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128 Cards in this Set
- Front
- Back
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what is finkelstien test and what is it used to diagnose
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pain with grasping thumb into palm
used to dx de quervains tenosynovitis |
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a/w grape like vesicles in the vagina
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hyditiform mole
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a/w snow storm pattern on US of vagina
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hyditiform mole
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what are the two different type of hyditiform mole
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complete
-46 -empty egg and 2 sperm incomplete -69 -egg and 2 sperm |
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what are the functions of B-hCG
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maintains the corpus luteum
promotes male sexual differentiation stimulates maternal thyroid gland |
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what is the difference between gestational age and developmental age
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DA = since fertilization
GA = since LNMP (GA is 2 weeks longer) |
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what is Nageles rules for dating
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LNMP - 3 months + 7 days
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what are the features of fetal hydantoin syndrome and what causes it
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caused by phenytoin or carbamazepine
hypoplastic nails cleft palate vit K def |
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when is a baby considered term
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38-42 weeks
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when is a baby considered preterm
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25-37 weeks
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what type of somatoform disorder is pseudocyesis
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conversion
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what causes the damage in iron poisoning
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lipid peroxidation and free radicals
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what is the order that parity is written in
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T-PAL
Term Pre term Abortions Living children |
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what must be ruled out in in hyperemesis gravidarum
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hyditiform mole
choriocarcinoma |
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what cells produce B-hCG and where are they derived from
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syncytiotrophoblasts
progenitor villous cytotrophoblast cells |
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when does B-hCG begin to be produced
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8 days after fertilization
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what is the best initial test to dx pregnancy
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B-hCG
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what test confirms a pregnancy
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US
- transvaginal earlier than transabdominal |
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what is done to prevent or treat 1st trimester abortions caused by incompetent cervic
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cervical cerclage
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what cardiology physiologic changes are seen in pregnancy
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increased HR
decreased BP |
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what respiratory physiologic changes are seen in pregnancy
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increased O2 consumption
increased tidal volume and minute ventilation |
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what is a common SE of amniocentesis
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amniotic fluid embolism
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low PAPP-A is a/w
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trisomy 18 and 21
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what is a/w banana sign on US
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compressed cerebellum
a/w neurotube defect |
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what should be done next is a triple or quad screen are found to be abnormal
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US to confirm date
then an amniocentesis |
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a/w
increased B-hCG decreased AFP decreased estriol |
trisomy 21
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a/w
decreased B-hCG decreased AFP decreased estriol |
trisomy 18
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what are braxton hicks contractions
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contraction without dilation in the 3rd trimester
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why is chorionic villous sampling indication
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known genetic disease in parents
mother > 35 yo abnormal US |
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why is amniocentesis indicated
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known genetic disease in parents
mother > 35 yo abnormal quad screen |
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what test is used for rapid karyotype analysis
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cordocentesis
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when would MTX therapy for ectopic pregnancy be contraindicated
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immunodeficient px
liver or renal disease ectopic larger than 3.5cm presence of fetal heart beat coexisting intrauterine pregnancy currently breast feeidng |
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what is intrauterine fetal demise
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fetal death after 20 weeks
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what is abortion
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fetal death before 20 weeks
(or a fetus that weighs <500g) |
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how should intrauterine fetal demised be evacuated
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before 24 weeks D/C
after 24 weeks PGE2, pisoprostal, oxytocin |
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what is the next step in diagnosing an abortion
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US
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what is the next step after threatened abortion is diagnosed
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reassure
follow up with US a week later |
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what is the Rx for septic abortion
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immediate surgical evacuation
levofloxacin and metronidazole |
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what is used during twin delivery to convert 2nd twin from transverse to oblique position
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internal podalic version
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what is the only difference in monozygotic twins
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finger prints
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how is cervical length a/w preterm birth
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>35 mm = decreased risk
<35 mm = increased risk |
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what is preterm labor
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contractions and dilation before 37 weeks
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what is PROM
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rupture of chorioamniotic membrane before 37 weeks
"gush of fluid from vagina) |
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what is cervical incompetence
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painless dilation of cervix w/o contraction
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when should preterm labor NOT be stopped
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preeclampsia and ecclampsia
maternal cardiac disease or hemorrhage cervical dilation more than 4cm fetal death chorioamnionitis PROM |
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what should be done if preterm labor occurs and you dont want to deliver
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give betamethasome or dexamethasone
followed by Mg sulfate or CCB |
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how can Mg toxicity be checked for
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depressed deep tendon reflexes
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what are the most feared complications of Mg toxicity
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respiratory depression
cardiac arrest |
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what are the complications of PROM
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preterm labor
cord prolapse placental abruption chorioamnionitis |
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how can chorioamnionitis risk be decreased in PROM
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decreasing the amount of examinations
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Rx for chorioamnionitis
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clindamycin and gentamycin
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how can maternal and fetal blood be differentiated
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Apt test
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what heart tracings is vasa previa a/w
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sinusoidal
-tachycardia to bradycardia |
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Rx for vasa previa
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crash c section
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what is the next step in placenta previa is preterm
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betamethasone
tocolytics |
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what is the next step in placenta previa in term
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schedule c section
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how is placental invasion Rx
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c section followed by hysterectomy
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what is invaded in placenta accreta
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superficial uterine wall
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what is invaded in placenta increta
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myometrium
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what is invaded in placenta percreta
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uterine serosa with
bladder wall or rectal wall |
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what is placental abruption
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separation of placenta from decidua basalis
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what must be done if placental abruption occurs during delivery and why
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rapid delivery to avoid retroplacental hemorrhage which could cause DIC
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what is a concealed placental abruption
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completely detached placenta
blood remains within uterine cavity |
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what is a external placental abruption
