Ob/gyn Wards Notes

Front 1

m/c cause of post-menopausal ascites?

Back 1

ovarian cancer

Front 2

m/c cause of post-menopausal bleeding?

Back 2

endometrial cancer

Front 3

marker of ovarian cancer?

Back 3

CA-125

Front 4

"omental cake" what suspect?

Back 4

ovarian cancer

Front 5

normal placental width =?

Back 5

2-4 cm

Front 6

m/c causes of increased placental thickness?

Back 6

CMV, non-immune hydrops fetalis due to fetal anemia

Front 7

most important RF for placenta previa? (2)

Back 7

Over 4 c-sections, also grand multiparous

Front 8

most important RF's for abruptio placenta?

Back 8

PREVIOUS AP!!, hypertension, abd/pelvic trauma, tobacco, or cocaine use

Front 9

types of placenta previa?

Back 9

complete, partial, marginal, low-lying

Front 10

which placenta previas can be safely delivered?

Back 10

if > 2cm from cervical os

Front 11

3 m/c places of placental hemorrhages?

Back 11

MC= subchorionic (marginal) = maternal venous blood; retroplacental (maternal arterial blood, worse outcome), pre-placental (fetal venous blood),

Front 12

what is Breus mole?

Back 12

a massive sub-chorionic (marginal ) placental hemorrhage

Front 13

4 causes of 3rd trim (>28wks) bleed?

Back 13

abruptio placenta; placenta previa; bloody show (loss of mucous plug with cerv dilation during 1st stage of labor), uterine rupture;
Non-uterine causes: genital tract lesions, cerv carcinoma

Front 14

abruptio placenta: two kinds?

Back 14

bleeding out, bleeding concealed

Front 15

m/c place of abrutpion placenta bleed?

Back 15

retroplacental (vs placenta previa bleed = marginal)

Front 16

Placental previa vs Abruptio placenta diagnosis?

Back 16

PP = diagnosed with trans-vag ultrasound (dont' do exam!!);
AP = diagnosed clinically=fetal distress, uterine hypertonicity, frequent UC's

Front 17

what is placenta acretia?

Back 17

abnormal adherence of pl to myometrium; ie cannot remove it from wall ; can lead to catastrophic blood loss

Front 18

sign of placenta acretia on ultrasound (2)?

Back 18

myometrial thinning, swiss-cheese/moth-like appearance

Front 19

what is vasa previa?

Back 19

ie bilobar placenta with fetal veins running in between; vessels run through membranes and over cervix

Front 20

vasa previa may cause?

Back 20

bleeding during vaginal delivery --> FETAL blood loss = death of baby!

Front 21

what must do if diagnose vasa previa?

Back 21

treatment immediately with an emergency cesarean delivery is usually indicated.

Front 22

preeclampsia may be dx'd with hypertension and what dipstick protein amt?

Back 22

at least +2 protein

Front 23

preeclampsia definition?

Back 23

hypertension and > 300 mg/24hrs proteinuria

Front 24

mild vs severe preeclampsia?

Back 24

mild = > 140/90 mmhg; proteinuria 300-5g/24 hrs; mild organ effects = cerebral changes, headaches; wt gain, edema, jvd, hyperactive reflexes
severe = > 160/110 mmhg; proteinuria > 5g/24 hrs; end organ DAMAGE: blurred vision, scotomata, RUQ/epigastric px, pulm edema/ cyanosis; LFT up, Pl's decr, decr UO, oligohydramnios, IUGR

Front 25

HELLP syndrome

Back 25

Hemolysis, Elevated LFT's Low Pl's

Front 26

why give MgSo4 for severe preeclampsia?

Back 26

not to help HTN but to prevent seizures.

Front 27

tx for severe preeclampsia?

Back 27

DELIVER!!
MgSO4 to prevent seizures

Front 28

results of having a single umbilical artery?

Back 28

IUGR;
Congenital malformations;
if these ruled out, = outcome will most likely be ok

Front 29

If pregnancy due date under 1 year since last delivery, is an attempted VBAC recommended?

Back 29

NO!

Front 30

success rate of VBAC?

Back 30

75%; rest will result in another c-section (actually depends on location/ center etc)

Front 31

what MUST you ask pt when considering VBAC?

Back 31

MUST ask what indications for last C-section were; ie if were small pelvis, VBAC has much higher chance of failure than if ie: breech presentation, transient infection; etc

Front 32

2 m/c conditions you MUST rule/out if bleeding?

