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115 Cards in this Set
- Front
- Back
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primary causes of third-trimester bleeding
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placental abruption and placenta previa
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classic ultrasound and gross appearance of complete hydatiform mole
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snowstorm appearance on ultrasound; cluster of grapes on physical exam
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chromosomal pattern of a complete mole
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46, XX
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molar pregnancy containing fetal tissue
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partial mole
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symptoms of placental abruption
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continuous, painful vaginal bleeding
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symptoms of placental previa
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self-limited, painless vaginal bleeding
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when should a vaginal exam be performed with a suspected placenta previa?
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never
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antibiotics with teratogenic effects
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tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
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shortest AP diameter of the pelvis
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obstetric conjugate: between the sacral promonotory and the midpoint of the line of the symphysis pubis
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medication given to accelerate fetal lung maturity
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betamethasone or dexamethasone x 48 hours
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the most common cause of postpartum hemorrhage
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uterine atony
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treatment for postpartum hemorrhage
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uterine massage; if that fails, give oxytocin
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typical antibiotics for group B strep (GBS) prophylaxis
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IV penicillin or ampicillin
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a patient fails to lactate after an emergency C-section with marked blood loss
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Sheehans syndrome (postpartum pituitary necrosis)
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uterine bleeding at 18 weeks gestation; no products expelled; membranes ruptured; cervical os open
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inevitable abortion
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uterine bleeding at 18 weeks gestation; no products expelled; cervical os closed
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threatened abortion
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what is the definition of pre-term labor?
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regular uterine contractions + concurrent cervical changes at <37 weeks gestation
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Group-B strep prophylaxix
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penicillin or ampicillin
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what defines a post-partum hemorrhage?
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>500mL with vaginal delivery or >1000mL with c-section
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most common cause of post-partum hemorrhage
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uterine atony
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treatment for uterine atony protocol
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1. uterine massage
2. oxytocin 3. methergine 4. prostin PGF2-alpha |
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when should the uterus be palpable above the pubic symphysis?
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12 weeks
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what does human placental lactogen do?
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insulin-antagonist to maintain fetal glucose levels
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what is the cut-off for anemia in pregnancy?
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Hgb below 11.0mg/dL
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what is the average WBC count during pregnancy? what about during labor?
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10.5 during pregnancy, 20+ during labor
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additional caloric intake required during pregnancy and breast feeding
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300kcal/day for pregnancy, 500kcal/day during breast feeding
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weight gain recommendations during pregnancy for the average woman
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25-35 pounds
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what is the triple screen?
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maternal serum-AFP, estriol, beta-HCG
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to who and when is the RhoGAM injection given?
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to RH(-) mothers at 28 weeks
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Naegles rule
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LMP + 9 months + 7 days
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what does a MS-AFP of >2.5 MoM's indicate?
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neural tube defects, abdominal wall defects, multiple gestation, fetal death, incorrect dating
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what does trisomy 18 look like on triple screen?
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all three are decreased
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what does trisomy 21 look like on triple screen?
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decreased AFP, decreased estriol, increased beta-HCG
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what is a normal non-stress test?
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2 accelerations of 15bpm above baseline in 15 seconds over 20 minutes
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what do you do if the NST has no response?
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biophysical profile
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what is a biophysical profile and what do the scores indicate?
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consists of fetal tone, breathing, movement, amniotic fluid volume, NST
score of 8-10 is reassuring, 0-2 indicates fetal asphyxia |
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what is an early deceleration and what does it indicate? and what do you do?
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cephalic compression, no indication of fetal distress; no treatment necessary
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what is a variable deceleration and what does it indicate? and what do you do?
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due to umbilical cord compression, best to have mother change positions
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what is a late deceleration and what does it indicate? and what do you do?
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due to uteroplacental insuffiency/fetal hypoxemia; if repetitive/severe then deliver ASAP
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what indicates a positive three hour glucose tolerance test?
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two of more of the following
fasting >95 one hour >180 two hours >155 three hours >140 |
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what is the criteria for gestational diabetes?
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two of the following
fasting >126 random >200 glucose challenge test @24 weeks >140 |
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hyperglycemia in the first trimester indicates what?
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suggest pre-existing diabetes
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what drugs are contraindicated for HTN control with pre-ecclampsia?
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do not give ACEI or diuretics
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what is the definition of pre-ecclampsia?
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new-onset HTN + proteinuria at >20 weeks
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what is the definition of ecclampsia?
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new-onset HTN + proteinuria at >20 weeks + seizures
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what the symptoms of pre-ecclampsia?
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persistent headaches, visual disturbances, epigastric pain, hyper-reflexia
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when should you suspect IUGR?
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if there is a discrepancy of >4cm between fundal height and gestational age
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pre-ecclampsia in the first trimester is pathognomonic for what?
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hydatidiform mole
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what do grape-like molar clusters indicate?
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gestational trophoblastic disease (GTD)
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what do you see on ultrasound with a complete hydatidiform mole?
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snowstorm appearance on pelvic U/S
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what does painful, dark vaginal bleeding that does not spontaneously cease indicate and what do you do?
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placental abruption, expectant management
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what does painless, bright red vaginal bleeding that spontaneously ceases in 1-2 hours indicate and what do you do?
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placenta previa, do not do a vaginal exam and delivery by c-section
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pregnant woman with intense abdominal pain with variable vaginal bleeding, what must you rule out?
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uterine rupture
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placental abruption + decrease in function of mother/fetus + early stage labor --> what treatment is indicated?
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c-section
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what is the most effective parameter for diagnosing suspected IUGR?
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abdominal circumference
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when can general/spinal anesthesia reduce uterine activity?
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if administered during the latent phase
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when should a GBS screen be performed?
