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OBSTETRICS

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banannie's version from 2016-08-10 20:04

NORMAL CHANGES

Question Answer
Cardiac changesS3, JVD, cardiomegaly on CXR, low grade SEM
HRmild tachy
CXRcardiomegaly
COincreases
renal perfusionincreases
GFRincreases
Crdecreases
SVRdecreases
BPdecreases (nadir at 28 wks)
SVincreases
visionblurry
dischargeleukorrhea of pregnancy
nosepolyps, mucosal hyperemia, nose bleeds
tidal volumeincrease
TLCdecrease
ERVdecrease
minute ventilationincrease
vital capacityunchanged
expiratory reservedecrease
acid-baserespiratory alkalosis (from progesterone)
CO2low
O2high
LES tonelow
gastric emptyingfaster
poopingconstipated, hemorrhoids
kidney sizeincreased, hydronephrosis R>L
RAASincreased
aldosteroneincreased
RBCincreased
WBCincreased
Hctdecreased
anemia?dilution
fibrinogenincreased
blood volumeincreased
clotting factorsincreased
prolactinincreased
glucoseincreased
TBGincreased
total T3 and T4increased
TSHdecreased
thyroid stateeuthyroid but transient hyperthyroidism
what to do with levothyroxine dose?increase dose in pregnancy
memorize

PRENATAL TESTING

Question Answer
initial visitCBC, Rh, T&S, UA, culture
rubella, HBV, PRP, GC, PPD, HIV, Pap
9 - 14 wksPAPP-A, nuchal transparency, free beta hCG, CVS
15 - 22 wksAFP or quad screen (AFP, estriol, beta HCG, inhibit A) +- AMNIO
18 - 20 wksUS for full anatomic screen
24 -28 wks1hr glucose challenge test for GDM
28 - 30 wksRhoGAM for Rh -
35 - 37 wksGBS culture, repeat CBC
34 - 40 wkshigh risk get GC, HIV, RPR
what is the cut-off for 1 hr glucose challenge test?>140 mg/dL is abnormal, follow up with GTT. If GCT is > 200, no need to follow up.
what is the cut-off for GTT? basically anywhere between >95 for fasting and > 140 for 3hr
what are maternal glucose level goals?fasting < 95, 1hr post prandial < 140, 2 hr post prandial < 120
how do you screen post partum for GDM?2 hr GTT 6-12 wks post
what meds can be used for UTI in pregnancy?nitrofurantoin 5-7 days, amoxicillin 3-7 days, single fosfomycin dose
definitive karyotype analysisCVS and AMNIO
which definitive karyotype analysis is more dangerous?CVS
elevated AFPneural tube defects
abdominal wall defects
multiple gestation
incorrect dating
fetal death
placental abnormalities
reduced AFPtrisomy 21 and 18
fetal demise
incorrect dating
Trisomy 18 quad screendecreased AFP, estriol, beta HCG
normal inhibin A
Trisomy 21 quad screen resultsincreased beta HCG, inhibin A
decreased AFP, estriol
neural tube or ab wall quad screen resultsincreased AFP
normal estriol, beta HCG, and inhibin A
CVS timeline> 10 wks (10-12)
AMNIO timeline>15 wks (15-20)
Cell free fetal DNA10 wks
to detect fetal hemolysis in Rh sensitized pregnancy?amnio
most common causes of downs in ordermeiotic nondisjunction --> inherited robertsonian translocation(if hx of other children with downs), mosaicism
how to treat magnesium toxicity?calcium gluconate
HTN increases risk of...preeclampsia
abruptio placenta
IUGR
preterm labor
still birth
risk for abruptio placentamaternal trauma
chronic HTN
cigs and cocaine!
external cephalic version
risk for uterine rupturemultiparty
old mom
surgeries: previous CS, myomectomy
risk for polyhydramniosfetal malformations
genetic disorders
maternal DM
multiple gestations
fetal anemia
IUFD protocol- US and get coag studies to r/o DIC
- Induce labor ASAP
symmetric IUGRbaby
- small head, small abdomen
- fetal anomalies
- abnormal karyotype
- early viral infection
asymmetric IUGRmom
- normal head, small abdomen
- vascular disease: HTN, DM, smoking
memorize

