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73 Cards in this Set
- Front
- Back
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Definition of an Abortion?
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A pregnancy that ends Prior to 20 wks.
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Ultrasound Finding and Treatment of a COMPLETE ABORTION
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NO PRODUCTS OF CONCEPTION FOUND ON US
FOLLOW UP IN OFFICE |
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Ultrasound Finding and Treatment of a INCOMPLETE ABORTION
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ON US HAVE SOME PRODUCTS OF CONCEPTION
DILATION AND CURETTAGE |
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Ultrasound Finding and Treatment of a INEVITABLE ABORTION
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products of conception INTACT, intrauterine bleeding is present and have DILATATION OF THE CERVIX ON US
dilation and currettage |
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Ultrasound Finding and Treatment of a THREATENED ABORTION
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Products of conception intact, intrauterine bleeding and NO DILATION OF CERVIX on US
Bed rest and Pelivic rest |
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Ultrasound Finding and Treatment of a MISSED ABORTION
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death of the fetus but all products of conception present in the Uterus ON US
DILATION and Curettage |
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Ultrasound Finding and Treatment of a SEPTIC ABORTION
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INFECTION OF THE UTERUS AND THE SURROUNDING AREAS
DILATION AND CURETTAGE + IV LEVOFLOXACIN AND METRONIDAZOLE |
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PRETERM LABOR DELIVER IF:
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34-37 WEEKS AND GREATER THAN 2,500 GRAMS
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PRETERM LABOR STOP DELIVERY IF:
AND GIVE... |
24-33 WEEKS OR UNDER 2,500 GRAMS
BETAMETHASONE AND TOCOLYTICS |
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PREMATURE RUPTURE OF MEMBRANES AND CHORIOAMNIONITIS...NEXT STEP
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DELIVER BABY NOW
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PREMATURE RUPTURE OF MEMBRANES AND TERM BABY?
IF NOTHING HAPPENS |
WAIT 6-12 HOURS
INDUCE LABOR |
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PREMATURE RUPTURE OF MEMBRANES WITHOUT CHORIOAMNIONITIS IN A PRETERM-->
IF HAVE A PENICILLAN ALLERGY? |
TREAT WITH
BETAMETHASONE AMPICILLAN AND GENTAMICIN REPLACE AMPICILLAN WITH ERYTHOMYCIN |
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PLACENTA PREVIA DEFINITION
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ABNORMAL IMPLANTATION OF THE PLACENTA OVER THE INTERNAL CERVICAL OS
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4 RISK FACTORS FOR PLACENTA PREVIA
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PREVIOUS C SECTION
MULTIPLE GESTATIONS PREVIOUS PLACENTA PREVIA PREVIOUS UTERINE SURGERY |
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PRESENTATION OF PLACENTA PREVIA? WKS?
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PAINLESS VAGINAL BLEEDING AFTER 28 WEEKS
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NEXT STEP IN MANAGEMENT FOR SUSPECTED PLACENTA PREVIA
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TRANSABDOMANINAL ULTRASOUND TO ACCESS IF WANT TO DELIVER VAGINALLY OR VIA A C SECTIONS
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CONTRAINDICATED IN 3RD TRIMESTER BLEEDING
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DIGITAL EXAM AND TRANSVAGINAL US EXAM
CAN CAUSE INCREASE SEPERATION OF THE PLACENTA AND UTERUS. |
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PLACENTA PREVIA: COMPLETE TYPE
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COMPLETELY COVERING THE INTERNAL OS
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PLACENTA PREVIA: PARTIAL
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PARTIAL COVERING OF THE INTERNAL CERVICAL OS COVERS MORE THAN MARGINAL
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PLACENTA PREVIA: MARGINAL
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MARGINALLY COVERING THE INTERNAL CERVICAL OS
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PLACENTA PREVIA: VASA PREVIA
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FETAL VESSEL PREVENT OVER THE CERVICAL OS
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PLACENTA PREVIA: LOW LYING PLACENTA
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PLACENTA IMPLANTED IN LOWER SEGMENTS OF THE UTERUS BUT DOES NOT COVER THE INTERNAL OS
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TREATMENT OF PLACENTA PREVIA
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DONE WITH DROP IN HCT OR LARGE VOLUME BLEEDING
STRICT PELVIC REST NOTHING IS ALLOWED TO GO INSIDE THE VAGINA DELIVERIES SEEM TO BE DONE BY C SECTION |
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WHICH TYPE OF PLACENTAL INVASION IS ASSOCIATED WITH PLACENTA PREVIA
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PLACENTA ACCRETA
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TYPE OF PLACENTAL INVASION
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PLACENTAL ACCRETA
PLACENTAL INCRETA PLACENTAL PERCRETA |
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PLACENTA ACCRETA
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PLACENTAL INVASION OF THE SUPERFICIAL UTERINE WALL MOST COMMON ASSOCIATED WITH PLACENTA PREVIA
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PLACENT INCRETA
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PLACENTAL INVASION OF THE UTERINE MYOMETRIUM
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PLACENTA PERCRETA
PRESENTATION |
PLACENTAL INVASION OF THE SEROSA BLADDER WALL OR RECTUM
HEMATURIA AND RECTAL BLEEDING |
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PLACENTAL ABRUPTION AND PATHOPHYS
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PREMATURE SEPERATION OF THE PLACENTA FROM THE UTERUS.
