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100 Cards in this Set
- Front
- Back
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Which uterotonic med is contraindicated in pts with HTN or preeclampsia?
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Methylergonovine (is a vasoconstrictor)
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Which uterotonic is contraindicated in pts with asthma?
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Prostaglandin F2 (Hemabate) (is a smooth muscle constrictor and therefore a bronchoconstrictor)
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Most common risk factor for uterine inversion?
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Excessive traction on umbilical cord during 3rd stage
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How might uterine inversion present?
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Globular pale mass presenting at introitus while attempting to deliver placenta + signs of hypovolemia
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How are prostaglandin F2 and methylergonovine delivered?
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IM (never IV, b/c can cause bronchoconstriction and stroke, respectively)
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Which vessel should be ligated in the case of an XL for refractory PPH?
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Internal iliac (hypogastric) to decrease vascular pressure in the pelvis
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4 signs of dizygotic twins
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Dividing membrane thickness >2mm
Twin peak (lambda) sign Different genders 2 separate placentas (anterior and posterior) |
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Time period of various types of monozygotic twins
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Di-di: 3-4 days
Dichorionic-monoamniotic: 4-8 days Mono-mono: 8-12 days Conjoined: >13 days |
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Rx for mastitis
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Antibiotics
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Breastfeeding with pink shiny nipples and peeling at the periphery + burning while feeding
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Candidiasis (examine baby's mouth)
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Signs that baby is getting sufficient milk
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3-4 stools in 24 hours, 6 wet diapers in 24 hours, weight gain and sounds of swallowing
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Rx for engorgement
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Frequent feedings, warm compresses, analgesic 20min before feeding, expressing some milk, good support bra
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Most Rh incompatible pregnancies have what amount of feto-maternal blood transfer
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<0.1 cc of fetal blood in the maternal circulation; however, that is all that is required for sensitization
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Noninvasive test for fetal anemia
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Doppler ultrasound of middle cerebral artery peak systolic velocity
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US findings of Rh disease
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Excess fluid (from decreased hepatic protein production) --> ascites, pericardial and/or pleural fluid, scalp edema, hepatosplenomegaly, placentomegaly, polyhydramnios
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What is the standard dose of RhoGAM and how much fetal blood does it neutralize?
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300ug
30cc |
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Diagnostic tests for a fetus with poor growth
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Amniotic fluid volume, NST, doppler umbilical artery systolic/diastolic
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Most likely cause of asymmetric growth restriction
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Uteroplacental insufficiency (whereas symmetric restriction indicates an earlier insult, e.g. aneuploidy)
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Fetal growth restriction can have adult disease complications of (4)
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Cardiovascular disease, chronic HTN, COPD, and diabetes
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Pts with what type of diabetes are most likely to have macrosomic infants?
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Gestational
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Pts with what type of diabetes are more likely to have growth restricted infants?
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Long-standing diabetes with end-organ damage
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Most common abnormal karyotype found in spontaneously aborted fetuses
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Autosomal trisomy
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When is the risk of developing microcephaly and severe mental retardation the greatest?
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Weeks 8-15
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Thrombophilic abnormality associated with stillbirth, preeclampsia, placental abruption and IUGR
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Factor V Leiden
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Fat tissue during a D&C?
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Worry is omental tissue/bowel, proceed with laparoscopy to better visualize
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Lab test to measure after a fetal demise
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Fibrinogen: worry about coagulopathy developing (if was one fetus of a twin gestation, continue to monitor throughout the rest of the pregnancy)
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Most significant reason for increase in C-section rate?
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Declining rate of vaginal births after C/S
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What is cytotec?
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Misoprostol
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Meds used for IOL
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Cytotec to increase favorability of cerix
Pitocin |
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Risk factors associated with breech presentation?
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Prematurity, multiple pregnancy, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids
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When should you not AROM?
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Latent phase of labor
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Likelihood of success of vaginal trial after C-section
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70-80% (lower if have had multiple C-sections)
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2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
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US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
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2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
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US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
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Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
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Placental abruption --> C section
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Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
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Placental abruption --> C section
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2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
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US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
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Smoking increases the risk of these five things during pregnancy
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Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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Smoking increases the risk of these five things during pregnancy
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Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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Bloody show as the cause for bleeding must be associated with
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Cervical dilation
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Bloody show as the cause for bleeding must be associated with
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Cervical dilation
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Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
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Placental abruption --> C section
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Causes of friable cervix/ bleeding in 2nd trimester
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Trauma, cervicitis, cancer
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Causes of friable cervix/ bleeding in 2nd trimester
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Trauma, cervicitis, cancer
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Smoking increases the risk of these five things during pregnancy
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Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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Bloody show as the cause for bleeding must be associated with
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Cervical dilation
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Causes of friable cervix/ bleeding in 2nd trimester
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Trauma, cervicitis, cancer
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Most common cause of preterm labor?
