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Q204. Placenta Abruptio - What is it
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A204. Premature separation of normally implanted placenta; any degree of separation; MCC of late-trimester bleeding; MCC of painful late-trimester bleeding
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Q205. Placenta Abruptio - Risk factors
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A205. HTN; abdominal/pelvic trauma; tobacco; coke; previous abruption; premature membrane rupture; rapid decompression of; overdistended uterus
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Q206. Placenta Abruptio - Sx
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A206. Painful, dark vaginal bleeding that doesn't spontan stop; abdom pain; fetal distress
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Q207. Placenta Abruptio - Dx
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A207. Mainly clinical (US sensitivity 50%); check for retroplacental clot
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Q208. Placenta Abruptio - Tx
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A208. Mild – admit, stabilize, IV, fetal monitoring, type and cross blood, bed rest; moderate to severe - immediate delivery; if both stable: amniotomy, vaginal delivery; if distress: C-section
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Q209. Placenta Abruptio - Complications
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A209. Hemorrhagic shock; DIC => ATN; fetal hypoxia; couvelaire uterus
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Q210. Placenta Previa - What is it
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A210. Abnorm implant of placenta:; total - covers internal os; partial - partially covers; marginal - at edge of os; low-lying - near os without reaching it
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Q211. Placenta Previa - Risk factors
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A211. Prior C-sections; multiparity; advanced maternal age; multiple gestation; prior placenta previa
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Q212. Placenta Previa - Sxs
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A212. Usually first occurs in late preg; painless, bright red bleeding; may be heavy; usually no fetal distress
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Q213. Placenta Previa - Dx
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A213. US
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Q214. Placenta Previa - Management
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A214. No vaginal exam; premature fetus - stabilize; tocolytics (MgSO4); serial US; detect fetal lung maturity - by amnio and augment; Delivery indicated if - persistent labor, life-threatening bleeding, fetal distress, fetal lung maturity, 36 weeks GA; deliver by C-section; vaginal - lower edge of placenta > 2cm from internal os
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Q215. Placenta Previa - Complications
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A215. Increased risk of pl. accreta; vasa previa; preterm delivery; PROM; IUGR; congenital anomalies
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Q216. PROM - What is it
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A216. ROM before onset of labor; > 37 weeks gestation; may be due to - vaginal or cervical infections; abnorm membrane physiology; cervical incompetence
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Q217. PPROM (preterm PROM) - What is it; Risk factors
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A217. ROM < 37 weeks gestation risk factors:; low socioeconomic status; young maternal age; smoking; STDs
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Q218. Prolonged ROM - What is it
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A218. ROM > 24 hours prior to labor
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Q219. PROM - History/PE
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A219. Gush of clear or blood-tinged vaginal fluid; may have uterine contractions
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Q220. PROM - Evaluation
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A220. Sterile speculum exam - amniotic fluid (in vaginal vault); meconium; vernix caseosa; positive nitrazine paper test; positive fern test; US - assess fluid volume; cultures; smears; no digital vaginal exam; check for chorioamnionitis - fetal heart tracing; maternal temp; WBC count; uterine tenderness
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Q221. PROM - Tx
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A221. Balance risk of infection when delivery is delayed with risks due to fetal immaturity; if no sign of infection - tocolytics: B agonists, MgSO4, NSAIDs, Ca2+ ch blocker, prophylactic Antibiotics, corticosteroids; if signs of infection or fetal distress – Antibiotics, induce labor
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Q222. PROM - Complications
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A222. Increased risk of; preterm L&D; chorioamnionitis; placental abruptio; cord prolapse
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Q223. Preterm Labor - What is it; Risk factors
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A223. Onset of labor bet. 20-37 weeks; primary cause of neonatal M&M; risk factors - multiple gestation, infection, PROM, uterine anomalies, previous preterm L or D, polyhydramnios, placental abruptio, poor maternal nutrition, low socioeconomic status; Most patients have no identifiable risk factors
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Q224. Preterm Labor - History/PE
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A224. May have menstrual-like cramps; onset of low back pain; pelvic pressure; new vaginal discharge or bleeding
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Q225. Preterm Labor - Dx
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A225. Regular contractions >3, 30 sec. each, over 30 min. concurrent cervical change; sterile speculum exam; US; UA/UC; cultures for – chlamydia, gonorrhea, GBS
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Q226. Preterm Labor - Tx
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A226. Hydration; bed rest; tocolytics; steroids; GBS prophylaxis - PCN or ampicillin
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Q227. Preterm Labor - Complications