CAUSES TEARING OF THE OF THE PLACENTAL VESSELS AND HEMORRHAGING INTO THE SEPERATED SPACE CAN OCCURE BEFORE DURING OR AFTER LABOR |
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COMPLICATIONS OF PLACENTAL ABRUPPTION
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LIFE THREATENING BLEEDING
PREMATURE DELIVERY UTERINE TETANY DIC HYPOVOLEMIC SHOCK |
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RISK FACTORS OF PLACENTAL ABRUPTION
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MATERNAL HTN : CHRONIC PREECLAMPSIA, ECLAMPSIA
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PRESENTATION OF PLACENTAL ABRUPTION:
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3RD TRIMESTER BLEEDING
SEVERE ABDOMINAL PAIN CONTRACTIONS POSSIBLE FETAL CONTRACTIONS |
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INDICATIONS FOR C SECTION WITH PLACENTAL ABRUPTION
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UNCONTROLLED MATERNAL HEMORRAGE
RAPIDLY EXPANDING CONCEALED HEMORRAGE FETAL DISTRESS RAPID PLACENTAL SEPERATION ( MORE LIKELY A CONCEALED TYPE ABUPTION) |
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INDICATIONS FOR VAGINAL DELIVERY WITH PLACENTAL ABRUPTION
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PLACENTAL SEPARATION IS MINIMAL
FETAL HEART TRACING IS ASSURING SEPARATION IS EXTENSIVE AND FETUS IS DEAD. |
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UTERINE RUPTURE PRESENTATION
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SUDDEN ONSET OF EXTREME PAIN
ABNORMAL BUMP IN THE ABDOMEN NO UTERINE CONTRACTIONS REGRESSION OF THE FETUS: WAS MOVING TOWARD DELIVERY BUT NO LONGER IN THE CANAL BECAUSE WITHDREW INTO THE ABDOMAN |
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RISK FACTORS FOR UTERINE RUPTURE
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INCREASED RISK WITH PRIOR C SECTION: CLASSICAL INCISIONS ( HIGHER RISK) AND LOW TRANSVERSE
-TRAUMA (MVA) UTERINE OVERDISTENTION ( POLYHYDRAMNIOS AND MULTIPLE GESTATIONS) UTERINE MYOMECTOMY PLACENTA PERCRETA |
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TREATMENT FOR UTERINE RUPTURE
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IMMEDIATE LAPAROTMY WITH DELIVERY OF THE BABY
NEVER DO A C SECTION BC BABY IN ABDOMEN NOW NOT UTERUS |
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WHEN DO YOU DO RH ANTIBODY SCREEN
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INITIAL VISIT
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ANTI-D Rh IMMUNOGLOBULINS SHOULD BE GIVE WHEN (5X)
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WHEN THE MOTHER IS Rh- and...
Amniocentesis Abortion Vaginal Bleeding Placental Abruption 28th week of pregnancy Delivery if have Rh+ baby and Rh- mother |
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What Weeks are Prenatal Rh Antibody screens done
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1 depending on if woman has a reason to Have rh ab's
28 and 35 |
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Rh titer needs to be what for patient to be sensitzied
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1:4
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If titer is less than 1:16 do what?