Back 32

AP and PP

Front 33

what never do with a placenta previa

Back 33

never do vaginal exam

Front 34

Under what 4 conditions may you give steroids?

Back 34

24-34 weeks (<24 = not viable; > 34= lungs most likely mature)
No amnionitis
No uncontrolled maternal DM
No immediate delivery (ie AP)

Front 35

labor induction depends on?

Back 35

Bishop score

Front 36

Bishop score?

Back 36

1 Cervical length/ effacement ( 80% = 3)
2 Cervical dilation (>5cm = 3)
3 consistency of cervix (soft = 2)
4 Position: post or ant cervix (ant = 2)
5 Station: (fetal head to isch spine high = -3 to low = +3) (low = 3)
TOTAL = 13; if > 9, labor will most likely commence spontaneously; if <5 most likely won't commence w/o induction

Front 37

How may you change bishop score to induce labor?

Back 37

dinoprostone =PGE2 =vasodilator and smooth muscle relaxant; affects cervical effacement factor of bishp score; INDUCES labor and also abortifacient; also causes bdilation and tachycardia

Front 38

confounders of appendicitis dx in preggers?

Back 38

constipation, leukocytosis, rlq px is also in normal pregnancy

Front 39

CT abd radiation amt? critcal level for pregger?

Back 39

2.5/ 5.0 = critical

Front 40

Def's and weeks that must induce labor in Gest DM AI vs AII

Back 40

* Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting (norm = <126mg/dL) and 2 hours after meals (lower than 140) ; diet modification is sufficient to control glucose levels; must induce at 38 weeks
* Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting (110-126 = impaired GT; over 126 = diabetes) and/or after meals (140-200 = impaired GT, over 200 at 2hrs = diabetes); additional therapy with insulin or other medications is required; must induce at 40 weeks

however study has shown that no indication for delivery before 40 weeks if glucose has been adequately controlled

Front 41

ways to change bishop score?

Back 41

1) dinoprostone ( PGE2) = induces labor by increasing cerv effacement
2) catheters: squeeze muscles and stimulate endogenous PG release
3) mechanical stripping: mechanically dilate cervix
4) Oxytocin = causes contractions which further dil/effacement

Front 42

def of IUGR?

Back 42

EFW< 3rd percentile; depends on which curve used to determine EFW

Front 43

first things to ask mother with fetus that 's IUGR?

Back 43

What is the TRUE gestational age?
Ie how were her last menst periods? regular/irregular/ long, short/ on time? during bfeeds?

Are parents small?

Front 44

when is ultrasound for EFW done

Back 44

= 1st trimester

Front 45

when is nuchal tlucency done?

Back 45

11-13.6 weeks

Front 46

what is def of REGULAR menstruation?

Back 46

28d +/- 7 d

Front 47

Causes of IUGR?

Back 47

Smoking: also causes prematuirty, preterm L/D, AP, IUGR, PPROM; is PROTECTIVE for preeclampsia
drugs: b-blockers
illnesses: EVERY chronic maternal illness may cause IUGR
Vasc disease
Hypertensive disorders
Uncontrolled asthma
High altitude
Anemia
Ethnicity (ie India)
Fetal: Cong anomalies, CHF, single umbilical art, chromosomal = T13, 16, 18, (21 less), (NOT turners), Twin-twin tfusion, TORCHES, Inborn errors
Plac: Oligohydramnios, tumors, septated uterus, uterine myoma, infarction, hemangioma

Front 48

Tx of IUGR:

Back 48

24-34 weeks, give steroids and try to put off delivery to develop fetal lungs;
monitor with non-stress test
US for biophysical profile:
HR monitor, Movements, Breathing movements, sufficient Amniotic fluid, Fetal tone (all 2pts or 0 pts only)
Do EFW measurements
US anatomy/anomaly scans
Bl tests for TORCHES
Doppler for placental insuff
= see notch on art pulse and/or redistribution of blood to MCA (hypoxia induced).
Oxyt challenge test: check response to see if baby is ok to do vag deliv
If all these are normal, may send home and folow up with FHR in 2 wks. If not normal, INDUCE LABOR!!!

Front 49

GCT catches what %'s of diabetes?

Back 49

if set at 140 mg/dL cutoff = catches 80%
if set at 130 mg/dL cutoff = catches 90% but will have more unnecessary secondary OGTT's performed

Front 50

When is GCT given?

Back 50

given b/w weeks 24-28

Front 51

Percent success rate of VBAC after CS for past breech position? vs: after past non-progression CS or relative CPD?