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A227. RDS; IVH; PDA; NEC; ROP; BPD; death
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Q228. Fetal Malpresentation - What is it; Risk factors
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A228. Any presentation not vertex (Normal is vertex); MC malpresentation - breech Risk factors; prematurity; prior breech delivery; uterine anomalies; poly- or oligohydramnios; multiple gestations; PPROM; hydrocephalus; anencephaly; placenta previa
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Q229. Fetal Malpresentation - What are the subtypes
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A229. Frank - thighs flexed and knees extend; footling - 1 or both legs extended below the butt; complete - thighs and knees flexed
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Q230. Fetal Malpresentation - Dx
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A230. Leopold maneuver
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Q231. Fetal Malpresentation - Tx
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A231. Follow external version - risks of placental abruptio, cord compression; prepare for emergency C-sect; elective C-section; breech vaginal delivery only if delivery imminent
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Q232. Postpartum Hemorrhage - What is it; MCC; MC Risk Factor
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A232. > 500 mL for vaginal delivery, > 1000 mL for C-section; MCC - bleeding at placental implantation site; MC risk factor - uterine atony due to overdistention
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Q233. Postpartum Hemorrhage - Dx
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A233. Palpation of soft, enlarged, "boggy" uterus; explore for lacerations and retained placental tissues
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Q234. Postpartum Hemorrhage - Tx
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A234. Bimanual uterine massage; oxytocin infusion; methergine - if not HTN; prostin (PGF2a) - if no asthma
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Q235. Mastitis - What is it
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A235. Cellulitis of perigland tissue; caused by - nipple trauma from breastfeeding & staph from baby's nostrils => nipple ducts
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Q236. Mastitis - History/PE
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A236. Sxs start 2-4 weeks postpartum; usually unilateral; breast tender erythema, edema, warmth; maybe purulent nipple drainage
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Q237. Mastitis - Dx
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A237. Sxs; possible breastmilk culture; increased WBC; fever
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Q238. Mastitis - Tx
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A238. Continue breastfeeding!; po Antibiotics - PCN, diclox, erythro; incise and drain abscess (if present)
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Q239. Sheehan's Syndrome - What is it
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A239. Postpartum pituitary necrosis; pituitary ischemia & necrosis => ant. pituitary insuff. due to massive obstetric blood loss & hypovol shock; decreased prolactin
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Q240. Sheehan's Syndrome - History
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A240. No lactation; menstrual disorder; fatigue; loss of pubic & axillary hair
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Q241. Postpartum Fever- What is it
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A241. Genital tract infection; temp >= 38 C at least 2 of 1st 10 postpartum days; not including 1st 24 hrs.
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Q242. Postpartum Fever- Risk Factors
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A242. MC - endometrial infection; C-section; emergent C-section; PROM; prolonged labor; multiple intrapartum vag exams; intrauterine manipulations
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Q243. Postpartum Fever- Causes (7 W's)
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A243. Wind - atelectasis, pneumonia; water - UTI; wound - incision, episiotomy; walk - DVT, PE; wonder drug; womb - endomyometritis; weaning - breast engorgement, abscess, mastitis
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Q244. Postpartum Fever- Dx
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A244. UA/UC; BC; pelvic exam - rule out hematoma; rule out lochial block
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Q245. Postpartum Fever- Tx
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A245. Admit; broad-spectrum IV Antibiotics - clindamycin, gentamicin until afebrile for 48 hrs. if complicated - add ampicillin; if 3 drugs not effective after 48 hrs. - consider other Dxs
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Q246. Breastfeeding - What inhibits prolactin rel.
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A246. Hi levels of progesterone & estrogen during pregnancy; high levels also cause breast hypertrophy
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Q247. Breastfeeding - Why can physiologically; breastfeed after birth
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A247. Levels of progesterone and estrogen drop after delivery of placenta; infant sucking stimulates rel. of prolactin & oxytocin
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Q248. Breastfeeding - What gives passive immunity; what gives active immunity
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A248. Colostrum has hi IgA; IgA - passive immunity; hi leukocyte levels - active
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Q249. Breastfeeding - Contraindications
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A249. HIV infection; active hepatitis; meds – tetracycline, chloramphenicol, warfarin
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Q250. Hyperemesis Gravidarum - What is it; Risk factors
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A250. Persistent vomiting => wt. loss > 5% (or poor wt. gain); dev. of dehydration and ketoacidosis; persists past 16-18 weeks – rare, can damage liver risk factors; nulliparity; molar pregnancy (increased B-hCG); multiple gestations
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