Step III - Ob/Gyn 2
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| What are the steps in management of late pregnancy bleeding | Vitals, fetal monitor, IV fluids, CBC, DIC workup, type and cross blood, give blood if needed, U/S to r/o placenta previa THEN do vag spec exam for lacerations, foley to measure UOP; if fetus in jeopardy deliver OR >36wks
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| Sudden onset vaginal bleeding, severe constant pelvic pain in late trimester pregnancy pt w/ hx HTN/trauma. Dx | Placenta abruption
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| What is a feared complication of placenta abruption and what are two things that can be done to decrease its risk | DIC; amniotomy or induction of labor
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| Sudden onset painless vaginal bleeding in late trimester pregnancy pt w/ hx trauma/coitus/pelvic exam. Dx | Placenta previa
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| Intractable bleeding caused by placenta increta/percreta/accreta can be managed by | Caesarean hysterectomy
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| What is the difference in depth of invasion for placenta increta/percreta/accreta | Accreta: does not penetrate entire thickness of endometrium; Increta: penetrates entire thickness into myometrium; Percreta: endo + myo + uterine serosa/bladder
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| What are the risk factors for having placenta previa | Prior placenta previa/multip/multip gestation/advanced maternal age
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| What are the risk factors for placenta abruption | Trauma/smoking/cocaine/PPROM/HTN/polyhydramnios
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| What are the forms of placenta previa | Total/partial/marginal/low lying
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| What test differentiates maternal from fetal blood | Apt test
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| Preterm pt found to have placenta previa but is stable and no more bleeding. Next step | Admit pt for bed rest and pelvic rest w/ tocolysis
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| Pt c/o extreme pain sudden onset. Vitals show tachy and HYPOtension. Exam shows uneven abdominal contour and no uterine contractions. Pt has hx of uterine surgery. Fetal monitor does not show fetal HR and there is recession of fetal head. Dx and tx | Uterine rupture; immediate laparotomy +/- hysterectomy after delivery
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| You wish to calculate dose of RhoGAM b/c suspect there is fetal blood in maternal circulation. What test do you perform | Kleinhauer Betke test
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| When placenta previa occurs over C section scar it may lead to | Placenta accreta
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| What is the tx for placenta accreta | Embolization or hysterectomy
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| Pt has rupture of membranes, painless vag bleeding and fetal monitor shows bradycardia. Dx and tx | Vasa previa; emergent C-section
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| What are the risk factors for uterine rupture | Prior uterine surgery leaving scar tissue/grand multip/excessive oxytocin
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| Pt has placenta previa, mom and baby are degteriorating. Next step | Emergent C-section
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| Pt has placenta previa @ >=36wks and continues to bleed. U/S shows placenta to be >2cm from internal os. Next step | Attempt vag delivery
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| Pt has abruption placenta @ >=36wks and continues to bleed. Next step | Vag delivery
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| Where is GBS colonized in mom | Vagina
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| Vertical transmission of GBS causes what in the neonate during what period of time | PNA and sepsis; hours after delivery up to days
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| GBS causing neonatal meningitis is caused by what form of transmission and occurs at what time period after delivery | Hospital acquired (NOT vertical from mom); 1 week
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| If mom is GBS (+) during pregnancy how do you treat | Intrapartum IV PCN G or if allergic IV cefazolin/clinda/erythromycin
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| Under what circumstances and when do you give GBS Antibx to mom | GBS(+) urine/cervical/vaginal cx @ any time during pregnancy and if mom has risk factors eg maternal fever, preterm delivery, prior baby w/ GBS sepsis, ROM >18hrs
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| In what situations would you NOT give GBS Antibx | Planned C-section w/o ROM despite (+) GBS cx and prior pregnancy (+)GBS but current pregnancy (-) GBS
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| Besides handling cat litter, what other hx can lead to toxoplasmosis | Drinking goat milk and eating raw meat
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| Most serious txo infections occur during what trimester | First
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| How does pt w/ toxo usually present | Mild mono-like S/S w/ hx of cat in house
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| What might you see in baby via U/S if mom has toxo | IUGR
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| What is the congenital toxoplasmosis triad | Chorioretinitis(uveitis), hydrocephalus, intracranial calcifications
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| Mom has toxo infection. What can you give to prevent vertical transmission | Spiramycin
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| Fetus/neonate has toxo confirmed with serology. Tx | Pyrimethamine and sulfadiazine
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| Pt presents w/ S/S of chicken pox and there is no record of PMH. Next step | VZ Ab assay (90% pt had prior VZ infection, this episode is not a primary infection)
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| What physical finding in mom during what time period would cause concern for vertical transmission of VZ to fetus | Rash @ 5 days ante- and 2 days post-partum
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| How does VZ infection present in neonate | Zig zag skin lesions, limb hypoplasia, microphthalmia, microcephaly, cataracts, uveitis
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| What kind of VZ vaccine is given to non-pregnant women | Live attenuated
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| What is the meaning of post exposure prophylaxis | Immediate tx for pt after they are exposed to pathogen to prevent pt from getting dz
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| What is the PEP for pts exposed to VZ and in what time frame do you give it | Anti-varicella Abs/Igs w/i 96 hrs of exposure (NOTE: tx only attenuates clinical effects of VZ it DOES NOT prevent infection w/ VZ)
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| What is the tx if mom has VZ | VZ Igs to mom and neonate
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| What is the tx if neonate has VZ | VZ Igs + IV acyclovir to neonate
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| During 3rd trimester what is measured via U/S to assess gestx age | Biparietal diameter, abdominal circumference, crown-rump length and femur length
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