Ob step 3

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Ob step 3
2014-06-05 00:35:28
Ob step

Ob step 3
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  1. when is a gestational sac seen on transvaginal ultrasound
    5 weeks or 1500 units of beta hcg
  2. what is ordered at the first prenatal visit
    • counseling +
    • cbc
    • type and screen
    • rh
    • pap
    • urinalysis and culture
    • rubella
    • chlamydia
    • gonorhea
    • herpes
    • hiv syphilis
    • hep b serology
  3. low platelts on cbc of pregnancy, next step
    rule out itp or HELP syndromes
  4. when is rhogam given to rh negative mothers
    at 28 weeks
  5. negative rubella antibodies during pregnancy, next step
    immunize after delivery
  6. + hep b antigen, next step
    order hep B e antigen
  7. +vdrl for a pregnant woman, next step
    confirm with fta-abs and if positive give penicillin , if allergic desensitize and give penicillin
  8. + screening test like high beta hcg, papp-a or nuchal translcency is confiremd how for downs
    with CVS
  9. which markers are increased in downs? edwards
    beta hcg and inhibin are high, alpha fetoprotein and estriol are low

    all the 4 markers are low in edwards
  10. high alpha feto protein is seen whe
    • ntd
    • ventral wall defect
  11. next step for alpha feto protein that is high
    high--amniocenteseis and acetylcholinesterase testing

    low--amniocentesis and karyotypin
  12. 4 tests in third trimester
    • cbc
    • glucose
    • gbs
    • antibodies for rh
  13. do you give rhogam to women who have anti-d antibodies
  14. +GBS NEXT step
    intrapartum antibiotics
  15. which antiemetics can be used in pregnancy
    all of them
  16. fasting blood glucose is 125, diagnosis
    gestational diabetes
  17. when do you give rhogam
    twice at 28 weeks and within 72 hours of delivery
  18. initial mnx of late trimester bleeding
    • vitals
    • fluids
    • external fetal monitor
    • cbc
    • type and cross
    • dic workup
    • ultrasound to r/o placenta previa
  19. further management for late trimester bleeding
    • foley
    • transfuse
    • vaginal exam
  20. feared complication of placenta abruption
  21. rupture of membranes and brady, dx
    vasa previa
  22. rx for vasa previa, uterine rupture, placenta previa, placenta abruption
    • c-section
    • altough vaginal can be attempted if the placenta is 2 cm away from cervical os
  23. uterine rupture may sometimes require what if the bleeding is profuse
  24. when do you give abx for gbs
    • prior baby with sepsis
    • culture + at any point
    • rom>18 hours
    • fever
    • preterm
  25. planned c section and + culture, abx
  26. triad of toxo
    • cranial calcifiations
    • chorioretinitis
    • hydrocephalus and resulting microcephaly
  27. rx for toxo to prevent transmision
  28. mnx of suspected toxo
    • igG and igM. high IgG avidity, past infection
    • low IgG avidity, recent infection
    • rx is pyrimethamine and sulfadiazine
  29. post exposure to varicella prophylaxis for mother
    rx for mother
    ivig for up to 10 dyas

    ivig to mother and neonate

    ivig and acyclovir to neonate
  30. rx for post exposure prophylaxis for rubella
  31. rx for a woman with cmv infection
    • gancyclovir
    • ivig
  32. rx for a woman thats pregnant and has hiv
    triple therapy
  33. when do you do c section for hiv
    if rna>100 and CD4<350
  34. a pregnant woman tests positive for std, next step
    HIV test
  35. rx for mild preeclampsia
    delivery above 36 weeks
  36. rx for hellp syndrome
    • delivery
    • steroids
    • mg sulfate
  37. heart failure what class is associated with maternal and fetal death
    class 3 and 4
  38. what htn mds can be continued
    loops, nitrates, bb, digoxin