Back 51

80%; vs 50-60% = avg of 75%

Front 52

what is the term given when the size, presentation and position of the baby's head in relationship to the mom's pelvis prevents dilation of the cervix and/or decent of the baby's head.

Back 52

Cephalopelvic Disproportion (CPD)

Front 53

risk of rupture during VBAC attempt?

Back 53

0.5% for any CS with past transverse incision (if classical vertical incision = rupture rate = 8%!!!)

Front 54

what % of uterine rupture ends in baby death or severe asphyxiation? what are other complication? if unrepairable?

Back 54

70%!!
May cause AP = baby dies immediately;
if unrepairable, must do hysterectomy immediately

Front 55

Ideal # months after CS before VBAC trial?

Back 55

18

Front 56

what sign during VBAC attempt indicates possible uterine rupture?

Back 56

sudden stop of contractions

Front 57

absolute C/I's to VBAC?

Back 57

classical scar
Over 2 CS's in past

Front 58

relative C/I's to VBAC?

Back 58

* < 1yr since last CS
* Indication for past CS was ie failure to progress, craniopelvic disproportion (CPD) etc
* ?

Front 59

site of epidural?

Back 59

between L3-L4 = at level of iliac crest

Front 60

Drug to tx HTN in pregnancy?

Back 60

L-Dopa

Front 61

Nonreassuring vs ominous fetal hr patterns?

Back 61

Nonreassuring patterns
Fetal tachycardia
Fetal bradycardia
Saltatory variability
Variable decelerations associated with a nonreassuring pattern
Late decelerations with preserved beat-to-beat variability

Ominous patterns
Persistent late decelerations with loss of beat-to-beat variability
Nonreassuring variable decelerations associated with loss of beat-to-beat variability
Prolonged severe bradycardia
Sinusoidal pattern
Confirmed loss of beat-to-beat variability not associated with fetal quiescence, medications or severe prematurity

Front 62

hypertonic uterus is assoc with?

Back 62

Abruptio Placenta!

Front 63

AFI (amn.fluid index) normal range?

Back 63

5-25cm

Front 64

90% of vaginitis is caused by?

Back 64

infection:
gardnerella vaginalis and candidiasis

Front 65

hormonal vaginitis is caused by?

Back 65

post-partum or especially post-menopausal = low estrogen levels = ATROPHIC vaginitis

Front 66

complications of vaginitis in pregos?

Back 66

PPROM, preterm delivery

Front 67

bact vaginitis vs candidiasis vs trachoma vaginalis appearance/smell?

Back 67

bact vag = fishy smelling, white d/c w/ clue cells
candidiasis = non-odorous, cottage-cheese like d/c
trachomas vaginalis = can be any color

Front 68

ROM normally occurs at what dilation?

Back 68

If cervix left alone, ROM will occur at 9-10cm!

Front 69

premature ROM (PROM) ?

Back 69

is actually pre - LABOR rupture of membranes

Front 70

PPROM = ?

Back 70

preterm PROM = prior to term/ maturity = 25-37 weeks

Front 71

Most significant RF for PPROM?

Back 71

previous PPROM or preterm delivery

Front 72

M/c etiology of PPROM?

Back 72

Infection ie chorioamnionitis

Front 73

sign of ROM in pelvic exam?

Back 73

pooling of fluid in posterior fornix

Front 74

vag pH of pregnancy? in amniotic fluid? Semen? sign of ROM?

Back 74

4.0
7.0 = amniotic fluid
7.0 = semen
if ROM, vaginal pH will be much more alkaline than normal 4.0 acidic state

Front 75

two tests for amniotic fluid?

Back 75

Nitrazine: alkaline amniotic fluid turns nitrazine paper blue
Ferning test: amn fluid smeared on slide forms "ferns" as it dries
other tests: tampon test: inject blue dye to amnion; wear tampon and check for turning blue = ROM

Front 76

When do you perform a digital exam if suspected PPROM?

Back 76

NEVER!!

Front 77

Indications for immediate delivery in PPROM?

Back 77

chorioamnionitis, advanced labor,

Front 78

difference b/w preterm contractions, preterm labor, and cervical os dysfxn?

Back 78

1) Preterm contractions = just contractions, no cerv dil/eff
2) preterm labor= preterm contractions>1/10mins PLUS cerv dilation > 2 cm or effacement > 80%
3) cerv os dysfxn/incompetence = preterm cerv dilation without painful contractions

Front 79

When does PPROM cause lung hypoplasia and why?

