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101 Cards in this Set
- Front
- Back
What are the fetal presentations?
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vertex: head down
breech: buttocks down transverse: neither down |
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Name the ways in which labor is induced?
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prostaglandins
oxytocic mechanical dilation of the cervix articical rupture of membranes |
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Early deceleration
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-began and end at the same time as contractions
-are the result of increased vagal tone secondary to head compression during contractions |
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Variable deceleration
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can occur at any time
they are the result of umbilical cord compression Rx: with amnioinfusion |
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Late decelerations
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begin at the peak of contraction and slowly return to baseline after contraction has finished
-care caused by uteroplacental insufficiency and are |
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Fetal scalp scalp electrode
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that sense the pot difference created by the depolarization of the fetal heart
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Fetal scalp pH
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directly asses fetal hypoxia and acidemia
-fetal blood by making a nick in the scalp |
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What are the dates of the different trimesters
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1st: up to 12 weeks
2nd: 12-28 wks 3rd: 28- delivery |
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What is considered preterm
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24- 37 wks
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What is Nageles rule for calculating the estimated date of confinement?
What is used if the LMP is uncertain |
(-)3 months from the LMP and add 7 days
- can us US but the further in trimester the less reliable it is - US should be within one week of the LMP in 1st trimester, 2 weeks for 2nd, 3 weeks for 3rd |
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What are the CV and pulmonary changes in preg
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CV: cardiac output increase by 30%, decrease systemic vascular resistance
pulmonary: 30-40% increase in tidal volume causing increase in minute ventilation increase in vital capacity |
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Gastro
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Gastro: nausea caused by elevated estrogen and progesterone
Reflux esophagitis cholestasis hepatic liver functions increase |
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What is hyperemesis gravidarum?
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sever form of morning sickness in which women lose greater than 5% of their preppregnancy wt and go into ketosis
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What are some first trimester labs
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CBC
VDRL/RpR Rubell Hep B Gonorrhea Chlamydia UA HIV Be |
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What urinary problems are pregnant women at increase risk for
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UTI and phyelonephritis due to urinary stasis
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What is done during the visit in the second trimester
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Labs:
Triple screen: alpha fetal protiens, , BhCG, estriol Screening ultrasound:look for common abnormalities, amniotic fluid volume, placental location, gestational age Amniocetesis- to determine if they want to keep the preg |
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What are the third trimester labs
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CBC
RPR CLT Group B strep |
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When is RhoGAM given?
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28 weeks if mother is nonsensitized and then again most postpartum
-given during any procedure where maternal blood can mix with fetus - |
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What are braxton hicks contractions?
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irregular contractions that do not lead to cervical changes
occur several times an hour |
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What should a person that has vaginal bleeding and abd pain be evaluated for?
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Ectopic pregnancyW
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What are risk factor for ectopic pregnacy?
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History of STD
prior ectopic preg Previous tubal surgery edometriosis |
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What lab value can help you tell the difference between an ectopic preg and IUP?
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B-hcg
b/c it doubles every 48hrs in a normal preg. If it does not most likely an ectopic - |
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What beta hcg levels can you see a fetus transvaginaly?
fetal heart beat? |
- 1,500
- 5,000 |
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What pt are able to have methotrexate
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for 4 cm or less ectopics
uncomplicated without a fetal heart beat reliable for follow up |
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What is a complete abortion?
What is incomplete abortion? |
- complete expulsion of all products of conception (POC) before 20 weeks gest
- partical expulsion of but not all POC before 20 weeks of gest |
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What is an inevitable abortion?
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no expulsion o POC but vaginal bleeding and dilation of the cervix that a viable preg is unlikely
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What is a threatened abortion?
What is a missed abortion? |
- any vaginal bleeding before 20 weeks without dilation of the cervix or expulsion of any POC
-death of the embryo or fetus before 20 week with complete retention of al POC |
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What is the differ for 1st trimester bleeding?
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Spontaneous abortion
postcoital bleeding Ectopic preg Vaginal or cervical lacerations extrusion of molar preg nonpreg caus of bleeding |
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What are some cause of 2nd trimester bleeding?