    never aceI or aldosterone blockers
  39. how are arrhythmias controlled in pregnancy
    as normally but dont give warfarin or amiodarone
  40. endocarditis prophylaxis in pregnancy
    • same as non pregnany
    • prophylax with rheumatic heart disease
  41. regurg or stenosis are not tolerated with pregnancy
  42. when do you anticoagulate
    • dvt/pe current or past pregnancy
    • afib with undrlying disease, not afib alone
    • hypercoagulable states
    • severe heart failure
    • eisenmenger syndrome
  43. hyperthyroid and hypo cause what effect on fetus
    • growth restriction and stillbirth--hyperthyroid
    • miscarriage and intellectual deficits-hypothyroid
  44. hypothyroid pregnant woman, next step
    increase thyroxine
  45. drug given for hypothryoid in pregnanc
  46. high hba1c in first trimester, next step
    • get sono at 20 weeks to looks for structure anomalies
    • 24 weeks fetal echo to look for defects
  47. monitoring for diabetics in pregnancy
    • hba1c every trimesetr
    • monthly sono
    • monthly biophysical profiles
    • nst at 32 weeks and amniotic fluid index
    • triple marker screen to look at ntd
    • caudal regression syndrome
  48. ntd and other congenital defects are seen when with what hba1c
    first trimester and at 8.5 Hba1c
  49. women with gestational diabtes are followed how after delivery
    6 weeks post partum 75gram oral glucose tolerance test
  50. complications of neonate from diabetic mother
    • polycythemia
    • high bilil
    • low calcium
    • low glucose
  51. rx for intrahepatic cholestasis of pregnancy
    • ursodeoxycholic acid
    • antihistamines
  52. how does acute fatty liver present
    • high LFT's
    • coagulation abnormalities
    • fluids and icu and delivery
  53. rx for acute cystitis and asymptomatic bacteruria in pregnancy
    • nitrofurantoin
    • cephallosporin

    iv cephalosporins
  54. 1st trimester abortio options
    • d and c up to 13 weeks
    • medical wtih mifepristone and misoprostol
  55. 2nd trimester abortion options
    dialation and evacuation

    intact dilation and evacuation--partial birth
  56. most common delayed complication of d and e for abortion
    cervical trauma and cervical insufficiency
  57. spontaneoius abortion vs fetal demise
    • <20 weeks
    • >20 weeks
  58. what are the only 2 abortions that have open cervical os
    • inevitable
    • incomplete
  59. how does missed abortion presetn
    • poc retained
    • closed cervical os
    • allow pasage of poc or use misoprostolr
  60. rx for threatened abortion
    • expectant mangametn
    • bed rest
  61. rx for incomplete and inevitable
    d and c
  62. most common cause of spontaneous abortion <20 weeks
    fetal demise>20 weeks
    chromosomal abnormaolites

    >20 weeks-maternal factors, antiphospholipid sydnrome, smoking, dm
  63. most serioius complication of prolonged fetal demise
    dic from tissue thromboplastin
  64. with prolonged fetal demise next step
    order coagulopathy studies
  65. presumed diagnosis of ectopic
    Bta hcg>1500 and no intrauterine pregnancy
  66. 4 indications for mtx rx for ectopic pregnancy
    • fetus <3.5 cm
    • beta hcg<6000
    • no fetal heart beats
    • no folic acid supplementaiton
  67. next step in mnx of a woman with cervical insufficiency
    r/o chorioamnioti
  68. when is an elective cerclage placed?
    • elective after 3 repeat abortions
    • urgent after labor and chorioamniotis is ruled out
  69. woman with short cervix but no other symptoms, next step
    monitor short cervix with sonogram
  70. iugr definition
    estimated fetal weight is 10%< gestational age or <2500 grams
  71. work up for asymmetic iugr
    • sono
    • afi
    • bpp
  72. ultrasound determines age when
    10 weeks
  73. percutaneous umbilical blood sample is taken when
    after 20 weeks
  74. cvs or amnio tests for alpha feto protein and acetylcholinesterase
  75. management of chorioamniotics
    • if infection present--iv abx, deliver
    • if infection is absent and <24--bed rest
    • 32 weeks --admit, steroids and deliver--abx prophylactically
  76. prolonged latent phase
    • 20hrs no change in cervix
    • analgesia
  77. prolonged active phase
    • <1.2cm/hr for nulliparous
    • <1.5 for multi
    • no change for 2 hrs arrest
    • 3 p/s
  78. how long does stage 2 last
    • 2 hrs
    • 1 hr
  79. how long does stage 3 last
    30 mins
  80. rx for umbilical cord prolapse
    c section
  81. variable accelerations are due to what
    umbilical cord compression---fetal hypoxia
  82. is variability normal?
    yes 6-30 beats
  83. non reassuring fhr, next step
    • stop med
    • give fluids
    • give oxygen
    • change maternal position
  84. when is vacuum , forceps the answer
    • non reasuringg fhr with no contraindications
    • prolonged 2nd stage
    • mother cant push bc of pulmonary or cardio causes
  85. when is c section indicated
    • cephalopelvic disporotpohs
    • arrest of labor
    • infections
    • breech presentations
    • placenta previa
    • non reassuring fhr
    • uterine scar from myom
  86. when is vbac done
    no indications for c sectio and prion c section ws a low c section
  87. what contraception can be started after delivery and not affect milk productions