Back 79

only if earlier than 25 weeks b/c the lung alveoli havne't formed yet (doesn't have to do w/surfactant production)

Front 80

PPROM tx?

Back 80

90% will spontaneous deliver in 1 week.
Other 10 %: wait or induce labor

Front 81

Normal leukocyte count in 3rd trimester ?

Back 81

up to 15,000!

Front 82

does use of tocolytics prolong tiem before premature delivery?

Back 82

NO/ NO EVIDENCE!

Front 83

Tocolytics?

Back 83

Terbutaline = B2 agonist =binds b2 R's in uterus/myometrium causing sm relax and decr in freq and intensity of contractions
MgSO4
Nifedipine = Ca Ch blocker
ritodrine = also B2 agonist

Front 84

C/I's to Tocolytics?

Back 84

CHAMPS:
Chorioamnionitis
Hemorrhage
Abruptio placenta
Mature fetus
Preeclampsia/eclampsia
Severe IUGR

Front 85

In workup for Preterm labor, what always give first? and why?

Back 85

always give IV hydration, b/c dehydration = stimulation of ADH (vasopressin) = mimics oxytocin!!

Front 86

Definition of true labor? Def of sufficient contractions?

Back 86

UC's sufficient in duration to cause cervical dilation >2cm OR effacement of >80%

Sufficient contractions are >200Mvideo units (pressure X minutes / 10 minutes ie 60x1min +80X2mis = 220

Front 87

fetal fibronectin test positive between what weeks means possible preterm labor or PPROM?

Back 87

between 22 - 38 weeks (outside of these, is already positive)

Front 88

what frequency of prenatal visits at what weeks?

Back 88

0-28 weeks = monthly
28-36 weeks = bimonthly
36-delivery = weekly

Front 89

preterm def?

Back 89

24-37 wks
term = 37-42 weeks

Front 90

what should EVERY prenatal visit check for?

Back 90

fetal movement
vag d/c or bleed
abd cramps or UC's
leakage of fluid or ROM
Blurred vision, hache, rapid wt gain, edema
Wt, fundal ht, BP, edema
Dipstick urine for protein and glucose
fetal heart tones (after 12 wks)

Front 91

trimester in weeks?

Back 91

ACOG:
1-14 first
14-28 = second
28- delivery = third

but other sources say:
0-12 first
12-27 = 2nd
27-40 3rd

Front 92

fundal height measurements at weeks?

Back 92

at sup symphysis = 12 wks
midway between sP and umbilicus = 16
umbilicus = 20
above umbilicus = ht above SP in cm = # weeks for weeks 20-32

Front 93

typical triple test in DS?

Back 93

low AFP
High BCG
Low estradiol

Front 94

amt folate preggers should take?

Back 94

400 ug/ day

Front 95

percent of preg's having gest DM?

Back 95

3-5%

Front 96

RF's for gest DM?

Back 96

family hx,
gest DM in previous preg
obesity
previous macrosomic baby,
habitual abortions or stillbirths

Front 97

macrosomic baby definition?

Back 97

>4500 g's at birth

Front 98

When is triple test supposed to be performed?

Back 98

at 16-18 weeks IF initial MS-AFP (maternal serum AFP) test was abnormal

Front 99

Positive GCT test?

Back 99

50 g glucose given
If blood glu 1hr later = over 140 to 200 = do OGTT test. If >200 (sheiner says 180)= DIAGNOSE gestational DM

Front 100

most common medical complication of pregnancy?

Back 100

gestational DM!!

Front 101

positive OGTT =?

Back 101

pre GTT test: if fasting >126 or random >200, dx gest DM
GTT: if fasting >95, or 1hr > 180, 2hr >155, or 3hr >140 and one abnormal level is confirmed by another subsequently, dx Gest DM

Front 102

when must you repeat glucose tolerance test for all positive GTT women?

Back 102

must repeat POST-PARTUM to diagnose those few who will REMAIN diabetic

Front 103

what % of women with gest DM will develop DM in five years?

Back 103

30%!!!!!

Front 104

when to do amniocentesis?

Back 104

between 16-18 weeks!! (=same as for afp screen, triple test, and us for anatomy evaluation)

Front 105

when do US for anatomy evaluation?

Back 105

16-18 weeks!!

Front 106

type of US to do and when?

Back 106

vaginal if HCG > 1500
abdominal if HCG >6000

Front 107

When would you do chorionic villus sampling (CVS)?

Back 107

9-12 weeks gestation

Front 108

indications for CVS and what weeks done?

