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41 Cards in this Set
- Front
- Back
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What is the next thing you should do when a woman has had a complete spontaneous abortion?
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FOLLOW B-HCG LEVELS TO ZERO to make sure all the POC were expelled.
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What will be signs of complete abortion as opposed to incomplete?
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Pain and bleeding will SUBSIDE and the cervix will CLOSE.
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What is the nature by which serial hCG levels will change following a COMPLETE SAb?
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They will Halve every 48-72 hrs
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What is indicated if the hCG levels PLATEAU?
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Retained POC - either an incomplete abortion or ectopic pregnancy.
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What is Vaginal bleeding before 20 weeks with a closed cervix?
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Threatened abortion
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What is Vaginal bleeding before 20 weeks with a dilated cervix?
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Inevitable abortion
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What is it important to differentiate an Inevitable abortion from?
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InCOMPETENT cervix!
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How do you distinguish inevitable abortion from incompetent cervix?
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Inev Ab - PAINFUL cervical dilation dt ctx's and bleeding
Incomp Cervix - PAINLESS dilation of the cervix. |
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Cervical dilation + contractions =
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Inev abortion
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Cervical dilation without CTX
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Incompetent cervix
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Txmt for incompetent cervix:
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cerclage
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Passage of tissue + cervix remains dilated:
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Incomplete abortion
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Txmt of Incomplete abortion:
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D/C
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Passage of tissue + cervix closes:
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Complete SAb
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Why does the cervix remain open in an Incomplete Ab?
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The uterus keeps on contracting to try and get the POC's out
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-Vaginal spotting
-No fetal heart tones -Very high hCG levels what is it? |
Molar pregnancy
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What is a molar pregnancy?
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Presence of trophoblastic tissue but no fetus
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Txmt for molar pregnancy:
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Suction curettage
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What is a risk factor for cervical incompetence?
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Previous conization
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What are 6 risk factors for shoulder dystocia?
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-Multiparity
-Prolonged 2nd stage labor -Fetal macrosomia -Maternal Obesity -Gestational diabetes -Postterm |
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What is the turtle sign?
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Fetal head retraction back toward the introitus when the shoulders get stuck
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What is Shoulder dystocia?
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Inability to deliver fetal shoulders spontaneously - the ant one gets stuck behind the pubic symphysis.
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What is the first step in managing fetal dystocia?
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McRobert's maneuver
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What is entailed in McRobert's maneuver?
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-Hyperflex the maternal hips
-Suprapubic pressure |
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What is a common fetal complication of shoulder dystocia?
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Erb's palsy from downward traction on the brachial plexus of the anterior shoulder.
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What nerve roots are involved in Erb's palsy?
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C5-C6
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What are the deficits seen in ERb's palsy?
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-Weak infraspinatus/deltoid
-Weak flexors of the forearm |
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What can delivery of the head followed by failure of the shoulders to deliver lead to?
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Fetal hypoxia
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What should you NOT do to resolve shoulder dystocia?
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Don't pull harder;
Don't press on the fundus |
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What are 3 other maneuvers in addition to McRobert's that can be done for dystocia?
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-Wood's corkscrew
-Deliver the posterior shoulder -Zavanelli maneuver |
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What is Zavanelli's maneuver?
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Pushing the head back inside and doing a c/section
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If a patient has all the signs of pyelonephritis but they're POD2 s/p TAH, what do you suspect?
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Ureteral obstruction or injury!
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What are the 2 tests you should run first in that case?
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-IVPyelogram
-CT scan of the abdomen |
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What are 6 conditions that predispose to ureteral injury in a TAH?
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-Interligamentous leiomyomas
-Cancer -Residual ovaries -Endometriosis -Extensive adhesions -TOA - tuboovarian abscess |
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What is the most COMMON location for ureteral injury during a TAH?
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The cardinal ligament
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What is contained in the cardinal ligament?
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Ovarian artery
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Where does the cardinal ligament lie wrt the ureter?
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OVER it (water under the bridge), 2-3 cm lateral to the internal cervical os.
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What is evidence of a urinary obstruction?
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Hydronephrosis
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What is percutaneous nephrostomy?
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Placement of a stent in the renal pelvis, going through the skin using radiologic guidance.
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What is percutaneous nephrostomy done for?
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Urinary obstructions
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What is an alternative way to place a stent?
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With cystoscopy
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