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partially detached placenta
blood drains through cervix |
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what are the serious complications of a concealed placental abruption
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DIC
uterine tetany fetal hypoxia sheehan syndrome |
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what is uterine rupture
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complete transection of uterus from endometrium to the serosa
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what c section has the highest risk factor for uterine rupture
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classical (longitudinal)
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what placental invasion has the highest risk for uterine rupture
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placenta percreta
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how can uterine rupture present
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abnormal bump in abdomen
regression of fetus mother may have a sudden relief of pain that then becomes diffuse pain |
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Rx for uterine rupture
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immediate laparotomy with delivery of the fetus
all future deliveries must be at 36 weeks by c section |
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what type of reaction is Rh incompatibility
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alloimmunization
isoimmunization |
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what is the typical situation for ABO incompatibility
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mother = O
baby = A or B |
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what is the MCC for RhoGAM not to work
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too low of a dose
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what is used as a qualitative test to see maternal fetal hemorrhage
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rosette test
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what is used to determine the amount of fetal blood in maternal blood stream
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klehauer betke stain
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what is transient or late HTN of pregnancy
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HTN during second half of pregnancy or later
w/o proteinuria |
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what is chronic HTN of pregnancy
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HTN before 20 week of gestation
w/o proteinura |
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Dx
chronic HTN of pregnancy that later develops prtoeinuria |
chronic HTN with superimposed preeclampsia
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what is gestational HTN
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HTN that starts after 20 week of gestation
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what is preeclampsia
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HTN after 20 week
edema proteinuria |
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what must chronic HTN or pregnancy be differentiated from
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molar pregnancy
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what are the symptoms for severe preeclampsia
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>160/110
>5g per 24 hours in urine impaired mental status, liver function and vision generalized edema oliguria thrombocytopenia |
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what is the pathophys of preeclampsia
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vasospasm
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what causes the seizures in eclampsia
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cerebral vasospasm leading to cerebral hypoxia
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Rx for ecclampsia
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deliver if
->34 weeks -lungs are mature -maternal or fetal deterioration |
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what causes the pain in HELLP syndrome
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distention of hepatic (Glissons) capsule
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what is seen histologically in the liver
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centrilobular necrosis and hematoma formation
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what causes fetal thyrotoxicosis in maternal graves disease
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IgG autoAb cross placenta
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how is gestational diabetes evaluated
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screen 24-28 weeks with glucose load
if >140 after 1 hour do glucose tolerance if any 2 are abnormal it is diagnostic -1 hour > 180 -2 hour > 155 -3 hour >140 |
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what is IUGR
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fetus weighs in 10% for gestational age
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what are the characteristics of symmetric IUGR
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brain is proportional to body
occurs before 20 weeks gestation caused by fetal factors |
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what are the characteristics of asymmetric IUGR
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brain weight is not decreased
occurs after 20 weeks caused by maternal factors |
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what is the most preventable cause of IUGR
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smoking
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how can IUGR be diagnosed
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US
-fundal hieght is atleast 3 cm smaller -abdominal circumference is best because it differentiates symmetric from asymmetric |
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what is macrosomia
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birth weight >4500g
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what is the only way multiple gestations can be delivered
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vertex vertex
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how is macrosomia Dx
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screened with fundal height >3cm greater than gestation age
confirmed with US |
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how is macrosomia Rx
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C section
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MCC of nonreassuring nonstress test
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sleeping baby
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what should be done in a nonreassuring nonstress test
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vibroaccoustic stimulation
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when and why is a NST performed
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high risk pregnancy 32-34 weeks
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when is a contraction stress test done
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equivical NST or BPP
assess uteroplacental dysfunctipn |
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what is a contraction stress test
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oxytocin challenge to see if it induces movement
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what is done if a BPP = 6
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contraction stress test
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what is done is BPP = 4
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delivery
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what is the next step in nonreassuring HR
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oxygen
change maternal position discontinue uterotonic drugs |
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what is the most serious and dangerous deceleration
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late
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what is the cause of early decelerations
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head compression -> vasovagal response
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what is the cause of variable deceleration
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umbilical cord compression
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what is the cause of late decelerations
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uteroplacental insufficiency ->hypoxia -> acidosis
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what kind of contractions are not a/w with labor
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irregular intervals
do not shorten do not increase in intensity |
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what are some epidural anesthesia SE
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urinary retention
hypotension decreased CO |
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what is luchia rubra
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first days bloody discharge
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what is luchia serosa
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3-4 days
pale discharge |
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what is luchia alba
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3-4 days
white yellow discharge |
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what is prolonged latent stage
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long time to reach 4 cm
> 20 hours in primipara > 14 hours in multipara |
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what is protracted cervical dilation
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slow dilation during active stage
< 1.2 cm per hour in primipara <1.5 cm per hour in multipara |
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what is arrest of cervical dilation
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no dilation for 2 hours
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what is arrest of fetal descent
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no descent for 1 hour
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what is the MCC of arrest disorders
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cephalopelvic disproportion
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what is used to extract fetal head in breech delivery
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piper forceps
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Rx for breech
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self correct by week 37
if not perform external cephalic version if not perform c section |
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Dx
mother has bilateral discharge of clear, yellow, green or brown fluid |
galactorhea
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what should be checked with suspected galactorrhea
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prolactin TSH
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what should be suspected in turtle sign
(head is delivered and then retracts) |
shoulder dystocia
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what is post partum hemorrhage
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bleeding more than 500mL after delivery
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MCC of postpartum hemorrhage
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uterine atony
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Rx for postpartem hemorrhage
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1- check for ruptured uterus or retained placenta
2- compression massage 3- oxytocin 4- crystalloid fusion if BP is <90 5- blood products may be given (FFP, PRBC) 6- hysterectomy |