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infection
cervical defects exposure to fetotoxins trama |
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What is an incompetent cervix?
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presents with painless dilation and effacement of the cervix
-infection, vaginal discharge and rupture of membranes are common findings |
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When is an amniocentesis done and what does it do?
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- offered at beyond 15 weeks gest
Indications: Fetal anomaly on US Abnormal msAFP family hx of cong abnormalitis pt > 35 year of age Assessment of lung maturity -good to obtain a fetal karyotype -rate of fetal loss is <.5% |
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What is chorionic villus sampling?
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- given 9-12 weeks
- involves placing a catheter into the intrauterine cavity to get fluid from the chorionic villi Allow for chromosomal status, fetal karyotyping, DNA test - increase risk .5% |
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What is PUBS?
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fetal blood sampling
- preformed by placing a needle transabdominall into the uterus and phlebotomizing the umbilical cord |
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What is the best time to screen for GDM?
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between the 24th and 28th week of gestation
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What is the initial test done to screen for DM?
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50g glucose load and measure the plasma glucose 1 hr if:
> 130 thatn you do a GGT |
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What is a GGT?
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100g glucose load, 3 hr oral glucose tolerance test
- gucose is measured at 1, 2, 3 hrs after load |
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What are the 5 aspects of labor?
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Dilation-how open cervix @ os (1-10)
effacement fetal station-fetal head @ ishchial spines cervical position consistency of cervix -All make up teh Bishop Score, score > 8 consistent with favorable labor |
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What are the different ways to determine fetal position?
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leopolds meneuvers
cervical examination U/S |
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What are the ways in which labor is induced?
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prostaglandins
Oxyytocic agents mechanical dilation (foley bulb) artifical rupture of memebranes (amniotomy) |
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What are some common reasons for induction?
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posterm preg
preeclampsia PROM nonreassuring fetal testing intrauterine growth restrictions |
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What are some things that can help with unsuccessful induction
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prostaglandin E2 gle
PGE2 pessary (cervidil) PGE1M misoprostol -all help to ripen the cervix |
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What is considered augmentation of labor
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helping a pt that is already in labor
-pitocin and amniotomy |
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What are the normal fetal HR and when does it get to be concerning?
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Normal range: 110-160
Tachy: > 160 fetal distress Brad> 90 for greater than 2 min |
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What is considered fetal heart rate variablility
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Absent: < 3 beats per min
minimal 3-5 beats per min moderate 5-25 beat per min marked 25 beats per min |
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What are the cardinal movements?
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Engagement
Decent internal rotation extend external rotation |
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What are the stages of labor?
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Stage 1: begins at the onset of labor and last 10cm dilated
Stage 2: full dilation --> delivery Stage 3: delivery --> placenta delivery |
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How long should the stage 1 labor last?
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6-20 hrs in nulliparous pt
2-12 hrs in a multiparous Latent phase: onset of labor until 4 cm active phase 1.2 cm/hr for nulliparous 1.5 cm/hr for multip |
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Some thing to note
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if there is no change in cervical dilation or station for 2 hrs during active phase of labor deemed active phase arrest
-need cesarean delivery |
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What is an Episiotomy?
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-incision in the perineum to facilitate delivery
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How long should stage 2 labor take?
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Nullip with epidurals: 3hrs
Nullp w/o epidurals: 2hrs Mult with epi: 2hrs Muli w/o epi; 1 hr Arrest of descent if the fetal head descends <1cm/hr null, <2cm/hr mult |
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What are tocolysis?
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used before < 34 wks
is an attempt to prevent contractions and the progression of labor - only help in prolonging gestation of 48 hrs so that steroids can be given |
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At what age is it good to start betamethasone t?
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24- 34 weeks in those in preterm labor
-to check for fetal maturity an amiocentesis can be preformed |
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T or F
In the case of preterm contractions without cervical change hydration can often decrease the # and strength of contractions |
TRUE!!!