FETAL HEART RATE MONITORING

Question Answer
normal HR110 - 160
tachygreater than 160
bradyless than 110
variable decelcord compression/prolapse
oligohydramnios
nuchal cord

(no association with contraction)
cord compression variable decel
cord prolapsevariable decel
oligohydramniosvariable decel
early decelhead compression, vagal stimulation
head compressionearly decal
placental insufficiencylate decels
accelerationsnormal fetal oxygenation
late decelsplacental insufficiency (could be from placental abruption)
repetitive late decels -- how to treat?CS emergently
nadir aligns with peak of contractionearly decel
nadir occurs after peak of contractionlate decel
decrease in FHR more than 15 ppm from baseline in more than 15 secondsvariable decel
recurrent variable decelsfetal acidemia
tx variable decelsmaternal repositioning (L lateral), then amnioinfusion
look like W or Vvariable decal
nuchal cordvariable decal
post-term pregnanciesuretoplacental insufficiency / late decels
what causes bradycardia?uterine hyper stimulation, cord prolapse, rapid fetal descent
what causes tachycardia?hypoxia, maternal fever, fetal anemia
what causes minimal variability?hypoxia
- opioids
- magnesium
- sleep cycle
sinusoidal variability?fetal anemia or meperidine use in mom
what is a reactive NST?2 accelerations > 15 ppm above baseline for at least 15 seconds
what is a nonreactive NST?isufficient accelerations over a 40 minute period
what to do if NST is nonreactive?more tests like BPP
what do you do for evaluation of IUGR babies?doppler sono of the umbilical artery
components of BPP?NST, amniotic fluid volume, fetal mvmvnts, fetal tone, fetal breathing movements
what kind of CST is good?negative
what is normal AFI?5-25
when does latent labor become active?at 6cm dilated
what is arrest of labor?no cervical change for > 4 hrs despite adequate contractions or no cervical change for > 6 hrs with inadequate contractions
what to do when tachysystoly or tetanic ctx?tocolytics to relax uterus (terbutaline)
memorize

BLEEDING

Question Answer
painless bleedingplacenta previa, vasa previa
painful bleedingabruptio placenta, uterine rupture
placenta previa txCS
placenta implants across the osplacenta previa
titanic sawtooth uterine contractionsabruptio placenta
MVA and tx?abruptio placenta give IVF and put mom in lateral decubitus position for uterine displacement to optimize circulation
cocaine useabruptio placenta
HTNabruptio placenta
absent contractionsuterine rupture
previous CSabruptio placenta / placenta accreta
recession of fetal stationuterine rupture
accessory lobevasa previa
occurs with rupture of membranesvasa previa
tachysystoleabruptio placenta
frequent contractionsabruptio placenta
sinusoidal tracingvasa previa
fetal bradycardiavasa previa
inability to separate the placenta from uterusplacenta accreta
baby's bloodplacenta previa and vasa previa
mom's bloodplacental abruption
placenta previa protocoldx on US at 18-20wks, may resolve by 3rd trimester due to growth of lower uterine segment. tx: pelvic rest, abstinence from intercourse, avoid cervical exam. L&D contraindicated, schedule CS 36-37 wks
memorize

RANDOM

Question Answer
chorio sxmaternal fever + 1 sign (uterine tenderness, tachycardia, malodorous fluid/discharge)
tx chorioantibiotics and delivery, oxytocin to accelerate if necessary
tx for post part endometritis?polymicrobial IV clinda and gent
amniotic fluid embolism signsrapid onset resp failure, severe hypotension, DIC immediately post partum
tx amniotic fluid embolismintubate and mechanically ventilate, supportive care
memorize