Obstetrics
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| What is the mainstay of treatment in the pregnant women with pregestational diabetes | Rigorous control of blood glucose; FBS >105 may require insulin (no oral hypoglycemics used in PG)
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| What are the mainline antihypertensives used during pregnancy | Methyldopa, labetalol, nifedipine
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| In severe HTN what is the BP goal of antihypertensives | Systolic <160 and diastolic <105
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| In severe preeclampsia, acute BP control may be achieved with what drugs | Hydralazine, labetalol, or nifedipine
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| Severe preeclampsia tx: | Antihypertensives; c'steroids (improve liver/plt/ fetal lung devt); anticonvulsants (MgSO4); bed rest; Delivery Only Cure
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| Ectopic: tx | If ruptured, TOC: lap surg; salpingostomy; methotrexate
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| gestational trophoblastic neoplasia (GTN) tx | D&C; methotrexate, other CTx if malignant; follow w/serial hCG
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| Cervical insufficiency: tx | Bed rest; progesterone, indomethacin; cerclage
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| Uterine inversion tx | Replacement; relaxing agent; laparotomy?
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| Uterine atony tx | Oxytocin; PG F2 alpha (Hemabate); misoprostol; methergine; bimanual compression
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| An epidural may slow down labor, but does not increase the risk of: | C-section
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| What are the intervention options for arrest of descent | Forceps, vacuum, c-section
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| What are cervical ripening agents | Prostaglandins such as misoprostol
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| List the methods of labor induction | Cervical ripening agents (misoprostol), membrane stripping, oxytocin, mechanical dilation, amniotomy (artificial rupture of membranes)
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| Treatment for shoulder dystocia | McRoberts maneuver, episiotomy, suprapubic pressure, Rubin’s screw, Wood’s screw, delivery of posterior shoulder (humerus fx), Zavanelli
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| What are the tocolytic agents used in the management of pre term labor | Beta-mimetic (terbutaline), magnesium sulfate, calcium channel blockers (Procardia), prostaglandin synthetase inhibitors (indomethacin)
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| Should be given to women at risk for preterm delivery between 24-34 weeks to reduce risk of resp distress syndrome, mortality, & intraventricular hemorrhage | Antenatal steroids (betamethasone, dexamethasone)
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| ectopic PG tx | MTX (if HCG <5000 & mass <3.5 cm); or lap surg
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| preterm labor tx | Bedrest, hydration, pelvic rest, Abx, steroids, poss tocolytics
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| MgSO4 tox: Loss of patellar reflexes at Mg = | 10 mg/dL or higher
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| MgSO4 tox: Resp paralysis poss at Mg = | 15 mg/dL or higher
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| MgSO4 toxicity tx | Ca gluconate
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| to reduce risk of recurrent preterm birth: | 17-alpha-hydroxyprogesterone at 16-36 wks gestation
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| nonreassuring fetal heart tones: tx | stop oxytocin, change maternal position, O2 via mask, measure fetal scalp pH
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| Hep B vertical transmission: tx | Recombivax, HBIg to neonate after delivery (90% effective); mom can breastfeed after tx
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| VZV: perinatal exposure: tx | VZIg perinatally (5 days before - 2 days after delivery); acyclovir for maternal VZV
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| Which vax can be given during PG? | Hep B, flu, tetanus (Tdap); DO NOT GIVE VZV or Rubella (live)
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| GBS RFs and when to tx/not to tx | Do not tx if at term w/o RF; Tx if PTL or term w/RFs: fever, h/o GBS, ROM >24 hr
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| Rh incompatibility pathology | Rh neg mom, Rh pos fetus: mom exposed to fetal blood ->Rh Ab-> erythroblastosis -> RBC damage / hemolysis -> hematopoeisis -> hemolysis
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| RhIG | 300 micrograms IM at 28 weeks
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| GBS tx | PCN, ampicillin, cefazolin. clinda, or vanco PPx for pos cx.
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| HIV mgmt | AZT (Zidovudine) 100mg PO 5x/day; can reduce viral transmission to fetus. Vaccinations. Planned C-section at 38 weeks.
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| Chorioamnionitis tx | Ampicillin 2gm Q6h OR PCN 5 million U Q6h + gentamicin 1.5mg/kg Q8h
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| Surgical abortion | 5-13 weeks: D&C. 12+ weeks: D&E.
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| Pharmacologic abortion | Mifepristone 200-600mg PO on Day 1. Misoprostol 400-800 microgram PO or PV on Day 3 if needed.
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| Preterm labor mgmt | FHM. Tocolytic therapy (suppress uterine activity). Beta agonist (ritodrine or terbutaline). MgSO4. Nifedipine. Indomethacin. Corticosteroids (accelerate fetal lung maturity)
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| Hyperemesis gravidarum tx | B6 10-25mg TID. Ginger. ?Acupuncture. Antiemetics: doxylamine 12.5mg TID +/- promethazine 12.5mg Q4h or Benadryl 50mg Q4h.
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| Severe hyperemesis gravidarum mgmt | Admission. IVF and IV antiemetics. Correct lytes. ?Steroids. TPN if needed.
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| Placenta previa mgmt | Steroids at week 23-34 for fetal lung devt. Rhogam PRN. Bed rest & tocolytic. Fetal US Q3-4 weeks. C-section if total previa or severe bleeding.
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| Placental abruption mgmt | Mild: monitor. Check UOP. Moderate-severe w/fetal distress / maternal shock: immediate resuscitation & C-section; transfusion PRN. If no fetal distress: may induce w/pitocin for vaginal delivery, monitor closely post partum
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| Abx for postpartum fever/sepsis | IV Unasyn, gentamicin, clinda, ampicillin, or combo
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| To prevent hemolytic disease of the newborn, administer vitamin K within: | 4 hours of birth
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| Abx contraindicated in PG | Quinolones, aminoglycosides, tetracyclines, metranidazole
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| HTN meds contraindicated in PG | ACEI, ARBs, thiazides
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| Misc meds contraindicated in PG | Lithium, NSAIDs, thyroid meds, anticonvulsants, warfarin
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