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What are the different types of tocolytics?
and when are they used? |
Are used in <34 wks gestation
Beta mimetics Magnesium sulfate calcium channel blockers Prostaglandin inhibitors Oxytocin antagonist |
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Beta-mimetics
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-help in halting preterm contractions
-increase the level of CAMP -Ritodrine and terbutaline |
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Magnesium sulfate
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decrease uterine contractions by acting as a calcium antagonist
Side effects: depressed reflexes, pulmonary edema, fatiuge Tx: calcium gluconate |
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Calcium channel blockers
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decrease the influx of calcium into the smooth muscle by diminishing uterine contractions
- Nifedipine |
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Prostaglandin inhibitors
Oxytocin antagonist |
1. decrease the intracellular Ca mostly indomethacin
2. atosiban |
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PROM vs PPROM
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PPROM is rupture of memebranes before 37wks
-most would prolong pregnancy in < 32-36 wks -Tx is with ampicillin w or wo erthromycin |
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What are the options for breech delivery
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1. external cephalic version of the breech
2. trail of breech delivery: flexed pelvis, EFW 2,000-3800, frank or complete breech 3. elective cesarean delivery |
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Fetal bradycardia
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Prolonged deceleration: fetal heart rate is below 100 to 110 for longer than 2 min
-longer than 10 min is bradycardia |
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Shoulder Dystocia
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impaction of the ant. shoulder behind the pubic symphysis
-risk macrosomia, GDM, maternal obesity, postterm preg, - complications: fracture of humurs, clavical, brachial plexus nerve injury, phrenic nerve palsy, hypoxic brain injury - look on pg 75 for maneuvers |
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Uterine Rupture
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- risk: more than one c/s, treated with uterotonic agents fibroids, uterine malformation, obstructed labor
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What are the signs of preeclampsia
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triad: edema, hypertension, proteinuria
-classical presentation: nulliparous in her 3rd trimester |
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What is gestational hypertension?
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BP: > 140/90 after the 20th week of gestation
-Pt was normotensive prior to preg and return 10 days after delivery |
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What is mild pre-eclampsia
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BP: > 140/90, edema of face and hands, protenuria (>300/hr or 1 or 2 + on dipstick)
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What is sever preeclampsia?
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-BP: > 160/110, protenuria > 5g/hr or 3 0r 4+ on dipstick)
- end organ damage: headache visual changes RUQ pain impaired liver functions Oliguria (<400 ml) pulmonary edeam thrombocytopenia |
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What is HELLP syndrome
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H: Hemolysis (increase LDH, total bilirubin, schistocytes)
EL: elevated liver enzymes LP: low platelets Ass. with: High mortality multiparous mothers Mothers older than 25 Less than 37 weeks gestation -deteriorating liver functions and thrombocytopenia |
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What is the treatment for mild, sever pre ecplamsia and HELLP syndrome
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- delivery is the ultimate tx
- Mild: start mag for 12 to 24 hrs after delivery - severe: mag, hydralazine or labetalol or labetalol -if gest is 24 to 32 do expectant management - 30% recurrence rate |
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T or F
You can take aspirin as a prophylaxis to prevent pre eclampsia with a second preg |
True
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Placenta previa
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abnormal implantation of the placenta over the internal cervical os
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Placenta accreta
increta percreta |
accreta: abnormal invasion of the placenta into the uterine wall
Increta: placenta invades the myometrium Percreta placenta invades through the myometrium into the serosa |
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How do you treat UTI?
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amoxicillin
nitrofurantoin Bactrim cephalexin |
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What is the treatment for pyelonephritis?
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hydratioin
Antibiotics -cephalosporins -ampicillin and gentamicin -tx until afebrile for 24-48 hrs |
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When is GBS tested and how is it treated?
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Given around 35-37 wks
- can cause UTI, chorio, endomyometritis -tx: IV penicillin or ampicillin |
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what are some ss of chorioam
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materinal fever, elevated wbc count, uterine tenderness and fetal tachycardia
- the gold standard is culture of amniotic fluid via amniocentesis - tx: cephalosporin or ampicillin and gentamicin |
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What is considered to be LGA
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- greater than 4,500
- higer risk of shoulder dystocia, hypoglycemia, polycythmia |
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What is the cause of macrosomic infants?
