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OB Tx

Obstetrics

QuestionAnswer
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)
What are the mainline antihypertensives used during pregnancy Methyldopa, labetalol, nifedipine
In severe HTN what is the BP goal of antihypertensives Systolic <160 and diastolic <105
In severe preeclampsia, acute BP control may be achieved with what drugs Hydralazine, labetalol, or nifedipine
Severe preeclampsia tx: Antihypertensives; c'steroids (improve liver/plt/ fetal lung devt); anticonvulsants (MgSO4); bed rest; Delivery Only Cure
Ectopic: tx If ruptured, TOC: lap surg; salpingostomy; methotrexate
gestational trophoblastic neoplasia (GTN) tx D&C; methotrexate, other CTx if malignant; follow w/serial hCG
Cervical insufficiency: tx Bed rest; progesterone, indomethacin; cerclage
Uterine inversion tx Replacement; relaxing agent; laparotomy?
Uterine atony tx Oxytocin; PG F2 alpha (Hemabate); misoprostol; methergine; bimanual compression
An epidural may slow down labor, but does not increase the risk of: C-section
What are the intervention options for arrest of descent Forceps, vacuum, c-section
What are cervical ripening agents Prostaglandins such as misoprostol
List the methods of labor induction Cervical ripening agents (misoprostol), membrane stripping, oxytocin, mechanical dilation, amniotomy (artificial rupture of membranes)
Treatment for shoulder dystocia McRoberts maneuver, episiotomy, suprapubic pressure, Rubin’s screw, Wood’s screw, delivery of posterior shoulder (humerus fx), Zavanelli
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)
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)
ectopic PG tx MTX (if HCG <5000 & mass <3.5 cm); or lap surg
preterm labor tx Bedrest, hydration, pelvic rest, Abx, steroids, poss tocolytics
MgSO4 tox: Loss of patellar reflexes at Mg = 10 mg/dL or higher
MgSO4 tox: Resp paralysis poss at Mg = 15 mg/dL or higher
MgSO4 toxicity tx Ca gluconate
to reduce risk of recurrent preterm birth: 17-alpha-hydroxyprogesterone at 16-36 wks gestation
nonreassuring fetal heart tones: tx stop oxytocin, change maternal position, O2 via mask, measure fetal scalp pH
Hep B vertical transmission: tx Recombivax, HBIg to neonate after delivery (90% effective); mom can breastfeed after tx
VZV: perinatal exposure: tx VZIg perinatally (5 days before - 2 days after delivery); acyclovir for maternal VZV
Which vax can be given during PG? Hep B, flu, tetanus (Tdap); DO NOT GIVE VZV or Rubella (live)
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
Rh incompatibility pathology Rh neg mom, Rh pos fetus: mom exposed to fetal blood ->Rh Ab-> erythroblastosis -> RBC damage / hemolysis -> hematopoeisis -> hemolysis
RhIG 300 micrograms IM at 28 weeks
GBS tx PCN, ampicillin, cefazolin. clinda, or vanco PPx for pos cx.
HIV mgmt AZT (Zidovudine) 100mg PO 5x/day; can reduce viral transmission to fetus. Vaccinations. Planned C-section at 38 weeks.
Chorioamnionitis tx Ampicillin 2gm Q6h OR PCN 5 million U Q6h + gentamicin 1.5mg/kg Q8h
Surgical abortion 5-13 weeks: D&C. 12+ weeks: D&E.
Pharmacologic abortion Mifepristone 200-600mg PO on Day 1. Misoprostol 400-800 microgram PO or PV on Day 3 if needed.
Preterm labor mgmt FHM. Tocolytic therapy (suppress uterine activity). Beta agonist (ritodrine or terbutaline). MgSO4. Nifedipine. Indomethacin. Corticosteroids (accelerate fetal lung maturity)
Hyperemesis gravidarum tx B6 10-25mg TID. Ginger. ?Acupuncture. Antiemetics: doxylamine 12.5mg TID +/- promethazine 12.5mg Q4h or Benadryl 50mg Q4h.
Severe hyperemesis gravidarum mgmt Admission. IVF and IV antiemetics. Correct lytes. ?Steroids. TPN if needed.
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.
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
Abx for postpartum fever/sepsis IV Unasyn, gentamicin, clinda, ampicillin, or combo
To prevent hemolytic disease of the newborn, administer vitamin K within: 4 hours of birth
Abx contraindicated in PG Quinolones, aminoglycosides, tetracyclines, metranidazole
HTN meds contraindicated in PG ACEI, ARBs, thiazides
Misc meds contraindicated in PG Lithium, NSAIDs, thyroid meds, anticonvulsants, warfarin
Created by: Abarnard
 

 



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