Back 108

done at 9-12 weeks (advantage= before amniocentesis may be done)
indications:
* Mother's age of 35 years or greater
* Abnormal first trimester screen results
* Increased nuchal translucency or other abnormal ultrasound findings
* Family history of a chromosomal abnormality or other genetic disorder
* Parents are known carriers for a genetic disorder

Front 109

when to do gest diabetes screen for all preggers?

Back 109

26-28 weeks

Front 110

cross the placenta and are therefore teratogenic and CONTRAINDICATED during pregnancy?

Back 110

oral hypoglycemics

Front 111

what is indication to START insulin in DM type AII mother?

Back 111

If studies reveal PERSISTENT (1-2week) fasting blood glucose level over 95mg/dL or PERSISTENT 2hr postprandial glu >120 mg/dL, then start insulin!!

Front 112

what increased risk for preeclampsia/eclampsia do gest DM mothers have?

Back 112

4-fold increased risk for ecl/preeecl!!

Front 113

fetal complications of gest DM?

Back 113

preterm labor
polyhydramnios
CS
pre-eclampsia/eclampsia (4-fold incr risk)
risk of future DM!!
macrosomia--> shoulder dystocia, etc
perinatal mortality (2-5%
congenital defects (3-fold increase)
delayed organ maturity

Front 114

RF's for hypertension?

Back 114

nulliparity
multiple gestations
<15 or >35 y/o
vascular disease (ie lupus,)
diabetes **(although HTN is NOT a risk factor for gest DM)
chronic HTN

Front 115

chronic hypertension DEFINITION?

Back 115

BP > 140/90 measured 2 x, >6hrs apart BEFORE 20 WEEKS GESTATION!!!!

Front 116

PIH definition?

Back 116

BP > 140/90 measured 2 x, >6hrs apart AFTER 20 WEEKS GESTATION!!!!

Front 117

Only cure for severe preeclampsia?

Back 117

delivery! (b/c patholgy is related to placenta= must remove placenta)

Front 118

PGE2 and prostacyclin are?

Back 118

VASODILATORS!!

Front 119

mild vs sever preeeclampsia?

Back 119

mild = bp >140/90 and proteinuria >300, <5g/24hrs
severe = bp >160/110 OR proteinuria >5g/24hrs OR
visual changes, RUQ pain, pulm edema/cyanosis, elev lft's, decr platelets, decr urine output, oligohydr, or IUGR

Front 120

differential for preeclampsia?

Back 120

renal disease, renovasc htn, primary aldosteronism, cushing's, pheochromocytoma, SLE

Front 121

differential for eclampsia?

Back 121

primary seizure disorder
TTP

Front 122

drugs you may give for severe preeclampsia while preparing for delivery? (and for eclampsia?)

Back 122

MgSO4 (to prevent seizures)
Labetalol or hydralazine for HTN
Postpartum- continue MgSO4 while monitoring for Mg toxicity (hyporeflexia, resp paralysis, coma).

For eclampsia, same as above but also give foley catheter to check I/O's; and O2 while monitoring ABC's

Front 123

should hospitalize for mild preeclampsia?

Back 123

yes, to observe and monitor labs closely (preterm) or to induce (term)

Front 124

tx for magnesium toxicity?

Back 124

same as for K+ toxicity = Ca gluconate IV

Front 125

If PIH occurs in first trimester, suspect what?

Back 125

think either chronic hypertension OR
MOLAR PREGNANCY!!

Front 126

3 m/c sx preceding eclamptic attack?

Back 126

hache, visual changes, and RUQ or epigastric pain!!!!

Front 127

rf's for hypertension in pregnancy (same for chronic as for PIH)

Back 127

*NULLIPARITY
multiple gestations
extreme ages <15 and >35
vascular disease (htn 2ndry to SLE or DM)
DM
Chronic htn

Front 128

Definition of Chronic hypertension

Back 128

>140/90 measured twice, at least 6 hrs apart BEFORE 20 WKS gestation!

Front 129

PIH def

Back 129

htn after 20 weeks

Front 130

Only cure for preeclampsi?

Back 130

Delivery of PLACENTA!!

Front 131

mild preecl def?
severe preecl def?

Back 131

>140/90 and 300mg-5g/24hrs
max of BP >160/110 and/or proteinuria > 5g/24hrs

Front 132

When is only situation in preeclampsia in which you do not deliver immediately but you hospitalize and observe?

Back 132

MILD PRETERM preeclampsia; if full term, always just deliver

Front 133

severe preecl tx?

