Doctor High Yield Ob-Gyn Already Graded A+
define post partum hemorrhage
500mL by vaginal
1L if by CS
most common cause of post partum hemorrhage
uterine atony= spiral a. can't contract fast enough because of flaccid, weak uterus
key finding in uterine atony
boggy uterus above umbilicus
first line tx for uterine atony
#1: uterine massage
#2: oxytocin
key US finding and tx in retained placenta
uneven endometrial lining
tx: D&C
risk for laceration causing postpartum hemorrhage
forceps delivery
when is latent phase of labor
0-6cm of cervical dilation
when is active phase of labor
6-10cm of cervical dilation
define arrest of active phase of labor
1- no cervical change over 4h w/ adequate contractions
2- 6h w/o adequate contractions
define adequate contractions
every 2-3 min w/ contractions
or
,>200 Montevideo units in 10 minutes
define arrest of descent
10cm max cervical dilation
delivery takes longer than 3h
#1 cause of arrest of descent
Cephalopelvic Disproportion
pathognomonic for uterine rupture
intense pain
baby's head was at 0 station and now at -3 station
difficult to palpate where fetus is in uterus
what is prolapsed cord and tx?
umbilical cord prolapsed through cervix and is in way of path of descent so need to go to C-section
causes of fetal tachycardia
160+
maternal fever
define tachysystole and what can it cause to fetus? tx?
5+ contractions every 10 minutes
fetal bradycardia
tx: terbutaline= B2 agonist
#1 adverse effect of tocolytic
pulmonary edema
marker to distinguish B thalassemia from other microcytic anemias
elevated HBA2
normal maternal changes in pregnancy
increased cardiac output
elevated GFR= glucosuria
respiratory alkalosis
increased tidal volume= PCO2 lower than average
increased plasma volume dilutes RBC= physiologic anemia of pregnancy
shoulder dystocia definition
, anterior should gets stuck behind mom's pubic bone
first step tx for shoulder dystocia
mcrobert's maneuver= hyperflex the hip
prenatal risk factors for shoulder dystocia
prior hx for mom
macrosomia due to GDM
GDM v pre-GDM-- which is more dangerous?
pre-GDM is diabetes before week 20!!
- more dangerous because of cardiac defects
fetal bradycardia can be caused by
maternal hypotension because of reflex vasoconstriction of spiral aa. in attempt to increase TPR
what causes vasoconstriction of spiral aa? (2)
uterine atony
cord compression
fetal heart rate accelerations
what is adequate?
used in fetal non-stress test= measure HR in 20 min
adequate= 15 in 15, 2 in 20
increase in HR by 15 in 15 seconds and see 2 of these in 20 min
when do we do a fetal non-stress test?
less mvmts felt by mom
what to do if fetal non-stress test is equivocal or not conclusive?
did not see 15 in 15, 2 in 20
go to biophysical profile
biophysical profile components and interpretation
BATMN
breathing
amniotic fluid= need a 2cm pocket
tone
movements of baby
non-stress test
define post partum hemorrhage
500mL by vaginal
1L if by CS
most common cause of post partum hemorrhage
uterine atony= spiral a. can't contract fast enough because of flaccid, weak uterus
key finding in uterine atony
boggy uterus above umbilicus
first line tx for uterine atony
#1: uterine massage
#2: oxytocin
key US finding and tx in retained placenta
uneven endometrial lining
tx: D&C
risk for laceration causing postpartum hemorrhage
forceps delivery
when is latent phase of labor
0-6cm of cervical dilation
when is active phase of labor
6-10cm of cervical dilation
define arrest of active phase of labor
1- no cervical change over 4h w/ adequate contractions
2- 6h w/o adequate contractions
define adequate contractions
every 2-3 min w/ contractions
or
,>200 Montevideo units in 10 minutes
define arrest of descent
10cm max cervical dilation
delivery takes longer than 3h
#1 cause of arrest of descent
Cephalopelvic Disproportion
pathognomonic for uterine rupture
intense pain
baby's head was at 0 station and now at -3 station
difficult to palpate where fetus is in uterus
what is prolapsed cord and tx?
umbilical cord prolapsed through cervix and is in way of path of descent so need to go to C-section
causes of fetal tachycardia
160+
maternal fever
define tachysystole and what can it cause to fetus? tx?
5+ contractions every 10 minutes
fetal bradycardia
tx: terbutaline= B2 agonist
#1 adverse effect of tocolytic
pulmonary edema
marker to distinguish B thalassemia from other microcytic anemias
elevated HBA2
normal maternal changes in pregnancy
increased cardiac output
elevated GFR= glucosuria
respiratory alkalosis
increased tidal volume= PCO2 lower than average
increased plasma volume dilutes RBC= physiologic anemia of pregnancy
shoulder dystocia definition
, anterior should gets stuck behind mom's pubic bone
first step tx for shoulder dystocia
mcrobert's maneuver= hyperflex the hip
prenatal risk factors for shoulder dystocia
prior hx for mom
macrosomia due to GDM
GDM v pre-GDM-- which is more dangerous?
pre-GDM is diabetes before week 20!!
- more dangerous because of cardiac defects
fetal bradycardia can be caused by
maternal hypotension because of reflex vasoconstriction of spiral aa. in attempt to increase TPR
what causes vasoconstriction of spiral aa? (2)
uterine atony
cord compression
fetal heart rate accelerations
what is adequate?
used in fetal non-stress test= measure HR in 20 min
adequate= 15 in 15, 2 in 20
increase in HR by 15 in 15 seconds and see 2 of these in 20 min
when do we do a fetal non-stress test?
less mvmts felt by mom
what to do if fetal non-stress test is equivocal or not conclusive?
did not see 15 in 15, 2 in 20
go to biophysical profile
biophysical profile components and interpretation
BATMN
breathing
amniotic fluid= need a 2cm pocket
tone
movements of baby
non-stress test
