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98 Cards in this Set
- Front
- Back
by what percent should B-HCG levels rise in a normal pregnancy for the first 42 days?
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50%/48h
up to 100,000 |
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progesterone level > _____ strongly suggests normal pregnancy, while a level < ______ suggests an abnormal one
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a. 25
b. 5 |
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review criteria for MTX in ectopic pregnancy
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--hemodynamic stability
--nonruptured ectopic --size of ectopic mass <4 cm without a fetal heart rate or <3.5 cm in the presence of a fetal heart rate --normal liver enzymes and renal function --normal white cell count --ability of the patient to follow up rapidly (reliable transportation, etc.), if her condition changes |
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discriminatory B-HCG level for ectopic
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2000
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options x3 for pts with early pregnancy loss
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expectant management
drug therapy to assist with expulsion surgical evacuation |
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def:
vaginal bleeding before 20 weeks without the passage of any products |
threatened abortion
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def:
abortion in which some, but not all, of the products of conception have passed |
incomplete abortion
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def:
fetal demise without cervical dilatation or passage of products of conception |
missed abortion
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def:
three successive first trimester pregnancy losses |
recurrent abortion
check for occult systemic disease |
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most common abnormal karyotype encountered in spontaneous abortuses
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autosomal trisomy
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the majority of first trimester spontaneous abortions are due to this type of problem
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Conceptus genetic anomalies
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ddx:
3T vaginal bleeding |
Uterine rupture
Placenta previa Bloody show Abruptio placenta Cervical trauma |
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EFM signs of fetal anemia
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tachycardia, sinusoidal pattern
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HELLP =
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"hemolysis, elevated liver enzymes, low platelets”
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goal of treating elevated BP in preX
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reduce the diastolic blood pressure into a safe range of 90-100mm Hg to prevent maternal stroke or abruption, without compromising uterine perfusion
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what SBP/DBP merit antihypertensives in preX?
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SBP > 160
DBP > 100 |
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review Mg toxicity levels/sequelae
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4-7 therapeutic
7-10 loss of DTR >12 resp depression >15 cardiac arrest thus the reason for "mag checks" in preX women receiving treatment |
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mgmt:
ecclampsia |
magnesium sulfate
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only definitive therapy for preeclampsia
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delivery of the fetus and placenta
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30 year-old G5P4 @ 24wks w/ 3x prior c/s has anterior previa -> most likely serious complication leading to obstetric hge?
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placenta accreta
low-lying anterior previa suggests accreta into old C/S scar |
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trade name:
prostaglandin F2 |
hemabate
(uterotonic) |
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why should hemabate (PGF2) not be used in asthmatics?
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PGF2 -> constriction of smooth muscle
constricts uterine vessels as well as bronchi |
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most common cause of PPH
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uterine atony
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which of the uterotonics should be avoided in women with preX?
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methylergonovine (Methergine) - vasoconstrictive agent
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review factors assoc w retained placenta
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prior Cesarean delivery
leiomyomas prior uterine curettage succenturiate lobe of placenta |
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define PPH (vaginal and cs)
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vaginal >500
CS > 1000 |
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how should PGF2 (Hemabate) and methylergonovine (Methergine) be delivered?
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IM
IV delivery leads to bronchoconstriction (PGF2) and stroke (metyhlergonovine) |
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describe how rhogam is used to prevent isoimmunization
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-give at 28 weeks to all Rh- women with no Abs
-one ppx dose at 72h if an Rh+ baby delivered |
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test of fetal-maternal hge (measures #s of fRBCs in mom's circulation?)
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Kleihauer Betke test
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def:
collection of fluid in two or more body cavities, such as ascites, pericardial and/or pleural fluid and scalp edema |
hydrops fetalis
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most likely volume of feto-maternal hemorrhage that occurs in a normal pregnancy?
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<0.1cc
NB: this amount can sensitize an Rh- patient with an Rh+ fetus |
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300 ug of RhoGAM neutralizes ___cc of fetal blood
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30cc
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the delta OD450 test, performed on amniotic fluid, represents what compound in the fluid?
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bilirubin
abnormal test indicates presence of heme pigment, ie, severe hemolysis (test used in ?isoimmunization) |
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mgmt:
severe hemolytic dz in fetus 2/2 maternal isoimmunization |
Intrauterine intravascular fetal transfusion
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non-invasive test to detect severe fetal anemia
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MCA peak systolic velocity
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24-year-old G2 P1 woman is sensitized to the D and C antigens despite receiving RhoGAM following her first delivery. What is the best explanation?