Back 133

DELIVER!!! until then, stabilize with
hydralazine for htn
MgSO4 to prevent seizures and postpartum for 24 hrs monitoring for MgSO4 toxicity ( coma, decr reflex, resp paralysis

Front 134

causes of 1st trimester bleed?

Back 134

Spont abortion ALWAYS RULE OUT
ectopic preg ALWAYS RULE OUT
hydatidiform mole
trauma
infections (cervicitis, genital tract traumua or infection)

Front 135

workup for 1st trimester bleed?

Back 135

b-HCG for levels
Transvag US (if bHCG <1500) or trans abd US (if >6000)
Pelvic exam for adnexal masses, cervical dil, or trauma, infection
Type and screen (for RhoGAM administration if Rh - )

Front 136

Spont abortion def?

Back 136

term of preg at <20wks or with an EFW at <500.

Front 137

percent of all pregnancies that end in spontaneous abortion?

Back 137

50-70%

Front 138

definition and tx of inevitable abortion?

Back 138

ROM, severe uterine BLEEDING or heavy cramps with NO products of conception expelled yet; cervical os opened; tx = D &C

Front 139

missed abortion def and tx?

Back 139

no heavy bleeding, no severe cramps, cervical os not opened but ABNORMAL US (if Normal = consider "threatened abortion")

Front 140

etiologies of spontaneous abortions:

Back 140

Chrom abnormalities (up to 50% of first trim spont ab's)
Infections
Anatomical defects ie septate bicornuate uterus, cerv os incompetence, or adhesions
Endocrine factors: prog deficiency, PCOS
Immunologic: SLE antiocoag; APLA

Front 141

spont abortion in first trim tx?

Back 141

stabilize mom with liquids
RhoGAM to all antibody (-) preggers
D&C

Front 142

PPH def and causes?

Back 142

def = blood loss >500ml for normal vag deliv / 24 hrs or >1000ml for CS
PPH = postpartum hemorrhage
4 T's:
Tone (uterine atony)
Trauma/tear (ie AP, PP), uterine rupture, uterine inversion
Thrombosis (anticoag problems)
Tissue retained (ie post-birth after place previa)

Front 143

% of 3rd trim bleeds in all pregnancies?

Back 143

5%

Front 144

percent of women with recurrent aboritons that also have APLA?

Back 144

15

Front 145

m/c 3rd trimester bleeds caused by?

Back 145

AP PP, bloody show, uterine rupture, or nonobstetric causes = gen tract lesions, cervial carcinoma

Front 146

why give US to mother with 3rd trimester bleeding before vag/spec exam?

Back 146

to rule out PP, in which case you DON"T want to do vag/spec exam!!

Front 147

In 3rd trim bleeding, what must do to rule out what immediately?

Back 147

First do U/S to r/o PP. then
do vag exam to rule out LABOR or PPROM/ ROM!!

Front 148

in 3rd trim bleeding due to severe PA, what do? what if fetus is term?

Back 148

C-section indicated immediately
C-section indicated immediately, however if bleeding stops and fetus is ok, may do immediate vaginal deliv (if at term)

Front 149

AP vs PP, which is painless?

Back 149

PP

Front 150

AP vs PP, which causes fetal distress?

Back 150

AP

Front 151

AP or PP, bleeding usually spontaneously stops in 1-2 hrs?

Back 151

PP

Front 152

clinical exam results for AP?

Back 152

tender abd, signs of fetal distress, frequent UC's, hypertonicity

Front 153

which AP or PP is dx'd via US?

Back 153

PP - look for abnormally placed placenta

Front 154

tx for AP vs tx for PP

Back 154

AP: immediate CS (or vag deliv if fetal hr is stable)

PP: NO VAG EXAM!! for preme, observe, check fetal growth. For near term, amniocent to check fetal lung maturity and then may give steroids (betamethasone), then later deliver via CS. OR ALWAYS deliver if persistent labor (bleeding does not subside), unstable bleeding , coag defects, or preme with documented fetal lung maturity

Front 155

complic's of AP vs PP

Back 155

AP: hemorrhagic shock, coagulopathy (DIC), ischemia/necrosis of end organs, incraeesed recurrence rate, fetal anemia
PP: placenta accreta , vasa previa, increased risk fo congen abnorms, PPH; fetal anemia

Front 156

10% of all AP's are complicated by?

Back 156

DIC!!!!

Front 157

up to 25% of those with prev CS who now get PP have what?

