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OB 9 (L&D part 2)


What are some sx of a lacunar stroke? pure motor hemiparesis, pure sensosry defect, ataxic hemiparesis, sensorimotor stroke symptoms, dysarthria/clumsy hand syndrome
What are the classic sx of placenta previa? painless vaginal bleeding during 3rd trimester
What is the next step in the evaluation of a pt with 2 consecutive pap smears with atypical squamous cells of undetermined significance (ASCUS)? colposcopy and endocervical curettage
What is the definition of uterine hyperstimulation? uterine hyperstimulation is defined by >5 contractions over 10 minutes with duration >60 seconds, and/or significant FHR decels.
What adrenergic antagonist is particularly helpful in reversing uterine hyperstimulation? terbutaline
_____________________ should be offered to all women with breech pregnancy when near term, after ________weeks. External cephalic version. after 36-37 weeks.
How should a breech presentation be managed after 36 weeks gestation? offer external cephalic version
What are some maternal indications for C/S? maternal eclampsia, prior uterine surgery, prior classic c/s, cardiac dz, birth canal obstruction, cervical CA, active genital HSV, maternal death.
What are some fetal indications for c/s? acute fetal distress, malpresentation, cord prolapse, macrosomia
What are some combined indications (maternal and fetal) for c/s? failure to progress in labor, placenta previa, abruptio placenta, cephalopelvic disproportion
T/F lithium should be avoided during breastfeeding? False. Lithium is ok in breastfeeding. Levels must be monitored in the NB.
T/F warfarin should be avoided during breastfeeding? False. Warfarin does not pass into breast milk.
T/F Alcohol does not pass into breast milk. False, it passes into breast milk and generally recommended to limit consumption to 1 gass per day
What is a galactocele? small area of tenderness, redness, and a small mass
What type of oral contraceptive can be given to lactating women? progesterone only
What is the tx for a woman that does not wish to breastfeed postpartum? first line is ice packs, tight fitting bras, avoid nipple stimulation, analgesia. Second line is OCPs, bromocroptine
What are the risk factors for uterine atony? uterine over-distension(multiples, macrosomia etc), exhausted myometrium(prolonged labor), decreased ability to generate contractions(chorioamnioitis), prior history(mutiparity, prior history of postpartum hemorrhage)
What is the tx options for uterine atony/postpartum hemorrhage? uterine massage, oxytocin, methergine, Hemabate(give to moms with HTN), surgical options.
What are the characteristic features of postpartum endometritis? fever on postpartum day 1-7 (temp >100.4F twice or >101F), and uterine tenderness on bimanual exam, absence of other potential fever etiologies. May also have foul lochia, chills, low ab pain, leukocytosis with L. shift.
What is the tx for postpartum endometritis? gentamicin + clindamycin +/- amp. Continue abx until afebrile for 24-48hours
A postpartum woman presents with pain and tenderness of the breast that is limited to only on region. There is no redness or warmth. What is the most likely dx? Galactocele
When can OCPs be initiated in postpartum pts that do not intend to breastfeed? 6 weeks postpartum (because of increased risk of DVT)
Within the immediate postpartum period a pt develops sudden onset of hypoxia, cardiogenic shock and DIC. What etiology is at the top of you differential? amniotic fluid embolism
A pt loses more than 500cc of blood postpartum and now has anemia. Attempts at breastfeeding have been unsuccessful, as it appears she is unable to generate any mild. What dx do you suspect? sheehan syndrome
What medications can be used to control postpartum hemorrhage? oxytocin, methergine, hemabate
Created by: shelybel



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