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amt of fetal-maternal hge was more than estimaged
RhoGAM works in a dose-dependent fashion |
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review US markers suggestive of dizygotic (fraternal) twins
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dividing membrane thickness greater than 2 mm
twin peak (lambda) sign different fetal genders two separate placentas (anterior and posterior) |
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most important intervention to reduce risk of a preterm LBW infant in a multifetal gestation?
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early good weight gain
these pregnancies deliver early, so must give more nutrients early |
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twin-twin transfusion occurs in this type of twin pair
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monochorionic, monoamniotic
this setup allows for formation of vascular anastomoses |
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two factors that have increased the # of twin gestation
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-advanced maternal age
-ART |
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optimal mode of delivery for twins in which the first twin is in the breech presentation
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csxn
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2x major problems with breech vaginal delivery
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head entrapment
umbilical cord prolapse |
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twin infant death rate is ____x higher than that of singletons
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5x higher than singletons
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BMZ given to premature fetuses to increase pulm maturity, reduce incidence of RDS. It is also assoc with decr incidence of these two dz of premature infants?
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-intracerebral hge
-NEC |
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which tocolytic works by the mechanism below?
Increases cAMP in the cell, which decreases free calcium |
B-adrenergic agonist (terbutaline)
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which tocolytic works by the mechanism below?
Decreases prostaglandin (PG) production by blocking conversion of free arachidonic acid to PG |
PG synthetase inhibitor
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which tocolytic works by the mechanism below?
Inhibits calcium transport -> calcium can't enter muscle cells |
calcium channel blocker
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which tocolytic works by the mechanism below?
Competes with calcium for entry into cells |
MGSO4
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fetal fibronectin ...
a. what is it used for? b. what is its most valuable use? |
a. PTL - found in disrupted cervical secretions near time of delivery; indicates disruption in materno-fetal interface
b. if it is ABSENT, the patient is VERY unlikely to delivery in next 14d |
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most common etiology of PTL
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idiopathic
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____% of patients with preterm contractions have spontaneous resolution of abnormal uterine activity
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50%
NB: preterm contractions not the same as PTL (ie, they aren't leading to cervical change) |
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adverse fetal effect associated with indomethacin tocolytic treatment for PTL?
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premature closure of ductus arteriosus
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Fetal hypoxia and decreased uteroplacental blood flow have been associated with the use of this tocolytic
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CCB (nifedipine)
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mgmt:
20yo G2P1 @32.0 p/w ctx q4mins. Exam benign, 2/50/-1. FHT 140s, reassuring. WBC 18000. |
amniocentesis to rule out intra-amniotic infection
BMZ is another important step here, but must r/o infxn before giving steroids |
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3 tests needed if IUGR diagnosed on screening pregnancy US
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-amniotic fluid volume
-UA doppler systolic:diastolic ratio -NST |
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_____ percent of patients with oligohydramnios delivered growth restricted infants
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90%
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IUGR:
incr UA doppler systolic:diastolic ratio indicates what? |
increased vascular resistance
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review the components of a biophysical profile
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ultrasound evaluation of fetal movement, fetal tone, amniotic fluid and breathing
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a fetus with IUGR will be monitored once or twice weekly with these 2x tests
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-NST
-biophysical profile (US eval of fetal mvmt/tone, amn fluid, breathing) |
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the crown-rump length on US can reliably date a fetus to within ___to____days
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5 to 7 days
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symmetric growth restriction more likely to be due to events ____in pregnancy
review causes on reverse of card |
early in pregnancy
organ system anomaly aneuploidy chronic intrauterine infection |
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symmetric growth restriction more likely to be due to events ____in pregnancy
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late
usually re/fr uteroplacental insufficiency |
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the _______(test) is a rough estimate of the amount of amniotic fluid
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amniotic fluid index
normal 8-18 oligohydramnios <6 polyhydramnios >20 |
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normal range for AFI
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normal 8-18
oligohydramnios <6 polyhydramnios >20 |
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mgmt:
33 yo G2P1 @ 36 weeks with IUGR and non-reassuring tests of fetal wellbeing |
induction of labor
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2x common side effects of SSRI
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sleep disturbance
sexual dysfunction (decr libido, anorgasmia) |
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what neonatal condition is associated with using fluoxetine (Prozac)
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fetal cardiac defects
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Mgmt:
22-yo F with regular periods reports tension, depressed mood and decreased productivity towards the end of each cycle. She is otherwise healthy and maintains a high-profile job. |
ascertain timing of sx each month
consider dx of premenstrual dysphoric disorder |
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dx:
28 yo G1P1 3d post-delivery reports insomnia, easy crying, depression, poor concentration, irritability or labile affect and anxiety |
"postpartum blues" - likely related to biochemical changes of puerperium
depressive sx are more pronounced |
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def:
the period between childbirth and the return of the uterus to its normal size |
puerperium
"pure-peer-ee-yum" |
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most likely complication of PPTL?
