OBGYN shelf stuff 2

ruhland1's version from 2015-07-21 18:28

Section 1

Question Answer
AFPscreen at 15-18wk
AFP detectsNTD/trisomy
NTD (up MSAFP)anaceph,meningomyelocele,encephalocele, TWIN gestations
tri 21dn MSAFP
tri 18dn MSAFP
BPP(biophysical profile) measurements of fetal well being
BPP 8-10normal
BPP 6deliver if x>36wk, repeat in 24hours is x<36wks
BPP x<5abnormal (immediate intervention)
fetal breathing BPP measure
BPP measuregross body movements
fetal toneBPP measure
qualitative amniotic fluid volBPP measure
BPP measurereactive fetal heart rate
x> 160 for more than 10 minfetal tachy
fetal tachy causematernal fever
x< 110 for more than 10 minfetal brady
fetal brady causecogenital heart block
FHR variabilityreliable indicatior of fetal wellbeing
accelerationup FHR above base 15 sec
FHR good finding=acceleration
early decelerationcoincide with uterine contraction (non harmful)
variable decel meansdecel does not coincide with uterine contractions
W, V shapevariable decel
causes of variable decelumbilical cord compression, shifting maternal position
late decelafter contraction
late decel assocuteroplacental insuff (dangerous)
repitive late decelerations require intervention

Section 2

Question Answer
50% of spontaneous abortions due tochromosomal abnormalities
x> 35 yr momindic for genetic testing
chorionic villous sampling10-12 wks
why can u sample chorionic villiplacenta has same genetic makeup as developing fetus
limb reduction abnormalities causeCVS
capture of free floating fetal cells in amniotic fluidaminocenteisis
aminocentesis causesROM, chorioamnionitis
fundal height deviation2cm from norm b/t 18-36wk
CRLuseful in early preg only
gest sacuseful in early preg only
HC=cerebellar diam
AC=abd circum
FL=femur length
four measure requirementHC, BPD, AC, FL all required due to wide deviation in each

Section 3

Question Answer
false laborBraxton Hicks contractions
85% undergo spont deliveryb/t 37-42wk
uterine contract w/o effacement/dilationbraxton hicks
come to hospitalregular contractions q 5 min for at least an hour
rupture of memcome to hospital
dn fetal movmentpresentation of labor
leopold manuver determinesfetal position
0 stationfetus is at ischial spine

Section 4

Question Answer
stage 1 latent contractstarts reg contact
stage 1 latent cervixends at 4cm dil
stage 1 latent length hours1-6
stage 1 latenthighly variable duration, cervix effaces and slowly dilate
stage 1 active cervix start4cm
stage 1 active cerix end10cm
stage 1 activeregular/intense contractions, effaces/dil quick, fetal head descends into pelvis
stage 1 monitoring FHR(doppler, fetal scalp electrode)
FSEfetal scalp electrode
stage 1 active length hr4-6
stage 1 monitoring uterustocodynamometer, internal uterine pressure cath
stage 1 analgesicepidural, merperidine (contra w/ MAOI)
stage 2 startcomplete cervical dil
7 cmpop can
1 cmcheerio
stage 2 length hr1-2
stage 2 enddelivery of baby
cardinal 1descent
cardinal 2flexion
cardinal 3internal rotaion
cardinal 4extension
cardinal 5external rotation
once head deliveredsuction nose and mouth, eval nuchal cord
shoulder deliveryant fist posteior 2nd
cord blood testABO,Rh,ABG
stage 3 startafter baby delivered
stage 3 endat placenta delivery
stage 3 length hr0 - .5
stage 3placenta seps and uterus contracts to stop bleed
stage 4 startimmediate postpartum
stage 4 end2 hours postpartum
stage 4period of significant physio changes
eval at stage 4cervix,vag,vulva,perineum,periurethra

Section 5

Question Answer
"all or none"1-3 wk
organogenesis3-8 wk
embryonic periodorganogenesis
ACEidn renal
aminoglycosidesdn CNVIII
anticonvulscleft lip/palate
cocaineplacental abrupt
DESvaginal clear cell adenocx
MTXNTD (myelomeningocele)
lithiumebsteins anomaly (atrialized R ventricle)
GDMcaudal regression synd (sirenomelia(mermaid), renal dysp, imperforate anus)
phenytoincleft, heart defect
potassium iodidegoiter, hypothy, cretin
nicotinepremature, low lb, IUGR, ADHD
tetracyclinediscolored teeh
thalidomidephocomelia ("seal limbs
valpinhibit FOLATE absorption, cleft, renal
isotretinoinabort, cleft, heart, eye
warfarinbone, hemm, abort, sz, spastisicty

Section 6

Question Answer
serious morning sickhyperemesis gravidum
hyperem gravid MOAup sensitive vomit (hCG, thyroid, GI hormone)
more common hyperem gravid inprimigravida (1st trim)
2-5% of all pregGDM
#1 medical complication of pregGDM
GDM MOAHPL antags insulin
HPL=human placental lactogen
HPL [ ] is proportional togestational age
obesity and x>30 youp risk GDM
GDM eval24-28wk
plasma level after 1 hr of glucolax<180
plasma level after 2 hr of glucola<155
plasma level after 3 hr of glucola<140
fasting dx of GDM<95
GDM UAglycouria
GDM txADA diet
GDM and oral hypoglycemicgenerally contra except metformin and glybruide
4000+g + GDMconsider C section
risk of T2DM if GDM50%
GDM up 2x risk ofPIH
GDM aminotic volup
GDM urethraup UTI
GDM laborup preterm
GDM eyeretinopathy
c-sec 2ndary tomacrosomia
spontaneous abortion and GDMud risk if well controlled
GDM perinatal mort2-5%
GDM laborup abrupt up pret
neonate in GDMdn glc at birth because of large amount of fetal insulin in fatass mom
GDM liverhyperbiliemia
GDM changepolycythemia
GDM in neonateresp distress synd

Section 7

Question Answer
gest htn (PIH=preg induced htn)htn at >20wk but NO prouri
htn + prouri =preeclampsia
preclamp + ____ = eclampsz
HELLP rbc cell rupture, up LFT, dn platelet
must ddx HELLP fromgest thrombocytopenia
risk of HTN+prouri+sztime window 20wk gest to 6 wk postpartum
MOA of PIHplacental ish 2ndary to impaired vaso dil of spiral arterys
placenta is ischemicincreases maternal vascular tone to compensate for lack of blood (gest htn/precl/ecl)
PIHHA, blurred vision, abd pain
PIH pxexhtn, edema, alterred mentation (mind), hypereflexia
PIH=gest htn or preelcampsia or eclampsia
PIH prouri mildx>300mg/day
PIH prouri severex. 5g/day
PIH findingthrombocytopenia
PIH findinghyperuricemia
hemoconcentrationPIH finding
only definitive tx of PIHdelivery
PIH bp druglabetalol
PIH bp drughydralazine
PIH bp drugnifedipine (dn BP)
PIH foodsalt restrict
MgSO41st line for ppx/tx of eclamp sz
1st line for ppx/tx for ecl szdiazepam
Mg toxbradypnea, dn DTR
Mg antidotecalcium
PIH and mom brainhemorrhage
PIH and mom lungARDS
PIH and mom vascDIC
PIH and mom genitalabrupto placentae