if titer is greater than 1:16 do what? |
nothing
serial amniocentestis looking for fetal biliirubin levels must do serial amniocentesis's starting at 16-20 wks looking at spectrophotmeter for levels of bili |
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Rh+ baby with Rh- mother who has AB's > 1:16
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Serial amniocentesis first done at 16-20 weeks
if low levels of bili: repeat amnio in 2-3 weeks if medium levels of bili repeat amnio in 1-2 If high levels of bili baby is prob. anemia Do a Percutaneous Uterine Blood Sample if low Hct do intrauterine transfusion. |
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Chronic Hypertension of Pregnancy
can lead to ? Rx with? |
BP > 140/90 BEFORE the patient was pregnant
Preeclampsia Methyldopa, labetalol nifedipine |
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Gestational Hypertension
when must it start? What is missing from urine dipstick what is missing from physical exam RX |
BP > 140/90
after 20 weeks gestation no protein in Urine No Edema methyldopa, labetalol or nifedipine ONLY DURING PREGNANCY |
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Preeclampsia rsk factors
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chronic HTN
renal disease |
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Mild Preeclampsia:
HTN PRTOTIENURIA EDEMA MENTAL STATUS CHANGE VISION CHANGE IMPAIRED LIVER FUNCTION |
HTN: >140/90
PROTIENURIA: Dipstick is 1-2+ 24 hour collection is > 300mg EDEMA: hands and face MENTAL STATUS CHANGE: No VISION CHANGE: No IMPAIRED LIVER FUNCTION:No |
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Severe Preeclampsia
HTN PRTOTIENURIA EDEMA MENTAL STATUS CHANGE VISION CHANGE IMPAIRED LIVER FUNCTION |
Severe Preeclampsia
HTN: >160/110 PROTIENURIA: DIPSTICK IS 3+--> 4+ 24 hour is > 5 grams EDEMA: generalized MENTAL STATUS CHANGE: yes VISION CHANGE: yes IMPAIRED LIVER FUNCTION: yes |
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Once a pregnant woman is put on insulin what testing starts at 32 weeks
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Fetal Testing
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Fetal Testing for a woman on insulin weeks 32-36?
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Weekly Non Stress Test: fetal well being
Ultrasound: for fetal size |
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Fetal Testing for a woman on insulin weeks >36?
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Twice weekly testing
One NST for fetal well being One Biophysical profile: amount of amniotic fluid and fetal welling |
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Fetal Testing for a woman on insulin week 37
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Lecithin/Sphingomyelin ratio
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Symmetric IUGR
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Brain in proportion to rest of the Body
Occurs prior to twenty weeks gestation |
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Asymmetric IGUR
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Brain weight is NOT decreased
Abdomen smaller than the head occurs after 20 weeks |
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Nonstress Test is reactive if
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Detection of two fetal movements
Acceleration of the heart rate greater than 15 bpm lasting 15-20 seconds over a 20 min period |
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If have non reassuring stress test next step
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vibroacoustic stimulation: baby could be sleeping.
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Biophysical Profile consists of (5 components)
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NST
Fetal chest expansions ( want 1 in 30 mins) Fetal Movement ( want 3 in 30 minutes) Fetal muscle tone( fetus flexes an extremity) Amniotic fluid index Each category gets 2 points 8-10 is normal 4-8= inconclusive <4 is abnormal |
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Fetal Heart rate: Brady ? Tachy?
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Bradycardia is less than 110 bpm
Tachycardia is more than 160 beats per minute Normal is between 110-160 bpm |
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Fetal Electric Monitoring: Normal Accelerations
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increase in heart rate of 15 or more beats per minute ABOVE BASELINE for longer than 15-20 seconds if this happens twice in 20 mins it is reassuring.
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Type of deceleration : Early decels
Description: Cause: |
Description: decrease in heart that occurs with contractions
Cause: head compression |
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Type of deceleration ; Variable Decels
Description: Cause: |
Description: Decrease in heart rate and return to baseline with no relationship in contractions
Cause:Umbilical cord compression |
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Type of deceleration: Late Decelerations
Description: Cause: |
Description: Decrease in heart rate after contraction started no return to baseline until
Cause: Fetal Hypoxia |
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Stage 1 of labor
Beginning to End: Duration: |
Beginning to End: onset of labor to full cervix dilation
Duration: Primipara 6-18 hours Multipara 2-10 hours |
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Stage 1 Latent phase
Beginning to End: Duration: |
Beginning to End: Onset of Labor --> 4cm dilation
Duration: Primapara 6-7 hours Multipara: 4-5 hours |
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Stage 1 active phase
Beginning to End: Duration: |
Beginning to End: 4cm dilation to -->full dilation
Duration: Primapara: 1 cm per hour minimum Multipara: 1.2 cm per hour minimum |
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Stage 2 of labor
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Beginning to End:Full dilation of cervix till delivery of neonate
Duration: Primapara: 30 mins to 3 hours multipara: 5 mins to 30 mins |
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Stage 3 of delivery
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Delivery of neonate --> delivery of placenta
Time 30 minutes |
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During First Trimester how often should patient be scene
When is gestational age and nuchal translucency checked by US |
4-6 weeks
11wks-14 wks |
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2nd Trimester testing
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Triple or Quad screen at 15-20 weeks
auscultation of fetal heart 18-20 weeks US for fetal malformation |
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Increased MSAFP causes
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Dating Error
Neural tube defect abdominal wall defect |
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Third Trimester Tests
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27 weeks = CBC if < 11 replace with iron and stool softener
26-28 weeks= Glucose load 36 weeks = Chlamydia/GC and Group B strep ( treat at time of birth if +) |
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Chorionic Villous Sampling
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Done at 9-12 weeks
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Amniocentesis
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Done after the 15th week
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