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future pregnancy
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what is the main advantage of CVS over amniocentesis?
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CVS performed earlier
CVS 10-12 wks amnio >15 weeks |
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fetus at highest risk of MR 2/2 radiation exposure from ____ to ____ weeks
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8 to 15 weeks
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dx:
21yo G1 @39wks pmhx of vte on OCP p/w decr fetal mvmt x2d -> US w/ asymmetric IUGR and IUFD |
FVL
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what lab most important?
21yo G1 p/w vaginal spotting and has US showing IUFD at 9 weeks |
maternal blood type
want to give RhoGAM to prevent sensitization if necessary |
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mgmt:
mom with a dead fetus in utero for an unknown duration |
check maternal fibrinogen levels
after >4 weeks of IUFD with retained fetus, can re/in severe maternal coagulopathy |
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what is a Spalding sign on fetal xray?
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overlapping skull bones suggesting IUFD
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mechanism:
coagulopathy after >4wks retained IUFD |
release of tissue factor from placenta into maternal circulation -> consumption of clotting factors -> coagulopathy if bleeding occurs
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mgmt:
18yo G0 w/ LMP 14d ago presents with unprotected intercourse 12h ago, has taken OCPs in past and asks if she can just re-start them |
provide emergency contraception
restart OCP immediately |
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how long does unpredictable bleeding usually last with progesterone contraception?
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2-3 mos
50% of DP pts amennorheic at 1y |
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review contraindications to estrogen-containing OCP x4
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history of thromboembolic disease
women who are lactating women over age 35 who smoke women who develop severe nausea with combined OCP |
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what components of the clotting cascade are found in FFP? (x3)
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fibrinoge
factor V, factor VIII |
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what components of the clotting cascade are found in cryoprecipitate? (x3)
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fibrinogen
VIII vWF |
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dx:
32yo G3P2 woman at 40.1 presents in spontaneous labor and with painless vaginal bleeding; SVE reveals 5.0/100/-1 friable cervix that bleeds easily with intact membranes |
bloody show
occurs due to bleeding from highly vascularized cervix near the time of delivery |
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The time from premature rupture of membranes to labor is inversely related to ________________________.
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gestational age
|
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2x methods to confirm rupture of membranes
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-ferning vaginal fluid
-nitrazine testing |
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primary risk factor for PPROM
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genital tract infxn (esp BV)
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recurrence rate of pprom
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~30%
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what is the role of tocolysis in pprom (say, in a 31 weeker?)
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delay delivery long enough for steroids to be on board for 48h
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this drug class prolongs latency in pprom by 5-7d
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antibiotics
also decr rate of maternal amnionitis and neonatal sepsis |
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what is the cause of fever in this pt?
23yo G1P1 PDD#2 after NSVD now with T=100.4, no complaints, normal exam except for firm and tender breasts without erythema |
breast engorgement
-milk letdown can cause fever if baby is not feeding well -lactating women can feed often and use breast pump to prevent this |
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postpartum fever: ddx (x3
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-endometritis
-cystitis -mastitis |
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mgmt:
32yo g2p1 @41 weeks with an unfavorable cervix and who strongly desires NOT to have induction of labor |
"modified BPP"
NST/AFI twice weekly with IOL for nonreactive NST or oligohydramnios |
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in order to accurately date a pregnancy, ultrasound should be obtained prior to ___ weeks
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20 weeks
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def:
procedure in whcih normal saline is infused into intrauterine cavity |
amnioinfusion
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indication for amnioinfusion?
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repetitive variable decelerations
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def:
infant with EGA > 43 weeks who "looks like an old man" and has peeling skin, meconium staining, long nails, and appears frail |
dysmaturity
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most commonly used cervical ripening agent
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misoprostol (local PGE1 analogue)
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