Back 157

placenta accreta

Front 158

in labor, when should report to hospital? (4)

Back 158

if:
*contractions at least 2 every 10 minutes for at least 1 hr
*gush or continuous leakage of liquid/blood (ROM)
*significant bleeding
or
*decreased fetal movement

Front 159

RF's for Preterm labor?

Back 159

MAPPS
multiple gestations
abdominal surgery during preg
Previous preterm labor
Previous preterm delivery
Surgery to cervix

Front 160

How to check for fetal lung maturity and surf production in ie 35 weeks PPROM?

Back 160

do amniocentesis and check L/A ratio

Front 161

false + nitrazine test caused by?

Back 161

blood, semen, vaginitis ( all alkalinize the normally LOW pH (4.0) of vagina)

Front 162

signs of false labor include?

Back 162

irregular intervals and duration of UC's w/no cerv dilation
unchanged contraction intensity
lower back and abd discomfort (vs true = lower abd)
relief with sedation

Front 163

tx of failure to progress through steps I or II:

Back 163

rest or augment labor with oxy
amniotomy (artificial ROM)
Intrauterine pressure cath to measure force of each contraction
Attempt forceps, vacuum delivery if vertex is low enough
C-section if maternal/fetal destiress, breech, or CPD

Front 164

does scalp FHR monitoring require ROM?

Back 164

YES

Front 165

causes of fetal tachycardia?

Back 165

FFAASTT Heart:
Fetal infection
Fever (maternal)
Arrhythmia
Anemia of fetus
Sympathomimetics
Thyrotoxicosis of mother
Tachycardia of mother
Hypoxia

Front 166

causes of fetal bradycardia?

Back 166

Bblockers
Autoimmune disease (maternal)
Conduction system damage
Hypoxia (fetal)

Front 167

In FHR monitoring what is the MOST reliable indicator of fetal wellbeing?

Back 167

Beat-to-beat variability (but not easily seen on fhr pages b/c every 2-4 beats averaged and recorded as one)

Front 168

What's a "reactive" tracing on a FHR monitor?

Back 168

at least 2 accelerations (acc =rise of over 15 beats over baseline for at least 15 secs) during a 20 minute period;
is a sign of fetal well-being; NOT expected in preme's <28wks

Front 169

cause of early decel? late? variable?

Back 169

early = benign = caused by head compression/ vagal stim

late = abnormal = uteroplacental insufficiency tx is 02, lat decub position, stop oxy

variable = (abrupt, variable onset) = abnormal = due to umbilical compression; tx = amnioinfusion

Front 170

when do early vs late decel's reach their nadir?

Back 170

early decelerations nadir is at peak of a contraction; late = when a contraction is ending

Front 171

PPH definition?

Back 171

>500ml lost w/in first 24 hrs of vag delv or >1000 ml lost after CS

Front 172

Top 3 causes of PPH?

Back 172

Uterine Atony
Genital tract trauma
Retained Placental tissue
Uterine invesrion, rupture
Cervical carcinoma

Front 173

tx of uterine atony that causes PPH

Back 173

MOP ME!!
Massage uterine bimanually
Oxy
PGF2 (if no asthma or htn)
Methylergonovine Maleate (if no htn)
Empty the bladder (overdistension can prevent uterine contractions)

Front 174

what may be necessary in the case of continued PPH due to placenta accreta/inreta/percreta where placental villi invade the uterine tissue?

Back 174

Hysterectomy may be required as life-saving therapy!

Front 175

3 m/c causes of Uterine Atony?

Back 175

MOP
multiple gestations
overdistension (hydramnios, macrosomia)
prolonged labor = muscle fatigue
MgSO4, anasthesia
Infection

Front 176

presentation % breakdown?

Back 176

96% vertex, 3.5% breech, .3% face, .4% shoulder

Front 177

hw will face presentation deliver?

Back 177

normal, b/c has way of shifting positions during exit

Front 178

how will brow presentation deliver?

Back 178

WONT!! will never deliver b/c has largest diameter = occipitomental

Front 179

true pelvis is? false?

Back 179

composed of space between inlet and outlet
false = above pelvic brim (inlet)

Front 180

wat is A-P diameter of outlet?

Back 180

usually around 9.5-11.5 cm

Front 181

when is the head engaged?

Back 181

when it enters the pelvic inlet/brim

Front 182

cardinal movements?

Back 182

EDFIEEE
engagement
descent
flexion
internalrotation
extension
external rotation
expulsion

Front 183

cause of increased fetal heart rate?

Back 183

NOT USUALLY hypoxia!
usually FEVER/ fetal infection.