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gestational DM, maternal obesity, , posterm pregnancy, multiparity adn advanced materanl age
-if 3cm greater than fundus size date need an ultrasound |
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Tell me about amniotic fluid measurements?
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- max volume 800ml @ 28 weeks gest then falls to 500ml @ 40 wks
AFI < 5 is oligo AFI > 20 or 25 poly |
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Oligohydramnios
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amniotic fluid is produced by the fetal kidneys and lungs
Ass with an AFI: < 5 -ass with congenital GU anomalies, potters sydnrome, rupture of membranes |
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Polyhdramnios
Cause What is the AFI dx |
most common in preg: diabets, hydrops, multiple gestations, neural tube defect
AFI: > 20 - is dignosised by ultrasound |
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RH incompatibility
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IgG antibodies cross the placenta and cause hemolysis of fetal RBC
-cause Erythroblastosis fetalis a syndrome that cause HF, ascites anemai -can tx with Rho-GAM |
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What is considered Posttterm pregnancy
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-last longer than 42 wks
- increase risk o macrosomic infants, meconium, IUFD, dysmaturity tx: is to induce |
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What are is placental abruption and what are some risk factors
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Premature separation of placenta from uterine wall before the delivery of baby
Risk: Trauma Preeclampsia (maternal HTN) smoking cocaine abuse previous hx of abruption |
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What are some clinical presentation of placental abruption
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vaginal bleeding
constant and sever back pain irritable, tender, and hypertonic uterus Evidence of fetal distress Dx: with ultrasound Tx: expectant management, or perform C section |
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What is the clinical presentation placenta previa
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painless profuse bleeding in T3
Postcoital bleeding Spotting during T1 and T2 cramping |
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What is Vasa Previa
how does it present? |
fetal cord vessels unprotectedly pass over the internal os, making them susceptible to rupture and bleeding
Present: rapid bleeding, fetal distress |
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What is velamentous cord insertion
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insertion of the umbilical cord into the fetal membrane.
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What are some caused of third trimester bleeding?
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Placental abruption (most common)
Placenta previa (most common) Vasa previa Uterine rupture circumvillate placenta blood show cervicitis polpys neoplasm |
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What is the difference between the:
Apt test Kleihauer Bettke test Wright stain |
Apt test: blood from the vagina turns brown if maternal and pink if fetal
KB:blood from air to determine % of fetal RBC im maternal ciruclation Wright: vaginal blood, nucleated if fetal |
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How do you mange and dx, tx placenta previa?
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Dx: with transabdominal ultrasound
mang: cesearean section |
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What is associated with placenta privia
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placental accreta superfical invasion of the placenta into the uterine myometrium
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How does endometritis present?
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mostly 2-3 days after c/s
with fever, elevated white blood count uterine tenderness -Tx:give IV |
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What are the risk factors for endometritis
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meconium
chorioamnionitis prolonged rupture of membrane |
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What are some causes of postpartum infections
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prolonged rupture of memebranes
C section colonization of lower genital tract premature labor vaginal exams foreign body diabetes |
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What is the difference in Di-Di, Mo-Di, Mo-Mo-
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Di-Di: two chorions, two amnions
Mo-Di: single placenta, one chorion, two amnions Mo-Mo: one placenta, one chorion, one aminon |
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What values are elevated with multiple births?
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b-hCG
HPL MSAFP |
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What disease and what type of twins are at risk for a certain disease/problem?
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Mo-Di twins
Twin to twin transfusion |
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What is twin to twin transfusion?
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Baby A: small anemic, oligohydram, growth restrictions, hypovolemia
Baby B: large, plethoric, polycythemic, cardiomegaly, ascities, hypervolemia, edema due to unequal flow withing vascualr Man: serial ultrasounds with AFI and amioreduction |
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what are they manifestations of Toxo?
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Fetus: symmetrical IUGR, microcephaly, intracranial calcification
Neonate: chorioretinitis, seizures, throbocytopenia |
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What is the tx for Toxo?
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Pyrimethamine and sulfadiazine
-Spiramycin is to prevent vertical transmission |