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Idiopathic
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Management of preterm contractions in a hydrated pt with a closed cervix
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Continue to monitor
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Management of preterm febrile pt with elevated WBC count presenting with ctx/cervical dilation
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Amniocentesis to rule out intra-amniotic infection
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Contraindications for tocolytics: terbutaline and ritodrine
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Diabetes
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Contraindications for tocolytics: magnesium sulfate
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Myasthenia gravis
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Contraindications for tocolytics: indomethacin
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33wks or later due to risk of premature ductus arteriosus closure
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How does mag sulfate work?
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Competes with calcium for entry into cells
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Side effects of terbutaline
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Beta-adrenergic: tachycardia, hypotension, anxiety and chest tightening or pain.
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Side effect of mag sulfate
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Respiratory depression (12-15mg), cardiac depression (.15mg), flushing, headache
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Betamethasone has shown decreased incidence of this non-pulm complication of prematurity
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Intracerebral hemorrhage
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When is fibronectin useful?
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For its negative predictive value to demonstrate women unlikely to deliver in next 2 weeks
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Sudden onset lower abdominal pain that radiates to the back + N/V
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Ovarian torsion (mass usually palpable)
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3 causes of late decels
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Uteroplacental insufficiency --> fetal acidosis --> fetal hypoxia
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When to think benign edema of pregnancy vs. DVT?
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Bilateral symptoms, esp. w/o fever, redness, or tenderness
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What % of cases of placenta accreta require a hysterectomy to stop the bleeding?
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66%
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Rx for placenta previa with continued bleeding
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Emergent C-section, even if premature
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Management of nipple discharge with blood
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Mammography
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Ulcerated papule w/ a punched out base and raised, indurated margins + painless inguinal LAD
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Syphilis
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Ulcer with red beefy base and no LAD
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Granuloma inguinale (Donovanosis)
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Best diagnosis of primary syphilis
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Dark field microscopy (may not have Abs yet)
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LH and FSH in PCOS
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High LH, low FSH
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4 indications for endometrial biopsy in pts with DUB
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Age >35, diabetes, obesity, chronic HTN
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Rx for DUB
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Cyclic progestins (if fail, endometrial ablation or hysterectomy)
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How does estrogen therapy affect thyroid hormones?
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Increases their metabolism/ increases TBG, so increases the need for L-thyroxine in pts w/ hypothyroidism
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Diabetes is often associated with this type of incontinence
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Overflow incontinence
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Rx for carpal tunnel syndrome (and back-up options)
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Wrist splint, then injection of corticosteroids, then surgical decompression; avoid NSAIDs in pregnancy
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Med to suppress endometriosis symptoms
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GnRH agonists
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Rx of DUB in adolescent with no abnormalities on US
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Iron therapy if mild
Add progestin if moderate Need high-dose estrogen if severe/ active bleeding |
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When is internal podalic version indicated?
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Twin gestation when 2nd twin is transverse or oblique and want to --> breech
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Where should the fluid be tested from for nitrazine/ ferning?
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Vagina, NOT cervical mucous
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Primary risk factor for PPROM?
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Genital tract infection, usually BV
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Nml cervical length
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34mm
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What can prolong the length of time before delivery by up to 7 days after PPROM?
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Antibiotics
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What does a tender uterine fundus indicate?
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Chorio
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Indicators of infection on amniocentesis
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Low glucose (<20), presence of leukocytes (poor predictive value), presence of IL-6
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Prevalence of PROM and PPROM
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10-15% and 1%, respectively
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Recurrence risk of PPROM
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30%
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Definition of postterm pregnancy
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42 completed weeks
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Post-date pregnancies are associated with these 4 factors:
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Placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, extrauterine pregnancy
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Postterm pregnancies are associated with these 5complications
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Macrosomia
Oligohydramnios Meconium aspiration Uteroplacental insufficiency Dysmaturity |
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Management of pt at 41wks with unfavorable cervix who doesn't want to be induced
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Biweekly NST and AFI, induce for nonreactive or oligo
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Usage (and non-indication) of amnioinfusion
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Does not affect neonatal outcomes or decrease incidence of meconium aspiration
Used to treat repetitive variable decels |
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Findings of dysmaturity
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Withered, meconium stained, long-nailed, fragile, small placenta
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Dysmature infants are at great risk for?
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Stillbirth
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Common cause of fetal tachy
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Maternal fever/chorio
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Common cause of variable decels (specific, not just umbilical cord compression)
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Nuchal cord
Oligo |
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Late decels do not begin until
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At or after the peak of the uterine contraction
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Acute/ fast decels are
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Variable
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3 complications of epidurals
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Spinal headache, localized back pain, meningitis
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Endometritis is a complication of these 3 things
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Prolonged labor, prolonged ROM, multiple exams
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Rx for endometritis
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Amp and gent (G+ and G- coverage, respectively)
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Cause of low-grade 3 day postpartum fever without other signs/symptoms
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Breast engorgement
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Ddx for postpartum fever
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Endometritis, mastitis, cystitis
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