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get vaginal/rectal swabs at 35-37 weeks
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what must you rule out with hyperemesis gravidarum?
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must rule out Gestational Trophoblastic disease via beta-HCG screen
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pregnant patient + persistent vomiting + weight loss + ketonuria = ??
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hyperemesis gravidarum
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treatment for chlamydia
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azithromycin or clindamycin
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copous vaginal discharge that is yellow/white, non-malorodous and not associated with any other symptoms = ??
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physiological leukorrhea
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initial test for infertile couples
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semen analysis
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HELLP syndrome at 34 weeks = what treatment?
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immediate delivery
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what do you do for a threatened abortion?
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have a follow up ultrasound in one week, advise they abstain from sex and go on bed rest with some reassurance
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what causes pre-ecclamptic LUQ pain?
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stretching of the hepatic (Glisson's) capsule
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why is MgSO4 given with ecclampsia?
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to prevent more seizures
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disappearance of N/V of early pregnancy + arrest of uterine growth = ??
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must rule out missed abortion
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post-partem fever + uterine tenderness + foul-smelling lochia = ??
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endometritis
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what bug causes endometritis?
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usually polymicrobial
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treatment for post-partem endometritis
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IV clindamycin and IV gentamicin
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epidural anesthesia can cause what bladder problem and how do you treat it?
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can cause overflow incontinence due to loss of bladder sensation; treat with intermittent caths until the sensation returns
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most common cause of a non-reactive non-stress test (NST)
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sleeping baby
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most important preventative measure for for HIV pregnant woman
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zidovudine throughout the pregnancy and 6 weeks post-partum for the baby
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what should you do with premature rupture of membranes with unknown GBS status?
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treat with prophylactic antibiotics
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what patient should you avoid using methylgonovine in?
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one that is hypertensive
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painful vaginal bleeding + uterine contrations = ??
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placental abruption
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what is placenta accreta?
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the placenta attaches to deeply/tightly to uterus; usually diagnosed upon attempt to deliver after-birth
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what is placenta percreta?
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worse than placenta accreta, attaches through uterus to nearby organs such as the bladder
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what is placenta previa? how does it present?
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placenta attaches on or near the cervix; presents as painless vaginal bleeding
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what are the signs of pregnancy on pelvic exam?
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Chadwicks sign = bluish discoloration of vagina/cervix
Goodwills sign = softening and cyanosis of cervix at four weeks Landins sign = softening of uterus at 6+ weeks |
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how is CMV transmitted? what precautions must a pregnant nurse take when treating a patient with CMV?
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transmitted via direct contact with secretions; use standard precautions
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best test to assess limb development and cardiac function
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level II ultrasound
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when is Rhogam given and to whom?
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given to Rh+ mothers, Rh- mothers with Rh+ or unknown Rh-status fathers at 28 weeks; or given after procedures that risk mixing of blood such as CVS or aminocentesis
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active herpes + patient is in labor = ??
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deliver via c-section
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incompetent cervix + history of recurrent painless spontaneous abortions = ??
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suspect maternal exposure of DES
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what does maternal exposure to diethylstilbestrol increase the off-spring risk for?
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vaginal cancer
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treatment for incompetent cervix
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cervical cerclage
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first line treatment for migraines in pregnancy
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acetominophen
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what is glucosuria indicative of in pregnancy?
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nothing; it is a normal finding
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first line treatment for prevention of ecclamptic seizures in pre-ecclamptic woman
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MgSO4
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what causes stress incontinence?
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due to displacement of the urethrovesical junction
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what tests are use to confirm rupture of membranes?
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fluid in vaginal vault, nitrazine test, fern test
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what do late decels indicate?
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uteroplacental insufficiency
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late decels + fetal bradycardia = ??
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immediate c-section
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most common cause of post-partum hemorrhage?
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uterine atony
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treatment protocol for uterine atony
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uterine massage + oxytocin --> methylergonovine --> prostin (PGF2) --> DNC --> ex-lap --> hyst
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pre-ecclampsia <20 weeks + snow-storm pattern on ultrasound = ??
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complete molar pregnancy
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treatment for molar pregnancy
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DNC
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which anti-HTN drugs are safe in pregnancy?
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labetolol, methyldopa
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is levothyroxine safe in pregnancy?
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yes
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pre-natal schedule for low-risk pregnancy
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<28 weeks = q4-5 weeks
28-36 weeks = q2-3 weeks >36 weeks = weekly until delivery |
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what are the four fetal measurements to assess fetal age
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biparietal diameter, abdominal circumference, crown-rump length, femur length
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what does maternal smoking put the fetus at risk for?
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low birth weight
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what does category A indicate?
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well-controlled studies with no risk to fetus in first trimester
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what test must you order to confirm the diagnosis of pre-ecclampsia?
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UA - proteinuria
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treatment for HELLP syndrome at >33 weeks
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immediate induction of labor
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what can an untreated UTI in pregnancy lead to?
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in order of risk:
preterm labor 2nd trimester abortion pre-ecclampsia maternal anemia amionitis |
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what is the most common cause of a UTI?
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E coli
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what is the treatment for symptomatic uterine bleeding?
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IV estrogen and subsequent DNC
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what test rules out pre-term labor at 22-34 weeks?
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fetal fibronectin
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most common cause of congenital abnormalities
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fetal alcohol syndrome
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treatment for asymptomatic bacturia in pregnancy
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single 3g dose of amoxicillin
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first step with a suspected placenta previa
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confirm with transabdominal ultrasound
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first step in management with suspected displaced IUD upon pelvic exam
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pregnancy test
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what is the fetus at risk for with a CVS performed <9 weeks?
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limb abnormalities
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