FFASTTH
fetal inf
fever
arrhtymia of fetus
sympathomimetics (b ags)
TC of mother
Ttoxicosis of mother
Hypoxia

Front 184

greater than 6 contractions / 10 minutes for at least 2 consecutive periods?

Back 184

tachysystole

Front 185

tachysystole or hypertonus with associated fetal tachycardia, late decelerations, and/or loss of beat-to-beat variability ? treatment?

Back 185

= hyperstimulus
i) Treatment: - Terbutaline 250 micrograms IV/IM or - MgSO4 4g load over 20 minutes followed by 2g/hr IV

Front 186

normal variability is what?

Back 186

6-20 bpm variation

Front 187

sinusoidal hr is always a sign of?

Back 187

fetal anemia

Front 188

TC, loss of variation, plus late decelerations. nsim?

Back 188

emergency C-section!

Front 189

what is 'molding'

Back 189

when cranial bones of baby overlap temporarily to help fit through canal

Front 190

Schultz vs Duncan?

Back 190

shiny placenta = schultz
dirty = duncan = more associated with PPH

Front 191

trimesters?

Back 191

1-14
15-28
29-40

Front 192

1st prenatal visit?

Back 192

8-10 wks

Front 193

anti-D given?

Back 193

28 weeks

Front 194

weight gain in mother is a risk factor for?

Back 194

gest dm
preeclampsia

Front 195

difference between 1)menorrhagia
2)polymenorrhea
3)oligomenorrhea
4) metrorrhagia?
5) menometrorrhagia?

Back 195

normal interval, but heavy menses ( too long (>7d) or excessive blood (>80ml)
2)frequent menses ie <21d intervals in between
3)menses with intervals >21 d
4) menses at irregular intervals with intermenstrual bleeding

5) heavy menses AND irregular / intermenstrual bleeding menses

Front 196

for every pregnancy >20 weeks, what set of q's must be included in every history?

Back 196

q's about preeclampsia!!

Front 197

what % of pregnancies are complicated by asymptomatic bacteriuria?

Back 197

8%!!

Front 198

what are the diffeences in tx between severe and mild bacterial vaginosis?

Back 198

no such thing! tx all the same

Front 199

PPH with FIRM uterus?

Back 199

not uterine atony; is probably genital tract laceration

Front 200

For every NSIM question, what three categories must you consider?

Back 200

Next Step in Management may be either: "STD"
1) Staging of disease
2) Treatment of disease
1) further Diagnostic steps to determine disease
2)

Front 201

mechanism of process causing dyspnea 2 d after 18 y/o P1GO female takes AB's for pyelonephritis?

Back 201

condition = ARDS
mechanism = endotoxin release by bacteria --> capillary leakage-->leakage of fluid into pulmonary interstitial space

Front 202

RF's for endometrial cancer in 55 y/o with post -menopausal bleeding?

Back 202

DM, HTN,long history of anovulatoin , nulliparous,

Front 203

lower abd px, vag discharge, dyspareunia?

Back 203

PID or salpingitis

Front 204

m/c PID pathogen causing infertility?

Back 204

C. trachomatis

Front 205

red bulging mass noted at introitus directly after placenta is delivered?

Back 205

uterine inversion!!

Front 206

M/C cause of uterine inversion?

Back 206

undue umbilicial traction (pulling) before placenta separates and is delivered

Front 207

what are the 4 evidences of normal placental separation

Back 207

1 gush of blood
2 lengthening of umb cord
3 globular/firm shape of uterus
4 uterus rises up to anterior abd wall

Front 208

vaginal/cervical inversion vs. uterus inversion?

Back 208

vag/cervicla will have smooth appearance; uterus will have red, bulging, shaggy appearance

Front 209

abnormally prolonged 3rd stage of labor def? means what?

Back 209

defined as >30minutes in 3rd stage; means placental retention

Front 210

uterine inversion has what almost certain complication?

Back 210

MASSIVE hemorrhage!

Front 211

tx of inverted uterus?

Back 211

halothane for ut relaxation and/or emergency surgery
if already separated, gloved palm may replace
2 large bore IV's b/c hemorrhage may occur!
after replacement, give oxyt

Front 212

implantation site most predisposing to inverted uterus?

Back 212

fundal

Front 213

what type of uterus predisposes to inverted uterus?

Back 213

atonic

Front 214

incisions used to tx entrapped fetal head of a breech vaginal delivery?

Back 214

Duhrssen's incisions think:
Duh! get the head out!